Treating drug dependence with the aid of ibogaine: A retrospective study

This retrospective analysis (n=75) found no serious adverse events and 61% abstinence when ibogaine was used as an underground treatment for a variety of drug (e.g. alcohol, cocaine) addictions.

Abstract

“Ibogaine is an alkaloid purported to be an effective drug dependence treatment. However, its efficacy has been hard to evaluate, partly because it is illegal in some countries. In such places, treatments are conducted in underground settings where fatalities have occurred. In Brazil ibogaine is unregulated and a combined approach of psychotherapy and ibogaine is being practiced to treat addiction. To evaluate the safety and efficacy of ibogaine, we conducted a retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users (72% poly-drug users). We observed no serious adverse reactions or fatalities, and found 61% of participants abstinent. Participants treated with ibogaine only once reported abstinence for a median of 5.5 months and those treated multiple times for a median of 8.4 months. This increase was statistically significant (p < 0.001), and both single or multiple treatments led to longer abstinence periods than before the first ibogaine session (p < 0.001). These results suggest that the use of ibogaine supervised by a physician and accompanied by psychotherapy can facilitate prolonged periods of abstinence, without the occurrence of fatalities or complications. These results suggest that ibogaine can be a safe and effective treatment for dependence on stimulant and other non-opiate drugs.”

Authors: Eduardo E. Schenberg, Maria A. de Castro Comis, Bruno R. Chaves & Dartiu X. da Silveira

Summary

Introduction

Problems related to drug use, abuse and dependence have been receiving increasing attention worldwide. They are associated with considerable morbidity and mortality, as well as social problems.

Despite high rates of dependence, safe and effective pharmacological addiction treatments are still lacking. Ibogaine, a monoterpene alkaloid with strong psychoactive properties, is one alternative approach for the treatment of opioid dependence.

Ibogaine is an alkaloid found in the root bark of the Tabernanthe iboga plant, and has been used in Gabon, Cameroon and other parts of West central Africa in Shamanic rituals of the Bwiti religion. It has been shown to reduce cravings in opioid-dependent patients.

Ibogaine is an alkaloid purported to be an effective drug dependence treatment, but its efficacy has been hard to evaluate. A retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users suggests that ibogaine can be a safe and effective treatment for dependence on stimulant and other non-opiate drugs.

Ibogaine has been shown to attenuate morphine-induced place preference, reduce self-administration of morphine, and decrease dopamine efflux in the nucleus accumbens and striatum after cocaine or morphine administration.

In recent decades, ibogaine’s therapeutic potential has coalesced in what has been termed “a medical subculture” or a “vast, uncontrolled experiment”. However, in some places where the substance is illegal, ibogaine is used without quality control and without the supervision of trained and qualified medical staff.

QT prolongation is associated with ventricular arrhythmia, and may persist for 7 days after alcohol withdrawal has ceased, or diminish after a week of cocaine abstinence.

Ibogaine may potentiate QT prolongation from acute drug use or even from withdrawal, possibly causing a potentially fatal ventricular arrhythmia. However, acute toxic effects possibly related to QT prolongation may not explain some of the fatalities associated with ibogaine.

Ibogaine is being used more and more for the treatment of addictions, particularly among opioid-dependent individuals, but there is still little evidence for its use in treating other addictions.

Given the current lack of pharmacological interventions for treating psychostimulant dependence, it is important to assess the therapeutic potential of ibogaine in treating stimulant dependence. In Brazil, ibogaine has been used in the treatment of addiction to other classes of drugs since 2001.

Methods

A residential, private clinic in Curitiba, Paraná, Brazil, treated patients with substance use disorders using cognitive behavioral therapy (CBT) and ibogaine hydrochloride (ibogaine HCl), and patients paid for the treatment.

Patients were required to stay abstinent for at least 30 days prior to ibogaine administration, and were advised to stay at the clinic or at home after the ibogaine session, away from other people, duties or any kind of social activity for at least 7 days.

According to the general protocol provided, the inclusion criteria for ibogaine treatment were good health, absence of psychiatric comorbidities, strong psychological motivation to remain abstinent, and willingness to participate in the psychotherapy before and after ibogaine administration.

Ibogaine HCl was imported from a Canadian provider and placed in capsules by a local pharmacy. Patients were typically given a dose of 17 mg/kg and domperidone was administered 30 to 45 minutes prior to ibogaine administration.

Ibogaine was administered in the morning, around 9 a.m., and patients stayed in bed in a private hospital room, in silence, for approximately 10 hours.

The doctor avoided influencing the patients’ experiences, but provided psychological support if needed. Blood pressure, cardiac frequency and oxygen saturation were measured at each visit to the patient room.

