Ibogaine for Opioid Withdrawal
Michelle Tran, Pharm.D., Fairview Pharmacy Services
Ibogaine is a psychedelic drug that has been used for opioid withdrawal in other countries. It is a naturally occurring compound found in the roots of an African rainforest shrub called Tabernanthe iboga. Because ibogaine is a schedule I controlled substance in the United States, its data has come from use in Canada and Mexico treatment centers; however, data is limited. Its potential use for reducing opioid withdrawal symptoms has not gone unnoticed in the United States. New York, Maryland, Vermont, and New Hampshire have introduced ibogaine into legislation for use in pilot studies but none have yet passed.
Of clinical note, ibogaine has been shown to cause a dream-like state in those who use it. Initial dosing of the drug has shown to first produce vivid waking dreams. After the initial period, the individual may then experience a feeling of personal insight and mental clarity. Research is still being done on clinical dosing and duration of use. Significant adverse effects of ibogaine are its cardiotoxic effects, including delayed cardiac repolarization and prolonged QT interval. Because of these potential adverse effects, it is important to discourage individuals from purchasing ibogaine illicitly or using it without direct medical supervision. Sudden death and neurotoxicity have also been reported.
Drug-drug interactions may be associated with ibogaine as it is metabolized through CYP2D6, CYP2C9 (minor), and CYP3A4 (minor). Ibogaine also interacts with multiple neurotransmitters, including kappa and mu opioid receptors, N-methyl-D-aspartate (NMDA) receptors, acetylcholine, dopamine, and serotonin. Its use in patients on medications for mood disorders needs to be considered, weighing the risks and benefits of potential interactions.
With limited medications currently approved for opioid withdrawal, new drugs are always of interest. Especially with the rise in opioid use disorder and the difficulties associated with opioid withdrawal management, new therapies provide another avenue of possibility in helping lessen the patient’s symptoms and achieving success in abstinence. More research and data are needed to fully evaluate the safety considerations with its use and the potential ibogaine has for treating opioid withdrawal symptoms. Because of the safety implications and minimal evidence currently available to support its use, healthcare practitioners should discourage patients from using or purchasing ibogaine over the internet if a patient is interested in it.
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Multidisciplinary Association for Psychedelic Studies. Ibogaine Therapy. https://www.maps.org/research/ibogaine-therapy. Updated 2018. Accessed July 31, 2018.