ArticlePDF Available

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


Abstract and Figures

Ibogaine is an alkaloid purported to be an effective drug dependence treatment. However, its efficacy has been hard to evaluate, partly because it is illegal in some countries. In such places, treatments are conducted in underground settings where fatalities have occurred. In Brazil ibogaine is unregulated and a combined approach of psychotherapy and ibogaine is being practiced to treat addiction. To evaluate the safety and efficacy of ibogaine, we conducted a retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users (72% poly-drug users). We observed no serious adverse reactions or fatalities, and found 61% of participants abstinent. Participants treated with ibogaine only once reported abstinence for a median of 5.5 months and those treated multiple times for a median of 8.4 months. This increase was statistically significant (p < 0.001), and both single or multiple treatments led to longer abstinence periods than before the first ibogaine session (p < 0.001). These results suggest that the use of ibogaine supervised by a physician and accompanied by psychotherapy can facilitate prolonged periods of abstinence, without the occurrence of fatalities or complications. These results suggest that ibogaine can be a safe and effective treatment for dependence on stimulant and other non-opiate drugs.
Content may be subject to copyright.
Journal of Psychopharmacology
The online version of this article can be found at:
DOI: 10.1177/0269881114552713
published online 29 September 2014J Psychopharmacol
Eduardo Ekman Schenberg, Maria Angélica de Castro Comis, Bruno Rasmussen Chaves and Dartiu Xavier da Silveira
Treating drug dependence with the aid of ibogaine: A retrospective study
Published by:
On behalf of:
British Association for Psychopharmacology
can be found at:Journal of PsychopharmacologyAdditional services and information for Alerts:
What is This?
- Sep 29, 2014OnlineFirst Version of Record >>
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
Journal of Psychopharmacology
1 –8
© The Author(s) 2014
Reprints and permissions:
DOI: 10.1177/0269881114552713
Problems related to drug use, abuse and dependence have been
receiving increasing attention worldwide. The number of users of
illicit drugs, such as cannabis, opioids, cocaine, and crack is esti-
mated to be around 149–271 million (Degenhardt and Hall,
2012). On the other hand, lifetime use of licit drugs such as alco-
hol and tobacco is estimated at 55% and 30% of the world popu-
lation, respectively (Storr et al., 2010). The consumption of such
drugs has been associated with considerable morbidity and mor-
tality (Degenhardt and Hall, 2012) as well as social problems
(Nutt et al., 2007; 2010), making drug use, abuse and dependence
one of the most important public health concerns in psychiatry.
Despite high rates of dependence, safe and effective pharma-
cological addiction treatments are still lacking. While pharmaco-
logical interventions do exist for opioid dependence treatment,
they are targeted towards craving reduction (Nutt and Lingford-
Hughes, 2008). One alternative approach for the treatment of opi-
oid dependence is the use of ibogaine, a monoterpene alkaloid
with strong psychoactive properties (Alper, 2001; Brown, 2013).
Given its long-lasting and varied effects, a classification of ibo-
gaine has proved challenging. Nevertheless, some have proposed
classifying the compound as a hallucinogen, psychedelic or onei-
rogen (Alper and Lotsof, 2007).
Ibogaine is only one of a dozen alkaloids present in the root bark
of the Ta be r na n th e i bo g a plant, traditionally used in Gabon,
Cameroon and other parts of West central Africa in Shamanic
rituals of the Bwiti religion (Alper, 2001). Around 1960, ibogaine
gained more attention in the West when Howard Lotsof, an opioid-
dependent patient, discovered that ibogaine might be a useful
therapeutic tool in the treatment of drug addiction, particularly in the
alleviation of opioid craving (Alper, 2001; Brown, 2013).
After these initial uncontrolled case reports, non-clinical,
clinical and laboratory-based research has sought to assess ibo-
gaine’s efficacy in the treatment of opioid addiction. At least two
case studies have demonstrated the drug’s effectiveness at reduc-
ing cravings during opioid withdrawal: one from 32 patients
treated at a clinic (Mash et al., 2001), and another from 33
patients treated in non-medical settings (Alper et al., 1999).
Corroborating ibogaine’s therapeutic effects in the treatment of
opioid dependence are results from animal research, which have
shown reductions in withdrawal signs in morphine-dependent ani-
mals (Dzoljic et al., 1988; Glick et al., 1992; Leal et al., 2003;
Treating drug dependence with the aid of
ibogaine: A retrospective study
Eduardo Ekman Schenberg1, Maria Angélica de Castro Comis2, Bruno
Rasmussen Chaves3 and Dartiu Xavier da Silveira4
Ibogaine is an alkaloid purported to be an effective drug dependence treatment. However, its efficacy has been hard to evaluate, partly because
it is illegal in some countries. In such places, treatments are conducted in underground settings where fatalities have occurred. In Brazil ibogaine
is unregulated and a combined approach of psychotherapy and ibogaine is being practiced to treat addiction. To evaluate the safety and efficacy
of ibogaine, we conducted a retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users (72% poly-drug users).
We observed no serious adverse reactions or fatalities, and found 61% of participants abstinent. Participants treated with ibogaine only once
reported abstinence for a median of 5.5 months and those treated multiple times for a median of 8.4 months. This increase was statistically
significant (p < 0.001), and both single or multiple treatments led to longer abstinence periods than before the first ibogaine session
(p < 0.001). These results suggest that the use of ibogaine supervised by a physician and accompanied by psychotherapy can facilitate prolonged
periods of abstinence, without the occurrence of fatalities or complications. These results suggest that ibogaine can be a safe and effective treatment
for dependence on stimulant and other non-opiate drugs.
Ibogaine, dependence, addiction, cocaine, crack
1 Universidade Federal de São Paulo, Departamento de Psiquiatria,
Instituto Plantando Consciência, São Paulo, Brazil
2Instituto Plantando Consciência, São Paulo, Brazil
3M.P.P.G Hospital, Santa Cruz do Rio Pardo, Brazil
4 Universidade Federal de São Paulo, Programa de Orientação e
Atendimento a Dependentes (PROAD), Departamento de Psiquiatria,
Instituto Plantando Consciência, São Paulo, Brazil
Corresponding author:
Eduardo Ekman Schenberg, Universidade Federal de São Paulo,
Departamento de Psiquiatria; Instituto Plantando Consciência. Rua
Teixeira da Silva 251 apt 41, Jardim Paulistano, São Paulo, SP 04002-
030, Brazil.
552713JOP0010.1177/0269881114552713Journal of PsychopharmacologySchenberg et al.
Original Paper
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
2 Journal of Psychopharmacology
Parke et al., 2002; Sharpe and Jaffe, 1990), attenuation of mor-
phine-induced place preference (Parker and Siegel, 2001), reduc-
tion in self-administration to morphine (Glick et al., 1991, 1994)
and decreases in dopamine efflux in the nucleus accumbens or
striatum after cocaine or morphine administration (Glick et al.,
1994; Maisonneuve et al., 1991). Furthermore, animal research has
also indicated a potential efficacy of ibogaine in reducing self-
administration of alcohol (Rezvani et al., 1995), amphetamine
(Maisonneuve et al., 1992) and cocaine (Cappendijk and Dzoljic,
1993; Glick et al., 1994).
In recent decades, ibogaine’s therapeutic potential coalesced
in what was termed “a medical subculture” (Alper et al., 2008) or
a “vast, uncontrolled experiment” (Vastag, 2005) with more than
3000 documented cases reported until 2006 (Alper et al., 2008).
This is attributed, at least in part, to ibogaine’s hallucinogenic
action, which can induce very potent and prolonged psychologi-
cal and emotional effects.
However, in some places where the substance is illegal, ibo-
gaine or iboga extracts are used without quality control and with-
out the supervision of trained and qualified medical staff. Such
conditions may be responsible for some of the fatalities that have
been reported after ibogaine ingestion (Alper et al., 2012).
Although it is not possible to determine a single factor to explain
these adverse reactions (Alper et al., 2012), the presence of a
Long-QT Syndrome is the most accepted explanation (Hoelen
et al., 2009; Koenig et al., 2013, 2014; Maas and Strubelt, 2006;
Paling et al., 2012; Pleskovic et al., 2012).
Prolongation of the electrocardiogram QT interval, the tradi-
tional measure of ventricular de- and repolarization, is associated
with ventricular arrhythmia that can be caused by prolongation of
ventricular repolarization or repolarization with disturbances
(Van Noord et al., 2010). One of the most common causes of QT
prolongation is the use of drugs, including anti-psychotic, anti-
histaminic and gastrointestinal compounds. Importantly, QT pro-
longation has been reported in alcohol use (Aasebø et al., 2007)
and withdrawal (Cuculi et al., 2006; Kino et al., 1981; Otero-
Antón et al., 1997) as well as cocaine use (Hoffman, 2010). QT
prolongation during alcohol withdrawal may persist for 7 days
after alcohol consumption has ceased (Kino et al., 1981), while
for cocaine it significantly diminishes after a week of cocaine
abstinence (Levin et al., 2008).
