Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes
This review of open-label case series (n=191) examined the safety and efficacy of ibogaine for opioid and cocaine detoxification. It finds that ibogaine administration reduced drug cravings and withdrawal symptoms without significant adverse events, supporting its development for medically supervised detoxification.
Abstract
Ibogaine may be effective for transitioning opioid and cocaine dependent individuals to sobriety. American and European self-help groups provided public testimonials that ibogaine alleviated drug craving and opioid withdrawal symptoms after only a single dose administration. Preclinical studies in animal models of addiction have provided proof-of-concept evidence in support of these claims. However, the purported therapeutic benefits of ibogaine are based on anecdotal reports from a small series of case reports that used retrospective recruitment procedures. We reviewed clinical results from an open label case series (N = 191) of human volunteers seeking to detoxify from opioids or cocaine with medical monitoring during inpatient treatment. Whole blood was assayed to obtain pharmacokinetic measures to determine the metabolism and clearance of ibogaine. Clinical safety data and adverse events (AEs) were studied in male and female subjects. There were no significant adverse events following administration of ibogaine in a dose range that was shown to be effective for blocking opioid withdrawal symptoms in this study. We used multi-dimensional craving questionnaires during inpatient detoxification to test if ibogaine was effective in diminishing heroin and cocaine cravings. Participants also completed standardized questionnaires about their health and mood before and after ibogaine treatment, and at program discharge. One-month follow-up data were reviewed where available to determine if ibogaine’s effects on drug craving would persist outside of an inpatient setting. We report here that ibogaine therapy administered in a safe dose range diminishes opioid withdrawal symptoms and reduces drug cravings. Pharmacological treatments for opioid dependence include detoxification, narcotic antagonists and long-term opioid maintenance therapy. Our results support product development of single oral dose administration of ibogaine for the treatment of opioid withdrawal during medically supervised detoxification to transition drug dependent individuals to abstinence.
Research Summary of 'Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes'
Introduction
Ibogaine is an indole alkaloid derived from Tabernanthe iboga whose ceremonial and purported therapeutic uses have long been described in ethnobotanical literature. Earlier human observations and small case series suggested that single, relatively large oral doses may acutely reduce opioid withdrawal signs and drug craving, and preclinical studies offered mechanistic support. However, published clinical data have been largely anecdotal, heterogenous in outcome measurement, and have not included controlled clinical trials, while safety concerns and complex pharmacokinetics (notably CYP2D6-dependent metabolism to noribogaine) have hindered formal drug development. Logrip and colleagues set out to examine safety, pharmacokinetics and clinical outcomes from an open‑label, medically supervised inpatient case series of ibogaine detoxification. The study aimed to characterise adverse events and cardiovascular effects, to measure ibogaine and noribogaine blood levels (with CYP2D6 genotyping), and to assess effects on objective opioid withdrawal, drug craving and mood up to 1 month after discharge. The authors positioned the work as observational clinical evidence to inform whether single‑dose ibogaine merits further development for opioid and cocaine detoxification.
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Mash, D. C., Duque, L., Page, B., & Allen-Ferdinand, K. (2018). Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.00529
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