IBOGAINE

What is Ibogaine?

Ibogaine is a naturally occurring psychoactive substance that has been demonstrated to interrupt substance use disorders,1as well as possess other neurological and psychological benefits. It is found naturally in a number of plant sources, principally in a member of the Apocynaceae family known as Iboga (usually Tabernanthe Iboga), which has been used for centuries by traditional communities in West Africa for ritual and healing purposes.

In lower doses, Ibogaine acts as a stimulant, increasing energy and decreasing fatigue in a way that is distinct from other central nervous system stimulants like amphetamines and cocaine.2 In larger doses, Ibogaine produces oneirogenic effects, meaning that it stimulates a dream-like state while awake, as well as closed eye imagery and the retrieval of repressed memories.

Its physical effects can include ataxia, nausea and vomiting, sensitivity to light and sound, tremors, and cardiac effects.4 In the early 1960’s, the Chilean psychologist Claudio Naranjo conducted 40 Ibogaine sessions with his clients and was the first to scientifically describe the experience. He reported that Ibogaine helped people to view difficult experiences in an objective way, and that it helped to facilitate closure of unresolved emotional conflicts.

The occidental use of Ibogaine, especially its application in the treatment of substance use disorders, was pioneered by Howard Lotsof. In 1962, 19 year old Lotsof serendipitously found that a single dose of Ibogaine not only interrupted his physiological dependence on heroin, it also took away his craving to use, all with no withdrawal symptoms. Lotsof spent the rest of his life advocating for the development of Ibogaine as a prescription medicine.

In the early 1990’s, the US National Institute on Drug Abuse (NIDA) began the development of Ibogaine by fully funding pre-clinical animal trials as well as Phase 1 safety trials on human subjects under the auspices of Dr. Deborah Mash at the University of Miami. The results confirmed that Ibogaine decreases the self-administration of stimulants, opiates and alcohol, as well as a significant reduction in the withdrawal symptoms from opiates.6 ((Popik P, Glick S. Ibogaine, a putatively anti-addictive alkaloid. Drugs of the Future. 1996; 21:pp 1109-1115.))
Unfortunately, the development research was ended prematurely because of intellectual property disputes, its high cost and complexity relative to NIDA’s existing resources.

Phase 1 safety trials conducted by NIDA found that Ibogaine is not neurotoxic. However, there are a number of fatalities that have been temporally associated with the ingestion of Ibogaine. These were attributed to a variety of factors, including pre-existing medical conditions, especially cardiac conditions, as well as seizures resulting from acute withdrawal from alcohol or benzodiazepines, and in other cases the co-administration of one or more drugs of abuse.

One of the causes cited is that Ibogaine potentiates the effects of opiates, as well as their lethality if co-administered. It does this not by acting as an opiate agonist or antagonist, but by enhancing opiate signaling.8 Another is that, in addition to attenuating withdrawal symptoms, Ibogaine has been shown to reduce developed tolerance to opiates9 and alcohol,10essentially returning the user to a novice state. Using substances after administration of Ibogaine without taking this into consideration presents a significant risk of overdose.

In the late 1980’s, the first regular Ibogaine-assisted detox sessions were conducted by the Danish Drug Users Union in Amsterdam. Over the last several decades a global community of Ibogaine therapy providers, which has been dubbed a “medical subculture,” has developed to include former drug users and physicians. In 2007 it was estimated that over 3,400 therapy sessions for substance use disorders, as well as for personal and spiritual growth, had been conducted worldwide.11 This number continues to grow annually, as well as the number of clinics.

Ibogaine-assisted detox efficacy has been explored in two recent studies being conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS), attempt to track the long-term efficacy of Ibogaine-assisted detox therapy. The studies, in Mexico and New Zealand, have reported preliminary results of between 20% and 50% rate of clients remaining free from their primary substance of abuse for at least 12 months. Factors influencing this range were suggested to be the ease of follow-up in the New Zealand study become of closer proximity, as well as other factors such as plans for continuing care.12 Ibogaine therapy may have promising results in the treatment of other conditions, including Hepatitis C, Parkinson’s disease and Tourette’s syndrome.

