Introduction and Background

In the long struggle against drug addiction, scientists and medical researchers are constantly on the look out for new treatment options. Although opioid addicts can and do find freedom from their addictions, they must push through the horrible withdrawal symptoms that accompany them. Once those withdrawal symptoms have subsided, addicts can still struggle with cravings and the chance of relapse.

Ibogaine is a drug that was first written about as early as 1864, and was being recognized as a medication in the early 1900s. Its potential as an antiaddictive drug really came to prominence in 1962. Psychologist Howard Lotsof was looking for new mind-altering drugs in the still early years of LSD and other psychedelic experimentation. He gave ibogaine to a group of 20 individuals to try, seven of whom just happened to be heroin addicts (Alper, et al, 1990; Nielsen, 2018).

All seven of these heroin addicts reported back to Lotsof that the ibogaine had minimized their opioid withdrawal symptoms. Even more interesting, five of those seven users felt no cravings or desire to restart their habit for at least six months. The two who did start using again said they did so not because of cravings but because they identified as addicts (Nielsen, 2018).

Ibogaine originally comes from a shrub native to Africa, and historically has been used in initiation ceremonies in Gabon and Cameroon. It produces unusual hallucinogenic effects by activating a user’s long term memory. Users recall visual scenes from their past, followed by a long time of intense reflection of those memories and how they affected their lives (Jetter, 1994).

Since Lotsof’s discovery that ibogaine might work as an anti-addictive drug, multiple organizations and individuals have worked to develop it as a recognized and legal option for opioid addiction treatment. Unfortunately, the lack of interest by the pharmaceutical industry in the US, as well as deaths associated with its use, have forced the use of ibogaine to be reserved for underground treatment networks (ICEERS, n.d.).

Addictions Helped with Ibogaine Treatment

Ibogaine is most known for its helpful effects around opioid withdrawal and cravings. However, it has also been reported to help treat other drug addictions. Interestingly, it was declared a substance likely to cause dependence by the World Health Assembly in the late 1960s, but it has not been popular as a recreational drug (Nielsen, 2018).

Several research studies have shown that ibogaine itself does not appear to be addictive. For one, it doesn’t interact with a particular receptor in the brain that is typically involved in psychedelic addictions, like LSD. Also, in one research study, rodents were given ibogaine for six consecutive days. Researchers detected no withdrawal symptoms or signs that the rodents were experiencing cravings at the end of the trial. Even though ibogaine is still classified as a Schedule I drug, suggesting it has the potential for abuse, the National Institute on Drug Abuse does not consider it a danger for abuse (Nielsen, 2018).

Other drug addictions have seemed to respond well to ibogaine, including cocaine, nicotine, morphine, and alcohol; however, much of the research in these areas has been done with animals or in small case studies of humans. These studies revealed that addicted rodents, when treated with ibogaine, experienced fewer withdrawal symptoms and a decreased pursuit and intake of the addictive drug (Santos, et al, 2017).

How Ibogaine Works in the Brain

In general, the complex ways that ibogaine affects brain function are not well understood. This is largely related to the lack of long term studies that have examined its mechanisms of action, as well as the disinterest of the pharmaceutical industry to investigate it. However, scientists have a couple theories about how it works in the brain.

Ibogaine is an indole alkaloid, which means that it is a basic chemical, as opposed to acidic. It also contains carbon rings in its chemical structure, which can give it unique properties. For example, its ring structure allows it to mimic serotonin, a naturally occurring chemical in the brain. Scientists are interested in ibogaine as an addiction treatment, as well as a derivative of it that appears during metabolism in the body (Nielsen, 2018).

Ibogaine seems to influence drug withdrawal in two primary ways. First, it helps regulate levels of dopamine and serotonin in the brain, both of which are chemicals associated with pleasure and feelings of wellbeing. Second, ibogaine appears to help restore damaged areas of brain circuitry caused by long term drug use.

Regulation of Dopamine and Serotonin

Let’s look at how ibogaine might control the release of “feel good” and “reward” chemicals in the brain. When certain drugs or alcohol reach the brain, they can attach to specific receptors like those that stimulate the dopamine command centers. Think of a lock and key mechanism. If the drug, which has a unique chemical shape, finds a corresponding “keyhole” on the command center, it activates the center and tells it to release its chemical, such as dopamine.

Ibogaine is able to regulate dopamine surges that occur in addiction because it can inhibit access to some of these dopamine receptors. In other words, it gets in the way and won’t allow the drug, like opioid, to attach to the receptor and stimulate it. Ibogaine can also block transporter molecules that work to shift dopamine into brain cells (Nielsen, 2018).

When a person becomes depressed, it is often related to a decreased level of serotonin. There is a class of antidepressant drugs called selective serotonin reuptake inhibitors that block too much natural serotonin from being removed from circulation. Ibogaine seems to act in a similar way. Because it resembles serotonin, it can help stimulate the release of more serotonin in the brain, but also block the abnormal reuptake of serotonin caused by the addiction (ICEERS, 2018).

