Tabernanthe iboga is a shrub native to Central West Africa traditionally used in rites of passage and healing ceremonies. Its main alkaloid is ibogaine, which has been used since the 1960s for the treatment of addictions.
Ibogaine is the most researched of the known iboga alkaloids. It is estimated that the plant’s other alkaloids could also have therapeutic properties. Iboga has been shown to be effective in reducing addiction severity, eliminating the withdrawal syndrome associated with opioid use, and in reducing the compulsive desire to consume a wide variety of drugs. The iboga experience can facilitate a deep review of one’s personal history and current situation as well as modification of behavior and perceived role in family and society.
The root bark of the iboga plant has played a fundamental role in rites of passage and healing ceremonies of many tropical African cultures. The plant is used in Cameroon, Equatorial Guinea, Congo, Zaire and especially in Gabon by the pygmy people, as well as the Fang and Mitsogo Bwiti cultures. Etymologically, “Bwiti” is roughly translated as “ancestor” or “dead”, but may originate from the word “Mbouiti”, the accurate name for the pygmy people located between Gabon and Zaire.
Traditionally, iboga is used in Bwiti adolescent rites of passage or in healing ceremonies for both men and women, separately. The ritual surrounding iboga lasts five days and at the individual undergoes a process of death and rebirth, carefully guided by the community through the performance of a series of rituals in which many people take part; a symbolic death of the adolescent or of evil gives way to the birth of the adult or healthy person.
Ibogaine in modern society
In 1962, Howard Lotsof, a young man from New York with a heroin dependency, along with six other heroin-dependent friends, conducted an experiment. They ingested ibogaine and the next day, six of the seven friends stopped using heroin, since they had no withdrawal syndrome or desire to consume. In the following years, efforts to ensure that ibogaine would be considered a valid alternative for the treatment of opiate addiction obtained little response from the pharmaceutical industry. NIDA (National Institute of Drug Abuse) developed a 4000-page Drug Master File (DMF), including 16 volumes of pre-clinical studies. In 1993, the FDA approved a Phase 1 clinical trial, which concluded after the first treatment due to patent disputes. In 1995, NIDA decided not to continue supporting ibogaine research, but drug user groups and advocacy organizations promoted its use and made it available to the public in alternative non-clinical settings. The number of treatment providers and demand on behalf of those seeking to end drug dependency has grown exponentially in the last 10 years. There are ibogaine clinics in countries such as Brazil, Mexico, Thailand and South Africa, and treatment providers all around the world. In 2009, New Zealand was the first country in the world to accept ibogaine as a medication.
Chemical composition and dosage
The root bark of Tabernanthe iboga contains the alkaloids ibogaine, ibogaline and ibogamine in approximate proportions of 80%, 15% and 5%, respectively.
In the past, extracts from the bark of the plant have been used for different purposes, including the treatment of asthenia (in doses of 10-30mg daily), as a neuromuscular stimulant (in doses of 200mg of extract, about 8mg of ibogaine) and for the treatment of depression, fatigue and recovery from contagious diseases. These uses have not been properly investigated and there are currently no prescription medications containing ibogaine.
For the treatment of addictions, elimination of withdrawal syndrome and avoiding cravings, Lotsof recommended a dose of 15-20mg/kg of ibogaine. Doses above 12mg/kg are considered to carry a much higher cardiovascular risk because they can produce unforeseen physiological reactions, including fatality, so it is always recommended to consume these doses in controlled environments with health professionals trained in cardiac emergencies.
Another method that has been used to mitigate the withdrawal syndrome of methadone and other opioids to gradually reduce its use is the repeated dosing of small, increasing amounts of ibogaine. In one case, a total of 5 dosages were used, in amounts of 150, 300, 400, 500 and 600 mg of ibogaine. This dosing only produced mild psychological effects while allowing complete detoxification from methadone.
In personal growth and self-exploration contexts, high doses of bogaine, iboga or its extracts are commonly used, which produce an intense subjective experience. In these cases the doses are often similar to those proposed by Lotsof.
Ibogaine induces an introspective experience that is often referred to as deeply psychotherapeutic. It is referred to as an “oneirophrenic” as it can induce a waking dream state, although this is not always the case. An experience with ibogaine is not considered hallucinogenic because the individual is usually aware of where he or she is, that the experience is caused by the ingestion of ibogaine and that the visions that one has during the experience are internal projections, although there are exceptions to this.
The initial phase of the experience can often consist of intense visual introspection lasting between 7 and 12 hours and is often saturated with information that may be experienced more objectively, as an observer, while deeper psychological integration of the content is not accessible. During the following 24 hours of the experience, the visionary phase ends and the contents of the experience can be integrated in a cognitive process. Subsequently, this integration process may continue to develop in daily life for months as the individual re-defines their identity and interpersonal dynamics related to their environment.
Despite the existence of a vast quantity of animal studies, only limited evidence is available on the effectiveness of ibogaine in humans, although an increasing number of studies, case studies and testimonies of substance-dependent people who have undergone this treatment support the findings regarding its potential as a tool for the treatment of addiction. Iboga seems to be especially useful for opioid addiction, and to a lesser extent (and with greater risks) in the treatment of addiction to cocaine and amphetamines. Ibogaine does not attenuate alcohol or benzodiazepine withdrawal syndrome, although it attenuated alcohol intake in animal studies and has been shown to be helpful anecdotally in humans.
Iboga has potent neuro-regenerative effects due to its complex interactions with different neurotransmitter systems. Ibogaine up-regulates the dopaminergic system and increases the production of GDNF (a protein that promotes the survival of certain neurons), which creates a unique state of neuroplasticity.