Conditions treated by Ibogaine?

Ibogaine-Assisted Detoxification
The most common application of Ibogaine therapy is in the treatment of substance use disorders. Ibogaine has been shown to decrease the self-administration of stimulants, opiates and alcohol, as well as to significantly reduce the withdrawal symptoms from opiates after a single administration.1 Other research shows a reduction of developed tolerance to opiates2and alcohol,3 and a significant decrease in cravings for opiates and cocaine for an extended period of time after treatment.

Ibogaine-assisted detoxification was pioneered by Howard Lotsof. In 1962, 19 year old Lotsof serendipitously found that a single dose of Ibogaine not only interrupted his physiological dependence on heroin, it also took away his craving to use, all with no withdrawal symptoms. Lotsof spent the rest of his life advocating for the development of Ibogaine as a prescription medicine.

Since the 1980’s, Ibogaine has been used in the treatment of substance use disorders, first in peer-to-peer treatment networks such as the one conducted by the Danish Drug Users Union. Today, there are therapists and centers throughout the world that offer various programs, usually lasting from five days to two weeks, with some longer programs that focus on integration of the Ibogaine experience and early continuing care.
Is Ibogaine-assisted detox successful?

In the conventional addiction treatment industry, programs of this length are referred to as detoxification programs, and are distinguished from complete treatment programs, which often range between 30 to 90 days in length. Statistics show that conventional detox programs, which do not involve maintenance with methadone or buprenorphine, and which are not followed by complete treatment programs, have low completion rates, let alone long-term success rates, and practically never lead to long-term abstinence.

While these programs vary widely in the scope of what they offer, several studies into Ibogaine-assisted detox efficacy have confirmed that even short-term programs have results that are comparably better than much longer conventional treatment programs. This may not always be the case, and there are several factors that were shown to have a strong impact, such as continuing care programs.
How does Ibogaine-assisted detox work?

Some aspects of Ibogaine’s effects and pharmacology are understood, while others remain unknown. What is clear is that Ibogaine works on multiple receptor sites, and has effects that are both physiologically and psychologically therapeutic.

Physically, Ibogaine resets neurotransmitter receptors to a novice state, and has demonstrated neuroprotective effects on dopamine receptors. It has been shown to increases levels of GDNF,5 a protein that facilities the development of new neurons, producing a period of neuroplasticity, during which it is easier to learn new habits. Ibogaine’s oneirogenic effect, or waking dream state, has been reported to help people to view difficult experiences in an objective way, and to help facilitate the closure of unresolved emotional conflicts,6 which is often a cofactor in severe substance use disorders.

Is Ibogaine Therapy Safe?

Ibogaine therapy shows a definite promise in the treatment of substance use disorder. In general, Ibogaine can be administered safely and without incident, especially when done with proper preparation and supervision. However, there two interrelated issues have stood in the way of further development of Ibogaine as a prescription treatment: the lack of clinical research, and the issue of safety.

Phase 1 safety trials funded by the National Institute on Health (NIH) found that Ibogaine is not neurotoxic. However, because of Ibogaine’s systemic effects, there are certain contraindicated conditions that can pose serious health risks if not identified during a careful screening process.
Between 1990 and 2008, a total of 19 deaths were reported to be temporally associated with the ingestion of Ibogaine. These incidents were attributed to a number of factors that include pre-existing cardiac conditions, seizures resulting from acute withdrawal from alcohol or benzodiazepines, and in other cases the co-administration of one or more drugs of abuse while under the influence of Ibogaine.1

