Subjective effectiveness of ibogaine treatment for problematic opioid consumption: Short-and long-term outcomes and current psychological functioning

This survey study (n=88) found that ibogaine can be an effective treatment against opioid addiction.

Abstract

“Background and aims: Very few studies have reported the effectiveness of ibogaine as a treatment for chronic opioid use. Therefore, this study evaluated the acute subjective effects of ibogaine, outcomes on problematic opioid consumption, and the long-term associations with psychological functioning.

Methods: Using online data collection, 88 patients who received ibogaine treatment in Mexico between 2012 and 2015 completed our survey.

Results: Most participants (72%) had used opioids for at least 4 years and 69% reported daily use. Most (80%) indicated that ibogaine eliminated or drastically reduced withdrawal symptoms. Fifty percent reported that ibogaine reduced opioid craving, some (25%) reporting a reduction in craving lasting at least 3 months. Thirty percent of participants reported never using opioids again following ibogaine treatment. And over one half (54%) of these abstainers had been abstinent for at least 1 year, with 31% abstinent for at least 2 years. At the time of survey, 41% of all participants reported sustained abstinence (>6 months). Although 70% of the total sample reported a relapse following treatment, 48% reported decreased use from pretreatment levels and an additional 11% eventually achieved abstinence. Treatment responders had the lowest rates of depressive and anxious symptoms, the highest levels of subjective well-being and rated their ibogaine treatment as more spiritually meaningful compared with treatment non-responders.

Conclusion: The results suggest that ibogaine is associated with reductions in opioid use, including complete abstinence, and has long-term positive psychological outcomes. Future research should investigate the efficacy of ibogaine treatment using rigorous longitudinal and controlled designs.”

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

Summary

Most participants reported daily use of opioids for at least 4 years, and 80% reported that ibogaine eliminated or drastically reduced withdrawal symptoms. Over one half of participants reported never using opioids again following ibogaine treatment, and 41% reported sustained abstinence.

Introduction

Opioid addiction is one of the largest public health epidemics in the United States and Europe, and is greater among vulnerable populations such as U.S. military veterans and chronic pain patients.

Opioid maintenance therapies are the current mainline intervention in the U.S., but they require long-term use and monitoring with potentially hazardous iatrogenic effects. Ibogaine is a single-dose medication that can interrupt/reduce withdrawal and craving for opioids and provide important psychotherapeutic effects.

Ibogaine history and evidence for use as a treatment for opioid addiction

Ibogaine is a naturally occurring alkaloid, obtained from the root bark of the African shrub Tabernanthe iboga, and is also produced through semi-synthesis of voacangine from the African tropical tree Voacanga africana.

Ibogaine was first marketed in France in the 1930s as a medical product called Lamberene. Howard Lotsof identified ibogaine as effective in ameliorating withdrawal and craving from his own heroin addiction, but several Phase I/Phase II human clinical trials were developed but not completed.

In clinical settings, a typical flood dose ibogaine experience (15 – 20 mg/kg) lasts 12 – 36 hrs and is segmented into different experiential phases or stages. These phases include vivid waking dreams, evaluative experiences, and a residual phase that can last up to 72 hrs.

Several clinical outcome studies have been conducted on ibogaine, including a 1999 case series and an open-label prospective evaluation in St. Kitts, West Indies with 32 patients diagnosed with a severe opioid use disorder.

Ibogaine treatment improved the medical, psychological, social, and legal outcomes among opioid users. 24% of subjects quit using all substances, and 33% continued to use their primary substance but decreased the amount used.

The current observational study aimed to evaluate the effectiveness of ibogaine for treating opioid use disorder by evaluating long-term opioid use reduction and abstinence, and current psychological functioning.

Recruitment procedure

We recruited individuals who had received ibogaine treatment for problematic opioid consumption by sending an e-mail to the medical director at Crossroads Treatment Center. The participants had to be at least 18 years old and able to read, write, and speak English fluently.

During the recruitment period, 285 people were contacted by study personnel. Of these, 134 people consented to participate, but 33 did not complete all of the main ibogaine treatment experience questionnaires.

