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 |
|---|---|
| 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.