Depressive DisordersPTSDOpioid Use Disorder (OUD)Substance Use Disorders (SUD)Safety & Risk ManagementIbogaine

A systematic literature review of clinical trials and therapeutic applications of ibogaine

This systematic review (2021) explores clinical trials involving ibogaine and noribogaine. Across the number of trials included, a total of 705 individuals were treated with either ibogaine or noribogaine. It was found that such interventions may be useful for treating substance use disorders, alleviating withdrawal symptoms and cravings. Importantly, a number of severe side effects, including death, that have been recorded in the trials are discussed.

Authors

  • Köck, P.
  • Frölich, K.
  • Walter, M.

Published

Journal of Substance Abuse Treatment
meta Study

Abstract

Background

Iboga and its primary alkaloids, ibogaine and noribogaine, have been of interest to researchers and practitioners, mainly due to their putative efficacy in treating substance use disorders (SUDs). For many SUDs, still, no effective pharmacotherapies exist. Distinct psychoactive and somatic effects of the iboga alkaloids set them apart from classic hallucinogens like LSD, mescaline, and psilocybin.

Aims

The study team performed this systematic review focusing on clinical data and therapeutic interventions involving ibogaine and noribogaine.

Methods

The team conducted a search for all publications up to December 7, 2020, using PubMed and Embase following PRISMA guidelines.

Results

In total, we identified 743 records. In this review, we consider 24 studies, which included 705 individuals receiving ibogaine or noribogaine. This review includes two randomized, double-blind, controlled clinical trials, one double-blind controlled clinical trial, 17 open-label studies or case series (including observational or retrospective studies), three case reports, and one retrospective survey. The published data suggest that ibogaine is an effective therapeutic intervention within the context of SUDs, reducing withdrawal symptoms and cravings. Data also point toward a beneficial impact on depressive and trauma-related psychological symptoms. However, studies have reported severe medical complications and deaths, which seem to be associated with neuro- and cardiotoxic effects of ibogaine. Two of these fatalities were described in the 24 studies included in this review.

Conclusion

Treatment of SUDs and persisting comorbidities requires innovative treatment approaches. Rapid-onset therapies such as the application of ibogaine may offer novel treatment opportunities for specific individuals. Rigorous study designs within medical settings are necessary to warrant safe application, monitoring, and, possibly, medical intervention.

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Research Summary of 'A systematic literature review of clinical trials and therapeutic applications of ibogaine'

Introduction

Köck and colleagues frame iboga, ibogaine, and noribogaine as indole alkaloids of growing scientific interest because of reported ‘‘anti-addictive’’ properties and distinct psychoactive and somatic effects that differ from classical hallucinogens. Earlier research, largely preclinical and observational, has suggested potential efficacy in opioid use disorder (OUD), cocaine use disorder (CUD) and other substance use disorders (SUDs), but controlled clinical evidence remains scarce and safety concerns—particularly cardiotoxicity and several fatal cases—have been repeatedly reported. Regulatory approaches and clinical guidance vary internationally, and the mechanisms underlying therapeutic effects are not fully characterised. This systematic review set out to identify all human studies of ibogaine or noribogaine with investigative or therapeutic intent published up to 7 December 2020, and to summarise effectiveness and safety outcomes. The authors aimed to update prior reviews by applying PRISMA-guided searches of PubMed and EMBASE, synthesising clinical trials, open-label studies, observational reports, case series and case reports to assess what clinical data exist on efficacy, subjective effects, pharmacology and adverse events.

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Study Details

References (30)

Papers cited by this study that are also in Blossom

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The iboga alkaloids

Lavaud, C., Massiot, G. · Progress in the Chemistry of Organic Natural Products (2017)

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Mania following use of ibogaine: A case series

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Frampton, C. M., Yazar-Klosinski, B., Nollar, G. E. · The American Journal of Drug and Alcohol Abuse (2017)

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Psychedelics and the human receptorome

Ray, T. S. · PLOS ONE (2010)

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Treating drug dependence with the aid of ibogaine: A retrospective study

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Detoxification from methadone using low, repeated, and increasing doses of ibogaine: A case report

Wilkins, C., Dos Santos, R. G., Solá, J. et al. · Journal of Psychedelic Studies (2017)

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