These effects generally result from pharmacological inhibitory
actions at delayed rectifier potassium channels encoded by the
human ether a go-go related gene (hERG) (Van Noord et al., 2010).
Once ibogaine induces this pharmacological action (Koenig et al.,
2013, 2014), it may potentiate QT prolongation from acute drug
use or even from withdrawal, possibly causing a potentially fatal
ventricular arrhythmia (Van Noord et al., 2010). Therefore, care-
fully monitoring QT prolongation has been proposed as an impor-
tant safety measure (Roden, 2008). Yet this remains controversial,
mainly due to the fact that not all QT prolongations are actually
proarrhythmic, and that some proarrhythmias are found in the
absence of QT prolongation (Hondeghem, 2008).
However, given that most of the fatalities associated with ibo-
gaine occurred many hours or even days after ibogaine ingestion,
acute toxic effects possibly related to QT prolongation may not
explain some of these cases (Alper et al., 2012). As such, the
occurrence of comorbidities, detected in 12 of the 14 reported
cases, may have contributed to some of these deaths. Such
comorbidities included liver disease, peptic ulcer disease, brain
neoplasm, hypertensive and atherosclerotic cardiovascular dis-
ease and obesity (Alper et al., 2012). Taken together, the com-
plexity of these fatalities suggests that new studies about
ibogaine’s effect on the ECG are needed.
Despite the reported adverse reactions, the therapeutic use of
ibogaine seems to be growing more prevalent, particularly among
opioid-dependent individuals (Brown, 2013). Yet, evidence for
the use of ibogaine in the treatment of other addictions, such as
psychostimulant dependence, is still scarce, despite considerable
research from animal models that suggests ibogaine has thera-
peutic potential for treating non-opioid drug dependence
(Cappendijk and Dzoljic, 1993; Glick et al., 1994; Maisonneuve
et al., 1992; Rezvani et al., 1995).
Given the current lack of pharmacological interventions for
treating psychostimulant dependence, such as cocaine and
crack-cocaine, the assessment of ibogaine’s therapeutic poten-
tial in treating stimulant dependence is of particular importance,
especially because most pharmacological treatments for stimu-
lant dependence revolve around the use of benzodiazepines to
alleviate symptoms of withdrawal (Nutt and Lingford-Hughes,
2008). In Brazil, although opioid consumption is extremely low
(Eckschmidt et al., 2013; Fonseca et al., 2010), ibogaine has
been used in the treatment of addiction to other classes of drugs
since 2001. Given that there are important behavioral and neu-
robiological differences between addiction to opioids and to
psychostimulants (Badiani et al., 2011), it is imperative to
assess both the efficacy and safety of using ibogaine in the
treatment of psychostimulant dependence. Here we provide a
report based on retrospective results from an ibogaine treatment
currently being practiced in Brazil, in order to assess the safety
and efficacy of ibogaine in the treatment of addiction to non-
opioid substances.
We retrospectively evaluated data from a residential, private
clinic in Curitiba, Paraná, Brazil, which treats patients with sub-
stance use disorders using cognitive behavioral therapy (CBT).
The clinic owner, a psychologist, works in association with a
physician who administers ibogaine hydrochloride (ibogaine
HCl) in a private hospital in Santa Cruz do Rio Pardo, São Paulo,
Brazil. Patients paid for the treatment, since both the clinic and
the hospital are private institutions.
Patients were psychologically and physically evaluated at the
clinic by a multi-professional team, including psychiatrists, psy-
chologists, nurses, physiotherapists and music therapists. Drug
dependence was reportedly established using the diagnostic criteria
from the Diagnostic and Statistical Manual for Mental Disorders
When the clinic first opened, patients were required to stay
abstinent for at least 30 days prior to ibogaine administration, but
this was later extended to 60 days after a new protocol was estab-
lished. This change was reported as necessary to prevent any
pharmacological interactions with ibogaine. This period was also
considered important to ensure that patients were motivated to
follow treatment procedures and to stop using drugs. The absti-
nence period could be achieved either at home or at the center as
a 24-hour residential patient at the clinic.
Upon arrival at the clinic, if patients exhibited any violent
behavior, they were confined to a special isolated room for a few
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
Schenberg et al. 3
days. All patients were advised to stay at the clinic or at home
after the ibogaine session, away from other people, duties or any
kind of social activity for at least 7 days. Participants were only
accepted into the ibogaine treatment if they agreed to comply
with the psychological follow-up.
According to the general protocol provided, the inclusion cri-
teria for the ibogaine treatment were general conditions of good
health, as measured by routine clinical exams (electrolyte levels,
aspartate aminotransferase, alanine aminotransferase, bilirubins,
gamma glutamyl transferase, creatinine, blood sugar and hemo-
gram), an absence of psychiatric comorbidities, strong psycho-
logical motivation to remain abstinent and willingness to
participate in the psychotherapy before and after ibogaine admin-
istration, with familial support. Exclusion criteria were preg-
nancy, surgery in the last 6 months, uncontrolled high blood
pressure, uncontrolled diabetes, cardiac arrhythmias, renal insuf-
ficiency, hepatic insufficiency, Alzheimer’s disease and
Parkinson’s disease.
Ibogaine HCl was imported from a Canadian provider
(Phytostan Enterprises, Inc.), individually for each patient, in
powder form (5 g). Upon arrival, ibogaine was weighed and
placed in capsules by a local pharmacy at the request of the phy-
sician responsible for importing ibogaine.
Patients were typically given a dose of 17 mg/kg, but this was
subject to change depending upon the patients’ weight at the time
of treatment. Ibogaine administration was preceded by a 20 mg
dose of domperidone, a dopamine D2/D3 receptor antagonist
prescribed to reduce potential nausea from the ibogaine (Lotsof
and Watchel, 2003) between 30 to 45 minutes prior to ibogaine
administration. Doses were divided and administered in multiple
capsules and if a patient exhibited a weak response to the initial
dose, an additional 100 to 200 mg was administered to the patient.
A total dose of 20 mg/kg was never exceeded.
Ibogaine was administered in the morning, around 9 a.m., with
patients having been previously advised to eat just only a light
breakfast that morning in order to prevent nausea. The acute effects
lasted approximately 10 hours. Patients stayed in bed in a private
hospital room, in silence. The physician responsible for the proce-
dure remained in the hospital throughout the entire treatment and
visited the patient’s private room every 25 or 30 minutes.
During the effects of ibogaine, the doctor avoided influencing
the patients’ experiences, but provided any psychological or
emotional support if needed. This typically involved reassuring
clients that all effects and reactions were part of the experience.
Patients were encouraged to be quiet, calm and confident. Blood
pressure, cardiac frequency and oxygen saturation were meas-
ured at each of the visits to the patient room. Patients stayed in
the hospital overnight, and were dismissed only after 24 to 48
hours. After leaving the hospital, they returned to the clinic for
further psychological therapy.
Based on psychological evaluation of the patient in the
months following ibogaine administration, it was sometimes
decided by the psychologist and the physician that another ibo-
gaine session might be beneficial to the therapeutic outcome.
This was typically decided if patients experienced intense crav-
ings, lapses (here defined as a brief return to drug use, with the
patient rapidly asking again for help) relapses (here defined as a
complete return to drug use), difficulty in changing old-habit pat-
terns related to drug use, continued involvement with previous
friends who were also drug users, or difficulty in reintegrating
with the family. The decision to take another dose or not was
always decided upon through close consultation between the
patient, family and therapeutic team.
Patient data were provided to the researchers separately by
the clinic staff and by the physician responsible for both the
ibogaine administration and patients’ assistance during ibo-
gaine sessions. In addition, lapse, relapse and abstinence data
were obtained directly from the patients or their close relatives
through telephone conversations. These data were obtained
from 5–20 minute interview, without using specific question-
naires or rating scales. Abstinence was defined as not using any
drugs, with the exception of the occurrence of brief lapses.
Data were then entered in a Microsoft Excel database,
which was subsequently analyzed using SPSS 17.0 statistical
software. Parametric data were analyzed by a Student’s t-test
and non-parametric data were analyzed using a Mann–Whitney
U test or a Friedman’s test followed by a Wilcoxon signed-rank
test with Bonferroni correction. Associations between categor-
ical variables were evaluated by Pearson Chi-square tests.
Level of significance was set at p < 0.05, after Bonferoni cor-
rection when appropriate. Data are expressed in mean ± stand-
ard deviation. Median and range are also reported for the
examined variables.