Depending on psychological evaluation, another ibogaine session might be beneficial to the therapeutic outcome. This decision was made in close consultation with the patient, family and therapeutic team.

Data were obtained from patients, clinic staff and physicians, and were analyzed using SPSS 17.0. Associations between categorical variables were evaluated by Pearson Chi-square tests, and level of significance was set at p 0.05 after Bonferroni correction when appropriate.

Patients consented to participate in the study at the start of each telephone conversation, where they were asked about lapses, relapses, drug use and abuse history and their current pattern of use or abstinence.

Patient information

Data were gathered from 75 drug-dependent patients who underwent a total of 134 ibogaine HCl sessions. Fifty-five patients were contacted by telephone, six by mail, and 14 by parents, wives, or ex-wives.

There were no significant differences in age or previous drug use between male and female participants in the ibogaine program. Men were heavier than women and had completed more previous treatments than women.

Patient drug use history

Of the patients, 48 reported lifetime use of alcohol, 61 of cannabis, 62 of cocaine, 8 of injected cocaine, and 51 of crack-cocaine. Some 54 patients reported using multiple substances, including alcohol, cannabis, cocaine, and crack.

There were no statistically significant associations between gender and use of alcohol, cannabis, cocaine or crack.

Participants reported initiation of alcohol use at a younger age than other drugs, followed by cannabis, cocaine and crack. Men started using crack significantly later than women.

Ibogaine sessions

The physician has been working with ibogaine since 2001, but the first treatment session took place on 9 January 2005.

75 patients underwent at least one ibogaine session, of which 33 took it twice, 14 took it three times, five took it four times, and two took it five times.

The mean time interval between the first and second ibogaine sessions was 245.34 days, 303.14 days, 111.60 days, 95.50 days, 72.83 days, and 95.6 days, respectively.

Ibogaine dosage

The dose in the first ibogaine session was significantly higher among men than among women. Only three women participated in a second ibogaine session, rendering data unsuitable for statistical comparison with the second dose of men.

Relapses and abstinence status

All women reported being abstinent at the time of contact, and only two reported having had a relapse after the initial ibogaine session.

After the first ibogaine session, 22 of the male patients recovered without relapses, whereas 53 of the female patients relapsed. There was a significant association between gender and relapse after the first ibogaine session.

Duration of abstinence

Data was obtained for 66 patients regarding the period of abstinence after the first ibogaine session and after all ibogaine sessions. There were no significant differences in the number of days of abstinence before taking ibogaine between men and women.

Seventeen men reported abstinence since their ibogaine session, but 13 of them relapsed during this abstinence period. The time of abstinence between the relapse and contact with researchers was significantly shorter.

Adverse reactions

No serious adverse effects occurred in any patient, but some mild adverse effects occurred frequently. Four patients complained about the psychotherapeutic process, but not about the physical or psychological effects of ibogaine.

Discussion

The present data show that no fatalities occurred as a result of ibogaine administration in the controlled dosing and medical setting described here, and no serious negative reactions were reported. This is important in light of the fact that 19 deaths have been associated with iboga consumption until 2008.

The absence of fatalities in the present results suggests that ibogaine hydrochloride use in a controlled hospital setting is safe. This is also likely due to the long mandatory abstinence period prior to the administration of ibogaine, which may have prevented potential pharmacological interactions between the treatment and other drugs of abuse.

This is the first report to assess the outcome of ibogaine treatment for patients who abused alcohol, cannabis, cocaine, and crack but not opioids. The patients may have under reported their alcohol and cigarette use.

The present results are very encouraging considering that all women in the sample were found abstinent at the time of contact.

We were not able to analyze the length of abstinence achieved after the first ibogaine session, but the median abstinence period achieved after all subsequent ibogaine sessions was 5.5 months, statistically significant longer than the required period of abstinence achieved before ibogaine administration. Most clients who recovered from drug-related problems did so as full-time residents in the clinic, where some were provided benzodiazepines to assist in the treatment process. Moreover, most patients reported that the ibogaine session(s) were indeed essential to their recovery.

Ibogaine treatment has a robust therapeutic outcome, with abstinence periods much longer than those achieved with the drug topiramate. However, we must be cautious when comparing data from this retrospective study with clinical trials due to methodological differences and biases.

It is important to consider secondary measures in addition to abstinence and relapse when evaluating drug dependence treatment outcomes. Furthermore, future studies should also seek to establish the advantages and disadvantages of using ibogaine instead of other related psychedelic compounds, such as LSD.

Despite the limitations of the present report, the data suggest that ibogaine has strong therapeutic potential in the treatment of dependence to stimulants and other non-opiate drugs.