Medications are a critical tool for individuals struggling with opioid misuse. Research has repeatedly shown the efficacy of this pharmacological component in treatment. There are 3 FDA approved medications for OUD: Methadone, Suboxone, and Naltrexone (Vivitrol).
There are, however, other non-FDA-approved substances that individuals sometimes use to attempt to self-treat opioid use disorder (OUD). These substances are neither evidence-based nor prescribed legally by physicians in the United States.
These alternative self-treatment substances are often herbal remedies. This article summarizes the history, uses, pharmacology, and clinical research findings of ibogaine, one such substance.
What Is Ibogaine?
Ibogaine is a naturally derived, psychoactive alkaloid extracted from the root bark of the Tabrananthe iboga plant native to West-Central Africa. Ibogaine has two chief molecular ingredients, noribogaine and 18-methoxycoronaridine (18-MC), producing stimulatory and hallucinogenic effects.
Historically, ibogaine has been used in religious and initiatory ceremonies by the native people of West-Central Africa. It has also been used in low doses to treat fatigue, thirst, and hunger.
The United States Drug Enforcement Administration (DEA) categorizes ibogaine as a Schedule I drug. Schedule I drugs are defined as having no medically approved purpose and considered to have a high potential for abuse.
Ibogaine & Opioid Use Disorder
Despite its Schedule I status in the United States, ibogaine is used in dozens of clinics worldwide. Its legal status varies geographically. In New Zealand, for example, the medical use of ibogaine is legal. These clinics sometimes treat addiction.
In these clinics, ibogaine is administered as a single, one-time dose. This one-time use makes the treatment method unique from most FDA-approved MOUDs.
Does Ibogaine Work?
In 2016, a 12-month longitudinal study in New Zealand examined legal ibogaine treatment outcomes for opioid dependence. The study found that a single ibogaine treatment reduced opioid withdrawal symptoms and achieved opioid cessation or sustained reduced use in dependent individuals over 12 months.
Clinical studies on the effects of ibogaine in animals suggested that the alkaloid alleviated the symptoms of opioid withdrawal and reduced opioid cravings after detoxification.
Why Studies Stopped
A 1993 clinical study in the Netherlands was conducted to assess the effects of ibogaine in humans. Unfortunately, one of the female participants of the study died suddenly.
As a result, the National Institute on Drug Abuse (NIDA) defunded further studies on human participants, and clinical research on ibogaine slowed to a halt.
Risks of Using Ibogaine for OUD
Ibogaine isn't an approved therapy for OUD at this time. Currently, there is no medical evidence to suggest that ibogaine is safe or effective in treating OUD.
Until further clinical studies are conducted, the efficacy and safety profile of ibogaine remains unknown.
There is serious concern about the cardiotoxicity of ibogaine. Cardiotoxicity refers to any toxic effect on the heart. In the context of ibogaine, there is concern that the alkaloid may disrupt the heart's rhythm.
Other Reported Issues
Other reported adverse side effects associated with ibogaine include seizures and reports of sudden death.[6,7] However, due to the lack of clinical research and investigation into ibogaine, these life-threatening side effects can neither be confirmed nor rejected.
Where We Stand
Bicycle Health strongly discourages the use of ibogaine to treat OUD, given this lack of methodologically rigorous research and medical evidence of efficacy.
"Given the potential severity of heart toxicity and death, we don't recommend using Ibogaine due to all the unknowns and the likelihood of harm that exceeds the benefit," says Brian Clear, MD, FASAM, Medical Director at Bicycle Health.