Is Ibogaine A Safe And Effective Treatment For Addictions?

By Santiago Federico Richetti via El Planteo.

The consumption of substances of different types is inherent to human beings. Throughout history, individuals belonging to different cultures, societies, and civilizations have sought pleasurable sensations or comfort through them. The use of drugs does not represent a problem in itself as long as it is not abusive.

However, when it is continuous and excessive, it can have negative consequences of great impact, including changes in people's behavior, damage to the organism, and even death. Addiction is the excessive and prolonged consumption of a substance, regardless of its consequences, which the individual cannot do without due to the dependence it generates.

Nowadays, addictions are one of the most difficult conditions to treat. However, thanks to the revival of the use of psychedelics in medicine, several studies, and clinical experiences claim that there is a promising substance for those struggling with this condition: ibogaine.

The difficulty in treating dependence lies mainly in the fact that addictive behaviors tend to modify the structure and functioning of the brain. Reversing these modifications involves an enormous effort.

The road to recovery from addictions is usually a long and winding process, in which the patient may suffer numerous relapses. Therapeutic strategies comprise highly structured programs that integrate different psychological, physiological, behavioral, pharmacological, and social aspects.

According to the U.S. National Institute on Drug Abuse (NIDA), addictions, like other chronic diseases, are not curable, although they can be successfully treated. It is about achieving sustained recovery through avoidance of use leading to extended abstinence. In other words, to prevent relapses so that the patient overcomes the abstinence syndrome. The use of certain drugs, in combination with psychological therapies, is often the most effective way to achieve this end. However, relapse rates of people treated for drug use disorders reach, according to NIDA data, 60%.

This reflects the limitations of traditional addiction treatment. In recent years, a considerable amount of research has proliferated to provide evidence that leads to alternatives with better results. Studies on the properties of ibogaine to treat patients with addiction problems date back to 1962 when the young researcher Howard Lotsof discovered by chance the ability of this substance to interrupt the heroin withdrawal syndrome.

Currently, there are numerous studies that scientifically demonstrate that ibogaine has the ability to reverse the neuroadaptive changes that induce addictive behaviors. This article takes up some of the most relevant results in this regard, exploring the possibility of treating addictions safely through therapies based on the administration of ibogaine.

What Is Ibogaine?

Ibogaine is an indole alkaloid extracted from the root bark of Tabernanthe iboga, a shrub that grows naturally in equatorial Africa, particularly in the Ogoué river delta and in the rainforests of Congo and Gabon. The medicinal and ceremonial use of this plant has a long history. There is evidence that the pygmies of the Congo Basin ingested iboga for their sacred rituals at least 20,000 years ago.

Since then, different peoples of the region have made use of the hallucinogenic and stimulant properties of iboga, giving it cultic value. A paradigmatic case is that of the Bwiti religious movement, which originated in Gabon and spread throughout Equatorial Guinea and Cameroon, which has been using this plant for about three centuries to promote the spiritual growth of its followers and to resolve issues related to the restoration of health.

In the West, research and the first therapeutic uses of ibogaine date back to the beginning of the 20th century. The first to commercialize an iboga extract in tablet form for medicinal use was the physician Albert Schweitzer in 1939. This medicine, baptized by Schweitzer as Lambarene, was reserved for hospital use and was banned in 1967 due to its toxicological and hallucinogenic effects.

Studies on the beneficial effects of ibogaine on mental health have, however, their peak in the research of Howard Lotsof. It is known that the young Lotsof was addicted to heroin and that in 1962, he discovered by chance that the intake of ibogaine helps to reduce the symptoms of the withdrawal syndrome. This discovery awakened his scientific interest in the subject, and for the rest of his life, Lotsof devoted himself to research on this substance and its effects on patients with dependent consumption problems.

Of particular relevance are the studies published by this author and his collaborators between the eighties and nineties of the last century. The trials conducted under the direction of Lotsof between 1989 and 1993 show the detoxifying effects of ibogaine in patients with opioid addiction problems. Indeed, 29 of the 33 participants in these studies demonstrated complete detoxification.

However, it was not until 1993 that the U.S. Food and Drug Administration (FDA) approved the first phase 1 study of ibogaine. Since then, the number of studies on the potential of ibogaine to treat addiction has been steadily increasing. In recent years, the Multidisciplinary Association for Psychedelic Studies (MAPS) has developed two observational studies in order to define the long-term efficacy of ibogaine-assisted addiction treatment. But the study with the largest number of patients treated with ibogaine for addiction so far comes from Brazil, where the use of ibogaine is authorized under medical supervision, in hospitals.

Studies Conducted In Brazil

In Brazil, ibogaine is neither registered nor prohibited. In addition, the country's health authority allows, since 2013, the importation of unregistered drugs,as long as it is for personal use and the patient has a medical prescription. In the state of São Paulo, there is even a decree from 2016, to require that treatment with ibogaine be mandatory under medical supervision and in hospital settings. It was in this context that the study on ibogaine for addiction was produced with the largest sample of patients carried out to date.

The research was carried out in 2014 by a group of Brazilian scientists, who analyzed the results of 75 patients treated with one or more doses of ibogaine. Among the women in the sample, 100% declared themselves abstinent at the time of the interview. Among men, 72% remained abstinent, with 57% without any parallel treatment. For 66 patients, it was possible to compare the mean period of abstinence before and after treatment. Between the two genders there was a significant increase in time without relapse.

