Psychedelic Therapy: A Primer for Primary Care Clinicians – Part V. Ibogaine

Background: Ibogaine is a plant-derived alkaloid that has been used for thousands of years in rites of passage and spiritual ceremonies in West-Central Africa. In the West, it has primarily been used and studied for its anti-addictive properties and more recently for other neuropsychiatric indications, including post-traumatic stress disorder (PTSD), depression, anxiety, and traumatic brain injury (TBI). Areas of Uncertainty: Ibogaine requires careful patient screening and monitoring due to significant safety issues. There is potential for cardiotoxicity (prolonged QT interval); without rigorous screening, fatal arrhythmias may occur. Additionally, ibogaine may have dangerous interactions with opiates, so patients who receive ibogaine treatment for opioid use disorder must withdraw from long-acting opioids. Other potential concerning effects of ibogaine include rare incidents of mania or psychosis. Anticipated transient effects during ibogaine treatment can include ataxia, tremors, and gastrointestinal symptoms.Therapeutic Advances: Nonetheless, robust effects following a single treatment with ibogaine have been reported. In open-label and randomized controlled trials (RCTs), ibogaine reduces heroin and opioid cravings by upwards of 50%, up to 24 weeks after the treatment. Observational studies have shown that ibogaine, in combination with the psychedelic 5-methoxy-dimethyltryptamine (5-MeO-DMT), significantly diminishes PTSD (d = 0.414) and depression symptoms (d = 0.275). Treatment clinics have opened in countries where ibogaine is either legal or unregulated for people struggling with substance use disorders or refractory distress.

Conclusions: Given the promising preliminary findings, ibogaine could potentially fill a much-needed gap in treatments for challenging conditions, including opioid dependence and combat-related symptom complexes. However, there is currently a lack of rigorous research, such as double-blind, placebo-controlled RCTs, to support ibogaine’s safety and efficacy. It is imperative to develop practices that reduce patient risk and improve treatment sustainability, given high rates of ibogaine trafficking.