This combination of effects reduces the desire to consume certain substances and promotes the tendency toward new behaviors, which makes it an effective tool for both substance and behavioral addictions when used with the appropriate expectations and perspective.
Although some people are able to resolve their addiction with a single iboga administration, for many others this is unrealistic, as habituations can be deeply embedded and withdrawal symptoms and the desire to consume may persist, often due to chronic nutritional deficiencies that may cause neuro-chemical imbalances.
Ibogaine can be a substance dependency interrupter and a catalyst for change and may provoke deep psychological insights and increased self-awareness.
Since the discovery of the anti-addictive properties of ibogaine in 1963, the global acceptance of its therapeutic application and its development as a medicine has been very slow.
Ibogaine is not on the international lists of controlled psychotropic substances of the United Nations International Narcotics Control Board, but it is illegal in the USA, Australia, Belgium, France, Switzerland, Sweden, Poland, Denmark, Hungary and Israel. In 2017, Health Canada added ibogaine to the Prescription Drug List noting that it was “not authorized for use in Canada”.
Prevalence of use
Iboga is a relatively minimally used substance among circles of psychoactive plant users. It is not a substance that is commonly offered on the black market and only some exchange exists within opiate user circles. It is usually administered in centers or clinics that specialize in detoxification treatment. The range of these centers is extremely varied, from legal clinics that openly advertise their services and have medical equipment and personnel, to individual providers that administer ibogaine in apartments or rural homes to those seeking detoxification treatment.
Certain circles exist that use ibogaine with introspective, shamanic or spiritual intentions, doing retreats that provide an experience in settings oriented toward personal growth.
Sometimes rituals based on Bwiti tradition are performed, although these types of settings are not common. Certain Western ibogaine providers do incorporate elements of a variety of African traditions into their treatments, such as music, plant baths and ritual offerings.
In the 2018 survey conducted as part of the scope of this European Union funded project, out of 593 respondents, all users of some variety of psychoactive plants, only 60 answered yes to having ever used iboga. This percentage is one of the lowest, along with Khat, Argyreia nervosa, Bufo alvarius and the Daturas.
Health and risk reduction
The greatest concern about the known risks of using ibogaine is that it decreases the heart rate (bradycardia) and prolongs QT intervals, a measurement of the time between the onset of the Q wave and the end of the T wave in the electrical cycle of the heart. Therefore, people with a history of myocardial infarction, murmurs, arrhythmias, heart surgeries or severe obesity should not take ibogaine. An electrocardiogram (ECG) is the absolute minimum test required, but a stress test and/or 24-hour monitoring with a Holter increases the possibility of detecting important abnormalities. The presence of a skilled physician (preferably a specialist in cardiology and emergency medicine) during the session, who monitors variations in heart rhythm and other vital signs, significantly increases the safety of this treatment.
Another risk factor is pulmonary embolism. This occurs when there are blood thrombi in the veins, such as those that can occur during prolonged immobility during airplane travel, car accidents or blood-related diseases. When these clots circulate through the body during an ibogaine session, they can reach the lungs, where they can cause an embolism with the risk of suffocation. The risk of pulmonary embolism can be reduced by doing sports or exercise after long, sedentary trips and by avoiding initiation of treatment immediately after arrival at the destined treatment location. People with bleeding problems, chronic blood clots, or people who have recently been involved in accidents that have caused bruising and bleeding should be excluded from treatment.
Medical conditions such as asthma, cancer, cerebellar dysfunction (e.g. Meniere’s disease and difficulty in maintaining balance), chronic fainting, diabetes, emphysema, epilepsy, diseases of the intestinal tract (Crohn’s disease, inflammatory bowel disease), gynecological problems, HIV, AIDS, Hepatitis C (if active with liver enzymes 200% above normal), kidney problems, liver problems, thyroid problems, tremors, tuberculosis and ulcers are also contraindications in most cases, but some centers accept people with certain ailments, increasing the treatment risk.
Another cause of adverse effects is the interaction of ibogaine with other drugs or pharmaceuticals. Before taking ibogaine, the recipient should avoid consuming drugs for a sufficient period of time to ensure that the drug has been eliminated. This depends on the half-life of the drug, and is different for each substance. On the other hand, foods and substances that are metabolized by the enzymes CYP450 (an enzyme involved in the metabolism of many drugs) should be avoided, since they could interact with ibogaine, and potentiate its effects of bradycardia and QT prolongation. There are lists of such substances available on the Internet. Quinine and grapefruit belong to this group and should be avoided before and during treatment.
Given that iboga is offered in such a variety of forms, taking a material whose chemical composition and potency are unknown is another risk factor. It is important to know the exact dose and composition of ibogaine to avoid overdose or complications.
Although some centers accept people with psychiatric disorders such as bipolar, borderline personality disorder, etc. – and certain patients do report an improvement in their condition – nothing is known about the effects of ibogaine on such disorders or the risks that it involves. It is a dangerous landscape. In general, people with psychiatric disorders such as those mentioned above, as well as those suffering from schizophrenia and a history of psychosis, must be excluded from this treatment, since ibogaine could cause the reappearance or worsening of symptoms. Similarly, the interaction of ibogaine with certain psychotropic drugs can be dangerous. An in-depth psychiatric review as well as the supervision of a psychiatrist is important before engaging in ibogaine treatment in case of the existence of a psychiatric disorder or the use of certain medications.
In addition to psychiatric risks, ibogaine is a powerful psychoactive substance that can induce an introspective experience that is not always easy to manage. Episodes of extreme anxiety can occur, and in more serious cases, paranoia. A skilled facilitator should be able to offer necessary support to the individual and assist with difficult episodes. Proper preparation with the guidance of a therapist can help greatly in improving self-confidence, going into the experience with an appropriate mental state and being prepared for possible difficult experiences.