All procedures for the study were approved by the Research
Ethical Committee from Universidade Federal de São Paulo prior
to the start of the research. However, all the treatment procedures
had been previously conducted independently of the participation
of the University and of the authors of the present investigation
(except BRC who is responsible for the ibogaine administration).
Patients consented to participating in the study at the start of each
telephone conversation, where they would be asked about lapses,
relapses, drug use and abuse history and their current pattern of
use or abstinence.
Patient information
Data were gathered from 75 drug-dependent patients (67 male, 8
female) who underwent a total of 134 ibogaine HCl sessions.
Fifty-five patients (73%) were contacted by telephone, six (8%)
were contacted and met in-person, and 14 (19%) were not avail-
able at the time of contact, but their data were provided by the
patients’ parents (11 cases), wives (2 cases), or ex-wife (1 case).
Among those 14 individuals that could not be reached, 10 were
residential patients at other clinics for drug dependence treat-
ment at the time of contact, one was working abroad, two were
in jail, and one was hospitalized due to an accident unrelated to
ibogaine use.
There were no statistically significant differences (U = 186.5;
p = 0.16) between the ages of male (34.16 ± 8.33 years old) and
female (29.50 ± 5.31 years old) participants. Men were signifi-
cantly heavier (79.32 ± 12.25 kg) than women (67.74 ± 4.02 kg)
(U = 94.0; p < 0.01). There were no significant differences
(U = 174.0; p = 0.89) in the number of previous treatments com-
pleted by male (5.40 ± 0.91) and female (3.83 ± 3.31) partici-
pants prior to joining the ibogaine program. Only six patients
(8%) reported no drug treatments previous to joining the ibo-
gaine program. One man had been in jail previous to joining the
ibogaine treatment.
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
4 Journal of Psychopharmacology
Patient drug use history
Of the patients, 48 (64%) reported lifetime use of alcohol, 61
(81%) of cannabis, 62 (83%) of snorted cocaine, six (8%)
reported previous use of injected cocaine and 51 (68%) reported
having had previously used crack-cocaine. Some 54 patients
(72%) were users of multiple substances: alcohol, cannabis,
cocaine, and crack. Tobacco use was reported by 11 patients
(15%). Opioid use was reported by only one female patient, who
came from Italy with the specific purpose of undergoing ibogaine
treatment. Other drugs mentioned included methamphetamine
(one patient), “acid”, “ecstasy”, and prescription substances such
as benzydamine (Benflogin) and metylphenidate (Ritalin).
There were no statistically significant associations between
gender and use of alcohol (Chi2 = 0.284, p = 0.594, n = 50), can-
nabis (Chi2 = 0.129, p = 0.719, n = 62), cocaine (Chi2 = 0.127,
p = 0.722, n = 63) or crack (Chi2 = 0.053, p = 0.818, n = 68).
Participants reported initiation of alcohol use at a younger age
than other drugs (13.79 ± 2.97, range 7–21), followed by canna-
bis (15.25 ± 3.09, range 11–30), cocaine (19.21 ± 4.57, range
12–32) and then crack (25.20 ± 7.25, range 14–50). There were
no significant differences between men and women regarding the
age of onset of use for alcohol (t = 0.106, p = 0.916, n = 47), can-
nabis (t = -1.891, p = 0.064, n = 59) or cocaine (t = 0.303,
p = 0.763, n = 58). However, men started using crack (25.88 ± 7.31,
range 15–50, n = 41) significantly later then women (19.60 ± 3.51,
range 14–23, n = 5) (U = 41.0, p = 0.030, n = 46).
Ibogaine sessions
Although the physician has been working with ibogaine since
2001, the first treatment session with ibogaine in this sample took
place on 9 January 2005 and the last on 22 March 2013. Twenty
ibogaine HCl sessions (20%) occurred between 2008 and 2009,
53 (40%) between 2010 and 2011 and 52 (40%) between 2012
and March 2013.
All 75 patients underwent at least one ibogaine session.
Among those, 33 (44%) took it twice, 14 (19%) took it three
times, five patients (7%) participated in four sessions, two (3%)
were administered ibogaine five times, and one patient (1%) took
it nine times. Five women (63%) participated in only one ibo-
gaine session, and three (38%) were administered ibogaine twice.
There was no significant association between gender and the
number of ibogaine sessions (Chi2 = 2.166, p = 0.826).
The mean time interval between the first and second ibogaine
sessions among all participants was 245.34 ± 226.297 days
(range 31–979), 303.14 ± 277.93 days (range 48–1012) between
the second and third, 111.60 ± 100.30 days (range 24–267)
between the third and fourth, 95.50 ± 72.83 days (range 44–147)
between the fourth and fifth. Only one patient continued taking
ibogaine after the fifth session (he took a total of nine treatments).
Between the fifth and sixth session there was an interval of 87
days, followed by an interval of 93 days before the seventh ses-
sion, of 88 days before the eighth session and more 96 days
before the ninth session.
Ibogaine dosage
The dose in the first ibogaine session was significantly higher
among men (14.81 mg/kg ± 1.61, n = 67) than among women
(12.03 mg/kg ± 0.85, n = 8) (U = 19.0, p < 0.001). Only three
women participated in a second ibogaine session, rendering data
unsuitable to statistical comparison with the second dose of men.
The second dose of the male patients was 13.75 mg/kg ± 2.10
(n = 31), whereas for women it was 11.85 mg/kg ± 0.21. In the
third session, the dose for men was 13.34 mg/kg ± 2.28 (n = 14),
and in the fourth it was 12.22 mg/kg ± 3.04 (n = 5). Only two
male patients participated in a fifth ibogaine session; the doses
were 7.5 mg/kg and 14.89 mg/kg. The one patient who took ibo-
gaine over five times took a fixed dosage of 7.5 mg/kg in the
sixth through ninth administrations.
Relapses and abstinence status
All women reported that they were abstinent at the time of con-
tact, and only two reported having had a relapse after the initial
ibogaine session. Both of these women then took ibogaine a sec-
ond time and have reportedly not relapsed since. Forty-eight
men (72%) stated that they were abstinent, but 10 of those were
currently undergoing other treatment interventions. Except for
those 10, 38 (57%) men achieved abstinence with no other
After the first ibogaine session, 22 of the male patients (29%)
recovered without relapses, whereas 53 (71%) relapsed. After the
second session, 15 patients (45%) maintained sobriety, and 18
reported relapse (55%). After the third session, eight (57%)
remained abstinent, and six (43%) relapsed. After the fourth ses-
sion, one patient did not relapse (20%), and four relapsed (80%).
After the fifth session, one patient maintained abstinence (50%),
and one patient relapsed, and continued to take ibogaine four
more times. These data are visually depicted in Figure 1. There
was a significant association between gender and relapse after the
first ibogaine session, with men relapsing more frequently than
women (Chi2 = 9.009; p = 0.007).
Duration of abstinence
With the data obtained, it was possible to calculate the period of
abstinence after the first ibogaine session and after all ibogaine
sessions for 66 patients. Data regarding days of abstinence just
before the first ibogaine session were also provided by 41
patients. There were no significant differences in the number
of days of abstinence before taking ibogaine between men
(190 ± 265.82) and women (75.26 ± 60.36) (U = 53.50; p = 0.11).
There was a significant increase in the period of abstinence
achieved when comparing the days before the first ibogaine ses-
sion (88.30 ± 15.92, median = 60.00), after the first ibogaine
session (298.76 ± 42.26, median = 165.00), and after all sessions
combined (419.15 ± 52.86, median = 252.00) (Friedman
Chi2 = 23.471; p < 0.001), as shown in Figure 2.
Seventeen men reported abstinence since their ibogaine
session, but with the occurrence of one and only relapse during
this abstinence period. Thirteen of them were administered
ibogaine only once. For this subsample, the number of days of
abstinence between the most recent ibogaine session and the
relapse (138.06 ± 105.07, range 16–365 median = 120.00) was
significantly shorter than the time of abstinence achieved after
this relapse until contact with researchers (547.41 ± 369.21,
range 48–1292 median = 520.00) (Z = -3.385; p < 0.001).
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
Schenberg et al. 5
Figure 1. Summary of relapse occurrence in the 75 contacted patients after each ibogaine session. The numbers inside the larger blue circles
represent the number of patients who participated in each treatment stage. Each step in the tree corresponds to one ibogaine administration.
Numbers in the smaller light blue filled circles indicate the number of patients who had stopped at that point of treatment, and therefore were
not administered ibogaine again. All upward blue arrows indicate patients who did not relapse after a given ibogaine administration. Downward
red arrows point to the number of patients who did relapse after a given session. Each column represents the outcome of a given ibogaine
administration (first, second, third and so on).
Figure 2. Abstinence duration data. Top = Days of abstinence spent at an inpatient clinic immediately previous to ibogaine administration. Middle
= Days of abstinence after first ibogaine session. Bottom = Days of abstinence after all ibogaine sessions. Vertical lines in the histograms depict the
corresponding median.