In another study conducted in 2021, Bruno Ramos Gomes describes his participant observation in various Brazilian clinics that perform ibogaine-assisted therapies, as well as his follow-up of a series of patients who underwent this type of treatment to combat addictions. According to this author, the space that ibogaine is gaining in drug addiction treatments in Brazil responds, more than anything else, to its effectiveness in combating withdrawal symptoms.

How Does Ibogaine Work?

The effects of ibogaine differ from those of other psychedelics, such as LSD, psilocybin, and mescaline, since, besides having hallucinogenic effects, it possesses dissociative properties.

According to the testimony of different users, this substance produces an intense dreamlike experience that induces a deep state of introspection and the activation of long-term memory. It is estimated that the psychoactive properties of ibogaine provide moments of realization and self-understanding, reconnecting the individual with his or her own nature and bringing to light those unhealthy processes and behavioral patterns. This explains why most of the research on this drug focuses on its potential use to treat addictions.

According to Mandrile and Bongiorno de Pfirter, it is possible to affirm that the hallucinogenic effects of ibogaine are mainly due to "an occupation of the cellular serotonin receptors, which predominates the action of the antagonistic sympathetic centers". The authors in question do not hesitate to consider this substance as one of the most active in the Central Nervous System.

For their part, Alper and Lotsof maintain that the neurological effects of ibogaine are due to its capacity to antagonize the nicotinic acetylcholine receptor nAChR through its metabolite 18-MC, promoting the decrease of sensitivity to the flow of dopamine in the nucleus accumbens, the neutral interface between motivation and motor action. Thus, the action of ibogaine intervenes in the reward system, which could be the mechanism of action that tends to reduce the withdrawal syndrome.

Is Ibogaine A Safe Method For Addictions Treatment?

Ibogaine produces multiple effects on the Central Nervous System and the Cardiovascular System. These effects often vary depending on different factors, ranging from the dose administered to other issues related to the individual's medical history, predisposition to different diseases, age, and social environment. It is for this reason that it is necessary to consider these factors by knowing the patient's medical history and carrying out medical examinations before starting any type of addiction treatment based on the administration of this substance.

The controversial nature of this type of therapeutic intervention resides, mainly, in the risks that they entail. Among the most frequent side effects are the presence of dizziness, nausea, vomiting, motor coordination difficulties and tachyarrhythmias. It is for this reason that it is necessary to carry out treatments with ibogaine in hospital environments, under strict medical supervision and with prior check-ups necessary to detect any type of abnormality that may represent a risk to the patient.

"In fact, ibogaine is contraindicated in some patients with heart problems," says Bruno Rasmussen, medical director of Beneva Clinics, which offers ibogaine treatments in hospital wards in Brazil. “Each case must be analyzed individually. With proper preparation and testing, even certain patients with heart murmurs or heart attacks, for example, can be safely treated in hospital.”

Ibogaine may also be contraindicated in patients with psychiatric disorders, such as schizophrenia, psychosis, bipolar disorder, or borderline personality disorder. “The psychiatrist is essential to analyze the presence of these disorders and their severity. In certain cases, these patients are usually excluded from ibogaine treatment if there is a possibility of the substance causing the reappearance or worsening of symptoms”, explains Bruno Rasmussen.

Likewise, it is necessary to consider that not all patients manage to deal with the introspective experience produced by ibogaine, and may suffer episodes of anxiety and paranoia. Here again, the need for a thorough psychiatric and psychological evaluation before starting ibogaine is highlighted. In addition, it is essential, by virtue of reducing risks, the follow-up of mental health professionals during treatment.

It is also of particular importance to avoid any consumption of psychoactive drugs a few weeks before and during the administration of the treatment since the interaction of ibogaine with other substances could increase both the cardiac and psychiatric risks of the patients.

Where Can One Get Ibogaine Addiction Treatments?

In the international context, the legal status of ibogaine restricts its medicinal use in several countries. In the United States and several European states this substance is banned. However, other countries, such as Mexico, offer ibogaine-assisted therapies to treat patients with addiction problems. In this country, there are several private centers where this type of therapy is performed, receiving patients from different parts of the world. However, Mexican government regulations do not require that the treatments be carried out in a hospital environment, nor that purified ibogaine be used.

In Brazil, on the other hand, as indicated above, the use of ibogaine for treatments against dependent consumption is authorized as long as they are carried out in hospital settings and under the proper supervision of medical professionals. Currently, in the State of São Paulo, Clinicas Beneva, an integrative mental health company that offers psychedelic-assisted psychotherapy treatments, performs this type of procedure according to a careful protocol, in hospital wards, and with constant monitoring by health professionals.

This protocol requires patients to undergo a period of abstinence of at least 30 days to avoid the possible risks of ibogaine in the body. It should be noted that these clinics are under the direction and supervision of Dr. Bruno Rasmussen, who has not only conducted a series of investigations into the effects of ibogaine on patients with dependent consumption problems but has also treated more than 2,000 people with this substance in his 27 years of activity.

 

 

Photo: Alex Green, Pexels