Hallucinogen Persisting Perception Disorder After Ibogaine Treatment for Opioid Dependence.
Thomas Knuijver, Maarten Belgers, Wiebren Markus, R. Verkes, Toon Van Oosteren, Arnt Schellekens
Journal of Clinical Psychopharmacology December 1, 2018 DOI: 10.1097/jcp.0000000000000966 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study (open-label trial, single subject) Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | One healthy adult volunteer |
| Intervention | Ayahuasca |
| Measures | VAMS, BAI |
| Topics | Addiction Ibogaine |
| Key findings | Ayahuasca intake was associated with reduced anxiety on the VAMS and BAI scales and with a continuous decrease in serum AEA levels over time, opposite to the increase expected from the literature, while 2-AG increased as basic studies predict. The authors caution that a single open-label case cannot establish that these changes were causally related to ayahuasca. |
Abstract
expressed in brain regions associated with emotional processing. Modulation of the hypothalamic-pituitary-adrenal axis by altering cortisol tone also seems to be involved in this effect. The ECS modulates stress and anxiety. Serum AEA and 2-AG levels are increased after stress, and AEA levels are negatively associated to baseline anxiety and are significantly reduced in womenwith major depression. Although we replicated the increase in 2-AG observed in basic studies, our results regarding AEAwere less consistent, because we observed a continuous decrease in AEA levels over time and not an increase (which would be expected based on the literature). Interestingly, ayahuasca intake was not related to increases in anxiety in two of the scales used (VAMS, BAI), but it was associated with reductions in anxiety. These inconsistencies could be related to the high variability in EC levels in humans (regarding age, ethnicity, sex, etc.), and to the fact that this is a single case. Nonetheless, our observations suggest that the volunteer was calm and relaxed. Indeed, he reported on more than one occasion that he was feeling serene. Considering that the 5-HT2A receptor and the ECS are co-expressed in brain regions associated with emotional processing, it is plausible to speculate that an interaction among those systems could be related to the antidepressive and anxiolytic properties of ayahuasca. More research is needed to better understand the effects of ayahuasca in the ECS and its relation to anxiety and mood. Moreover, the fact that AEA plasma levels were the opposite of what would be expected from the literature suggests that EC plasma measurements should be performed in a bigger sample in case our subject is an outlier. Indeed, since this is an open-label trial involving only one subject we cannot say that any subjective or objective changes were causally related to ayahuasca. To overcome these limitations, we are currently conducting 2 RCTs (one with healthy volunteers and other with socially anxious individuals) to better explore the effects of ayahuasca and the possible involvement of the ECS in these effects.
Comparable studies
Other non-randomized and open-label trials on ibogaine for addiction, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Medication Development of Ibogaine as a Pharmacotherapy for Drug Dependencea. Cocaine-dependent patients | 1998 | Rising tolerance study (Phase I trial) | |
| Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes. Human volunteers seeking to detoxify from opioids or cocaine | 2018 | Open-label case series | n = 191 |
| Safety of ibogaine administration in detoxification of opioid-dependent individuals: a descriptive open-label observational study. Patients with opioid use disorder on opioid maintenance treatment who failed to reach... | 2022 | Open-label observational study | n = 14 |
| Feasibility, safety and preliminary effects of ibogaine in patients with moderate and severe alcohol use disorder: a pilot, open-label study Adults with moderate to severe alcohol use disorder | 2026 | Open-label pilot feasibility study | n = 9 |