Observational research published in American Journal of Drug and Alcohol Abuse
Ismail Ali, Policy Fellow, MAPS
SANTA CRUZ, CALIF. — The promising results of two observational studies into treating opioid dependence with ibogaine, a naturally occurring psychedelic compound, have been published in the peer-reviewed American Journal of Drug and Alcohol Abuse. Sponsored by the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS) in Mexico and New Zealand, both studies show that ibogaine should be further studied as a potential treatment for opioid dependence through rigorously controlled studies.
Ibogaine is a psychoactive compound usually extracted from the West African Tabernanthe iboga plant. In animals, a single dose of ibogaine decreases signs of opioid withdrawal and produces sustained reductions in the self-administration of heroin, morphine, cocaine, nicotine and alcohol. Ibogaine is illegal in the U.S., and legal but unregulated in Canada and Mexico. New Zealand, South Africa, and Brazil authorize the use of ibogaine by licensed medical practitioners. While its mechanism of action is not yet fully understood, it differs from that of standard opioid agonist treatments such as methadone and buprenorphine which maintain dependence, and thus may show promise as an innovative pharmacotherapy for opioid addiction.
The results are particularly notable given the growing opioid epidemic, which the U.S. Centers for Disease Control and Prevention estimate caused 91 deaths per day in the United States in 2016, and which has been recognized as a health policy priority by the White House’s Commission on Combating Drug Addiction and the Opioid Crisis.
The Mexico study, published on May 25, showed that ibogaine administration was associated with substantive effects on opioid withdrawal symptoms and drug use in subjects for whom other treatments had been unsuccessful. Using the Addiction Severity Index and Subjective Opioid Withdrawal Scale as primary outcome measures, the study enrolled 30 participants who received ibogaine treatment at an independent clinic in Mexico. 12 out of 30 participants reported 75% reductions in their drug use 30 days following treatment, and 33% reported no opioid use three months later. The paper is co-authored by Thomas Kingsley Brown, Ph.D. (University of California, San Diego) and Kenneth Alper, Ph.D. (New York University School of Medicine).
As one participant in the Mexico study reported: “Iboga could give an opiate addict several months to half a year of freedom from craving, and a period of time in which to get their life together and learn to face things straightforwardly, directly and honestly. Iboga will not do the work for you.”
The New Zealand study, published on April 12, showed that a single ibogaine treatment could reduce opioid withdrawal symptoms and achieve either cessation from opioids or sustained, reduced use for up to 12 months following treatment. The results indicate that ibogaine may have a significant pharmacological effect on opiate withdrawal. All participants in the study described their ibogaine experience in positive terms. The analysis includes data from 14 out of 15 participants enrolled, with one participant disqualified and one who died during treatment while under the supervision of a qualified medical practitioner. The paper is co-authored by Geoffrey E. Noller, Ph.D., (Dunedin School of Medicine); Chris M. Frampton, Ph.D. (University of Otago); and Berra Yazar-Klosinski, Ph.D. (MAPS).
Historically, a number of other ibogaine treatment deaths have occurred outside of medically supervised environments. Although there was no evidence that the deceased participant had a preexisting cardiac condition, the coroner’s report suggested that the death was likely related to ibogaine ingestion, though not necessarily to cardiotoxicity. Though an experienced physician, the practitioner “nonetheless was adjudged to have failed in their duty of care” through a failure to appropriately monitor the patient, according to a second investigation into the death. The authors acknowledge the potential shortcoming of ibogaine treatment highlighted by the mortality associated with the therapy, especially in non-medical settings, specifically concerns about potential cardiovascular complications related to ibogaine’s metabolism in the body.
Although the Mexico study had no adverse events, the authors acknowledge specific limitations to this study including the number of participants, the lack of a control group, and the reliance on self-reporting. The authors of both studies emphasize the need for further studies, stating that randomized controlled clinical studies are required to further explore ibogaine’s potential as a legal, regulated treatment option in the U.S.
Ultimately, the authors of the studies conclude that given the potential demonstrated by ibogaine’s substantive treatment effect in opioid detoxification, its novel (though not yet fully understood) pharmacological mechanism of action, and its clinical effect in opioid-dependent subjects who have not satisfactorily responded to other treatments, ibogaine has promise for future research and development as a novel pharmacotherapy for opioid addiction.
Founded in 1986, MAPS is a 501(c)(3) non-profit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana. Since its founding, MAPS has raised over $36 million for psychedelic therapy and medical marijuana research and education.
- Mexico study (open access): Published online May 25, 2017
- New Zealand study (pending open access): Published online April 12, 2017
- More about ibogaine therapy research