Ibogaine also influences different receptor types to release chemicals called neurotrophic factors. When drugs and alcohol are used repeatedly, various circuits and receptors in the brain become damaged. The damaged brain circuits and malfunctioning dopamine and serotonin receptors contribute to the horrible withdrawal symptoms experienced by addicts. Neurotophic factors appear to help repair these damaged tissues, promote normal releases of “feel good” chemicals, and prevent the addictive responses that normally happen after long term drug and alcohol use (Carrera, 2018).

An interesting aspect of ibogaine is that one single dose can diminish withdrawal symptoms and cravings very effectively. Other drugs used to help with addiction frequently require tapering off over time, but ibogaine does not need to be reduced gradually. Ibogaine also seems to act as a stimulant in the body, reducing the need for sleep. This property landed it on the banned-drug lists for Olympic athletes and international cyclists (Ibogaine Legal Status, n.d.).

Ibogaine Versus Noribogaine

After ibogaine is administered to a patient, the body begins to metabolize it. Noribogaine is a chemical that is left when the liver breaks down ibogaine into smaller molecules. It is almost identical to its parent molecule, but it stays in the body for longer and also interacts with brain circuits differently because of its structural nuances (Mash, et al, 2018).

Like ibogaine, scientists have speculated that noribogaine might also be involved in helping addicts avoid withdrawal symptoms and cravings. In fact, because it stays in the body longer, it could be the actual chemical responsible for helping addicts remain abstinent from drug use for extended periods of time. If this is true, noribogaine might be the preferred treatment option (Mash, et al, 2018).

Ibogaine is subject to many chemical reactions in the body that can change its structure and function, called biotransformations. Noribogaine is a more stable molecule and less prone to these kinds of changes. However, there are still many unanswered questions regarding the effectiveness and action of both of drugs, and much more research is needed to fully understand how they work (Mash, et al, 2018).

Addicts’ Experience of Ibogaine Treatment

Ibogaine has traditionally been used in parts of Africa during Bwiti religious and initiation ceremonies. African hunters also discovered that taking the drug on hunting trips helped them stay alert and still while stalking prey (Glick, et al, 1991). When ibogaine (or iboga bark, in this case) is used during formal rituals, the process is taken very seriously and requires days of preparation. Participants in the Bwiti rituals believe that the ibogaine they gather from the iboga shrub bark gives them access to advanced spiritual knowledge and transcendent experiences (Dancing, 2018).

The hallucinogenic properties of ibogaine may be one of the most important parts of helping addicts overcome their addictions. After a dose of ibogaine is given, many addicts begin to recall memories from their past. Some report interacting with spirits or feeling as though they were flying. These visual hallucinations can last for several hours. Following this playback of life events, the addicts tend to spend an extended time of intense focus, pondering all of their recalled memories (Life After Ibogaine, n.d.).

Many addicts have reported that they believe it is this life contemplation that has enabled them to stay clean. As they considered their memories, they could evaluate their past choices and see how their actions might have affected friends and loved ones. The huge reduction in craving from ibogaine also gave them a sense of freedom and fresh perspectives with which to make new choices. This freedom didn’t seem to exist when they struggled with the compulsion and obsessive behavior that had accompanied their addictions (Dosani, et al, 2014).

The hallucinogenic states experienced by addicts treated with ibogaine can vary. After the initial treatment is given, many addicts have one episode of vomiting, which researchers suggest might be related to motion sickness. Addicts undergoing treatment usually then want to lie still, seeking out quiet, dark rooms. This type of calm, distraction-free setting might be the kind of environment most conducive for the intense introspection they have following visual hallucinations (ICEERS, n.d.).

After 12 to 24 hours, depending on the individual person and ibogaine dose given, the addict will gradually begin to experience less of the hallucinogenic state. They can once again turn their attention toward what is going on around them instead of being so intensely focused on their memories (Lotsof & Wachtel). Although there is some variability in research results, some reports suggest that a single treatment of ibogaine can stop cravings for up to six months. A series of four treatments could help an addict remain free of cravings for three years or more (Nielsen, 2018).

Patient Safety and Toxic Side Effects

One of the primary reasons that ibogaine has not been investigated well as a drug is because of deaths that have been tied to its use. There are many anecdotal reports that ibogaine does work well in addicts without any serious side effects. However, there have also been multiple deaths in patients related to toxicity in the heart and nervous system. Ibogaine toxicity at high doses has also been verified in experiments on rodents (Schep, et al, 2016).

There are several potential reasons that ibogaine may work differently from person to person. First, it normally has a very short half life (the amount of time it exists before the liver begins to break it down and clear it from the body). However, it can evade metabolism for a long time by hiding in fat tissue. As a result, individuals may retain ibogaine and its metabolite, noribogaine for varying amounts of time (Hough, et al, 1996).

Another reason that it might interact differently among addicts is that all humans can have slightly different DNA patterns in their genetic code called polymorphisms (Nielsen, 2018). These variations may change the way and amount of time it takes ibogaine to break down, which can then impact its effect on an addict’s body. One person might clear ibogaine from the body quickly because of a unique metabolism resulting in shorter-lived effects, and vice versa.

