IBOGAINE

How is Ibogaine used?

Traditionally, the Babongo and Mitsogo peoples in West Central Africa, who follow the Bwiti religion, have used ibogaine in healing ceremonies and spiritual celebrations. In those rituals, this root is used for its stimulating effects and to connect with ancestors in the spirit world.

People take it by chewing on the shrub’s roots or by swallowing the powder mixed with water. The most common form is ibogaine hydrochloride salt, taken by mouth.

Beyond religious ceremonies, some individuals struggling with substance use have found that ibogaine helped them reduce withdrawal symptoms from substances like opioids (e.g., heroin, pain pills, fentanyl) and cocaine. Also, it temporarily lessened cravings.

What does ibogaine look like?

Iboga is a shrub commonly kept as a decoration in West African countries. The root bark is either brewed into palm wine or chewed to ease feelings of hunger and tiredness. In Gabon, where iboga is most common, the roots are sold in markets as pieces of bark or in powdered form.

Outside of Africa, people sell it illegally online as a brownish powder marketed as an aid for detox in treating substance use disorders.

How does ibogaine affect people?

Ibogaine produces strong mind-altering effects, including hallucinations (e.g., seeing or hearing things that aren’t there) and experiencing a different state of mind. It’s like having vivid dreams while being awake.

Even though scientists don’t completely understand how ibogaine works, they know it affects various parts of the brain. These include chemical messengers in our brain, such as dopamine and serotonin, which are linked to feelings of happiness and well-being.

Researchers have divided the ibogaine experience into three phases. The first phase is dream-like, when individuals experience an altered version of their surroundings and recall earlier life. This phase lasts from 4 to 8 hours. The second phase is emotionally neutral and reflective, lasting from 8 to 20 hours. The third phase involves greater awareness and mild stimulation, continuing for up to 3 days.^[1]

Some reports suggest that ibogaine can create a more intense experience than other substances like psilocybin. People who have tried it mention gaining insights into life’s meaning, the universe’s evolution, life after death, and feeling relieved from guilt.^[2]

Those who have used this substance describe feeling remorse and regret for their actions towards others. They have also reported lower or no feelings of worthlessness in addition to being spiritually transformed.^[3]

Why is there growing interest in ibogaine?

Since the 1960s, Americans and Europeans who were part of self-help groups have been sharing stories about how a single dose of ibogaine can help reduce the desire for substances and ease opioid withdrawal symptoms. They claim that just one dose can prevent a relapse for weeks, months, or even years.

In online forums, people have spoken positively about ibogaine, calling it an “addiction interrupter.” It’s estimated that over ten thousand people have sought treatment in countries where this substance is not regulated.^[4] Some clinics that offer ibogaine treatments for opioid use disorders feature rave reviews from patients.

One reason ibogaine has become more popular is because it’s seen as having anti-addictive properties. People say it doesn’t cause cravings or withdrawal symptoms, even after being used multiple times.

Is ibogaine legal or illegal?

Ibogaine is illegal in the United States. It falls under Schedule I, a category that includes drugs like heroin, cannabis, and peyote. This classification means it’s seen as having no recognized medical benefits and a high risk of misuse. Unlike cannabis or psilocybin, no state has decriminalized its use.

Ibogaine is also illegal in several countries including Belgium, France, Ireland, Israel, Italy, Norway, Sweden and Switzerland. However, it is legal in Australia, Finland, New Zealand and Uruguay. Some countries, like Brazil, Canada, Denmark, Hungary, and South Africa, allow it as a controlled substance that a person can get with a doctor’s prescription. In places like Mexico, the Netherlands, Germany, or Gabon, there are no specific rules about it.^[5]

Ibogaine is used to treat addiction in clinics and facilities in countries where it is legally prescribed or where its use is unregulated, including New Zealand and Mexico.

