Changes in Withdrawal and Craving Scores in Participants Undergoing Opioid Detoxification Utilizing Ibogaine

This retrospective cohort study (n=50) investigated the efficacy of ibogaine (1.26 – 1.4g/70kg) to treat withdrawal symptoms amongst patients with opioid use disorder and found that ibogaine reduced effectively facilitated opioid detoxification, reduced cravings, and reduced withdrawal.

Abstract

“Introduction: Opioid use disorder (OUD) is currently an epidemic in the United States (US) and ibogaine is reported to have the ability to interrupt opioid addiction by simultaneously mitigating withdrawal and craving symptoms.

Methods: This study examined opioid withdrawal and drug craving scores in 50 participants with OUD undergoing a week-long detoxification treatment protocol with ibogaine. The Addiction Severity Index (ASI) was used for baseline characterization of participants’ OUD. Clinical Opioid Withdrawal Scale (COWS), Subjective Opioid Withdrawal Scale (SOWS), and Brief Substance Craving Scale (BSCS) scores were collected at 48 and 24 hours prior to ibogaine administration, as well as 24 and 48 hours after ibogaine administration.

Results: At 48 hours following ibogaine administration, withdrawal and craving scores were significantly lowered in comparison to baseline: 78% of patients did not exhibit objective clinical signs of opioid withdrawal, 79% reported minimal cravings for opioids, and 68% reported subjective withdrawal symptoms in the mild range.

Discussion: Ibogaine appears to facilitate opioid detoxification by reducing opioid withdrawal and craving in participants with OUD. These results warrant further research using rigorous controlled trials.“

Authors: Benjamin J. Malcolm, Martin Polanco & Joseph P. Barsuglia

Summary

Ibogaine was administered to 50 participants with opioid use disorder (OUD) undergoing a week-long detoxification treatment protocol. Ibogaine reduced opioid withdrawal and craving symptoms in participants with OUD, and these results warrant further research using rigorous controlled trials.

Introduction

Opioid use disorder (OUD) involving prescription and non-prescription opioids is currently epidemic in the United States. Methadone is more effective than buprenorphine in retaining patients in treatment programs, but is no more effective in suppressing illicit opioid use.

Current treatment options for opioid use disorder (OUD) are limited and may lead to drug interactions, QTc prolongation, and death. Additionally, patients may become dependent on opioids and may relapse after successful detoxification.

Ibogaine, a psychoactive alkaloid found in the root bark of Tabernanthe iboga or bark of Voacanga africana, has a complex pharmacokinetic and pharmacodynamic profile that is not completely understood. It has significant affinity for targets in many neurotransmitter systems and can interact with many drugs.

Noribogaine (12-OH-ibogaine) is an active metabolite of ibogaine that has a higher affinity for and opioid receptors than its parent compound. It may be used to treat opioid withdrawal symptoms and provide a “self-tapering” effect to those undergoing opioid detoxification.

Ibogaine was first hypothesized to have utility in the management of opioid use disorder in 1962 and was patented as an interrupter of narcotic addiction in 1985. Three studies have used a measurement scale to evaluate opioid withdrawal symptoms in patients undergoing detoxification utilizing ibogaine.

Despite its promising preclinical and pilot data, research regarding ibogaine’s therapeutic potential for opioid use disorder is scarce. However, US residents may travel across the border to Mexico to access treatment with ibogaine.

Program description

The program enrolls patients between the ages of 21 and 60 who are experiencing problematic substance use. It includes a three-part treatment program that includes coaching and medical screening prior to ibogaine administration.

Patients are excluded from treatment if they have severe psychiatric conditions, a prolonged QTc interval, history of heart disease, pulmonary embolism, deep vein thrombosis, severe respiratory conditions, obesity, gastrointestinal disorders, chronic infectious diseases, cerebellar dysfunction, delirium, organic brain disease, epilepsy, current pregnancy, abnormal electrolytes, or impaired hepatic or renal function.

