Ibogaine in Acute Opioid Withdrawal: An Open Label Case Series

Ibogaine is an indole alkaloid derived from the bark of the root of the African shrub Tabernanthe iboga . It has a history of use as a medicinal and ceremonial agent in West Central Africa, and has also been alleged to be effective in the treatment of drug abuse. The National Institute on Drug Abuse (NIDA) has given significant support to animal research, and the US Food and Drug Administration (FDA) has approved phase 1 studies in humans. Evidence for ibogaine’s effectiveness includes a substantial pre-clinical literature on reduced drug self-administration and withdrawal in animals, and case reports in humans. From a pharmacologic standpoint, ibogaine is interesting because it appears to have a novel mechanism of action distinct from other existing pharmacotherapeutic approaches to addiction. Ibogaine is not a substitution therapy, such as methadone. Ibogaine has activity at a variety of different receptors in the brain, and its effects may involve complex interactions between multiple neurotransmitter systems and persistent changes in second messenger signal transduction. There is evidence to suggest that ibogaine treatment might result in the “resetting” or “normalization” of neuroadaptations related to sensitization or tolerance. The lack of official approval of ibogaine led to the advent of a distinctive informal treatment network involving lay “treatment guides.” Over the last several years this network has been increasingly active, particularly in Europe. Opioid dependence is the indication for which addicts have most commonly sought ibogaine treatment, and the focus of a large proportion of published research on evidence of efficacy