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
6 Journal of Psychopharmacology
Adverse reactions
No serious adverse effects, such as cardiac arrhythmias or fatali-
ties, occurred in any patient. However, some mild adverse effects
that have previously been reported in the ibogaine literature did
occur frequently, but only during the acute effects of ibogaine.
These include nausea, ataxia, vomiting, tremors, headaches and
mental confusion. Importantly, not a single patient complained
about ibogaine’s physical or psychological effects, even in cases
in which the experienced effects were considered very strong or
unpleasant, or in cases where relapses occurred within a short
period of time after treatment.
On the other hand, four patients (5%) complained about the
psychotherapeutic process or other activities during the intern-
ment period at the clinic, or during the post-ibogaine psychother-
apeutic sessions.
The most important result from the present data is that no fatali-
ties occurred as a result of ibogaine administration in the con-
trolled dosing (between 7.5 and 20 mg/kg) and medical setting
described here. Furthermore, not a single case of serious negative
reactions, such as cardiac arrhythmias or persistent ataxia, was
reported. These data are relevant in a scenario where at least 19
deaths have been associated with iboga or ibogaine consumption
until 2008 (Alper et al., 2012), two fatalities reported in 2013
(Jalal et al., 2013; Mazoyer et al., 2013) and at least three more
cases of complications (Paling et al., 2012) reported to date. It is
important to note that the dose used in the current work is far
from the LD50 observed in studies with mice (263 mg/kg)
(Kubiliene et al., 2008). This important safety precaution could
be achieved in the current protocol only because ibogaine was
not obtained from underground providers, since ibogaine is not
controlled or prohibited in Brazil (Anvisa, 2014). The lack of
persistent ataxia in the present study is a particularly important
indicator of the absence of cerebellar toxicity, an effect observed
after high doses (100 mg/kg) were administered to rats (Molinari
et al., 1996; O’Hearn and Molliver, 1997; Xu et al., 2000).
The absence of fatalities in the present results suggests a rela-
tive safety of the use of ibogaine hydrochloride in a controlled
hospital setting. It is also important to note that in at least five of
the 21 (24%) previously documented fatalities, the substance
ingested was not ibogaine HCl (Alper et al., 2012). Moreover,
many of the documented fatalities occurred in underground treat-
ments, where a physician was often not present (Alper et al.,
2012; Jalal et al., 2013; Mazoyer et al., 2013; Paling et al., 2012).
Another factor that may have contributed to the absence of medi-
cal complications in the present account might be the almost
complete lack of opioid use history among the patients involved
in the study. Indeed, pharmacological interactions between opi-
oids and ibogaine have been implicated in some of the previous
reported cases of fatalities (Alper et al., 2012; Brown, 2013).
Finally, the treatment protocol includes a long mandatory absti-
nence period prior to the administration of ibogaine. This likely
contributed significantly to the safety of the therapeutic approach
by preventing any potential pharmacological interactions
between the treatment and other drugs of abuse.
Given that Long-QT Syndrome, potentially induced by ibo-
gaine, may be responsible for some fatalities, electrocardiograms
before and during ibogaine administration may be a reliable prac-
tice to reduce this kind of adverse effect. In the present work,
however, results of electrocardiograms previous to ibogaine
administration were provided to the researchers for only 36 patients
(48%), because some of these treatments occurred many years ago.
To our knowledge, this is the first report to assess the outcome
of the use of ibogaine for the treatment of patients who abused
alcohol, cannabis, cocaine, and crack but not opioids (with only
one European patient having a previous history of opioid use). This
is likely the result of the generally low incidence of opioid abuse in
Brazil (Baltieri et al., 2004; Fonseca et al., 2010). It is important to
emphasize, however, that in this sample, alcohol and cigarette use
may have been under reported by the patients, since these data
were not obtained using a structured questionnaire. Thus, when
asked about previous drug use, they may not have reported alcohol
and cigarettes because these substances often do not fit into the
cultural conception of a “drug.” It should also be noted that it was
not possible to specifically confirm the adopted criteria of depend-
ence or distinguish between different types of drug dependence.
Considering the occurrence of relapses after ibogaine adminis-
trations, the present results are very encouraging. Although there
were only eight women in the sample, all were found abstinent at
the time of contact. Among men, 51% were also abstinent at the
time of contact, and an additional 10 participants were also absti-
nent, but were participating in other drug dependence treatment
Since we were not able to analyze abstinence periods as a func-
tion of number of ibogaine treatments completed given the decreas-
ing number of patients participating in subsequent ibogaine
sessions, we analyzed only the length of abstinence achieved after
the first session as compared with the average abstinence period
achieved after all subsequent sessions combined. Despite this
caveat, participants reported surprisingly long periods of absti-
nence, reaching a median of 5.5 months after the first ibogaine
session and 8.4 months after all subsequent ibogaine sessions. This
increase was statistically significant, corroborating previous
reports that participating in more than one ibogaine session may be
beneficial in achieving long-term abstinence (Brown, 2013). The
abstinence periods reported after completing both a single and
multiple ibogaine sessions was also significantly longer than the
required period of abstinence achieved before ibogaine administra-
tion (median = 60). However, one might argue that this presents a
potential confound in evaluating the treatment outcome of ibo-
gaine, because the present sample only included individuals capa-
ble maintaining the one or two-month abstinence period required
before the first ibogaine session. Yet contrary to this reasoning,
most clients were only able to achieve and maintain sobriety as
full-time residents in the clinic, where some were provided benzo-
diazepines to assist in the treatment process. Moreover, 69 patients
(92%) had already tried other treatments for their drug-related
problems without success. In patients’ oral reports, most of those
who recovered reported that the ibogaine session(s) were indeed
essential to their recovery, although they acknowledged they may
not have succeeded without the accompanying psychological treat-
ment. The fact that 44% decided to participate in more than one
ibogaine session further attests to the fact that they saw benefits in
using ibogaine as part of their treatment. Furthermore, the propor-
tion of patients reporting full abstinence (100% for women, 51%
for men) was considerably greater than the less than 26% reported
from psychotherapy alone (Ouimette et al., 1997). Even when
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
Schenberg et al. 7
compared with other pharmacological interventions, the therapeu-
tic outcome of ibogaine is robust: the abstinence period achieved
after ibogaine treatment tended to be much longer than that
observed in recent clinical trials for the treatment of psychostimu-
lant dependence with the drug topiramate (Johnson et al., 2013;
Mariani et al., 2012). However, we must be cautious when compar-
ing data from this retrospective study with clinical trials due to
methodological differences and biases.
Given that the present study employed retrospective method-
ology based on answers from unstructured interviews and data
collected over a long period of time, it is not possible to infer a
causal relationship between ibogaine and the observed outcomes.
Indeed, only a randomized double-blind clinical trial could accu-
rately assess this. Another important limitation to the present
results is that data on both relapse occurrence and abstinence
periods achieved were obtained directly from the patients’ (or
close relatives’) reports.
Considering the limitations of self-reported data, it was recently
suggested that, besides abstinence and relapse, it is also very
important to take into account secondary measures to better evalu-
ate drug dependence treatment outcomes (Tiffany et al., 2011).
According to these authors, the most important variables to evalu-
ate, in addition to reductions in drug use, are change in self-effi-
cacy, psychosocial functioning, network support/social support,
craving, and quality of life. Thus, it will be important to also con-
sider these additional variables in future studies of ibogaine in the
treatment of drug dependence.
Future studies should also seek to establish the advantages
and disadvantages of using ibogaine instead of other related psy-
chedelic compounds, such as LSD, which has therapeutic poten-
tial in the treatment of alcoholism (Krebs and Johansen, 2012).
While ibogaine may be more effective at treating a wider range of
chemical dependencies (e.g. opioids, alcohol, cocaine, crack)
than other psychedelic substances, it may present higher risks for
medical complications. For example, LSD has very low toxicity
and none of the effects on heart rhythm (Hintzen and Passie,
2010) that ibogaine does.
Despite the limitations of the present report, outlined above,
the present data are the first formal clinical report to our knowl-
edge that suggests that ibogaine has a strong therapeutic potential
in the treatment of dependence to stimulants and other non-opiate
drugs and that the medical complications previously reported can
be avoided by administering the compound in the presence of a
physician in a safe and legal medical setting.
We would like to thank the clinical staff responsible for this intervention
for providing their data and their patients’ contacts, and all the patients
and/or families who cooperated with the research. We would also like to
thank G. Loewinger for his help with English correction of the whole
Conflict of interest
BRC has a financial interest in this work given that the ibogaine treatment
is part of his private practice.
This research was partially financed by Instituto Plantando Consciência,
a Brazilian non-profit organization.