Certain countries, such as Spain and Brazil, are testing ibogaine to assess it’s safety and effectiveness (Phase II trials). These trials aim to gather more information about its potential benefits, risks, dosing, and side effects, as well as who should or should not try it.

In the United States, the biotech company Delix Therapeutics got an award in 2023 from the National Institute on Drug Abuse (NIDA) to study a non-hallucinogenic analog (analogs are like cousins) of ibogaine called DLX-007. They are looking into its potential use for different substance use disorders, including opioids and stimulants like cocaine.^[6]

What does the research say about ibogaine?

Information from over 30 scientific studies suggests that ibogaine might help reduce withdrawal symptoms and cravings.

However, there have only been two scientifically sound trials testing the use of ibogaine as a treatment for substance use disorders. In these trials, involving 47 people, ibogaine was given in controlled settings, with one group receiving it and another getting a fake substance (placebo) without knowing which one they were taking.

One of these trials had mixed results. Although it found that ibogaine reduced withdrawal symptoms in people who used opioids compared to the placebo group, the difference between the two groups was insignificant.^[7] Another trial found a significant reduction in symptoms for people in a severe stage of cocaine dependence and fewer relapses.^[8]

To prove ibogaine efficacy and safety, more studies like these conducted at the highest scientific standard and with a larger number of people are necessary. This is especially important as ibogaine can impact heart functions and fatal cases of people using ibogaine have been reported.

Other studies, where people knew they were taking ibogaine, look promising. However, these kinds of trials may be biased as participants may perceive improvements simply because they know they are receiving treatment.^[9]

Considering their limitations, some of these studies found that more than 70% of patients didn’t show signs of opioid withdrawal after 24 or 48 hours (about 2 days) of treatment.^[10][11][12]

When it comes to long-term effectiveness and recovery, the research seems encouraging. After one month and again after 12 months, many participants showed reduced opioid withdrawal symptoms and either stopped using opioids or used them less.^[13][14]

Data also suggests that ibogaine has a beneficial impact on depression and trauma-related mental health symptoms. It has also shown promise for post-traumatic stress disorder and anxiety in trials in which ibogaine was administered along with magnesium to reduce the risk of cardiac arrhythmia (where the heart beats too quickly or slowly).^[15]

In general, even though ibogaine’s results in treating substance use issues seem promising, the lack of enough controlled clinical trials means the scientific community can’t say for sure how effective and safe ibogaine really is.^[16][17]

In 2022, an evaluation of scientific trials of psychedelic medications for mental health and substance use disorders was not optimistic about ibogaine´s potential. It concluded that ibogaine may not reduce short-term opioid withdrawal symptoms compared to a placebo (or a fake pill). It also concluded that it was unclear whether ibogaine use reduces long-term opioid use.^[18]

Given these issues, experts have stated that it may take up to 10 years before the Food and Drug Administration (FDA) considers ibogaine as a treatment for substance use disorders.^[19]

What are the risks?

More than 30 deaths have been linked to ibogaine in the last 40 years, according to scientific reports.^[20] Most of these deaths were related to heart failures linked to ibogaine consumption. In many cases, other substances may have played a role too.

In one instance, a person with a heroin use disorder suddenly died hours after swallowing a powder labeled Tabernanthe iboga, bought online for detox during addiction treatment. The information suggests that the death was likely due to the heart-related effects caused by the ibogaine powder, although codeine and morphine were also present.^[21]

This case brings attention to the global issue of ibogaine being easily accessible on the internet. The products may not undergo any kind of quality control. In addition, it may be difficult to understand dosing and risks without the support of a healthcare provider.

Another concern is that the demand for ibogaine has increased in recent years, putting stress on Gabon’s natural resources. This has also led to more vendors selling potentially contaminated or fake iboga, both in local markets and internationally.^[22]

Aside from the risk of fatal outcomes, ibogaine has been associated with a significant likelihood of developing headaches after treatment.

What about microdosing?