It is crucial that patients with childhood congenital heart defects, prolong QT intervals, a history of heart failure, enlarged heart, any history of blood clots, stroke, transient ischemic attacks, pulmonary embolism, deep vein thrombosis, or irregular heart rhythms do not attempt to take Ibogaine because of these risks. Other pre-existing heart conditions should be carefully examined and a risk/benefit assessment taken into consideration.
Other conditions that should prevent someone from taking Ibogaine are certain psychiatric conditions, such as bipolar disorder, schizophrenia, depersonalization disorder, cerebellar dysfunction, epilepsy, non-substance induced psychosis, organic brain disease, and dementia. While there may be exceptions, these conditions usually do not see an improvement, and could be exacerbated by taking Ibogaine.
Impaired liver or kidney function, dehydration, and depleted electrolytes can also prevent serious risks.
Ibogaine does not attenuate withdrawal symptoms from alcohol or benzodiazepines, and seizures, which are commonly associated with withdrawal from these substances, pose a substantial health risk. It is very important that acute alcohol detox be completed under medical supervision prior to taking Ibogaine, and that benzodiazepine use be stabilized and continued throughout the treatment. Detoxification from benzodiazepines should be managed by a gradual taper after Ibogaine treatment, under the supervision of a medical professional.
One of the other causes cited in research on adverse events is Ibogaine ability to potentiate the effects of opiates, as well as their lethality if co-administered. It does this not by acting as an opiate agonist or antagonist, but by enhancing opiate signaling.2 It is very important that substances are given an opportunity to fully leave the system before Ibogaine is administered, and that half-lives of all substances are taken into careful consideration. This process is especially sensitive with long-acting opiates such as methadone and buprenorphine.Although many people seek out Ibogaine treatment for its ability to mitigate withdrawal symptoms from short-acting opiates, it has been suggested that the safest route is to fully detox prior to ingesting Ibogaine.
In addition to attenuating withdrawal symptoms, Ibogaine has been shown to reduce developed tolerance to opiates3and alcohol,4 essentially returning the user to a novice state. Using substances after administration of Ibogaine without taking this into consideration presents a significant risk of overdose.

These statistics about adverse events associated with Ibogaine have been presented as a case against the development of Ibogaine as a prescription medicine. However this argument does not take into consideration that those suffering from substance use disorder are a high-risk population, more than 4 times more likely to die of unnatural causes than the general population because of many of the factors associated with substance use.

Even though these statistics took into account Ibogaine administration that happened in a wide variety of settings, some which included medical supervision, and many that did not, these mortality rates remain similar with those reported from methadone treatment, which is one of the most conventional treatments prescribed for opiate addiction.

In 3,414 Ibogaine treatment episodes reported between 1989 and 2006, 11 resulted in a fatality. That is 1 Ibogaine-related fatality per 427 treatment episodes.6 In Australia between 2000 and 2003, 282 fatalities met the criteria for methadone-related death occurred in 102,615 TEs, which is 1 methadone-related death on 364 treatment episodes.78 In 2004, 110 fatalities in which the medical examiner mentioned methadone as a cause of death occurred in Utah in 52,350 methadone prescriptions, which is 1 methadone-related death on 476 methadone prescriptions.

It is for this reason that GITA strongly advises against the self-administration of Ibogaine, and that the information presented throughout the rest of this site is considered in the context of supervised Ibogaine therapy. Research supports the suggestion that professional standards for the administration of Ibogaine could have a significant impact on making Ibogaine therapy safer and more effective.

What is Noribogaine?

Ibogaine’s metabolite noribogaine, or 12-hydroxyibogamine, was discovered by Dr. Deborah Mash. Noribogaine is an active metabolite of ibogaine that is produced in the liver after ibogaine 1 administration.2

Ibogaine is known to have a half-life of about one hour in the blood, and while it has been shown to possibly be stored in fat tissue, it is believed that much of the long-acting benefits of ibogaine are attributable to the presence of noribogaine,3which has a much longer half-life, and remains in the blood up to a day after the administration of a therapeutic dose of ibogaine4

Studies have demonstrated that noribogaine has many of the same therapeutic qualities as ibogaine, including lowering self-administration of opiates, cocaine5 and alcohol, as well as increase of levels of GDNF,6 which is neuroprotective and stimulates the growth of new neurons. Other studies failed to demonstrate noribogaine’s effectiveness in lowering self-administration of opiates, which suggests it may have different neurochemical pathways than ibogaine.7

It is believed that noribogaine’s longer-acting nature contributes greatly to the therapeutic benefit of ibogaine administration. Research is currently underway in New Zealand and elsewhere to assess the therapeutic benefit of treatment with noribogaine.