Aasebø W, Aasebø W, Erikssen J, et al. (2007) ECG changes in patients
with acute ethanol intoxication. Scand Cardiovasc J 41(2): 79–84.
Alper KR (2001) Ibogaine: A review. Alkaloids Chem Biol 56: 1–38.
Alper KR and Lotsof HS (2007). The use of ibogaine in the treatment
of addictions. In: Winkelman MJ and Roberts TB (eds) Psychedelic
Medicine: New Evidence for Hallucinogenic Substances as Treat-
ments (Vol. 2). Westport: Praeger.
Alper KR, Lotsof HS and Kaplan CD (2008) The ibogaine medical sub-
culture. J Ethnopharmacol 115(1): 9–24.
Alper KR, Lotsof HS, Frenken GM, et al. (1999) Treatment of acute opi-
oid withdrawal with ibogaine. Am J Addict 8(3): 234–242.
Alper KR, Stajić M and Gill JR (2012) Fatalities temporally associated
with the ingestion of ibogaine. J Forensic Sci 57(2): 398–412.
Anvisa - Agência Nacional de Vigilância Sanitária (2014) Lista compara-
tiva de entorpecentes, substâncias psicotrópicas, precursores e outras
substâncias sujeitas a controle especial. Available at: www.anvisa. Accessed
15 May 2014.
Badiani A, Belin D, Epstein D, et al. (2011) Opiate versus psychostimu-
lant addiction: The differences do matter. Nat Rev Neurosci 12(11):
Baltieri DA, Strain EC, Dias JC, et al. (2004) Brazilian guideline for the
treatment of patients with opioids dependence syndrome. Rev Bras
Psiquiatr 26(4): 259–269.
Brown TK (2013) Ibogaine in the treatment of substance dependence.
Curr Drug Abuse Rev 6(1): 3–16.
Cappendijk SL and Dzoljic MR (1993) Inhibitory effects of ibogaine
on cocaine self-administration in rats. Eur J Pharmacol 241(2–3):
Cuculi F, Kobza R, Ehmann T, et al. (2006) ECG changes amongst
patients with alcohol withdrawal seizures and delirium tremens.
Swiss Med Wkly 136(13–14): 223–227.
Degenhardt L and Hall W (2012) Extent of illicit drug use and depen-
dence, and their contribution to the global burden of disease. Lancet
379(9810): 55–70.
Dzoljic ED, Kaplan CD and Dzoljic MR (1988) Effect of ibogaine on
naloxone-precipitated withdrawal syndrome in chronic morphine-
dependent rats. Arch Int Pharmacodyn Ther 294: 64–70.
Eckschmidt F, Andrade AG de and Oliveira LG de (2013) Compari-
son of drug use between Brazilian and American college students
and young Brazilian general population. J Bras Psiquiatr 62(3):
Fonseca AM, Galduróz JCF, Noto AR, et al. (2010) Comparison between
two household surveys on psychotropic drug use in Brazil: 2001 and
2004. Cien Saude Colet 15(3): 663–670.
Glick SD, Kuehne ME, Raucci J, et al. (1994) Effects of iboga alkaloids
on morphine and cocaine self-administration in rats: Relationship to
tremorigenic effects and to effects on dopamine release in nucleus
accumbens and striatum. Brain Res 657(1–2): 14–22.
Glick SD, Rossman K and Steindorf S (1991) Effects and aftereffects of
ibogaine on morphine self-administration in rats. Eur J Pharmacol
195: 341–345.
Glick SD, Rossman K, Rao NC, et al. (1992) Effects of ibogaine on acute
signs of morphine withdrawal in rats: Independence from tremor.
Neuropharmacology 31(5): 497–500.
Hintzen A and Passie T (2010) The Pharmacology of LSD. Oxford:
Oxford University Press.
Hoelen DWM, Spiering W and Valk GD (2009) Long-QT syndrome
induced by the antiaddiction drug ibogaine. N Engl J Med 360(3):
Hoffman RS (2010) Treatment of patients with cocaine-induced arrhyth-
mias: Bringing the bench to the bedside. Br J Clin Pharmacol 69(5):
Hondeghem LM (2008) QT prolongation is an unreliable predictor of
ventricular arrhythmia. Heart Rhythm 5(8): 1210–1212.
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
8 Journal of Psychopharmacology
Jalal S, Daher E and Hilu R (2013) A case of death due to ibogaine use for
heroin addiction: Case report. Am J Addict 22(3): 302.
Johnson BA, Ait-Daoud N, Wang X-Q, et al. (2013) Topiramate for the
treatment of cocaine addiction: A randomized clinical trial. JAMA
Psychiatry 70: 1338–1346.
Kino M, Imamitchi H, Morigutchi M, et al. (1981) Cardiovascular status
in asymptomatic alcoholics, with reference to the level of ethanol
consumption. Br Heart J 46(5): 545–551.
Koenig X, Kovar M, Boehm S, et al. (2014) Anti-addiction drug ibogaine
inhibits hERG channels: A cardiac arrhythmia risk. Addict Biol 19:
Koenig X, Kovar M, Rubi L, et al. (2013) Anti-addiction drug ibogaine
inhibits voltage-gated ionic currents: A study to assess the drug’s
cardiac ion channel profile. Toxicol Appl Pharmacol 273: 259–268.
Krebs TS and Johansen P-Ø (2012) Lysergic acid diethylamide (LSD) for
alcoholism: Meta-analysis of randomized controlled trials. J Psycho-
pharmacol 26: 994–1002.
Kubiliene A, Marksiene R, Kazlauskas S, et al. (2008) Acute toxicity
of ibogaine and noribogaine. Medicina (Kaunas) 44(12): 984–988.
Leal MB, Michelin K, Souza DO, et al. (2003) Ibogaine attenuation of
morphine withdrawal in mice: Role of glutamate N-methyl-D-aspar-
tate receptors. Prog Neuropsychopharmacol Biol Psychiatry 27(5):
Levin KH, Copersino ML, Epstein D, et al. (2008) Longitudinal ECG
changes in cocaine users during extended abstinence. Drug Alcohol
Depend 95(1–2): 160–163.
Lotsof HS and Watchel B (2003) Manual for ibogaine therapy screen-
ing, safety, monitoring, and aftercare. Watchel B (ed.), monograph
on the Internet; © 2003, 1–1. Available from: http://www.ibogaine.
Maas U and Strubelt S (2006) Fatalities after taking ibogaine in addiction
treatment could be related to sudden cardiac death caused by auto-
nomic dysfunction. Med Hypoth 67(4): 960–964.
Maisonneuve IM, Keller RW and Glick SD (1991) Interactions between
ibogaine, a potential anti-addictive agent, and morphine: An in vivo
microdialysis study. Eur J Pharmacol 199(1): 35–42.
Maisonneuve IM, Keller RW and Glick SD (1992) Interactions of ibo-
gaine and D-amphetamine: In vivo microdialysis and motor behavior
in rats. Brain Res 579(1): 87–92.
Mariani JJ, Pavlicova M, Bisaga A, et al. (2012) Extended-release mixed
amphetamine salts and topiramate for cocaine dependence: A ran-
domized controlled trial. Biol Psychiatry 72(11): 950–956.
Mash DC, Kovera CA, Pablo J, et al. (2001) Ibogaine in the treatment of
heroin withdrawal. Alkaloids Chem Biol 56: 155–171.
Mazoyer C, Carlier J, Boucher A, et al. (2013) Fatal case of a 27-year-old
male after taking iboga in withdrawal treatment: GC-MS/MS deter-
mination of ibogaine and ibogamine in iboga roots and postmortem
biological material. J Forensic Sci 58: 1666–1672.
Molinari HH, Maisonneuve IM and Glick SD (1996) Ibogaine neurotox-
icity: A re-evaluation. Brain Res 737: 255–262.
Nutt D and Lingford-Hughes A (2008) Addiction: The clinical interface.
Br J Pharmacol 154(2): 397–405.
Nutt DJ, King LA, Phillips LD, et al. (2010) Drug harms in the UK: A
multicriteria decision analysis. Lancet 376(9752): 1558–1565.
Nutt DJ, King LA, Saulsbury W, et al. (2007) Development of a rational scale to
assess the harm of drugs of potential misuse. Lancet 369 (9566) : 1047– 1053.
O’Hearn E and Molliver ME (1997) The olivocerebellar projec-
tion mediates ibogaine-induced degeneration of Purkinje cells:
A model of indirect, trans-synaptic excitotoxicity. J Neurosci
17(22): 8828–8841.
Otero-Antón E, González-Quintela A, Saborido J, et al. (1997) Prolonga-
tion of the QTc interval during alcohol withdrawal syndrome. Acta
cardiol 52(3): 285–294.
