What is iboga?
Psychedelic compounds like psilocybin and ayahuasca are known for their therapeutic benefits. Studies show psilocybin is as effective as SSRIs in the treatment of depression, and ayahuasca has been shown to decrease clinical scores of depression for up to 80% of people, with effects lasting up to 6 months.
There is another, less-known psychoactive compound called ibogaine which has shown promise for treating mental health conditions like substance use disorder. Given the growing opioid crisis in North America (Fisher et al., 2020), the time is right to explore the potential benefits that ibogaine may offer.
Ibogaine is a compound that is extracted from the roots of iboga, a shrub native to the rainforests of Gabon, Cameroon and Guinea in West Africa.
Iboga has been used ceremonially for centuries - since at least the 1800s, members of the Bwiti religion in Gabon have eaten it during coming-of-age ceremonies and initiations, with participants reporting visions of their ancestors and God (Oaklander, 2021). The substance is traditionally ground into a powder to be ingested, but can also be consumed in tea. Followers of Bwiti refer to the root as the "tree of life".
Iboga ceremony in Gabon, West Africa
Iboga vs. ibogaine
Iboga roots contains many compounds, including ibogaine, ibogamine, tabernanthine, voacangine, coronaridine, conodurine, conessimine, iboluteine, and ibogaline (although ibogaine is the most thoroughly researched to date). In traditional settings, the whole iboga root bark is consumed, with as much as 1 kilogram needing to be ingested per session. Consuming iboga can cause physical discomfort, nausea and vomiting during ceremonies and given a large number of active chemicals in the plant, maintaining consistent dosing is a challenge.
Ibogaine was first isolated in 1901, and its structure was deduced in 1958 (Bartlett et al., 1958). Soon after, ibogaine was sold and prescribed as a medication for depression in France from 1930-1960. After World War II, it was used by French athletes to increase focus, reduce fatigue, and decrease inflammation (Popik & Skolnik, 1999). However, reports of adverse effects emerged, including cardiovascular and neurological complications, leading to concerns about its safety. Ibogaine was banned in France in 1966 and has since remained a controlled substance.
In 1970, ibogaine was classified by the US government as a Schedule 1 drug with no medicinal value - a result of the so-called “War on Drugs”. The International Olympic Committee also banned it as a potential doping agent. This halted any research or medical use that was occurring at the time.
During these years, ibogaine was also strictly prohibited in Sweden, Denmark, Belgium, Poland, Croatia and Switzerland. It remains legal for treatment only in New Zealand and Mexico.
The legal status of ibogaine around the world in 2023
However, interest in the use of ibogaine for therapy continued throughout this time.
In 1962, a young American man named Howard Lotsoff accidentally ingested ibogaine in powder form. He said of the experience, “I followed the tree up into the sky and I saw these clouds in the sky, and I realized for the first time in my life, I wasn’t afraid”. The experience subsequently cured his heroin addiction and he went on to organize an informal study with 20 people addicted to harmful substances. Following ibogaine treatment, 12 out of the 20 patients no longer experienced withdrawal symptoms or went into complete remission.
Interest grew, and in 1988 the first placebo-controlled trial from Erasmus University in the Netherlands found that ibogaine attenuated opioid withdrawal symptoms in rats (Dzoljic et al., 1988). A few years later, another study from the Netherlands demonstrated that cocaine self-administration decreased in rats following ibogaine administration (Cappendijk & Dzolijic, 1993).
Research has continued since then, with further studies into ibogaine treatment for humans. Ibogaine is particularly exciting because current addiction treatments, such as opioid replacement therapy, aim to stabilize the patient on a safe supply of medical opioids, whereas ibogaine offers the opportunity to abstain from substances altogether.
Effects
How does ibogaine work? And why do 84% of people who experience its effects say it’s among the top 5 most meaningful experiences of their lives (Davis et al., 2020)?
While ibogaine’s specific target in the brain remains unknown, it has been shown to interact with receptors in the central nervous system that are related to addiction. Ibogaine targets brain function, and through increased neuroplasticity, can “heal” a brain (“Ibogaine for depression”, 2021).