Ibogaine-Assisted Detox Efficacy

In any treatment offered for substance use disorders, there are a large number of variables that make it difficult to predict the success of treatment. This is partially because people’s needs and goals when entering treatment vary dramatically based on their personality, age, gender, employment status, and other social factors. However, in order to consider the efficacy of ibogaine-assisted detoxification, there are a few efforts have been made to quantify treatment outcomes.

Ibogaine Efficacy Research

Two studies being conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS), attempt to track the long-term efficacy of ibogaine-assisted detox for opiate dependence. The studies, in Mexico and New Zealand, have reported preliminary results of 20% and 50% respectively, for clients remaining free from their primary substance of abuse for at least 12 months. Factors influencing this range were suggested to be the ease of follow-up in the New Zealand study become of closer proximity, as well as other factors such as plans for continuing care.1

Another study recently completed in Brazil shows a 61% rate of long-term total abstinence from alcohol, cannabis, cocaine and/or crack in a total of 75 people who completed a combination of ibogaine therapy and psychotherapy.2 There were several important distinctions in the treatment offered. For example, participants were encouraged to be abstinent, either at home or in inpatient care, for 30-60 days prior to ibogaine administration, and also had access to an extended stay inpatient treatment environment after treatment. Also, several of the participants underwent multiple treatments during the course of the study.

Comparisons with Conventional Detox

It is difficult to compare these results to conventional substance use disorder treatment programs for several reasons. Firstly, conventional inpatient treatment usually describes programs between 30 to 90 days in length. Programs that manage the initial withdrawal symptoms are generally described as detoxification programs, which usually last between 3 to 7 days. Ibogaine therapy programs usually last between five days and two weeks, and in several ways resemble conventional detox services, particularly the time-frame and the support for acute withdrawal symptoms.

Secondly, conventional detoxification programs in the United States have a completion rate of only 78% for three day to seven day programs, including those who were transferred for further treatment. Short-term inpatient treatment programs are completed, or lead to further treatment, in 74% of cases.3 The ibogaine-assisted detox studies above saw participants drop out of study follow-up, but everyone enrolled completed treatment.

In conventional studies, success rates for those who do complete treatment are never measured by strict abstinence as in the ibogaine studies mentioned above. The rates are based more generally on reduction of use and the negative consequences associated with it, such as the improvement of health, familial, social and economic situations. By those indicators, NIDA has compiled research statistics on the success of treatment for substance use disorders, and describes relapse rates following treatment ranging between 40 and 60%,4 where relapse is a worsening of symptoms related to substance use disorders.

NIDA’s first large-scale study on the treatment of prescription pain medication showed that 49% of participants saw an improvement during a 12-week or longer Suboxone treatment. The success rate dropped to 8.6% once Suboxone was discontinued,5 which again, does not mention levels of abstinence. Most conventional detox-only programs report negligible results without following through with a comprehensive treatment program, and that, again, is only considering an improvement in substance use disorder related symptoms. Sustained abstinence after attending only a conventional detox program is practically non-existent.

While the above is an attempt to connect the dots between two separate bodies of research, it is primarily a call for further research to be done. GITA sees great value in and supports the diversity of treatment options that are able to help people to reach their recovery goals.

Conclusions

When ibogaine is administered in programs of similar length to conventional detox, and even without long-term case management, ibogaine-assisted detox seems to lead to total abstinence from substances more often than most conventional treatment programs. And while many of the participants who were listed as “unsuccessful” on the MAPS’ studies, based on the criteria of a year of abstinence, most reported across-the-board improvements in the indicators used by NIDA and other agencies to calculate success.

While more research and comparative analysis is needed, the data above suggests that ibogaine can be highly effective, not only in detoxification, but also in treating the underlying causes of substance use disorders.

Further Research

GITA is collaborating with the International Center for Ethnobotanical Education Research and Service (ICEERS) in order to design a long-term multi-site study that will observe a much larger sample of ibogaine therapy clients in order to provide more a thorough picture of ibogaine’s efficacy, as well as the efficacy of different ibogaine therapy protocols.

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