Ouimette PC, Finney JW and Moos RH (1997) Twelve-step and cog-
nitive-behavioral treatment for substance abuse: A comparison of
treatment effectiveness. J Consult Clin Psychol 65(2): 230–240.
Paling FP, Andrews LM, Valk GD, et al. (2012) Life-threatening
complications of ibogaine: Three case reports. Neth J Med 70(9):
Parke LA, Burton P, McDonald RV, et al. (2002) Ibogaine interferes
with motivational and somatic effects of naloxone-precipitated with-
drawal from acutely administered morphine. Prog Neuropsycho-
pharmacol Biol Psychiatry 26(2): 293–297.
Parker LA and Siegel S (2001) Modulation of the effects of rewarding
drugs by ibogaine. Alkaloids Chem Biol 56: 211–225.
Pleskovic A, Gorjup V, Brvar M, et al. (2012) Ibogaine-associated ven-
tricular tachyarrhythmias. Clin Toxicol 50(2): 157–157.
Rezvani AH, Overstreet DH and Lee YW (1995) Attenuation of alcohol
intake by ibogaine in three strains of alcohol-preferring rats. Phar-
macol Biochem Behav 52(3): 615–620.
Roden DM (2008) Keep the QT interval: It is a reliable predictor of ven-
tricular arrhythmias. Heart Rhythm 5(8): 1213–1215.
Sharpe LG and Jaffe JH (1990) Ibogaine fails to reduce naloxone-precip-
itated withdrawal in the morphine-dependent rat. Neuroreport 1(1):
Storr CL, Cheng H, Alonso J, et al. (2010) Smoking estimates from
around the world: Data from the first 17 participating countries in the
World Mental Health Survey Consortium. Tob Control 19(1): 65–74.
Tiffany ST, Friedman L, Greenfield SF, et al. (2011) Beyond drug
use: A systematic consideration of other outcomes in evaluations
of treatments for substance use disorders. Addiction 107(4):
Van Noord C, Eijgelsheim M and Stricker BHC (2010) Drug- and non-
drug-associated QT interval prolongation. Br J Clin Pharmacol
70(1): 16–23.
Vastag B (2005) Addiction research. Ibogaine therapy: A ‘vast, uncon-
trolled experiment’. Science 308: 1260.
Xu Z, Chang LW, Slikker W, et al. (2000) A dose-response study of
ibogaine-induced neuropathology in the rat cerebellum. Toxicol Sci
57(1): 95–101
at UNIV FEDERAL DE SAO PAULO on September 30, 2014jop.sagepub.comDownloaded from
... Administration of noribogaine, the main active metabolite of ibogaine, also reduced alcohol self-administration in rodents [9]. In humans, several case reports and case series (including between 1 and 88 patients) have been published, most involving opioid or multiple drug use disorders [1,3,[10][11][12][13][14][15]. Results suggest that ibogaine reduces withdrawal syndrome and the desire to consume opioid within the first two hours after consumption. ...
... Results suggest that ibogaine reduces withdrawal syndrome and the desire to consume opioid within the first two hours after consumption. These findings appear to hold true for cocaine and alcohol use disorders as well [1,3,[10][11][12][13][14]. In general, evidence among humans has been scarce and largely limited to observational studies and case series [13,14]. ...
Full-text available
Ibogaine is a psychoactive alkaloid derived from the west-African shrub Tabernanthe iboga. Western cultures are increasing the interest for the substance due to its claimed anti addictive properties, although the evidence supporting this effect is still preliminary. The use of ibogaine often occurs with no medical supervision in uncontrolled settings, and its use has been associated with several reports of severe adverse events. This review aims to evaluate the clinical studies of ibogaine, with a focus on administration settings, to elucidate specific criteria that may promote safer contexts for ibogaine use. A systematic review of the literature was conducted based on PRISMA guidelines. PubMed, Scielo, and electronic databases were searched, and clinical studies published until November 17, 2022, were retrieved. The final synthesis included 12 sources. Information about general characteristics of the studies, adverse effects, screening of participants and setting characteristics were summarized and discussed. It is concluded that the use of controlled settings, supported by trained professionals and equipment allowing for rigorous medical, psychiatric, and cardiac monitoring, are essential to promote the safety of patients receiving ibogaine.
... An observational open-label study with 191 patients presenting opioid and cocaine withdrawal symptoms according to the ASI and the DSM-IV showed that ibogaine detoxification protocol decreased the depressive symptoms and the craving scores of the individuals, according to the Heroin and Cocaine Craving Questionnaires [146] . Another retrospective study evaluated 75 subjects who reported alcohol, cannabis, cocaine, and crack use and were treated with ibogaine and Cognitive Behavioral Therapy jointly between 2005 and 2013 [147] . The individuals underwent 1 to 9 sessions and after the last session, all women participants were abstinent, while 51% of the men remained abstinent and another 15% were abstinent through other interventions. ...
... The abstinence lasted a median of 5.5 months after the first session, while for those who needed more sessions, the median before the first session and all subsequent sessions was 8.4 months. The authors emphasized that compared with psychotherapy alone or topiramate pharmacological therapy, this result showed higher abstinence rates [147] . The first double-blind, placebo-controlled study with noribogaine was conducted by Glue et al. [148] . ...
Full-text available
Substance use disorder (SUD) is a global public health concern that affects millions of people worldwide. Considering current research, addiction has been noted as the last stage of a chronic disease that may impair brain reward circuit responses and affects personal and social life. Treatments for SUD face challenges including availability and limited pharmacological response, often resulting in low retention of patients. A growing number of studies from the 'psychedelic renaissance' have highlighted the therapeutic potential of psychedelics for several psychiatric disorders, including SUD. In this non-systematic review we discuss past and current clinical and observational studies with classic (LSD, DMT, psilocybin and mescaline) and non-classic (ibogaine, ketamine, MDMA, salvinorin A and THC) psychedelics for the treatment of SUD published until December 2021. Although results are still inconclusive for LSD, DMT, mescaline, MDMA and Salvinorin A, in general, the literature presents moderate evidence on the controlled use of psilocybin and ketamine for Alcohol Use Disorder, ketamine for management of opiate and alcohol withdrawal, and THC preparations for reducing withdrawal symptoms in Cannabis and possibly in Opioid Use Disorder. Importantly, studies suggest that psychedelics should be more effective when employed as an adjunct therapy. Extensive research is warranted to further elucidate the role of psychedelics in the treatment of SUD.
... Additionally, the antiaddictive effects of ibogaine were studied in 75 users of alcohol, cocaine, crack, and cannabis. Schenberg et al., 2014 showed that a single dose of ibogaine could lead to significant long-term abstinence from drugs without any fatalities (Schenberg et al., 2014). ...
... Additionally, the antiaddictive effects of ibogaine were studied in 75 users of alcohol, cocaine, crack, and cannabis. Schenberg et al., 2014 showed that a single dose of ibogaine could lead to significant long-term abstinence from drugs without any fatalities (Schenberg et al., 2014). ...
Full-text available
Classical psychedelics represent a family of psychoactive substances with structural similarities to serotonin and affinity for serotonin receptors. A growing number of studies have found that psychedelics can be effective in treating various psychiatric conditions, including post-traumatic stress disorder, major depressive disorder, anxiety, and substance use disorders. Mental health disorders are extremely prevalent in the general population constituting a major problem for the public health. There are a wide variety of interventions for mental health disorders, including pharmacological therapies and psychotherapies, however, treatment resistance still remains a particular challenge in this field, and relapse rates are also quite high. In recent years, psychedelics have become one of the promising new tools for the treatment of mental health disorders. In this review, we will discuss the three classic serotonergic naturally occurring psychedelics, psilocybin, ibogaine, and N, N-dimethyltryptamine, focusing on their pharmacological properties and clinical potential. The purpose of this article is to provide a focused review of the most relevant research into the therapeutic potential of these substances and their possible integration as alternative or adjuvant options to existing pharmacological and psychological therapies.
... This is particularly relevant also in the mental health domain, where treatments are known to be underprovided globally (cf. worldwide treatment gap in mental health [34][35][36][37][38][39]). In parallel, in the context of what is often labeled a 'psychedelic renaissance', compounds acting on the nervous system, which have formerly been known only for their harmful uses (e.g., psilocybin, cannabis; but also non-botanical compounds such as 3,4-methylenedioxymethamphetamine [MDMA] or lysergic acid diethylamide [LSD]), are now investigated for their therapeutic benefits in rapidly growing numbers of clinical trials [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. In this context Amazonian traditional medicine, due to ayahuasca, has recently become the object of much scientific attention. ...