Treatment setting and content

All participants received ibogaine-assisted detoxification at Crossroads on a fee-for-service basis. Exclusions included severe psychiatric conditions, prolonged QTc interval, history of heart disease, pulmonary embolism, deep vein thrombosis, severe respiratory conditions, obesity, gastrointestinal disorders, chronic infectious diseases, current pregnancy, and abnormal electrolytes or impaired hepatic or renal function.

Most patients at Crossroads clinic have a primary substance use problem related to heroin or prescription opioid use. They receive ibogaine hydrochloride treatment, which includes live cardiac monitoring, intravenous saline and electrolytes, and medical monitoring throughout treatment.

Measures

We developed items to assess whether participants had consumed opioids before and after ibogaine treatment, and whether they had consumed any opioids in the 6 months prior to the study.

We developed items to assess the variety of acute subjective effects that one might experience after ingesting ibogaine as a treatment for problematic substance use. The items were based on shared knowledge, literature review, and commonly reported patient experiences.

The Depression, Anxiety, and Stress Scale (DASS-21) is a 21-item scale that includes seven items in each subscale. The DASS-21 has an internal consistency reliability of .91.

We used the 5-item Satisfaction With Life Survey to assess participants’ general satisfaction with life at the time of the study.

Data analysis plan

We conducted frequency counts of demographic, substance use, and treatment history variables, split the sample into two subgroups based on treatment response, and conducted chi-square and Fisher’s exact analyses with two-proportion z-tests, and t-test analyses to evaluate differences between these treatment response subgroups.

Characteristics of sample and pretreatment substance use and treatment history

Most participants were male, between the ages of 18 and 34, and identified as White/Caucasian. Over half had received detoxification with ibogaine at least 1 year prior to the survey, and almost equal proportions sought treatment for problematic heroin or prescription opioid consumption.

Subjective effectiveness of ibogaine treatment for problematic opioid consumption

The majority of the sample indicated that ibogaine treatment was “Very effective” and 71% indicated that it was “Much better” compared to other treatments they had tried.

Almost one third of participants reported never returning to using opioids after being treated with ibogaine, and almost one half reported that although they relapsed, their consumption had decreased from pretreatment levels. Approximately one quarter reported a neutral or negative response to treatment in terms of their posttreatment substance use.

Comparisons of substance use history, ibogaine experiences, and current psychological functioning between treatment response subgroups

There were no differences in demographic, substance use history, or treatment history variables between those who were considered a treatment responder or a non-responder to ibogaine treatment.

We evaluated the acute subjective effects of ibogaine on participants. The results indicated that over three fourths of participants endorsed the following acute subjective effects of ibogaine: saw visions or visuals, withdrawal symptoms were eliminated or drastically reduced, experienced physical discomfort, saw geometric shapes, and gained insightful knowledge about self.

Treatment responders had lower mean ratings of depression and anxiety compared with treatment non-responders, and higher mean ratings of subjective well-being compared with treatment non-responders.

Discussion

We designed this study to evaluate the short- and long-term outcomes of ibogaine detoxification among individuals with chronic opioid use. We found that 80% of participants experienced reduced withdrawal symptoms during treatment.

In terms of opioid use outcomes, we found that abstinence rates were higher in our sample compared with a sample comprised of primarily opioid users, and that long-term levels of depression and anxiety were lower among those with positive treatment outcomes.

Results are consistent with prior research, and this study extends these findings to a larger sample and included a long-term follow-up. It is possible that spiritual and insightful experiences during an ibogaine session may enhance addiction treatment outcomes.

Several methodological limitations may limit the generalizability of our findings. Furthermore, it is unknown whether the effectiveness of ibogaine treatment is representative of the population receiving ibogaine, and whether self-selection, retrospective recall and social desirability biases influence treatment perception. Although we were unable to determine with 100% accuracy which participants had received 5-MeO-DMT following ibogaine treatment, we conducted a series of chi-square and t-test analyses to evaluate whether there were differences in primary outcomes between those most likely to have received 5-MeO-DMT and those who most likely did not.

This study suggests that ibogaine treatment may be a promising treatment alternative for people struggling with opioid addiction. However, there have been no rigorous randomized controlled trials to date, and future research should evaluate the safety of this treatment using a rigorous controlled design.