One case report described a successful treatment for opioid use disorder with repeated small doses of ibogaine.^[23] Another article reported that three people with opioid use disorder benefited from getting small doses of ibogaine multiple times.^[24]

Using small doses of ibogaine, known as microdosing, might be a helpful strategy to avoid harmful effects and deaths while still having positive treatment results. However, besides stories from West African countries and the mild stimulating effect of small amounts, there aren’t well-designed research studies on microdosing.^[25]

What if my loved one considers using ibogaine?

Reports from people who’ve experienced it firsthand suggest that ibogaine is unlikely to be popular as a recreational drug, probably because the mind-altering effects can be very intense and sometimes unpleasant.

However, some individuals still use it to treat substance use problems in facilities abroad or even on their own, buying ibogaine illegally, sometimes online. This is risky for two reasons: no quality control of the product and ibogaine’s impact on the heart.

If you know or suspect that your loved one is thinking of using ibogaine for substance use treatment outside of the US or without professional help, here are some suggestions:

• Establish and create a safe space for open communication so that your child feels comfortable sharing their experiences and reasons for deciding to use ibogaine.
• Share your concerns about the potential risks and health dangers associated with ibogaine use.
• Tell them that, according to some doctors, the risks of heart failure can be minimized by screening out patients with existing cardiovascular issues and using electrocardiograms during treatment.
• Other doctors and addiction experts have also found that giving magnesium to patients before and during ibogaine treatments minimizes the risks of heart failure.^[26]
• Talk with your loved one about treatments legally available in the US for opioid use disorder involving medications. You can learn more about Medications for Opioid Use Disorder (MOUD) in this article.
• There is also an earpiece that helps ease the pain of withdrawal symptoms and assists in the treatment process of opioid use disorders.
• Make sure your loved one carries naloxone when using substances. Naloxone, known also by the brand name Narcan, is a medication that can reverse an opioid overdose. This nasal spray could save your loved one’s life. Learn more about it here.
• Before deciding on treatment, suggest to your loved one to seek professional help from healthcare providers, addiction specialists, or mental health professionals who can offer appropriate guidance and support.
• Remind them that your worry is because you care about their safety and well-being.

Reducing the risks of ibogaine use

The safest choice is not to use ibogaine. But if your loved one insists on using it despite its downsides, consider sharing ways to reduce the risks. Remember, the top priority is keeping them safe. Reducing risks doesn’t mean promoting substance use; it means finding ways to minimize the consequences.

Here are some suggestions if your loved one travels to a clinic abroad to receive treatment:

• Accredited medical facility: Find a fully accredited medical facility, where psychotherapy is also offered as part of the treatment. Ensure that the staff are credentialed physicians and therapists who can manage an emergency.
• Research: It’s a good idea to get as many references as possible about the facility. If possible, try to get in touch with someone who has tried that clinic and ask them about their experience.
• Costs: Consider that these treatments are not inexpensive as a few weeks’ treatment may be $12,000, and it is not covered by insurance.

Medical facilities should offer the following:

• Medical screening: Your loved one’s overall health must be checked, especially their heart, with a thorough medical screening. Ibogaine might cause heart issues, especially for those with existing heart conditions. Also, the screening must consider interactions with other medications your loved one is taking, if any. Ibogaine may not be appropriate for people with serious mental illness.
• Professional supervision: Ibogaine should be administered by experienced healthcare professionals who know about its risks.
• Dosage control: It’s crucial to use the right amount to minimize side effects. People react differently to ibogaine, so starting with a lower dose helps assess their response before a full treatment.
• Preparation and aftercare: Education about potential risks and side effects before starting treatment should be offered. Also, be sure support is available afterward to help with any psychological or physical effects.
• Monitoring: Vital signs must be regularly checked during and after ibogaine use to quickly identify and address any issues.

Consider a clinical trial

If your loved one decides to try ibogaine in a clinical trial, you can apply to become part of a research study. Check out this database of privately and publicly funded clinical trials.