Full-text available
Harmful usage of tobacco is a global public health problem associated with adverse health effects and addiction. Yet, in the Peruvian Amazon, the native region of Nicotiana rustica L., this plant is used in remarkably different manners: it is considered a potent medicinal plant, applied in liquid form for oral ingestion to treat mental health problems, a common and ancient healing practice in this region. Using a transdisciplinary field research approach with mixed ethnopsychological methods, this work aimed to report for the first time a case study in this context. The intervention took place in the Peruvian Amazon (Loreto) and involved ritual tobacco ingestion in a weeklong retreat-like frame, administered by a specialized traditional Amazonian healer. The patient was a 37-year-old woman with diagnosed mood, anxiety, and attention deficit disorders, as well as a chronic somatic condition. We applied qualitative experience-sampling during and quantitative symptom assessments pre- and post-treatment. Our findings offer a detailed description of the experiential therapeutic process during the treatment week and suggest clinically relevant improvements in patient well-being. This work is significant in view of the globally prevalent harmful uses of tobacco and the current scientific trend of revisiting herbal psychoactives (e.g., cannabis, psilocybin) for their therapeutic potentials.
... The most studied therapeutic applications of ibogaine have focused on assessing its effects as a treatment for substance use disorders. Over the recent years, ibogaine has been taken into consideration as a therapeutic agent, able to treat or assist the treatments for drug addictions such as heroin [71], cocaine [72], methamphetamine [73], cannabis and crack [74]. The advantage of the use of ibogaine as a therapeutic for drug addiction resides in the fact that a single large dose seems effective in blocking withdrawal and reduces cravings in drug-dependent individuals [72], contrary to standard pharmacological treatments which typically require a prolonged administration. ...
Full-text available
The need to identify effective therapies for the treatment of psychiatric disorders is a particularly important issue in modern societies. In addition, difficulties in finding new drugs have led pharmacologists to review and re-evaluate some past molecules, including psychedelics. For several years there has been growing interest among psychotherapists in psilocybin or lysergic acid diethylamide for the treatment of obsessive-compulsive disorder, of depression, or of post-traumatic stress disorder, although results are not always clear and definitive. In fact, the mechanisms of action of psychedelics are not yet fully understood and some molecular aspects have yet to be well defined. Thus, this review aims to summarize the ethnobotanical uses of the best-known psychedelic plants and the pharmacological mechanisms of the main active ingredients they contain. Furthermore, an up-to-date overview of structural and computational studies performed to evaluate the affinity and binding modes to biologically relevant receptors of ibogaine, mescaline, N,N-dimethyltryptamine, psilocin, and lysergic acid diethylamide is presented. Finally, the most recent clinical studies evaluating the efficacy of psychedelic molecules in some psychiatric disorders are discussed and compared with drugs already used in therapy.
... It has been used to treat substance dependence and, experimentally, for other mental disorders, such as depression. [1][2][3] The most commonly used dose is between 15 and 20 mg/kg. 4 Recent studies reported on the effects of microdosing classic psychedelics, i.e., administration of less than 20% of the usual total dose in a semi-regular schedule. ...
Full-text available
Introdução: A internet é um dos principais meios para o compartilhamento de informações, além de ser uma plataforma com recursos para o comércio on-line. Recentemente tem-se observado um aumento no interesse e consumo de substâncias psicotrópicas de origem natural, seja em um contexto religioso, cultural ou hedonístico. Objetivo: Avaliar se as informações sobre psicotrópicos de origem natural disponíveis em sites publicados em português estão embasadas na literatura científica, se apresentam conteúdo distorcido ou tendencioso de forma a estimular o consumo e se há indícios de que a página está sendo usada como plataforma de venda clandestina desses produtos. Método: Foram realizadas buscas no Google utilizando os nomes populares das substâncias ou de plantas e preparações que as contêm (por exemplo: maconha, ayahuasca) e as informações disponíveis nas páginas visitadas foram classificadas e tabuladas. Resultados: Dos 328 sites analisados, aproximadamente 55% foram classificados como páginas informativas e 60% do conteúdo analisado estava de acordo com a literatura científica, sendo considerado como confiável. Aproximadamente um quarto dos sites incentivavam o consumo dessas substâncias, seja direta ou indiretamente, e cerca de 25% apresentavam a comercialização de produtos contendo alguma das substâncias pesquisadas. Conclusões: Os resultados sugerem que um usuário que busca de forma on-line por substâncias naturais psicotrópicas a partir de seus nomes populares é exposto predominantemente a informações que podem ser respaldadas pela literatura científica. Entretanto, a quantidade de sites que disponibilizam produtos que contêm essas substâncias para venda ou que compartilham métodos para o consumo também é significativa, muitas vezes sem apresentar advertências quanto ao uso incorreto dos produtos, caracterizando um risco à saúde do usuário.
Drug addiction is considered a chronic disorder affecting the individual’s life, his/her family and society. Up till now the treatment of drug addiction is considered a problematic issue. Synthetic drugs available for the treatment of drug addiction are few, of limited efficacy and associated with serious side effects. Therefore, there is a continuous search for better therapeutic agents for drug addiction. Natural products represent a promising source for drug addiction treatment. This review summaries drug addiction definition, its mechanism of action, its types, its diagnosis, factors affecting its development and different available approaches for its treatment especially the use of natural products. Six plants were discussed thoroughly in this review, including, Tabernanthe iboga Baill., Mitragyna speciosa Korth., Pueraria montana var. lobata (Willd.) Sanjappa & Pradeep, Hypericum perforatum L., Panax ginseng C.A. Mey., and Withania somnifera (L.) Dunal.
In recent years, researchers in the “psychedelic renaissance” have been reinvestigating the therapeutic potential of psychedelic compounds for conditions like post-traumatic stress disorder, clinical anxiety/depression, and addiction. Each of these has treatment-resistant cases, sometimes decades in the making, but studies employing psychedelics to address them are yielding impressive results. Given the evolving legal situation around these substances as well as corporate investment in them, their availability and appeal promise to increase. The question facing Christians is: How do these developments impact the theological significance of psychedelics as a broader phenomenon? This paper argues that since the population standing to benefit from these treatments is likely to include Christians, a thoughtful and rigorous response is necessary. The inquiry proceeds by analyzing some of the pertinent research, showing the insufficiency of previous Christian responses, and considering some hurdles and objections before issuing a call to theologize on this timely and important cultural moment.
This research qualitatively investigated four treatments for addiction in Brazil that use ibogaine as the main tool in the process. Ibogaine is a substance derived from an African plant, Tabernanthe iboga, traditionally used in its region of origin and which leads to intense sensations during its acute effects and also different experiences of oneself and the surrounding world in the period after its use. It’s considered a non‐typical psychedelic. We visited the clinics and interviewed professionals and patients of these places. In this article, we focus on how ibogaine is used for addiction and depression treatment and how its effect is understood. There is variation in patient screening and preparation, how the ibogaine is determined, and the care practices proposed after the treatment. These variations seem to be influenced by the context where ibogaine is inserted and their practices. We identified three different contexts that influence ibogaine use in Brazil: the market of addiction treatment clinics, the Brazilian urban religious use of ayahuasca, and the medical context of ibogaine use developed by Howard Lotsof.
Full-text available
Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Method Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. Interpretation These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.
Full-text available
Objetivo: Comparar o uso de drogas entre os universitários e a população geral brasileira, assim como com os universitários norte-americanos, identificando possíveis diferenças de uso pela interferência da cultura. Métodos: Para comparar o uso de drogas na vida entre as populações de interesse, foram utilizados os dados públicos de levantamentos estatísticos brasileiros realizados com universitários e a população geral, assim como levantamento estatístico norte-americano, por meio da comparação de intervalos de confiança (IC 95%). Resultados: O uso de drogas na vida é mais frequente entre os estudantes norte-americanos, que relatam usar mais tabaco, tranquilizantes, maconha, ecstasy, alucinógenos, cocaína, crack e heroína que os universitários brasileiros. Em contrapartida, os universitários brasileiros relatam usar quase duas vezes mais inalantes do que os universitários norte-americanos. Esse padrão se repete ao se analisarem as diferenças intragênero. A isso se soma que os universitários brasileiros parecem envolver-se com mais frequência no uso de bebidas alcoólicas, maconha, tranquilizantes, inalantes, alucinógenos e anfetamínicos que seus pares da população geral brasileira. Conclusões: Conhecer as particularidades do uso de drogas entre os universitários é de suma importância para a detecção precoce desse consumo. Investimentos nesse segmento e diferenças de sexo devem ser contempladas nas políticas preventivas, assim como na elaboração de estratégias para a redução e o controle desse consumo, como programas de triagem e intervenção breve, uma vez que possuem a melhor relação custo-benefício.
