A Mixed-Method Analysis of Persisting Effects Associated with Positive Outcomes Following Ibogaine Detoxification

This qualitative and quantitative retrospective survey study (n=73) investigated the effects of ibogaine (1050mg/70kg) on opioid withdrawal, with the aim of identifying differences related to whether the patients respond to treatment. Patients who were able to decrease or quit using opioids successfully experienced the greatest degree of changes in gratitude, authenticity, and sense of meaning in life, in response to ibogaine treatment.

Abstract

Introduction: We examined persisting effects, self-perceived challenges, and potential benefits associated with positive outcomes following ibogaine detoxification using data collected as part of a larger online retrospective study of 73 patients who received treatment for chronic opioid use in Mexico between 2012 and 2015.

Methods: A mixed-methods design was used comparing treatment responders versus non-responders, as well as content coding of themes from open-ended questions.

Results: Most participants reported positive persisting effects of ibogaine detoxification (e.g., enhanced personal sense of gratitude and authenticity, and meaning and appreciation for life). Compared to non-responders, treatment responders endorsed greater persisting changes in their ability to tolerate difficult/painful feelings, capacity for coping with stress, and reduced unhealthy anger. Treatment responders reported greater change in subjective levels of inner peace, joy, feelings of love/openheartedness, and experiences of sacredness in life. Qualitative analyses revealed that treatment responders reported a heightened sense of spiritual awareness and greater connection to their intra-/interpersonal relationships after ibogaine detoxification. Notable challenges of ibogaine detoxification included psychological and health-related difficulties during treatment and challenges with post-treatment integration.

Discussion: Findings highlight the persisting effects associated with positive response to ibogaine detoxification and possible post-treatment needs (i.e., more integration/aftercare resources). Future research using rigorous experimental designs is needed.”

Authors: Alan K. Davis, Elise Renn, Austin-Marley Windham-Herman, Martin Polanco & Joseph P. Barsuglia

Summary

We examined the persisting effects of ibogaine detoxification, self-perceived challenges, and potential benefits associated with positive outcomes following ibogaine detoxification. We found that treatment responders reported greater persisting changes in their ability to tolerate difficult/painful feelings, capacity for coping with stress, and reduced unhealthy anger.

Introduction

Opioid use disorder is now a public health epidemic in the United States and Europe. Opioid maintenance therapies (OMTs) are the standard treatment for detoxification and managing withdrawal in the U.S., but they have hazardous long-term effects, perpetuate dependency, and demonstrate limited efficacy.

Ibogaine, a plant-derived compound, improves mood and engenders novel psychological insights through its dream-like properties. Its mechanism of action appears to foster adaptive changes in the opioid and dopamine pathways.

International studies have documented the efficacy of ibogaine in treating opioid dependence in clinical populations, including rapid reductions in withdrawal symptoms and durable improvements in drug use and legal and social functioning.

Although studies have demonstrated positive clinical outcomes associated with ibogaine detoxification, little is known about the acute and persisting subjective effects of ibogaine treatment. For example, qualitative reports from patients in Brazil revealed that ibogaine treatment led to long-term improvements in family and social relationships.

This study aims to identify differences in persisting psychosocial effects and perceived benefits/challenges associated with ibogaine treatment between individuals with positive treatment responses and those with negative treatment responses among people with chronic opioid use.

Recruitment procedure

A secondary data analysis of a retrospective study of chronic opioid users who received treatment at an inpatient clinic in Mexico was conducted. 73 participants completed an anonymous web-based survey, and 88 were included in the main outcome publication.

Treatment setting and content

All participants received ibogaine detoxification treatment at a clinic in Mexico on a fee-for-service basis. They received cardiac monitoring, intravenous saline and electrolytes, and medical monitoring during their ibogaine session.

Opioid consumption before and after ibogaine detoxification

Participants were asked about their substance use, including whether they used opioids prior to ibogaine detoxification, how many years they had been using, and whether they had changed their consumption patterns.

Persisting effects of ibogaine

The Persisting Effects Questionnaire was modified to measure changes in attitudes, moods, behavior, and spiritual experience after ibogaine treatment. It included 145 items that were collapsed into one item each with a response option that captured whether the item being measured had decreased or increased.

