IGOBAINE

Abigail Gick Student Pharmacist

Fall 2022

Uses

Ibogaine has been used for its psychoactive and stimulatory effects, but it has also been used to treat opioid addiction and withdrawal symptoms2 .

Other Names

Other names include Iboga, Bois Sacré, and Eboka with the scientific name of Tabernanthe iboga1

History

Iboga is a naturally psychoactive stimulating drug found in the Ibogaine plant. The drug is more concentrated in the root than in other parts of the plant. It is found in various countries in Africa including Republic of Congo, Gabon, Cameroon, and Guinea and has been used in various religious activities. One such example is the Bwiti religion. It was discovered by European countries in the 1800s where it was continuously researched until 1901 when the compound was experimentally isolated. France was a country that started to sell ibogaine as Lambarene for a stimulant in the 1930s-1960s until it became illegal in 1966. In addition to France making it illegal, the World Health Organization (WHO) and Food and Drug Administration (FDA) also declared Ibogaine as illegal and classified it as a Schedule I drug1,2 .

MONITORING/DRUG SCREENING

There is not much monitoring/drug screening done for ibogaine as it is not used clinically in the United States. Research has been done with varying results showing that ibogaine is helpful in reducing opioid withdrawal symptoms and helped people recover from an opioid addiction. One study showed that most of the people who used ibogaine relapsed after treatment while another study showed that it reduced opioid cravings of the participants2,4 .

Drug Interactions/Toxicology

There are many toxicological effects of ibogaine throughout the body. The use of ibogaine has been shown to cause dysrhythmias, “agitation, hallucinations, vomiting, ataxia, muscle spasms, weakness, seizures, paralysis, arrhythmias, urinary retention, respiratory insufficiency, and cardiac arrest”3 .

There are no absolute contraindications with this drug nor are there any documented interactions. It has been shown though to cause more fatalities with people who take this and have comorbidities including opioid use, cardiovascular disease, depression, schizophrenia, and other autonomic nervous system disorders3 .

Pharmacology/Drug Effects

Ibogaine has been classified as a Schedule I hallucinogenic with many different possible mechanisms of action. It appears to have various effects with different doses. At a lower dose, it works mainly on the cerebella of the sympathetic nervous system and causes euphoria and an increase in muscle strength and endurance. This happens through many ways including kappa agonist effects, serotonergic effects, and nicotinic and N-methyl-Daspartate (NMDA) antagonism2. Some of these are considered options for why ibogaine could be used to treat opioid withdrawal symptoms. The kappa agonist effects increase the concentration of the chemical dynorphin, which creates cocaine aversion. The NMDA antagonism can help reduce the withdrawal symptoms. Also, the ibogaine metabolite noribogaine can treat opioid withdrawal as it binds to mu receptors2 .

At a medium dose, it starts to produce psychedelic effects and the person can experience dreams while awake. It also starts to stimulate the parasympathetic nervous system which can be so drastic as to cause a “feigned death”. It can decrease the amount of time spent in the rapid-eye movement (REM) stage of sleep which is a factor in the stimulatory effects. At a high dose, it causes hallucinations which is due to it being an indole alkaloid2,3

Laws

Ibogaine is a Schedule I hallucinogenic drug that is illegal in the United States of America1 .

Professional Opinion

While ibogaine has been shown to have some effect reducing opioid withdrawal symptoms and helping people transition out of substance abuse, not enough studies have been done to demonstrate its superiority to other treatments. Additional studies also need to be done proving types of dosing and the safety of the drug in general. Due to its main psychedelic effects of hallucinations and its lack of clinical efficacy, people should not be taking this drug and it should remain illegal in the United States.

~ A. Gick

References

1. Iboga. Natural medicines - databases. https://naturalmedicines.therapeuticresearch.com/datab ases.aspx. Accessed October 11, 2022.

2. Scottsdale Recovery Center. What is ibogaine? Scottsdale Recovery Center. https://scottsdalerecovery.com/what-is-ibogaine/. Published August 19, 2019. Accessed October 11, 2022.

3. Iboga. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 11, 2022.

4. Mash DC, Duque L, Page B, Allen-Ferdinand K. Ibogaine detoxification transitions opioid and cocaine abusers between dependence and abstinence: Clinical observations and treatment outcomes. Frontiers in Pharmacology. 2018;9. doi:10.3389/fphar.2018.00529

Justin Young, Student pharmacist Fall 2022