What can we gain from Ibogaine?
Promising treatment for opioid addiction, but it's safety is not yet established
A close friend of mine was having a terrible time getting his alcohol use under control, consuming up to two bottles of wine a day. He traveled to an unlicensed, grey zone ibogaine clinic in Central America. He found the experience to be intense and extraordinarily meaningful, if a little bit scary, both due to the intensity of the hallucinations and the fact that one of the other participants utterly freaked out. The facility didn’t have any sensible plan for this, and it didn’t go well. After this experience, my friend lost his taste for alcohol entirely. He also stopped smoking cigarettes which wasn’t even one of his goals. At the six-month mark, both the alcohol and the cigarettes came creeping back into his life.
Getting over an opioid addiction is one of the most difficult things I have ever accomplished, the excruciating nature of which I have written about in my memoir Free Refills. Last year, a record 108,000 people died from opioid overdoses, in the U.S. alone. As I know from bitter experience, once you are caught in the middle of an opioid addiction, it is difficult admit that you need help, or to know where to turn to get this help. Even with help, getting over an addiction is soul-shatteringly difficult, and many don’t make it to the other side. While there are effective treatments for opioid addiction, such as the medications buprenorphine (Suboxone) and methadone, the use of these pharmaceuticals presupposes a functioning medical system, and an intact safety net. Neither of these are consistently available in the United States. Even with medically accepted treatments, the outcome is uncertain, the mortality is high, and some people don’t wish to be stuck taking opioid replacement medications for life.
In recent decades there has been an increased interest in an unusual plant-based psychedelic drug, ibogaine, which comes from the bark of a central African shrub. Ibogaine has been used by traditional healers and shamans for centuries. Stories of ibogaine producing an enduring, seemingly miraculous cure for opioid addiction have been circulating for years. Usually, one hears of desperate patients making a pilgrimage to Mexico, or some other country where underground treatments are available, to try this highly touted cure. Stories filter up of amazing successes consisting of sustained remission from opioid use disorder with minimal withdrawal symptoms. It sounds too good to be true. To cure your opioid addiction, all you just have go through is an extremely intense (and interesting…) episode of life-altering hallucinations. Sign me up!
Many people have been skeptical of ibogaine for several reasons. To start, we have been bombarded with a general “drugs are bad” message, except, of course, if the drug is alcohol or whatever Big Pharma spits out. This toxic messaging has poisoned our discussion of so many potential treatments. The second reason is that ibogaine can be cardiotoxic, leading to dangerous, even fatal arrhythmias. There have been several well-documented deaths that have resulted directly from this treatment, mostly in unregulated circumstances. Of course, untreated, or poorly treated opioid addiction has a high mortality rate as well. Ibogaine can potentially help treat other addictions, including cocaine, cannabis, and alcohol, as well as other cruel and challenging conditions such as depression, PTSD and Traumatic brain injury.
What is the evidence that ibogaine works?
According to a 2022 review in the Journal of Substance Use and Addiction Treatment,
The published data suggest that ibogaine is an effective therapeutic intervention within the context of SUDs [substance use disorders], reducing withdrawal symptoms and craving. Data also point toward a beneficial impact on depressive and trauma-related psychological symptoms.
The evidence that ibogaine works is extremely intriguing, if inconclusive. Most of the studies are “observational” studies, retrospective studies, and case reports. Very few are randomized controlled trials which are the most convincing type of evidence, as they account for the placebo effect. Though, in truth…any drug that causes intense hallucinations is difficult to ‘blind’ from placebo. Even the most oblivious of people would likely notice the difference between a sugar pill and a huge dose of ibogaine, or LSD, with streaming colors and melting walls.
A small-ish number of existing studies demonstrate a reduction in opioid cravings, a reduction in the desire to use opioids, and a diminishment in the intention to use opioids such as heroin. This effect persisted one month after treatment. The use of ibogaine also allowed people to abstain from opioid use. One small study showed that half of participants remained abstinent from heroin at one-month follow up. Another study demonstrated most patients (85%) testing negative for opioids at a six-month follow up.
For context – these numbers are phenomenal. If this type of data is replicated, and if we can make ibogaine a safer treatment, then countless overdoses might be prevented.
Ibogaine was also useful in managing the dreaded opioid withdrawal symptoms. I can vouch that these are a living hell, and reliably include nausea, restlessness, diarrhea and abdominal cramping, muscle aches, sweats, anxiety, and depression. Understandably, the sheer misery of withdrawal can lead many people who are attempting to cease using opioids into relapse. In one study of patients addicted to opioids, 78% showed no objective signs of opioid withdrawal 48 hours after treatment with ibogaine. In other studies, one half to two thirds of participants reported significant reductions in withdrawal symptoms up to nine days after ibogaine treatment.
It is difficult to imagine how this dramatic treatment response, including the unaccountable cessation of withdrawal symptoms, could come about. Does ibogaine somehow reset our opioid receptors? In truth, we don’t yet understand, even remotely, how ibogaine helps with opioid addiction.