“Ibogaine works in the brain in a more unique way than most psychedelics…[i]t appears to go through your memory database, like a Rolodex of difficult experiences you’ve had that you haven’t metabolized psychologically.” (Sakellaridas, 2022)
This experience can be thought of as a "life review", and helps the patient confront any previous trauma or misalignments that exist in their subconscious. For many, the trip can last as long as 12 hours.
“I comforted all those parts of me that felt misunderstood, unloved, not taken care of – and I became their parent.” - Barsuglia, who serves as an advisor to Beond. (Sakellaridas, 2022).
On a physical level, ibogaine creates an ability to "reset" your previous beliefs by targeting "multiple neurochemical systems at once in a robust fashion", says Dr Averill, an associate professor at Baylor College of Medicine (Sakellaridas, 2022).
What follows is what has been called a “dream-like” state, differing from traditional hallucinogens. This is partly why ibogaine may be well suited for exploration of the past, unlike MDMA, which is most suitable for clarification of the present (“Why do people”, 2021).
The state of an ibogaine trip resembles that of REM sleep, when a person experiences dreams, in terms of electrical activity. Similar to REM sleep, this electrical activity increases neuroplasticity and consolidated learning. An ibogaine trip is like a waking dream.
With increased neuroplasticity, a long trip duration, and increased exposure to knowledge from childhood, the potential for therapeutic use is significant.
The Data
Ibogaine research to date has been limited for multiple reasons including difficulty in accessing the compound and a lack of recognition of its potential. Several placebo-controlled trials have taken place, but few indications have been studied.
However, open-label trials and anecdotal reports have been promising. According to one study, 84% of people said that taking ibogaine was one of the most important events of their lives (equal to the experience of having a child!) (Davis et al., 2020).
Studies to date have found that ibogaine reduces drug cravings, suicide ideation, cognitive impairment, depression, anxiety and symptoms of PTSD (veteran study). Morphine dependence and withdrawal symptoms such as jumping and chewing also decreased after ibogaine use (Popik et al., 1995). One 37-year-old woman, with a 19-year history of a severe opioid use disorder, went on to 18 months of abstinence following her ibogaine therapy.
"Ibogaine is the only treatment for opioid use disorder that consistently and significantly alleviates withdrawal symptoms that isn't itself an opioid, and it does so with an effect level on par with methadone". - Dr. Brown (Burge, 2022)
Ibogaine is also being studied as a potential cure for alcohol use disorder and substance use disorder (Belgers et al., 2016). Both of these indications are major drivers of mortality in the United States and globally.
Additionally, combining ibogaine with antidepressants produces a mutually beneficial effect in indications such as bipolar disorder, depression, schizophrenia, anxiety, PTSD and OCD - better than if used alone (Robert, 2022).
Ibogaine appears to hold powerful potential for mental health treatment, but is it safe?
Safety
Iboga has been used for centuries by people who follow Bwiti practice. Use over such a long period demonstrates anecdotal evidence of safety, although no long-term studies on use in a traditional setting have been performed.
More recently, ibogaine has been linked to some deaths (14) due to cardiac problems.
In a Dutch study, almost half the patients showed a delay in the time it takes for the heart muscle to recharge between beats (Wolswijk, 2023). Also, decreased heart rate and increased arrhythmia (Koenig et al., 2014), sudden death (Maas & Strubelt, 2006) and other symptoms such as low blood pressure, seizures and anxiety.
However, Dr. Srinivas Rao, Chief Science Officer at atai Life Sciences, thinks the issue is with the therapeutic setting, not the substance itself.
“In the context of more controlled settings with medical support, it has not really been associated with any kind of arrhythmia or significant adverse outcome". - Dr. Srinivas Rao, Chief Science Officer of atai Life Sciences (Oaklander, 2021)
Adverse effects may also be related to dosing. Similar to psilocybin, ibogaine potencies can vary greatly between sessions. So much so that only 75 percent of people who receive ibogaine therapy experience a "trip" or hallucinate at all ("Ibogaine for depression", 2021). This poses a particular problem in an industry that is currently not regulated, and subject to varying quality and consistency of ibogaine.
Whether problems stem from setting or potency, a standardized and consistent ibogaine product is clearly required to ensure the safety and efficacy of therapy.
