What is Ibogaine?

Ibogaine is a medication currently under consideration as an addiction treatment for people with opioid use disorder (OUD) and alcohol use disorder (AUD). It’s also under consideration as a treatment for various mental health disorders, including depression and post-traumatic stress disorder (PTSD).

Ibogaine is not new.

It’s derived from the root of a plant common in West Africa, used in spiritual rituals for centuries. Ibogaine was marketed in France as a stimulant before it was made illegal in the 1960s. Research into the mental health benefits of ibogaine began in the late 20^th century in the United States. This research was part of the psychedelic therapy movement. This movement recently gained traction with the approval and success of medications like Spravato and ketamine for treatment-resistant mental health disorders.

In 2023, ibogaine is in the news for three reasons:

1. The resurgent interest in psychotherapy supported by psychedelic medications
2. Preliminary evidence that ibogaine may be an effective addiction treatment
3. A potential 42-million-dollar research effort in Kentucky to study ibogaine as an addiction treatment that’s an alternative to the three current medications approved by the Food and Drug Administration (FDA) as medications for opioid use disorder (MOUD) in federally approved medication-assisted treatment (MAT) programs

In this article, we’ll briefly review the history of ibogaine treatment, the recent renewed interest in the therapeutic properties of ibogaine for addiction treatment and mental health treatment, the evidence supporting ibogaine for addiction treatment, and the risks associated with ibogaine. We’ll close this article with a report on the proposed clinical studies researchers may conduct in Kentucky in the next several years.

We should note that at Pinnacle Treatment Centers, we do not use psychedelics or psychedelic therapy. Our interest in ibogaine stems from its potential as an addition to the current medications for opioid use disorder.

History of Ibogaine and Ibogaine for Addiction Treatment

Ibogaine is an indole alkaloid found in the shrub Tabernanthe iboga, known as iboga, and the plant Voacanga africana. Practitioners of the indigenous Bwiti religion in West Central Africa use iboga in various traditional ceremonies. People who ingest iboga in this context report powerful visions and spiritual experiences. Evidence of this practice dates back to at least the 18^th century, but has likely been common for longer.

In the 20^th century, pharmaceutical companies in France sold ibogaine as a stimulant and antidepressant before authorities outlawed its sale in 1966. According to a story in Time Magazine, the first documented knowledge of the potential value of ibogaine for addiction treatment appeared around 1962 when a group of informal researchers – all addicted to heroin – led by Howard Lotsof, discovered that ibogaine eliminated withdrawal symptoms and completely reduced heroin cravings and desire to use heroin for at least six months. A detailed account of the Lotsof experiment appeared in Chapter 16 of the medical textbook “The Alkaloids: Chemistry and Biology” in 2001.

However, in 1970, the federal government classified ibogaine as a Class 1 controlled substance. This significantly curtailed the use of ibogaine in the United States. Nevertheless, use of ibogaine continued in various countries around the world. The National Institute on Drug Abuse (NIDA) initiated a series of studies on ibogaine in the animal model in 1991, but abandoned the effort in 1995 for various reasons, including concerns over safety.

Almost five years later, research into ibogaine for addiction treatment restarted, with the work of Dr. Kenneth Alper and a team of researchers in a study called “Ibogaine in Acute Opioid Withdrawal” that demonstrated benefits of ibogaine in mitigating opioid withdrawal symptoms. That work led us to where we are today: considering ibogaine’s potential for addiction treatment.

New Research on Ibogaine for Addiction Treatment

It’s important to recognize another part of the ibogaine story. Ibogaine is illegal in the U.S. and has been since the early 1970s. But around the world, other governments allowed the use of ibogaine for mental health and addiction treatment, and still do. Although it’s impossible to determine whether anecdotal evidence from U.S citizens traveling abroad for ibogaine addiction treatment and returning home with success stories impacted the resurgence of interest in ibogaine and FDA approval of clinical trials, it’s also impossible to completely dismiss this part of the ibogaine story.

