Medications for opioid use disorder (MOUD) are a critical tool for individuals struggling with opioids. Research has repeatedly shown the efficacy of this pharmacological component in treatment.
To date, there are three medications that are recommended by the World Health Organization (WHO) and approved by the US Food and Drug Administration (FDA) to treat opioid use disorder (OUD): methadone, buprenorphine, and naltrexone.
All brand-name MOUD prescriptions include one, or a combination, of these three medications. Common brand names include Bunavail, Belbuca, Subutex, Suboxone, Naltrexone (Vivitrol), Sublocade, and Zubsolv.
There are other non-FDA-approved substances that individuals use to self-treat OUD. These substances are not evidence-based, nor are they prescribed by physicians in the United States. These alternative self-treatment substances are often herbal remedies. This article summarizes the history, uses, pharmacology, and existing clinical research findings of ibogaine.
Ibogaine is a naturally derived, psychoactive alkaloid extracted from the root bark of the Tabrananthe iboga plant native to West-Central Africa. Historically, ibogaine has been used in religious and initiatory ceremonies by the native people of West-Central Africa. In low doses, it has also been used to treat fatigue, thirst, and hunger.
Ibogaine entered the medical arena of the Western world in the 1900s. It was used to treat a variety of conditions. In the 1960s, ibogaine became the subject of increasing interest and excitement, particularly for its purported anti-addictive properties. Clinical studies on the effects of ibogaine in animals suggested that the alkaloid not only alleviated the symptoms of opioid withdrawal but also reduced opioid cravings after detoxification.
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. Currently, 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 are considered to have a high potential for abuse.
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. In 2016, a 12-month, longitudinal study conducted 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.
Given the potential severity of heart toxicity and death, I don't recommend use of Iboga due to all the unknowns and the likelihood of harm that exceeds benefit.
Brian Clear, MD, FASAM, Medical Director at Bicycle Health
Ibogaine has two chief molecular ingredients, noribogaine and 18-methoxycoronaridine (18-MC), producing stimulatory and hallucinogenic effects. According to existing research, ibogaine is administered as a single, one-time dose in the treatment of OUD and other substance use disorders. This one-time use makes the treatment method unique from most FDA-approved MOUDs.
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 have a disruptive effect on the heart’s rhythm. Other reported adverse side-effects associated with ibogaine include seizures and reports of sudden death. However, due to the lack of clinical research and investigation into ibogaine, these life-threatening side-effects can neither be confirmed nor rejected.
At this moment, there is no medical evidence to suggest that ibogaine is safe or effective in the treatment of OUD. Until further clinical studies are conducted, both the efficacy and safety profile of ibogaine remain ambiguous and questionable. Bicycle Health strongly discourages the use of ibogaine to treat OUD given this lack of methodologically rigorous research and medical evidence of efficacy.
Bicycle Health is dedicated to helping people get off and stay off opioids. To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.