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Ibogaine and Related Compounds: Safety and Effectiveness
Ibogaine medical tourism has become increasingly popular in recent years for the treatment of drug and alcohol dependence. How safe and effective are these treatments?
In 1962, heroin dependent drug user Howard Lotsof took ibogaine with the intent of enjoying its hallucinogenic properties. Much to his surprise, he found that the ibogaine greatly reduced his craving for heroin as well as ameliorating the withdrawal symptoms. Lotsof subsequently administered ibogaine to seven other heroin dependent individuals, all of whom reported alleviation of craving and withdrawal symptoms. Five of these seven remained heroin-free for at least six months thereafter.
…heroin dependent drug user Howard Lotsof took ibogaine with the intent of enjoying its hallucinogenic properties. Much to his surprise, he found that the ibogaine greatly reduced his craving for heroin as well as ameliorating the withdrawal symptoms.-KennethAndersonLotsof was unable to obtain ibogaine after 1963 due to the intervention of the FDA, and in 1967 the United States classed ibogaine as a Schedule I which made it illegal for doctors to even prescribe it. However, many other countries chose not to outlaw the prescription of ibogaine. In 1989, the International Coalition for Addict Self-Help (ICASH) was created by Robert Sisko in the Netherlands to provide ibogaine treatment for opioid dependence, and thus, ibogaine medical tourism was born.
Soon others followed suit, including Lotsof himself whose company, NDA International began offering ibogaine treatment in the Netherlands in 1991. Lotsof also worked tirelessly to get researchers interested in studying ibogaine. As a result, animal studies on the effects of ibogaine began to appear in scientific journals in the late 1980s.
Studies of Ibogaine in Animals and Humans
Treatment with ibogaine has been demonstrated to significantly reduce substance self administration in morphine dependent, heroin dependent, cocaine dependent, nicotine preferring, and alcohol preferring rats for up to three days with reductions of up to 90% during the first day. Ibogaine also significantly reduced signs of morphine withdrawal in rat studies.
Doses of ibogaine exceeding 80mg/kg were associated with neurotoxicity and the death of Purkinje cells in rats, although this effect was not found in either mice or primates. Typical effective doses of ibogaine in rat studies are half that: 40 mg/kg. Human doses are even lower: Lotsof recommends 15 to 20 mg/kg.
No double-blinded, randomized clinical trials of ibogaine in humans have been completed. FDA approved clinical trials were begun by Deborah Mash and her team at the University of Miami in 1993; however, these were halted in 1995 due to lack of funding and other difficulties and hence never completed.
FDA-approved clinical trials were begun by Deborah Mash and her team at the University of Miami in 1993; however, these were halted in 1995 due to lack of funding and other difficulties and hence never completed.-Kenneth AndersonNIDA designed a clinical trial in 1994, but ultimately opted not to fund it. A proposed clinical trial at Erasmus University in Rotterdam, the Netherlands was also abandoned in 1993, due to the death of a woman undergoing ibogaine treatment elsewhere in the Netherlands.
However, case studies and anecdotal reports coming out of the ibogaine medical subculture are suggestive that ibogaine may have significant anti-addictive effects in humans. Lotsof did long term follow up of 52 ibogaine treatment episodes for over year with the results shown in Figure 1. (There were actually 41 only individual subjects, nine of whom were treated twice and one who was treated three times for a total of 52 treatment episodes. Each episode is treated as though it were a separate subject in Figure 1.)
Another recent retrospective study by Schenberg et al. found that the median duration of abstinence after ibogaine treatment was 5.5 months; however, this study required two months of abstinence prior to treatment, assuring that only highly motivated individuals took part.
Both the Lotsof study and the Schenberg study were open label and uncontrolled: in other words, all participants knew that they were getting ibogaine and there was no control group which received a placebo for comparison.
Ibogaine’s Effects on Humans
Ibogaine intoxication in humans is characterized by anxiety, nausea, vomiting, dizziness, incoordination, lowered and irregular heart rate, and hallucinations. Ibogaine induced hallucinations tend to be most prominent when the eyes are closed and are characterized by dreamlike imagery which may disappear when the eyes are open. This is in contrast to LSD hallucinations which are most prominent when the eyes are open and often involve light trails, although high doses of ibogaine may produce LSD-like synesthesia.
It remains a matter of debate whether the hallucinogenic effects of ibogaine are of importance to its putative anti-addictive effects or not. The related compounds noribogaine and 18-MC were equally as effective at reducing drug self administration in animal trials as ibogaine, but neither of these compounds produces any hallucinogenic effects in humans; these two compounds also lack many of ibogaine’s other side effects. It remains to be seen whether noribogaine and 18-MC would be more effective, less effective, or equally as effective as ibogaine in human studies.