In any case, around the year 2000, and with increasing frequency since 2014, research into ibogaine for addiction treatment began to garner renewed attention and interest. Ibogaine research is now in full swing in various studies and trials around the country. A team of scientists conducted a thorough review of this new research and published a paper called “A Systematic Literature Review of Clinical Trials and Therapeutic Applications of Ibogaine” in July 2022. This paper summarizes what we know about ibogaine for addiction treatment. It includes subjective experiences of ibogaine patients, clinical data from random controlled trials, and important information on the risks and adverse events associated with ibogaine treatment.

Let’s take a look at what they found.

Ibogaine: Impact on Opioid Withdrawal, Opioid Craving, Cocaine Craving, Depression Symptoms, Post-Traumatic Stress Disorder (PTSD) Symptoms

First, we’ll review the big-picture takeaways from this literature review. A synthesis of the available research shows:

• Ibogaine may be an effective new medication to treat substance use disorder (SUD). Disorders include opioid use disorder (OUD), cocaine use disorder (CUD), heroin use disorder (HUD), and alcohol use disorder (AUD)
• Ibogaine may be an effective medication for reducing symptoms associated with some mental health disorders. Disorders include major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and anxiety.
• Adverse events associated with cardiac (heart) issues, up to and including the documentation of two deaths during ibogaine treatment, indicate that a thorough medical screening process must precede any treatment with ibogaine, and treatment should be delivered in medical setting with rigorous safety standards and effective emergency protocols in place.
• Comprehensive screening and precautions can mitigate the risks mentioned in the previous bullet point. Researchers indicate that for appropriately screened and vetted patients, the benefits of ibogaine treatment outweigh the risks.

Now let’s drill down on the data and look at the specific benefits of ibogaine treatment.

Ibogaine: Impact on SUD and Mental Health Disorders

Opioid Use Disorder (OUD), Heroin Use Disorder (HUD)

Studies on patients with opioid use disorder showed significant reduction of opioid cravings and opioid withdrawal symptoms:

• A 2020 study showed:
  • 80% of participants reported a reduction in OWS
  • 50% reported decreased in cravings for one week
  • 25% reported decreased cravings for three months
• A random controlled trial assessed the safety or ibogaine – a slightly different variation of ibogaine – for patients on MAT with methadone:
  • Patients reported reduction in withdrawal symptoms
  • Patients reported improved mood
• Single dose ibogaine for people with heroin use led to reductions in heroin craving:
  • Reductions present post-treatment
  • Reductions persisted upon discharge
• A study compared single doses of ibogaine in people with OUD delivered pre- and post-treatment showed:
  • Both groups reported reductions in withdrawal symptoms measured by an objective clinical withdrawal scale
  • Both groups reported reductions in withdrawal symptoms as measured by the Opiate-Symptom Checklist, a self-reporting questionnaire for people with OUD

Cocaine Use Disorder (CUD)

Studies on patients with cocaine use disorder showed reductions in cravings:

• A large-scale trial showed significant reductions at discharge and one month follow up for cocaine cravings, as measured by the Minnesota Cocaine Craving Scale (MCCS)
• Single dose ibogaine led to a significant reduction in cocaine craving
• A double-blind placebo-controlled trial in Brazil showed:
  • Significant reduction in the MCCS at 72 hours and 24 weeks post-treatment
  • No change in MCCS in the placebo group did not change.
  • Fewer instances of relapses in the ibogaine groups

Depression, PTSD, and Anxiety

A small number of studies show ibogaine may be an effective treatment for some mental health disorders:

• A study used the Beck Depression Inventory (BDI) to measure depressive symptoms in people with MDD, and showed significant symptom reduction between intake and discharge
• A large-scale trial showed significant reductions in depressive symptoms using the following metrics:
  • Symptom Checklist-90-R Depression Subscale (SCL-90-R)
  • Beck Depression Inventory (BDI)
  • Profile Of Mood States (POMS)
• A study on U.S. veterans with mental health challenges showed significant reduction in:
  • Symptoms of post-traumatic stress disorder (PTSD)
  • Symptoms of depression
  • Anxiety related symptoms

Those results are persuasive, and explain the interest in ibogaine as an addiction treatment and a treatment for mental health disorders. However, questions concerning the safety of ibogaine treatment remain.