Other uses of ibogaine
It appears that ibogaine might also be helpful to patients suffering from other addictions such as to cocaine. In one of the few RCTs involving ibogaine, a small study, there was a significant reduction in cocaine cravings at both 72 hours and, remarkably, 24 weeks after treatment. This is particularly astounding when one considers that we don’t have any effective medications that directly treat cocaine addiction. Ibogaine might also help with alcohol use disorder and cannabis addiction. (Yes, cannabis is addictive, but the addictiveness has been exaggerated – as referenced in my latest book, ‘Seeing Through the Smoke‘)
There is also some recent data that Ibogaine is helpful for the treatment of PTSD, as well as for traumatic brain injury, including the disability and suffering that these conditions can cause. In an open label study, the researchers used ibogaine along with magnesium, and didn’t see any unexpected or serious adverse events, raising the possibility that the magnesium can help abate the dangerous effect that the ibogaine has on the cardiac receptors and ionic pathways. These benefits persisted at the one month point after treatment.
Onerous side effects
As mentioned, the main concern with ibogaine is cardiac arrhythmia, which can be fatal. This side effect is also a feature of other drugs, such as methadone. For my patients on methadone, we routinely check a cardiogram every six months, and can have to downwardly adjust the dose if it looks concerning (which can put the person into withdrawal and threaten their recovery – one of the flaws of methadone…). With ibogaine, it is unknown how common cardiac death is, as ibogaine remains sparsely studied. Much of the use has been in unmonitored settings using a supply of unknown purity, with an unregulated dose. It is also not known, in the cases of reported fatalities, if other drugs or medicines were being consumed at the same time, which might increase the risk of adverse cardiac outcomes, or if the patients had pre-existing cardiac conditions. According to the study cited above, it is possible that co-administering the ibogaine with magnesium can help mitigate this concern but, clearly, this needs to be studied much more thoroughly before we start widely treating with ibogaine. (One small study without a bad outcome doesn’t prove that ibogaine is safe when co-administered with magnesium; it could have been chance/luck).
Like all other drugs and medicines, ibogaine has its more routine side effects, of varying severity. These include tremors, nausea, ataxia (you walk as if you are drunk…), and psychiatric symptoms, such as mania and other types of psychosis. There can also be seizures. Finally, there is concern that ibogaine is neurotoxic, potentially causing lasting damage to nerve cells.
Moving forward with ibogaine
Ibogaine, and molecules derived from ibogaine, appear to have vast, untapped potential to help us alleviate our addiction crisis, as well as to help people suffering from PTSD and TBI. Yet, ibogaine don’t quite seem “ready for showtime” yet. We need to confirm the efficacy of ibogaine, learn how to use it more safely and in what dosages, and figure out how to protect patients from exceedingly serious side effects. As with all drugs, if the use of ibogaine were decriminalized, and brought out of the shadows, everything about it would be far safer. People would know exactly what they are taking. The supply would be consistent and the dosing more scientific. Barriers to academic research would lessen. Most importantly, if people needed help, they would feel more comfortable asking for it.
Given ibogaine’s demonstrated effectiveness, desperate people, who have failed rehab after rehab, are going to continue to use ibogaine. How can we make it safer? Here are several suggestions:
1) Better patient screening, so that we can avoid using it in people with preexisting cardiac conditions.
2) Better education. Certain medications, particularly psychedelics, can become idealized. People need to be educated about the risks, what they are getting into (e.g., a sequence of extremely profound hallucinations) and, that ibogaine isn’t, by any means, considered a first-line treatment for addiction, or anything else, at this point. Careful guidance, preparation, therapy, oversight, and integration should make this safer and more effective.
3) Safe, regulated supply and careful dosing. The cardiac effects appear to be dose related; perhaps smaller doses would be just as effective. Perhaps microdosing is helpful. At this point, we don’t know what the right dose is.
4) Avoid concomitant use of other drugs that can potentiate the side effects of ibogaine. For example, methadone can additively destabilize the cardiac membranes and increase the risk of a fatal arrhythmia.
5) Take ibogaine with medical supervision. This doesn’t necessarily mean a boring or sterile ‘set and setting’; e.g., have a doctor at the exotic retreat with some basic equipment. If there is a physician around, they can intervene if there are any dangerous side effects which, obviously, is better than having the participant die a lonely death in an isolated and unregulated clinic somewhere.
6) Study the biochemistry of ibogaine, and its derivatives, to see which interventions, such as co-administering with magnesium, can protect the heart.
7) Procure the ibogaine with the upmost respect for indigenous traditions, heritage, and economies. We have a lot to learn, and humility would serve us well.
8) Figure out how to make the benefits last longer. Maybe a booster dose? Or some microdosing? This needs to be studied, so that you don’t find yourself in the same sinking addictive boat six months later.
The use of ibogaine can help us address the deadly scourge of addiction, potentially in a game-changing manner. If we are humble and respectful, it can also help us incorporate ancient wisdom from indigenous cultures. This is wisdom which we truly need if we are going to survive as a species, with all the threats we are facing such as climate change, the nuclear threat, the potential collapse of democracy, and uncontrolled AI.
The potential of ibogaine is profoundly exciting. Yet, it needs further study. I would strongly recommend a context which includes close medical supervision if you are thinking of taking it.