Conclusion

Because of its illegal status in many parts of the world, ibogaine research has been limited in scope. Much of the reports about its effectiveness come from very small studies and case reports. Only three countries regulate ibogaine as a pharmaceutical that can be used in medical settings. As a result, most of the ibogaine treatment around the world happens through an informal underground network (Ibogaine Legal Status, n.d.).

Despite the lack of data from clinical trials, interest in ibogaine has continued. One company has developed a chemical that has many of the same properties of ibogaine, called 18-MC. This chemical seems to protect against brain cell damage and reduce cravings caused by drugs like opioids (Hannaford, 2017). Unlike ibogaine, it doesn’t stimulate hallucinogenic effects, but some believe the absence of this side effect will hinder 18-MC’s ability to promote long term addiction recovery (Szumlinski, et al, 2000).

Ibogaine is a puzzling drug with complicated mechanisms in the brain. As such, it should be used with close medical supervision. However, despite all the unanswered questions regarding how it works, ibogaine continues to offer hope for many in the fight against addiction. The many positive reports from decades of ibogaine treatment around the world suggest that it deserves continued attention and research.

 

 

 

References

 

Alper, K. R., Brossi, A., Cordell, G. A., Glick, S. D., Holmes, H. L., Manske, R. H., . . . Rodrigo, R. G. (1990). The alkaloids. chemistry and physiology.

Carrera, I. (2018, February 06). How the Psychedelic Ibogaine May Heal, Repair & Protect the Brain | Ignacio Carrera, Ph.D. Retrieved from https://chacruna.net/ibogaine-heal-repair-protect-brain/

Dancing With the Ancestors: Traditional Iboga Use in Bwiti Culture. (2018, June 03). Retrieved from https://psychedelictimes.com/iboga/dancing-with-the-ancestors-traditional-iboga-use-in-bwiti-culture/

Dosani, S., May, A., & Cooper, C. (2014, May 19). Could this drug help millions of American addicts? Retrieved from http://america.aljazeera.com/watch/shows/america-tonight/articles/2014/5/19/could-this-a-miracleadrughelpmillionsofamericanaddicts.html

Glick, S., Rossman, K., Steindorf, S., Maisonneuve, I., & Carlson, J. (1991). Effects and aftereffects of ibogaine on morphine self-administration in rats. European Journal of Pharmacology,195(3), 341-345. doi:10.1016/0014-2999(91)90474-5

Hannaford, A. (2017, December 10). Dying to get clean: Is ibogaine the answer to heroin addiction? Retrieved from https://www.theguardian.com/society/2017/dec/10/ibogaine-heroin-addiction-treatment-gabon-withdrawal-danger-death

Hough, L. B., Pearl, S. M., & Glick, S. D. (1996). Tissue distribution of ibogaine after intraperitoneal and subcutaneous administration. Life Sciences,58(7). doi:10.1016/0024-3205(95)02322-4

Ibogaine Legal Status. (n.d.).

Jetter, A. (1994, April 10). The Psychedelic Cure. Retrieved from https://www.nytimes.com/1994/04/10/magazine/the-psychedelic-cure.html

ICEERS Ibogaine Scientific Literature Overview. (n.d.). Retrieved from https://www.ibogainealliance.org/articledb/iceers-ibogaine-scientific-literature-overview/

Life after Ibogaine – ICEERS. (n.d.). Retrieved from https://www.iceers.org/docs/science/iboga/Bastiaans E_Life_After_Ibogaine.pdf

Lotsof, H., & Wachtel, B. (2003). Manual for Ibogaine Therapy Screening, Safety, Monitoring & Aftercare. Retrieved from https://ibogainedossier.com/manual.html

Mash, D. C., Duque, L., Page, B., & Allen-Ferdinand, K. (2018). Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes. Frontiers in Pharmacology,9. doi:10.3389/fphar.2018.00529

Neilsen, C. (2018). Ibogaine offers an alternative approach for treating opiate addiction (Doctoral dissertation, Boston University, 2018) (pp. 1-74). Boston, MA: Boston University. Retrieved from https://hdl.handle.net/2144/27421

Santos, R. G., Bouso, J. C., & Hallak, J. E. (2017). The antiaddictive effects of ibogaine: A systematic literature review of human studies. Journal of Psychedelic Studies,1(1), 20-28. doi:10.1556/2054.01.2016.001

Schep, L., Slaughter, R., Galea, S., & Newcombe, D. (2016). Ibogaine for treating drug dependence. What is a safe dose? Drug and Alcohol Dependence,166, 1-5. doi:10.1016/j.drugalcdep.2016.07.005

Szumlinski, K. K., Maisonneuve, I. M., & Glick, S. D. (2000). The potential anti-addictive agent, 18-methoxycoronaridine, blocks the sensitized locomotor and dopamine responses produced by repeated morphine treatment. Brain Research,864(1), 13-23. doi:10.1016/s0006-8993(00)02069-2