Is Ibogaine Safe for Addiction and Mental Health Treatment?

For most people, yes. For people with specific heart problems or cardiac issues, however, ibogaine may be unsafe, and contraindicated. In the 24 studies the research team reviewed, two fatalities occurred:

• In a study in 1995, a female patient died within 24 hours of receiving ibogaine. An autopsy was inconclusive, and researchers suspected unreported heroin use
• A participant in a study in New Zealand died after ibogaine treatment, and an official inquiry found “…the treatment provider as being in breach of their duty of care but did not offer a medical explanation for the death.”

In studies not reviewed in this publication, a total of 56 additional deaths occurred. Data shows the following:

• 35% of these deaths involved concomitant drug use (using another drug before/immediately after ibogaine treatment)
• 71% occurred in patients with OUD
• Adverse events were predominantly associated with cardiac arrhythmias, i.e., irregular heartbeat

In addition:

• One patient with schizophrenia reported increased psychotic symptoms
• Three patients reported symptoms of mania – with no previous diagnosis of bipolar disorder – after ibogaine treatment in unregulated overseas ibogaine clinics

There is currently no consensus in the medical community on what constitutes best-practices and safety around ibogaine treatment for addiction or mental health disorders. That’s the last piece of the puzzle for this medication. Data shows it can be effective, but for some patients, it can be dangerous. That’s one of the questions at issue in the state of Kentucky, which is currently considering funding an ibogaine research program to address the opioid crisis.

Ibogaine in Kentucky: Officials Debate Plans for Ibogaine Research

We recently published this article in the blog section of our website:

The Opioid Crisis in the United States: Update on Settlements with Opioid Manufacturers, Distributors, and Retailers

It’s about exactly what the title implies: the financial settlements reached between various states and the companies that manufactured and distributed the medications that caused the first phase of the opioid crisis in the United States.

The State of Kentucky will receive over $800 million dollars from the settlements we discuss in that article. Members of the Kentucky Opioid Abatement Advisory Commission (KOACC) plan to allocate $42 million dollars to a pilot program to study ibogaine for the treatment of opioid use disorder (OUD). Other state officials question the wisdom of allocating resources to a new medication when there are already FDA-approved medications for opioid use disorder (MOUD) that are considered the gold-standard in opioid addiction treatment.

Advocates of the ibogaine program indicate an all-of-the-above strategy is the best approach. They point to the research we cite in this article, as well as the first-person testimony of people like psychotherapist Juliana Mulligan, who is in recovery from a decades-long opioid use disorder. Mulligian says ibogaine saved her life. Interviewed in an article in a local Kentucky newspaper, she offered this insight:

“I remember suddenly feeling with total certainty that ibogaine is the future of opioid-disorder treatment…of course, ibogaine isn’t magic and it isn’t a cure, but it is hands-down the best door open to the path of healing that myself and many others could find.”

Dr. Kenneth Alper, a leading ibogaine researcher, who testified at a recent KOACC hearing, indicates that the deaths reported during early ibogaine studies were preventable. He believes that adequate screening and monitoring can make ibogaine treatment both safe and effective. Dr. Deborah Mash, founder of the company who may oversee the research initiative, describes the importance of this study:

“What we want to be able to demonstrate, working in a public-private partnership, is that this drug [will] help break the cycle of addiction. We need the best scientists, the best people who know how to do clinical trials, our academic colleagues together (with) public-private partnership, to accelerate the pace of this.”

The Kentucky Opioid Abatement Advisory Commission (KOACC) will vote on the funding for this research on November 13^th, 2023. We’ll keep an eye on the result of that vote. We’ll also keep any eye on the results of the studies that may follow – and report on them here as soon as they’re available.