Iboga and Filament Health
In answer to this need, Filament Health, has taken steps toward creating a standardized product.[2] [3] This is important for several reasons
1. A consistent drug product is required for scientific research.
2. A safe, standardized dose decreases the health risks associated with incorrect dosing.
3. A product in pill form that is relatively easily reproducible will increase cost-effectiveness - pertinent given the 5000-8000 USD cost of traveling to iboga ceremonies in countries like Mexico.
4. A standardized product supports a consistent trip, which allows therapists and patients to focus on the therapeutic process instead of the trip itself.
Filament recently completed an import of the first-ever Nagoya Protocol-compliant shipment of iboga root from Gabon to its Vancouver research and development facility. The iboga will undergo analysis at the facility, and be transformed into total alkaloid iboga extract for delivery to Ambio Life Sciences, an organization which operates several retreat facilities in Mexico.
Importation under the Nagoya Protocol, an international agreement which ensures sharing of the benefits arising from the utilization of genetic resources in a fair and equitable way, is crucial to exploring ibogaine in an ethical and sustainable manner.
“This is a significant accomplishment which will facilitate important healing work, while also supporting communities in Gabon,” said Jonathan Dickinson, Founder of Ambio Life Sciences.
Conclusion
It’s clear that ibogaine has unique therapeutic potential. Substance use disorders are a global crisis, and ibogaine could offer a potential treatment.
However, more research is needed. Filament Health is proud to be paving the way, and meaningfully collaborating with organizations around the world to explore this promising yet under-researched compound.
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References
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Brackenridge, P. (2010), "Ibogaine therapy in the treatment of opiate dependency", Drugs and Alcohol Today, Vol. 10 No. 4, pp. 20-25. https://doi.org/10.5042/daat.2010.0724
Belgers, M., Leenaars, M., Homberg, J. R., Ritskes-Hoitinga, M., Schellekens, A. F., and Hooijmans, C. R. (2016). Ibogaine and Addiction in the Animal Model, a Systematic Review and Meta-Analysis. Transl. Psychiatry 6 (5), e826. Nature Publishing Group. doi:10.1038/tp.2016.71
Burge, Brad. (August 30, 2022). Beyond’s Up-to-Date Summary of Ibogaine Therapy Research Makes Life-saving Information Available for Patients and Scientists. Cision. https://www.prweb.com/releases/2022/08/prweb18864506.htm
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Dzoljic ED, Kaplan CD, Dzoljic MR (1988). "Effect of ibogaine on naloxone-precipitated withdrawal syndrome in chronic morphine-dependent rats". Archives Internationales de Pharmacodynamie et de Therapie. 294: 64–70. PMID 3233054.
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Koenig, X., Kovar, M., Boehm, S., Sandtner, W., and Hilber, K. (2014). Anti-addiction Drug Ibogaine Inhibits hERG Channels: a Cardiac Arrhythmia Risk. Addict. Biol. 19 (2), 237–239. doi:10.1111/j.1369-1600.2012.00447.x
Maas, U., and Strubelt, S. (2006). Fatalities after Taking Ibogaine in Addiction Treatment Could Be Related to Sudden Cardiac Death Caused by Autonomic Dysfunction. Med. Hypotheses 67 (4), 960–964. doi:10.1016/j.mehy.2006.02.050
Oaklander, M. (2021, April 12). Time. https://time.com/5951772/ibogaine-drug-treatment-addiction/
Piotr Popik, Phil Skolnick, Chapter 3 - Pharmacology of Ibogaine and Ibogaine-Related Alkaloids, Editor(s): Geoffrey A. Cordell, The Alkaloids: Chemistry and Biology, Academic Press, Volume 52, 1999, Pages 197-231.
Popik, P., Layer, R. T., and Skolnick, P. (1995). 100 Years of Ibogaine: Neurochemical and Pharmacological Actions of a Putative Anti-addictive Drug. Pharmacol. Rev. 47 (2), 235–253.
Robert B. Kargbo. Ibogaine and Their Analogs as Therapeutics for Neurological and Psychiatric Disorders. ACS Medicinal Chemistry Letters 2022 13 (6), 888-890. DOI: 10.1021/acsmedchemlett.2c00214
Sakellaridas, F. (2022, July 26). Lucid News. https://www.lucid.news/can-ibogaine-treat-emotional-trauma/
Why do people use Ibogaine?. (2021, April 23). Psychable. https://psychable.com/iboga-ibogaine/why-do-people-use-ibogaine
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