The rapid proliferation of psychedelics in addiction therapy has been, by all counts, quite astonishing. Clinical trials and various research studies have shown that substances like psilocybin and MDMA can improve outcomes—sometimes dramatically so—for people grappling with addiction. And over the last few years, one psychedelic in particular has been getting a fair amount of attention: ibogaine.
Ibogaine is a powerful hallucinogen derived from the roots of the iboga plant. Ibogaine use has a long history in traditional African spiritual practices—rites of passage and initiation kinds of stuff—but is a relatively recent entrant in the Western pantheon of potential addiction treatments. A growing number of proponents herald it as a kind of miracle drug. Unfortunately, the risks associated with its use—up to and including the risk of death—can be quite dramatic as well.
Ibogaine is a Schedule I controlled substance, and it is not approved for any medical use in the United States. Its prospect as a potential addiction treatment isn’t all that well understood.
Understanding Ibogaine and Its Use in Addiction Treatment
Ibogaine is a natural psychotropic compound that is found in plants that are native to West Central Africa. The root bark of the Tabernanthe iboga plant, which is native to West Central Africa, is where ibogaine is derived. Locals have used the plant as a stimulant and as a way to make contact with the spirit world. Not until the 1980s and then in the 1990s did the use of ibogaine for a completely different purpose—not as a stimulant or for spirit contact—become known.
In the film, the natural compound is referred to as a plant medicine or entheogen, which is explained by the narrator as a “drug that may be dramatically transformative, and in some cases, spiritually the same, in the way that native cultures may ordinarily use them. They may be a narcotic in the ordinary sense when used in large quantities, but one that is non-addictive.” The filmmaker quickly jumps in with the essential fact that makes ibogaine non-addictive and quite an extraordinary plant medicine for the purposes of this film.
The Promises of Psychedelic Therapy
Psychedelic Therapy on the Rise
For many years now, people have been turning on to the idea that some substances that bend the mind can also be therapeutic. They’re called psychedelics, from an old Greek word that means “mind-revealing.” At a time when so many people are self-medicating with everything from junk food to opioids, it seems like a match made in heaven, or at least in neuroscience. All of that has led to the constant headlines that herald the “psychedelic renaissance,” as we stagger into the mysteries of the human brain and out of the darkness of the 20th century.
Once upon a time, psychedelic substances—like LSD, psilocybin, and mescaline—were sold over-the-counter as legal drugs. They were used in legitimate research on parapsychology and mental illness, and they were prescribed by doctors. They had names like Delysid and Indocybin. Mostly, though, what they had was a reputation. One could go to places like Millbrook and have their minds opened. For a few brief seasons, being “turned on” was not yet equated to being “burned out,” and there was a lot of curiosity on the part of everyone from housewives to government officials about what these drugs could do for the disorders of the human mind and conditions of the human heart.
The Risks and Side Effects of Ibogaine
The plant from which ibogaine is derived, Tabernanthe iboga, is native to West Africa and is commonly used in Gabon and the Cameroon for both medicinal and religious purposes. A recent review suggests that it has a complex mechanism of action. Although the drug has been associated with a reduction in withdrawal symptoms and cravings, it is probably best understood as a dissociative anesthetic (like ketamine) rather than an opioid agonist such as methadone.
In the past decade, the iboga root bark and its supposedly “purified” forms, most commonly ibogaine, have become popular in certain circles outside of Africa, notably among so-called “psychonauts” in the U.S. who experiment with non-addictive psychoactive substances. “Underground” clinicians have also provided ibogaine to addicts in recent years without the substantive, helpful (and necessary) long-term studies that would prove its effectiveness. One example of which came a few years back when a PLOS ONE article detailed the experience of an underground ibogaine clinic where only 3 of 30 subjects were observed to remain abstinent for more than a year without any detrimental side effects.
Comparing Ibogaine to Traditional Addiction Treatments
Usual care for substance use disorder combines several classic strategies: talk therapy, medication, and sometimes a safe place to live. But even though this combination works for many, it fails plenty too. The novel strategy of using an addiction-interrupting drug called ibogaine offers a promising new pathway to study. Working in a laboratory is one thing; giving a person in your care a potentially life-altering substance is a pretty serious enterprise all on its own. And I don’t use “potentially life-altering” lightly.
Many people who have taken ibogaine point to deep resets in their brains as well as profound insights that push beyond the kind of better-or-worse binary that fuels debate around the use of psychedelics in addiction treatment. Through a conversation I had with a researcher and a man who had taken ibogaine, I came to understand the dramatic switch in brain and body, as well as the awfully risky context in which a mother plant can deliver her medicinal relief.
“It’s a hell of a conversation to have,” I said, mostly to myself. What I anchored to was a very real dialog going on among serious scientists who were apt to disagree with the take-hallucinogen-resolve-addiction angle of whatever ibogaine treatment was being offered.
Making an Informed Decision
Ibogaine is an extremely potent psychoactive substance found in nature. It is most commonly associated with and is synthesized from the root bark of the African plant Tabernanthe iboga but is also found in lower concentrations in other members of the Apocynaceae family of plants. For many years, indigenous peoples have used these plants in low doses as stimulants and at higher doses in religious rituals. However, in our society, ibogaine has gained attention for its medicinal properties—especially when used in higher doses—as an apparent cure or at least a highly effective treatment for people who are addicted to opiates.
But the drug is not without its dangers, and several people—over a handful a year—die during or shortly after ibogaine treatment. Most of them, it seems, have serious preexisting medical conditions, like heart disease. A few of the ibogaine treatment centers we contacted in the course of our reporting take extensive measures to screen for such conditions. This, it should be noted, is not the standard of care.
The active ingredient in the Tabernanthe iboga root, ibogaine has gained a lot of attention in recent years. The plant is native to the countries of Gabon, the Republic of the Congo, and Cameroon, where the Bwiti and Mitsogo people have used it as a psychoactive substance for medicinal and ritual purposes for centuries.
Ever since the 1960s, when Howard Lotsof discovered that ibogaine could alleviate the symptoms of withdrawal and reduce cravings, a number of addicts seeking help from this hallucinogen has grown, and the results produced by a single dosage of ibogaine have been amazing. Raoul classifies the benefits into two categories: 1) the immediate, in which ibogaine decreases in the severity of withdrawal symptoms, and 2) benefits that arise in the days after the ibogaine sessions, in which the addict experiences a real reduction in cravings, a prominent feature in the disease. During the thirty-to-ninety-day period following the ibogaine session, the benefits manifest themselves fully.