New scientific research provides more evidence that the psychedelic drug ibogaine can help treat opioid withdrawal and cravings. The new findings are reported in the Journal of Psychoactive Drugs.
Ibogaine a psychoactive substance found in the root bark of the African Tabernanthe iboga plant, which has been used in the shamanic rituals of the Bwiti religion in West Africa. The drug is outlawed in the United States and many other countries, but remains legally available in Mexico. The new research examined 50 patients addicted to heroin or prescription opioids who participated in a week-long ibogaine treatment program in Tijuana.
“As a lover of biology, spiritual experience, indigenous cultures, and consciousness I developed a curiosity and passion for psychedelic substances, as they perfectly intersect these interests. This led me to pursue formal education and training in psychiatric pharmacy as well as public health, which further inspired me to be involved in researching the utility of psychedelic substances in the treatment of illness,” explained study author Benjamin J. Malcolm of Western University of Health Sciences’ College of Pharmacy.
“Recent (and older) research suggests that many psychedelic substances have potential clinical benefits in a variety of psychiatric illnesses, although ibogaine is seemingly unique in its ability to interrupt opioid addiction,” he told PsyPost. “Given the epidemic of death and harm associated with opioids in the United States presently and limitations of current therapies in treating opioid use disorders it seems very timely to study ibogaine further.”
Malcolm and his colleagues found ibogaine treatment was associated with significant reductions in opioid cravings and withdrawal symptoms. Most of the patients (78%) did not exhibit clinical signs of opioid withdrawal 48 hours after receiving ibogaine.
“It seems that ibogaine can interrupt the underlying neurocircuitry of opioid use disorder while delivering a profound psychological experience that reinforces recovery efforts,” Malcolm explained to PsyPost. “In our study ibogaine appeared to be able to reduce both the physical signs and symptoms of opioid withdrawal as well as reduce cravings for opioids.”
“This means that ibogaine may simultaneously address both physical and psychological aspects of opioid use disorder, whereas other therapeutic agents for opioid use disorders address either physical aspects through continued opioid dependence (methadone, buprenorphine) or psychological aspects of addiction like craving (naltrexone), but do not address both and cannot be used together.”
“Furthermore, the psychedelic nature of ibogaine tends to induce a dream-like state in which many report autobiographical subjective experiences, like watching their life as a movie from the vantage point of an observer,” Malcolm continued. “They see the moments of hurt or traumas from the past that predisposed them for substance use and undergo an emotional processing that allows for resolution of the underlying pain.”
In the early 1960s, anecdotal reports surfaced that ibogaine could help defeat drug addiction, prompting some scientists to investigate the anti-addictive properties of the drug. But ibogaine became a Schedule I substance in the United States in 1970, severely limiting the research into the psychedelic drug’s potential.
“Ibogaine and other psychedelic substances that are deemed illegal by the U.S. federal government have demonstrated therapeutic potential, albeit mostly in preliminary studies and anecdotally. This means that many psychedelics are likely subjected to erroneous classification as it is part of the definition of an illegal substance that it has no medical utility.”
“The other piece of the government’s definition of an illegal substance is a high potential for abuse, which is also very questionable with psychedelics, particularly ibogaine that tends to produce less euphoria than others like LSD. This regulatory framework results in oppression of legitimate scientific inquiry, and ultimately hurts the public given epidemic harms of opioids as well as enormous therapeutic need for better treatments.”
However, the new research — like all studies — has limitations.
“There are some caveats to this study as well as many unanswered questions in ibogaine research,” Malcolm explained. “The largest caveat of this type of study is the research design. This study did not have a control group and participants were not randomized to treatment or placebo, which introduces potential biases that can skew results.”
“It was a chart review of participants that received ibogaine at one center and different centers may have different administration or dosing protocols or practices that could enhance or diminish the therapeutic or adverse effects so it’s unclear how generalizable or optimal the studied setting is in the treatment of opioid use disorder.”
“This study also only followed participants through the acute withdrawal phase so lacks information on relapse rates after opioid detoxification with ibogaine. However, there are some other small studies that have partially addressed longer term outcomes and overall appear promising.”
Ibogaine can also have potentially fatal side effects.
“There are cardiac safety concerns with ibogaine and there are some reports of death in the literature, even in clinical settings,” Malcolm said. “Factors that increase risk for adverse cardiac effects require further study (we have some clues) and a cautious approach to participant selection in research is advisable.”
“Some would argue that a drug with a risk of death is too risky to continue clinical research with, although the current mainstay of opioid use disorder treatment is methadone which has FDA black box warnings for addiction, abuse, and misuse as well as fatal respiratory depression (death due to not breathing).”
“Furthermore, opioid use disorder is a deadly illness with 115 deaths per day reported by the Centers for Disease Control and Prevention (CDC) for 2016 in the US. So it appears that due to the risk of death from both the illness and current treatments that in this example further research is favorable despite known cardiac safety concerns.”
“Overall, the current body of research would probably be sufficient in other areas of medicine to garner enthusiasm and funding for research, yet due to the stigmas associated with psychedelic substances as well as drug addiction (opioid use disorder), the approach has been to attempt prohibition of research,” Malcolm remarked.
“Studies with more stringent methods are costly, yet due to the illegal regulatory status of ibogaine, are unlikely to be paid for by government or pharmaceutical sponsors without further action such as re-scheduling to a controlled substance instead of an illegal one.”
Malcolm also cautioned that ibogaine should not be over-hyped as the solution to opioid addiction.
“While results are very promising, ibogaine is surely not a magic bullet for the treatment of opioid use disorder and is in experimental stages of drug development as a therapeutic entity. If ibogaine proves to be safe and effective in controlled trials then one possible treatment model could feature ibogaine as the experiential core of a larger treatment intervention that incorporates preparatory counseling/psychotherapy before and after ibogaine as well as residential or inpatient aftercare programming-care to give individuals the best chances at successful recovery.”
“This type of model would combine elements of successful psychedelic protocols from MDMA or psilocybin research with traditional rehabilitation programs used in substance use disorders.”
“I also think for this type of model to work that a fundamental shift away from the stigmatized conceptions society holds for substance use disorders as well as psychedelics are necessary to earnestly facilitate rehabilitation,” Malcolm added.
“As far as substance use disorders, we should also be investigating and aggressively intervening on societal drivers of substance use (isolation, loneliness, lack of spirituality or connectedness, boredom, lack of alternatives to drug use, physical or emotional pain), which would probably offer the greatest rewards for society in the prevention of drug use.
“Lastly, maybe a disclaimer: due to known risks of ibogaine and illicit status in the US, please do not try a home detoxification. Consult medical professionals if you have a problem with opioids. Nothing in this interview is meant to encourage illegal activity.”
The study, “Changes in Withdrawal and Craving Scores in Participants Undergoing Opioid Detoxification Utilizing Ibogaine“, was authored by Benjamin J. Malcolm, Martin Polanco and Joseph P. Barsuglia.