Qualitative items regarding ibogaine treatment

We asked three open-ended questions to examine participants’ perceptions of their treatment experiences, including personal changes, greatest benefit, and most challenging part.

Data analyses

We conducted frequency counts of demographic characteristics, primary substance use and treatment history variables, and t-tests and effect size calculations on responses to items from the persisting effects of ibogaine questionnaire using the entire sample and two subgroups based on treatment response following ibogaine treatment.

We conducted a content analysis of open-ended questions to examine the personal changes, greatest benefits, and challenges associated with ibogaine treatment. We used a list of themes to define each theme and assigned a numerical code to each theme to link a participant comment to the associated theme.

Characteristics of sample and pre-treatment substance use and treatment history

Most participants were male, between the ages of 18 and 34, White/Caucasian, and had been using heroin or prescription opioids for at least four years. Of those, 36 reported never using opioids again, 33 reported decreased use, 11 reported no change in their opioid use, and three reported increased use.

Persisting attributions of the effects of ibogaine treatment and differences in functioning by treatment responder subgroup

Most participants believed that they had experienced positive changes in psychological, behavioral, and social functioning after ibogaine treatment, and those who responded to ibogaine treatment had significantly greater positive changes in sense of gratitude, ability to be a more authentic person, sense of meaning in life, appreciation for life, and acceptance of others.

Qualitative analysis of persisting subjective ibogaine experiences and challenges related to treatment

Regarding persisting experiences related to personal changes, treatment responders reported psychological changes (32% of utterances) and SUD symptom relief (32% of utterances), while treatment non-responders reported no such experiences.

Ibogaine treatment responders and non-responders mentioned psychological benefits and SUD symptom relief as the greatest benefits, while treatment non-responders did not mention emotional and spiritual benefits.

The most frequently expressed challenges of one’s ibogaine detoxification occurred post-treatment (61% of all utterances), with the most frequently mentioned themes being difficulty with integrating their ibogaine experience into their daily lives and psychological challenges.

Discussion

This study found that opioid users experience persisting benefits associated with a change in gratitude, authenticity, and sense of meaning in life following ibogaine detoxification, as well as comparatively greater persistent increases in positive affect, affective coping ability, and reductions in negative affect. Ibogaine detoxification may have secondary benefits associated with emotional regulation, but future research should examine this hypothesis using a longitudinal design.

Participants in this study reported that they experienced persisting effects related to social and interpersonal relationships, which may be due to the fact that they were able to re-engage with pre-existing social supports or because they were able to make new social connections following treatment.

The results of this study highlight the importance of persisting psychological and spiritual insights gained during the ibogaine session in the treatment of substance use disorders. These insights may be a necessary component of the experience, similar to the mystical experience found to be associated with persisting changes following psilocybin administration in clinical trials.

We recruited participants who received ibogaine detoxification from only one facility, and it is possible that patients who received treatment elsewhere or who are from diverse backgrounds experienced different persisting effects. Moreover, we used a modified version of a measure assessing the persisting effects associated with ibogaine detoxification.

The study findings have several implications, including the need for future analyses to include multiple domains of emotional, social, and spiritual functioning following ibogaine interventions, and the need for clinicians to provide aftercare services to patients who experience difficulty integrating their ibogaine experience into their daily lives.

Study details

Compounds studied
Ibogaine

Topics studied
Addiction Opioid Use Disorder

Study characteristics
Open-Label Longitudinal Survey Interviews Qualitative

Participants
73

Authors

Authors associated with this publication with profiles on Blossom

Alan Davis
Alan Kooi Davis is an Assistant Professor of Social Work at The Ohio State University and Adjunct Assistant Professor in the Center for Psychedelic and Consciousness Research at Johns Hopkins University.

Institutes

Institutes associated with this publication

Johns Hopkins University
Johns Hopkins University (Medicine) is host to the Center for Psychedelic and Consciousness Research, which is one of the leading research institutes into psychedelics. The center is led by Roland Griffiths and Matthew Johnson.

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