Full-text available
Ibogaine is a naturally occurring psychoactive indole alkaloid that is used to treat substance-related disorders in a global medical subculture, and is of interest as an ethnopharmacological prototype for experimental investigation and possible rational pharmaceutical development. The subculture is also significant for risks due to the lack of clinical and pharmaceutical standards. This study describes the ibogaine medical subculture and presents quantitative data regarding treatment and the purpose for which individuals have taken ibogaine. All identified ibogaine "scenes" (defined as a provider in an associated setting) apart from the Bwiti religion in Africa were studied with intensive interviewing, review of the grey literature including the Internet, and the systematic collection of quantitative data. Analysis of ethnographic data yielded a typology of ibogaine scenes, "medical model", "lay provider/treatment guide", "activist/self-help", and "religious/spiritual". An estimated 3414 individuals had taken ibogaine as of February 2006, a fourfold increase relative to 5 years earlier, with 68% of the total having taken it for the treatment of a substance-related disorder, and 53% specifically for opioid withdrawal. Opioid withdrawal is the most common reason for which individuals took ibogaine. The focus on opioid withdrawal in the ibogaine subculture distinguishes ibogaine from other agents commonly termed "psychedelics", and is consistent with experimental research and case series evidence indicating a significant pharmacologically mediated effect of ibogaine in opioid withdrawal.
Full-text available
Importance: No medication has been established as an efficacious treatment for cocaine dependence. We hypothesized that dual modulation of the mesocorticolimbic dopamine system by topiramate-a glutamate receptor antagonist and γ-aminobutyric acid receptor agonist-would result in efficacious treatment for cocaine dependence compared with placebo. Objective: To determine the efficacy of topiramate vs placebo as a treatment for cocaine dependence. Design, setting, and participants: Double-blind, randomized, placebo-controlled, 12-week trial of 142 cocaine-dependent adults in clinical research facilities at the University of Virginia between November 22, 2005, and July 25, 2011. Interventions: Topiramate (n = 71) or placebo (n = 71) in escalating doses from 50 mg/d to the target maintenance dose of 300 mg/d in weeks 6 to 12, combined with weekly cognitive-behavioral treatment. Main outcomes and measures: For the efficacy period, weeks 6 to 12, the primary outcome was the weekly difference from baseline in the proportion of cocaine nonuse days; the secondary outcome was urinary cocaine-free weeks, and exploratory outcomes included craving and self- and observer-rated global functioning on the Clinical Global Impression scales. Results: Using an intent-to-treat analysis, topiramate was more efficacious than placebo at increasing the weekly proportion of cocaine nonuse days, irrespective of whether missing data were not or were imputed conservatively to the baseline value (13.3% vs 5.3%, 95% CI for the estimated mean difference, 1.4%-14.6%, P = .02 or 8.9% vs 3.7%, 95% CI for the estimated mean difference, 0.2%-10.1%, P = .04, respectively). Topiramate also was associated, significantly more than placebo, with increasing the likelihood of urinary cocaine-free weeks (16.6% vs 5.8%; odds ratio, 3.21; 95% CI, 1.24-8.32; P = .02), as well as decreasing craving and improving observer-rated global functioning (all P < .05). Conclusions and relevance: Topiramate is more efficacious than placebo at increasing the mean weekly proportion of cocaine nonuse days and associated measures of clinical improvement among cocaine-dependent individuals.
Full-text available
We report the case of a man who died twelve hours after ingesting powdered iboga root, commonly taken for its stimulant and hallucinogenic properties. Ibogaine and ibogamine were quantified in the powder ingested and the victim's body fluids by GC-MS/MS after liquid-liquid extraction (Toxi-tubes A(®) ). The concentrations of ibogaine measured in the blood samples taken at the scene and in the peripheral blood, urine, and gastric fluid samples taken during the autopsy were 0.65, 1.27, 1.7, and 53.5 μg/mL, while the iboga content in the powder was 7.2%. Moreover, systematic toxicological analyses of biological samples showed the presence of diazepam and methadone in therapeutic concentrations. Death was attributed to the ingestion of a substantial quantity of iboga in the context of simultaneous methadone and diazepam consumption.
Full-text available
There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medical use of codeine and opiate-containing syrups. However, opioid dependence syndrome shows a significant total impact on mortality and morbidity. Over the past 20 years, scientific progress has changed our understanding of the nature of opioid addiction and its various possible treatments. Addiction is a chronic illness treatable if the treatment is well-delivered and tailored to the needs of the particular patient. There is indeed an array of treatments that can effectively reduce drug use, help manage drug cravings, prevent relapses and restore people to productive social functioning. The treatment of drug addiction will be part of long-term, medical, psychological, and social perspectives. This guideline aims at providing guidance to psychiatrists and other mental health professionals who care for patients with Opioid Dependence Syndrome. It comments on the somatic and psychosocial treatment that is used for such patients, and reviews scientific evidences and their strength. Also, the essential historical, epidemiological and neurobiological aspects of Opioid Dependence are reviewed.
Full-text available
The plant alkaloid ibogaine has promising anti-addictive properties. Albeit not licenced as a therapeutic drug, and despite hints that ibogaine may perturb the heart rhythm, this alkaloid is used to treat drug addicts. We have recently reported that ibogaine inhibits human ERG (hERG) potassium channels at concentrations similar to the drugs affinity for several of its known brain targets. Thereby the drug may disturb the heart's electrophysiology. Here, to assess the drug's cardiac ion channel profile in more detail, we studied the effects of ibogaine and its congener 18-Methoxycoronaridine (18-MC) on various cardiac voltage-gated ion channels. We confirmed that heterologously expressed hERG currents are reduced by ibogaine in low micromolar concentrations. Moreover, at higher concentrations, the drug also reduced human Nav1.5 sodium and Cav1.2 calcium currents. Ion currents were as well reduced by 18-MC, yet with diminished potency. Unexpectedly, although blocking hERG channels, ibogaine did not prolong the action potential (AP) in guinea pig cardiomyocytes at low micromolar concentrations. Higher concentrations (≥ 10 μM) even shortened the AP. These findings can be explained by the drug's calcium channel inhibition, which counteracts the AP-prolonging effect generated by hERG blockade. Implementation of ibogaine's inhibitory effects on human ion channels in a computer model of a ventricular cardiomyocyte, on the other hand, suggested that ibogaine does prolong the AP in the human heart. We conclude that therapeutic concentrations of ibogaine have the propensity to prolong the QT interval of the electrocardiogram in humans. In some cases this may lead to cardiac arrhythmias.
Ibogaine (IBO) is an indole alkaloid from the West African shrub, Tabernanthe iboga. It is structurally related to harmaline, and both these compounds are rigid analogs of melatonin. IBO has both psychoactive and stimulant properties. In single-blind trials with humans, it ameliorated withdrawal symptoms and inter- rupted the addiction process. However, IBO also produced neuro- degeneration of Purkinje cells and gliosis of Bergmann astrocytes in the cerebella of rats given even a single dose (100 mg/kg, ip). Here, we treated rats (n 5 6 per group) with either a single ip injection of saline or with 25 mg/kg, 50 mg/kg, 75 mg/kg, or 100 mg/kg of IBO. As biomarkers of cerebellar neurotoxicity, we spe- cifically labeled degenerating neurons and axons with silver, as- trocytes with antisera to glial fibrillary acidic protein (GFAP), and Purkinje neurons with antisera to calbindin. All rats of the 100- mg/kg group showed the same pattern of cerebellar damage pre- viously described: multiple bands of degenerating Purkinje neu- rons. All rats of the 75-mg/ kg group had neurodegeneration similar to the 100-mg/kg group, but the bands appeared to be narrower. Only 2 of 6 rats that received 50 mg/kg were affected; despite few degenerating neuronal perikarya, cerebella from these rats did contain patches of astrocytosis similar to those observed with 75 or 100 mg/kg IBO. These observations affirm the useful- ness of GFAP immunohistochemistry as a sensitive biomarker of neurotoxicity. None of the sections from the 25-mg/kg rats, how- ever stained, were distinguishable from saline controls, indicating that this dose level may be considered as a no-observable-adverse- effect level (NOAEL).
The chapter discusses some of the evidences that ibogaine modulates drug effects in animals. Results of research with ibogaine indicate that the alkaloid may modulate the rewarding properties of drugs and interfere with withdrawal reactions in animals. Ibogaine has been reported to modulate the development of morphine tolerance in rats. There are two commonly used methods for evaluating drug reward in animals” drug self-administration and place preference conditioning. In drug self-administration, an animal must make some response, such as a lever press, which is followed by a presentation of the drug reward. The place-conditioning paradigm is an alternative measure of drug reward. With this procedure, during a training period, rats are confined to one distinctive compartment following injection of a drug and an alternative compartment following injection of an inert substance. Advocates for ibogaine—as an antiaddictive medication—argue that ibogaine modulates a variety of addictive disorders, not only opiate addiction. Animal evidence reported above also indicates that ibogaine modulates the rewarding properties of stimulants when evaluated in the self-administration paradigm or in the place preference paradigm.