Indication-stratified mortality risk of ibogaine treatment under contemporary safety protocols: a multisite analysis of 19,071 patients and updated systematic review of fatalities
Martijn Arns, Kenneth Shinozuka, Joseph P Barsuglia
Research Square June 17, 2026 preprint DOI: 10.21203/rs.3.rs-9966269/v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective multisite study with systematic review |
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| Sample size | 19,071 |
| Population | Patients treated at 11 international ibogaine clinics |
| Intervention | Ibogaine treatment |
| Topics | Addiction Ibogaine |
| Keywords | Detoxification alternative medicine Poison control Mortality rate Injury prevention Medline Intensive care medicine Emergency medicine Cause of death Risk assessment |
| Key findings | Ibogaine-associated mortality is largely confined to opioid detoxification and rare in non-SUD indications. |
Abstract
Abstract Ibogaine has shown early therapeutic promise for substance use disorders (SUD) and post-traumatic stress disorder in veterans, but concerns about treatment-associated cardiac arrhythmia and death have constrained clinical development. Whether this risk is uniform across indications or concentrated in specific populations is unknown. We conducted a retrospective multisite study of 19,071 patients treated under established safety guidelines at 11 international clinics, with an updated systematic review of ibogaine-associated fatalities. Six deaths occurred within 72 hours, all among patients treated for opioid use disorder (6/10,382), with none among 8,689 non-SUD patients. This was mirrored in the review, where 41/44 fatalities with known indication involved SUD, predominantly opioid detoxification (P=1.6×10⁻⁹). The absolute rate represents a lower bound, given voluntary participation and non-adjudicated deaths; sensitivity analysis showed the conclusion robust to plausible unobserved deaths at non-participating clinics. These findings indicate that ibogaine-associated mortality is largely confined to opioid detoxification and rare in non-SUD indications.
In the evidence
This study is part of the evidence base for 2 syntheses in the library. Here is how each one recorded it.
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Six deaths within 72 hours occurred, all among patients treated for opioid use disorder (6/10,382) and none among 8,689 non-SUD patients, indicating mortality is largely confined to opioid detoxification.
Synthesized
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Six deaths occurred within 72 hours, all among patients treated for opioid use disorder (6/10,382) with none among 8,689 non-SUD patients; the review found 41/44 fatalities with known indication involved SUD, predominantly opioid detoxification.
Synthesized
Comparable studies
Other systematic reviews and meta-analyses on ibogaine for addiction, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| A systematic literature review of clinical trials and therapeutic applications of ibogaine. Individuals receiving ibogaine or noribogaine for substance use disorders | 2022 | Systematic review | n = 705 |
| Ibogaine and addiction in the animal model, a systematic review and meta-analysis. Animals in studies of substance use disorders | 2016 | Systematic review and meta-analysis | n = 27 |
| The antiaddictive effects of ibogaine: A systematic literature review of human studies Human studies assessing antiaddictive effects of ibogaine | 2017 | Systematic review | n = 8 |
| Ibogaine/Noribogaine in the Treatment of Substance Use Disorders: ASystematic Review of the Current Literature | 2022 | Systematic review | |
| The therapeutic effects of psychedelics for opioid use disorder: A systematic review of clinical studies. | 2025 | Systematic review |