Ibogaine

Key Insights

• Ibogaine is not listed as a scheduled substance by the United Nations but is a controlled or illegal compound in many Western countries, with the notable exception of New Zealand.
• Ibogaine has the potential to decrease a patient’s misuse of opioids, cocaine and alcohol, and reduces symptoms of withdrawal after the administration of a single dose.
• Ibogaine treatment is being offered in several countries around the world with costs ranging from US$5,000 to US$8,000 per treatment.

Ibogaine is a naturally occurring psychoactive compound that is found in several plants such as the roots of the iboga tree (Tabernanthe iboga); it can also be chemically synthesised. The traditional use of ibogaine stems from the Bwititribe of Gabon where it has been used for over 100 years. It has particular spiritual significance for practitioners of the Bwiti religion in West Africa and has an established history as a treatment for substance use disorders, particularly in South American countries such as Mexico and Guatemala, where ibogaine operates in a grey area, not illegal, but unregulated. The relatively unsafe profile, leading to at least 20 deaths in the past 30 years, has prompted researchers to research alternatives that offer the benefits without the cardiac dangers of ibogaine. 

Clinical trials and research

Two clinical trials list ibogaine as an intervention. These trials, which are taking place in Spain and Brazil and are recruiting patients, examine ibogaine’s potential to treat substance use disorder (SUD). The conditions treated were: 

• methadone detoxification
• alcoholism

In research conducted by pioneering advocates of the substance, such as Dr Deborah Mash, it has been shown that ibogaine has the potential to decrease a patient’s misuse of stimulants, opiates and alcohol, and reduce symptoms of withdrawal (from opiates) after the administration of a single dose. Similar findings have been recorded in observational studies funded by MAPS at independent treatment centres in Mexico and New Zealand. 

Other research studies have shown: 

• a reduction in users’ tolerance of opiates and alcohol 
• a significant decrease in cravings for opiates and cocaine for an extended period of time after treatment. 

Ibogaine therapy has been proposed for other mental health conditions, such as depression and PTSD. Its psychological effects have been reported to help people view difficult experiences in an objective way, and to help facilitate ‘closure’ of unresolved emotional conflicts or trauma. Ibogaine has also shown some early signs of promise in the treatment of neurodegenerative disorders such as Parkinson’s disease (in rodents), and it may also help to support the growth of new neurons in the brain. 

One reason why only a few researchers are actively studying ibogaine is the cardiovascular risks that are associated with its use. A Dutch study at Radboud University showed that nearly half of the patients in their study showed a delay in ventricular repolarisation, meaning the time it takes for the heart muscle to recharge between beats, of more than 450 milliseconds for over 24 hours.

Ibogaine analogues

Several companies are exploring ibogaine for its anti-addictive properties. DemeRx, in partnership with atai, is developing both ibogaine and noribogaine as oral, non-addicting treatments for opioid dependence. The latter has a greater affinity for opioid receptors than ibogaine. DemeRx has received approval from the MHRA in the UK to conduct clinical trials with ibogaine.

Give the limitation in currently available treatments, ibogaine represents an enormous leap forward for OUD (opioid use disorder) sufferers.

Debrorah Mash, CEO DemeRX

Delix, which spun out of the Olson Laboratory, has developed a completely non-hallucinogenic psychedelic analogue, tabernanthalog. The compound has been shown, in rats, to have anti-addictive properties and to promote neural plasticity. An ongoing debate between psychedelic researchers discusses if the non-hallucinogenic nature of tabernanthalog will undermine its long-term effectiveness in humans or if this is not necessary to achieve positive results.

First synthesised in a laboratory in 1996, 18-Methoxycoronaridine (18-MC) is a derivative of ibogaine. It was developed to remove the undesirable side effects of ibogaine, including a slowed heartbeat and tremors. The hallucinogenic effect of ibogaine is absent from 18-MC. In 2014, Savant HWP filed an IND application with the FDA. However, this stalled in review for a number of years until the psychedelic pharmaceutical company MindMed acquired the patent in September 2019. In April 2020, MindMed began dosing the first patient in an additional phase I human safety trial of 18-MC for opioid withdrawal and opioid use disorder.

Ibogaine therapy clinics 

An established model of ibogaine treatment centres exists for the treatment of SUD in countries where ibogaine is legal or unregulated, predominantly in Latin America. Ibogaine is an illegal substance in the US and throughout most of Europe (with the exception of a few countries, such as Portugal and the Netherlands) and occupies something of a ‘grey’ legal area in Canada, although a number of treatment centres are located there. More treatment centres have been established in South America. Patients living elsewhere and who suffer from a SUD are required to travel; if they wish to take advantage of ibogaine therapy. Some of the more successful clinics have been running for decades, such as Clear Sky Recovery in Mexico. More and more clinics are operating in Europe, for example, the Iboga Tree clinic in Portugal.

The sector is unregulated, so the quality varies considerably; reputable clinics offer patients access to trained medical professionals in a medicalised setting with accompanying psychological support such as talk therapy, both before and after treatment, to integrate the psychedelic experience and maximise effectiveness. In September 2015, the Global Ibogaine Therapy Alliance (GITA) published clinical guidelines for ibogaine-assisted detoxification, which outline clinical risk management protocols in detail. This measure may be due in part to a small number of deaths among detox patients who experienced cardiac arrest while receiving ibogaine treatment; mostly as a result of underlying but undetected heart conditions.

Cost to patients 

Ibogaine treatment therapy is not covered by health insurance providers in the US so its cost may be prohibitive to some; the therapy can cost between US$5,000 and US$8,000 per course of treatment when paid for privately. GITA offers ‘low’-rate unsecured loans to patients from the US or Canada seeking ibogaine therapy anywhere in the world, while the majority of private ibogaine clinics offer financing options to prospective patients. 

Legality of ibogaine worldwide

Although ibogaine is not listed as a scheduled substance on the United Nations List of Psychoactive Substances under International Control, its legality varies from country to country. The map below illustrates the status of ibogaine (for medical use or personal use outside a clinical setting) by country of relevance.