A man died twelve hours after ingesting powdered iboga root, a substance taken for its stimulant and hallucinogenic effects. Ibogaine and ibogamine were measured in the powder and the victim's body fluids using gas chromatography-tandem mass spectrometry. Ibogaine concentrations in blood samples taken at the scene, peripheral blood, urine, and gastric fluid were 0.65, 1.27, 1.7, and 53.5 μg/mL, respectively; the powder contained 7.2% iboga. Diazepam and methadone were also present at therapeutic concentrations. Death was attributed to ingestion of a substantial quantity of iboga combined with methadone and diazepam.
A 27-year-old man with a history of drug addiction died about twelve hours after ingesting powdered iboga root during a detoxification program. The main alkaloids ibogaine and ibogamine were measured in the powder and in biological fluids collected at the scene and during autopsy. Concentrations in peripheral blood taken at the scene, peripheral blood from autopsy, urine, and gastric fluid ranged from 0.65 to 53.5 µg/mL for ibogaine and 0.05 to 4.34 µg/mL for ibogamine. The powder contained 7.2% ibogaine and 0.6% ibogamine. Additional toxicological tests revealed concurrent use of diazepam and methadone, supporting the conclusion that death resulted from a mixed overdose with ibogaine as the primary toxic agent.
Ephenidine, diphenidine, and methoxphenidine are dissociative anesthetics that block NMDA receptors and were recently classified as narcotics in France. A retrospective analysis of 18 serious cases reported to the French Addictovigilance Network from 2012 to 2016 found the number of cases increased over time, mostly involving methoxphenidine. Most cases were considered possible due to polysubstance abuse, with two probable. Clinical complications were minor in five cases, moderate in six, and serious in four, including psychiatric, neurologic, and cardiovascular problems. The addictive potential appears highly probable, but further research is needed to limit harm.