Before treatment with ibogaine, patients are converted to short-acting opioids and maintenance therapies such as methadone and buprenorphine are discontinued four weeks prior to ibogaine treatment. Patients undergo a physical examination, 12-lead electrocardiogram, drug testing, complete physical, and complete blood count.

Ibogaine treatment consists of oral administration of 18 – 20 mg/kg of ibogaine hydrochloride, and occurs in a medically supervised inpatient setting with vital sign, telemetry, intravenous saline and electrolytes, and monitoring of withdrawal symptoms and mental status both during and after ibogaine administration.

Participants and study design

A retrospective chart review of participants admitted to a single residential ibogaine treatment center in Mexico during 2015 was conducted to gauge the severity of their problems with opioid consumption.

Participants lacking complete Clinical Opioid Withdrawal Scale (COWS) scores were excluded. The Brief Substance Craving Scale (BSCS) was used to assess intensity, frequency, and length of drug cravings and was administered at 48 and 24 hours prior to ibogaine administration.

Study outcomes and statistical analysis

Demographic and clinical variables collected at baseline included age, gender, and ASI. Changes in COWS scores pre- and post-ibogaine administration were analyzed using a repeated measures analysis of variance (ANOVA), and percent of participants experiencing different severities of withdrawal symptoms and cravings were analyzed categorically by predetermined symptom scale cutoff scores.

Results

Fifty participants were included in the studies’ analysis of COWS data, 40 participants were included in the demographic analysis, and 82.5% reported having at least one secondary drug problem. Most participants were polysubstance users and reported spending an average of $1666.85 on drugs in the past 30 days.

The average ASI composite score in the drug domain was 0.206, indicating medium-level problematic opioid use, although 47.5% scored high enough to indicate a severe drug problem.

Participants were observed to be experiencing mild opioid withdrawal symptoms while being maintained on immediate-release morphine. After ibogaine administration, 78% of participants did not exhibit clinical signs of opioid withdrawal, 20% had mild signs, and 2% had moderate signs.

The SOWS scores of participants were higher 48 hours prior to ibogaine administration than 24 hours prior, indicating that they were experiencing severe and moderate opioid withdrawal symptoms, respectively. The SOWS scores decreased over time, with significant differences between pre- and post-ibogaine phases of the detoxification protocol.

Participants were experiencing medium-level craving for opioids while being maintained on IR morphine. After ibogaine administration, 79.2% of participants displayed minimal craving for opioids, 14.6% rated their cravings as moderate, and 6.3% rated their cravings as severe.

Discussion

Ibogaine was found to reduce objective and subjective opioid withdrawal scale scores as well as patient-reported cravings for opioids in the largest sample of observed opioid-dependent patients to date.

Ibogaine may be able to help individuals with opioid use disorder (OUD) overcome withdrawal symptoms as well as opioid cravings in a relatively brief treatment time-frame. However, ibogaine is not a “magic bullet” for OUD and extensive support and aftercare are required for successful recovery.

Psychedelics have gained momentum as experimental therapies for the treatment of various psychiatric disorders, including substance use disorders. Ibogaine is unique from a subjective experience and safety perspective, but is associated with a higher risk of severe adverse outcomes, including fatalities. Ibogaine detoxification should not be attempted in an unsupervised environment. There have been reports of death, although administration below the standard of care was suspected in one case.

Ibogaine is used for opioid detoxification, but the populations presenting for ibogaine detoxification treatment often exhibit greater severity and chronicity of addiction, intravenous drug use, medical co-morbidities and fragility after failing mainstream treatments.

We used an open-label and retrospective design that lacked a control group, which introduces the possibility of a placebo effect and various forms of bias. We believe that the results are consistent with a complex mechanism of action for ibogaine that is not fully understood.

Ibogaine appears to be able to effectively detoxify participants from opioids while simultaneously reducing cravings. Further research is needed to elucidate predictive factors of treatment response, as well as employ greater methodologic rigor.