Ibogaine therapy shows a definite promise in the treatment of substance use disorder. In general, ibogaine can be administered safely and without incident, especially when done with proper preparation and supervision. However, there two interrelated issues have stood in the way of further development of ibogaine as a prescription treatment: the lack of clinical research, and the issue of safety.
Phase 1 safety trials funded by the National Institute on Health (NIH) found that ibogaine is not neurotoxic. However, because of ibogaine’s systemic effects, there are certain contraindicated conditions that can pose serious health risks if not identified during a careful screening process.
Between 1990 and 2008, a total of 19 deaths were reported to be temporally associated with the ingestion of ibogaine. These incidents were attributed to a number of factors that include pre-existing cardiac conditions, seizures resulting from acute withdrawal from alcohol or benzodiazepines, and in other cases the co-administration of one or more drugs of abuse while under the influence of ibogaine.1
- It is crucial that patients with childhood congenital heart defects, prolong QT intervals, a history of heart failure, enlarged heart, any history of blood clots, stroke, transient ischemic attacks, pulmonary embolism, deep vein thrombosis, or irregular heart rhythms do not attempt to take ibogaine because of these risks. Other pre-existing heart conditions should be carefully examined and a risk/benefit assessment taken into consideration.
- Other conditions that should prevent someone from taking ibogaine are certain psychiatric conditions, such as bipolar disorder, schizophrenia, depersonalization disorder, cerebellar dysfunction, epilepsy, non-substance induced psychosis, organic brain disease, and dementia. While there may be exceptions, these conditions usually do not see an improvement, and could be exacerbated by taking ibogaine.
- Impaired liver or kidney function, dehydration, and depleted electrolytes can also prevent serious risks.
- Ibogaine does not attenuate withdrawal symptoms from alcohol or benzodiazepines, and seizures, which are commonly associated with withdrawal from these substances, pose a substantial health risk. It is very important that acute alcohol detox be completed under medical supervision prior to taking ibogaine, and that benzodiazepine use be stabilized and continued throughout the treatment. Detoxification from benzodiazepines should be managed by a gradual taper after ibogaine treatment, under the supervision of a medical professional.
- One of the other causes cited in research on adverse events is ibogaine ability to potentiate the effects of opiates, as well as their lethality if co-administered. It does this not by acting as an opiate agonist or antagonist, but by enhancing opiate signaling.2 It is very important that substances are given an opportunity to fully leave the system before ibogaine is administered, and that half-lives of all substances are taken into careful consideration. This process is especially sensitive with long-acting opiates such as methadone and buprenorphine.Although many people seek out ibogaine treatment for its ability to mitigate withdrawal symptoms from short-acting opiates, it has been suggested that the safest route is to fully detox prior to ingesting ibogaine.
- In addition to attenuating withdrawal symptoms, ibogaine has been shown to reduce developed tolerance to opiates3 and alcohol,4 essentially returning the user to a novice state. Using substances after administration of ibogaine without taking this into consideration presents a significant risk of overdose.
These statistics about adverse events associated with ibogaine have been presented as a case against the development of ibogaine as a prescription medicine. However this argument does not take into consideration that those suffering from substance use disorder are a high-risk population, more than 4 times more likely to die of unnatural causes than the general population because of many of the factors associated with substance use.5
Even though these statistics took into account ibogaine administration that happened in a wide variety of settings, some which included medical supervision, and many that did not, these mortality rates remain similar with those reported from methadone treatment, which is one of the most conventional treatments prescribed for opiate addiction.
In 3,414 ibogaine treatment episodes reported between 1989 and 2006, 11 resulted in a fatality. That is 1 ibogaine-related fatality per 427 treatment episodes.6 In Australia between 2000 and 2003, 282 fatalities met the criteria for methadone-related death occurred in 102,615 TEs, which is 1 methadone-related death on 364 treatment episodes.78 In 2004, 110 fatalities in which the medical examiner mentioned methadone as a cause of death occurred in Utah in 52,350 methadone prescriptions, which is 1 methadone-related death on 476 methadone prescriptions.9
It is for this reason that GITA strongly advises against the self-administration of ibogaine, and that the information presented throughout the rest of this site is considered in the context of supervised ibogaine therapy. Research supports the suggestion that professional standards for the administration of ibogaine could have a significant impact on making ibogaine therapy safer and more effective.
Alper, Kenneth R. M.D., Marina Stajic, Ph.D., and James R. Gill, M.D. Fatalities Temporally Associated with the Ingestion of Ibogaine. Journal of Forensic Sciences, March 2012, Vol. 57, No. 2 ↩
Trujillo KA & Akil H, Inhibition of Morphine Tolerance and Dependence by NMDA Receptor Antagonist MK-801, Science, 2512:85-87, 1991. ↩
Khanna JM, Kalant H, Shah G, Chau A. Effect of D-cycloserine on Rapid Tolerance to Ethanol, Pharmacology Biochemistry & Behavior 45(4):983-986, 1993. ↩
Saitz R1, Gaeta J, Cheng DM, et al. Risk of mortality during four years after substance detoxification in urban adults. Journal of Urban Health. March 2007. http://www.ncbi.nlm.nih.gov/pubmed/17221296 ↩
Alper KR, Lotsof HS, Frenken GM, Luciano DJ, Bastiaans J. Treatment of acute opioid withdrawal with ibogaine. Am J Addict. 1999; 8(3):234-42. ↩
Gibson, A.E. and Degenhardt, L.J., (2007). Mortality related to pharmacotherapies for opioid dependence: a comparative analysis of coronial records. Drug and Alcohol Review 26, 405-410. ↩
Gibson, A. and Degenhardt, L.,(2005). Mortality related to naltrexone in the treatment of opioid dependence: A comparative analysis. NDARC Technical Report No. 229. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia 92 pp. ↩
Sims SA, Snow LA, Porucznik CA (2007): Surveillance of methadone-related adverse drug events using multiple public health data sources. Journal of Biomedical Informatics 40:382-389. ↩