Ibogaine Related Fatalities
- Nineteen ibogaine related fatalities were reported between 1990 and 2008.
- Six of these deaths were due to ibogaine being ingested by a person with a pre-existing heart condition.
- Eight deaths resulted from mixing ibogaine with a drug of abuse such as an opiate or cocaine.
- Five fatalities involved ingesting ibogaine in the form of root bark or alkaloid extract instead of pharmaceutically pure ibogaine hydrochloride.
- One fatality may have involved an alcohol withdrawal seizure.
- Time between ibogaine ingestion and death ranged from 1.5 to 76 hours.
- Since 2008 several other ibogaine related fatalities have been reported.
Because ibogaine can cause slowed and irregular heart rates for several days after ingestion, it is unsafe for people with pre-existing heart conditions to take ibogaine. Ibogaine has also been known to to increase the toxicity of opiates in rats, meaning the drug should be considered “unsafe” to mix with any drugs of abuse including cocaine, alcohol, benzodiazepines, amphetamines and opiates.
Since accurate dosing of ibogaine is impossible when using iboga bark or other crude extracts, they can potentially cause death due to ibogaine poisoning. The slowed and irregular heartbeat associated with the ingestion of ibogaine appears not to be due to ibogaine itself, but to the primary metabolite noribogaine, which has a much longer half life.
Noribogaine and 18-MC
Noribogaine and 18-MC are each chemical compounds which are closely related to ibogaine in structure, in fact, noribogaine is the primary metabolite of ibogaine. Both of these compounds have been tested in rat studies and shown to be equally as effective as ibogaine in reducing drug self administration in substance dependent rats.
Neither noribogaine nor 18-MC is hallucinogenic and both lack most of the negative side effects associated with ibogaine. One difference between the two is that noribogaine leads to slowed and irregular heart rate whereas 18-MC does not, suggesting that 18-MC is the safer of the two.
Preliminary clinical trials of safety and tolerability in humans have been completed for noribogaine. 18-MC is currently undergoing preliminary trials of safety and tolerability. Neither drug has yet undergone a clinical trial testing its effectiveness as an anti-addiction agent in humans. Neither drug appears to be offered by any agency engaged in medical tourism.
If you are considering ibogaine treatment for an addiction, proceed with caution.
First get yourself thoroughly checked out by a physician to insure that you have no heart problems or other health conditions that could lead to death under the influence of ibogaine.
Choose a program with a legitimate physician and adequate medical staff. Make certain that your treatment will be fully medically supervised not only during the time you are under the influence of ibogaine, but for several days before and after the treatment. Do not attempt to treat yourself with iboga bark or raw plant extracts obtained from the internet; this could result in death due to ibogaine poisoning.
Only choose a program which uses pharmaceutical grade ibogaine hydrochloride. Do not participate in a program using iboga bark or raw plant extracts which could lead to death through ibogaine poisoning. If you are currently using opioids you will need to be in withdrawal before taking ibogaine; taking ibogaine while you still have opioids in your system can lead to death from drug interaction even at the correct therapeutic dosage of ibogaine.
Ibogaine’s Safety in an Addiction Capacity
If you are seeking treatment for dependence on cocaine or another stimulant such as methamphetamine, make certain you are totally abstinent from these substances for a reasonable amount of time before taking ibogaine: a week is reasonable. Drug interactions between ibogaine and these stimulants are also potentially fatal. In the case of alcohol it is essential to be thoroughly detoxified and finished with all withdrawal before initiating ibogaine treatment.
Be wary of anyone who claims that ibogaine is safe because it is a plant or because it is natural. Also be wary of those claiming to be shamans trying to sell you a spiritual journey.-Kenneth AndersonAlcohol withdrawal induces heart rhythm irregularities and spikes in blood pressure which can be fatal in the presence of ibogaine. At least one week needs to elapse between the last drink and the initiation of ibogaine treatment–longer if possible. Ibogaine induced heart rhythm irregularities have been documented for up to five days after the ingestion of ibogaine, so it is essential to remain drug and alcohol free for at least a week following ibogaine treatment.
Be wary of anyone who claims that ibogaine is safe because it is a plant or because it is natural. Also be wary of those claiming to be shamans trying to sell you a spiritual journey.
Remember that ibogaine is not a magic bullet; in the absence of clinical trials it is not possible to say just how effective ibogaine actually is compared to other forms of treatment. In any case, you will still have to do a lot of work of your own to successfully overcome an addiction, even if you choose to undergo ibogaine treatment.