- Addiction & recovery
What is Ibogaine?
Vanessa de la Cruz, MD
March 7, 2022
Ibogaine is a naturally occurring alkaloid found in the roots of Tabernanthe iboga, a shrub native to the African rainforest. Indigenous communities in central Africa have consumed iboga for generations in healing ceremonies and initiation rituals. Current speculations suggest it can be used as an alternative natural remedy for opioid use disorder (OUD).
Although some preclinical studies have focused on Ibogaine as a potential treatment for OUD, Ibogaine is currently listed as a Schedule I controlled substance by the DEA, meaning that the substance possesses a high potential for misuse with no clinically accepted medical use. In addition, the World Health Assembly (WHA) reported that “Ibogaine is a substance likely to cause dependency and endanger human health.”
While the safety of using Ibogaine for OUD remains questionable, it has become a subject of debate in the medical community over its possible role in helping ease the opioid epidemic.
How Does Ibogaine Work?
Ibogaine is a psychoactive and psychedelic alkaloid with a complex pharmacodynamic profile that is yet to be understood. Ibogaine’s mechanism of action results from a complex interaction with multiple neurotransmitters rather than a single one. Ibogaine has been shown to interact with the acetylcholine, dopamine, and serotonin systems. Neurotransmitters are chemical messengers that allow the brain to control physical activities like heart rate, muscle function, respiration, sleep, mood, concentration, and appetite. Because Ibogaine affects so many different neurotransmitter systems, it’s difficult to pinpoint the exact actions of Ibogaine.
Retrospective studies suggest that Ibogaine is converted into noribogaine once consumed. Noribogaine is a chemical that targets certain areas of the brain linked to addictive behaviors. Thus, Ibogaine works by decreasing cravings and withdrawal symptoms by rewiring specific parts of the brain.
What Is Ibogaine Used For?
Indigenous groups have traditionally used Ibogaine and related compounds found in the iboga plant to alleviate fatigue, hunger, and thirst. Ibogaine is extracted from the iboga root bark, ground into a powder, and consumed as a drink. Ibogaine in lower doses acts as a stimulant, and in higher doses, it can generate a severe psychedelic state. Ibogaine in higher doses was reserved for initiation rituals and religious ceremonies, where they chewed the bark of the plant for medicinal and spiritual purposes.
Ibogaine’s medical history in the Western world dates back to the early 1900s, when it was used to treat asthenia and as a neuromuscular stimulant. However, since the early 1960s, it has been used in detoxification programs due to its ability to suppress cravings for substances such as alcohol, cocaine, methamphetamine, opioids, and nicotine.
Although not licensed as a therapeutic medication and despite safety concerns, Ibogaine is currently used experimentally as an anti-addiction medication in alternative medicine in dozens of clinics worldwide.
Ibogaine can generate psychedelic effects similar to a waking dream. Psychedelics (also known as hallucinogens) are a type of psychoactive chemical that causes cognitive and perceptual alterations. However, the psychoactive effects of Ibogaine are largely influenced by the dosage. While a modest dose can alleviate minor discomforts like headaches and fatigue, higher doses bring out its powerful hallucinogenic effects. In addition, advocates claim that certain properties of Ibogaine can alleviate opioid withdrawal symptoms with a single dose.
Although there is insufficient research and clinical trials to determine the safety and efficacy of Ibogaine, Ibogaine must be used under medical supervision due to the possibility of adverse effects.
Ibogaine can cause severe complications, such as slowed and irregular heart rates, making it off-limits for individuals with cardiac conditions. Other side effects of Ibogaine may include:
- Low blood pressure
- Dry mouth
- Difficulty breathing
- Impaired muscle coordination
It’s important to note that combining Ibogaine with psychiatric medications can result in life-threatening side effects such as heart attack and death. Researchers are still studying Ibogaine to determine appropriate dosages and safe administration. As such, additional research is needed to fully understand the long-term adverse effects of Ibogaine on the human body.
Misuse of various psychedelic substances such as Ibogaine is increasing rapidly. While Ibogaine does not appear to be addictive, it can still be misused. Ibogaine use has also been associated with sudden deaths, primarily due to concurrent medication use, comorbidities, and its use as an unsupervised treatment for detoxification. Mixing Ibogaine with other substances such as alcohol, benzodiazepines, amphetamines, and opioids can also be equally dangerous.
In addition, high doses of Ibogaine can result in Ibogaine poisoning. According to the National Center for Biotechnology Information (NCBI), 19 Ibogaine-related fatalities were recorded between 1990 and 2008 worldwide.
The Legality of Ibogaine in the United States
Since 1967, Ibogaine has been classified as a hallucinogen and made illegal in the United States. Despite this, advocates of Ibogaine have campaigned for greater testing in the United States, citing findings from other nations that are successful in treating substance use disorders (SUDs) such as heroin and cocaine. As such, the U.S. Food and Drug Administration (FDA) allowed testing of Ibogaine in the 1990s, but it was never completed due to health risks.
Although some experts believe Ibogaine could be an alternate treatment for SUD, the DEA’s classification indicates that it is yet to be proved. Furthermore, there have been no rigorous randomized controlled trials in the United States to test Ibogaine on humans. For this reason, any efforts to change the legal status of Ibogaine in the United States will be challenging.
How Effective Is Ibogaine Treatment for Opioid Use Disorder?
Ibogaine’s safety and effectiveness in treating opioid use disorder have been hindered by its widely differing regulatory status worldwide. Currently, Ibogaine is controversial due to the lack of clinical studies. However, Ibogaine’s mechanism of action has been shown in some studies to alleviate withdrawal symptoms of cocaine, alcohol, amphetamine, and nicotine. It is still too early to determine its efficacy and safety in treating SUDs.
Although research studies show Ibogaine may help a person stop using opioids, it’s not the complete answer to OUD. Ibogaine treatment simply interrupts substance misuse and acts as a tool for detoxing. Therefore, additional therapy and rehab are still necessary for a complete and lasting recovery.
Evidence-Based Treatments for OUD
Although Ibogaine treatment for opioid use disorder may seem appealing, it comes with far too many concerns. Fortunately, there are different treatment alternatives available to assist individuals in overcoming opioid dependence, including:
- Medical detoxification – The use of FDA-approved medications during a detox program can help minimize withdrawal symptoms and reduce the risk of a relapse. Specialized addiction treatment centers all across the country are staffed with compassionate experts trained to help people navigate the difficult road to sobriety.
- Behavioral counseling – Psychologists trained in substance use disorders work with individuals struggling with substance dependence through behavioral counseling. This type of evidence-based treatment aims to detect and assist in modifying potentially harmful or unhealthy behaviors. It is based on the notion that all behaviors are taught and can be modified.
- Community support groups – Community support groups like Narcotics Anonymous (NA) or Alcoholics Anonymous (AA) can be extremely beneficial to people in recovery. Regular attendance can give the accountability, encouragement, and positive peer interaction that individuals need while recovering from SUDs.
- Recovery support services – Recovery support services such as sober living and aftercare programs help people maintain a sober lifestyle while adjusting to increased responsibilities and freedom following rehab.
While medications can help with detoxification and help curb cravings, any medication used for treating substance use disorder must be viewed as only a small piece of the overall treatment approach. For this reason, it’s important to seek help and support from medical professionals who can work with you long-term in maintaining a sober lifestyle.
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