What is Ibogaine?
Ibogaine is a naturally occurring substance that has, since the 1980s, been increasingly used as an aid to detoxification from opioids and other drugs. It’s main benefits include dramatically increasing the sensitivity of dopamine receptors thereby alleviating withdrawal symptoms by reducing tolerance, as well as stimulating the repair of dopaminergic neurons.
Most people who go through ibogaine treatment for opioids experience at least an 80-90% reduction in acute withdrawal symptoms. Beyond that, most people notice a major reduction in PAWS and the associated depression and cravings with opioids and other substances, including various kinds of stimulants, alcohol and nicotine.
Along with these physical benefits, ibogaine is strongly psychoactive. It has been described as an oneirogen, suggesting that it stimulates “waking dreams.” Some people describe complex visual experiences that bring clarity and insight around past experiences or future goals. Regardless of whether or not these experiences are clear or easy to recall it is common for people to experience a significant change of perspective after treatment.
How well does ibogaine treatment work?
This is a common question, and one that can be complicated to answer. The main variable is what you consider to be success. Ibogaine is most effective at helping to transition from a dependent state to a non-dependent state. It is very effective at reducing short-term withdrawals and long-term depression. However, long-term abstinence is something that depends on many other factors that vary so much from person to person.
There are a number of observational studies that have documented the results of people who have through treatment. The results from these studies are very specific, but they may help to shape more realistic expectations about what ibogaine can do, as well as what other kinds of support are necessary afterwards.
In a MAPS funded study of 30 subjects from clinics in Mexico, Thomas Kingsley Brown, et al., showed:
- A significant reduction of opioid withdrawals.
- 50% of subjects reported no opioid use at 30 days post-treatment.
- 33% of subjects reported no opioid use at 3 months post-treatment.
- 40% of subjects were defined as having a “favorable outcome,” meaning retention in the study for at least 9-12 months, and at least a 75% reduction in Addiction Severity Index (ASI) Drug Use scores.
- Across the board reductions in ASI Drug Use scores. These changes were maximal at 1 month, and between 3-12 months the changes were sustained.
- Significant improvements in ASI Family/Social and Legal Status scores that were sustained over the 12 month follow-up.
- A notable reduction in Psychiatric Status scores.
In a MAPS funded study of 14 subjects from New Zealand, Geoff Noller, et. al. showed:
- A significant reduction of opioid withdrawals.
- 1 year of abstinence from opioids in 50% of participants, and overall, an 80% reduction on the Addiction Severity Index (ASI-Lite) Drug section.
- Increased motivation and pursuit of other health services post treatment.
- A significant reduction in post treatment depression.
- Some participants reported significant reductions in other drug or alcohol use.
In a private study of 88 patients from Mexico, Alan Koi Davis, et. al., showed:
- 80% of participants reported elimination or dramatic reduction of withdrawal.
- 50% reported reduction of opioid cravings, with 25% reporting reduction of cravings lasting at least 3 months.
- At 6 months 41% reported abstinence from opioids.
- 30% reported never using opioids again with half of these people interviewed at 1 year and almost a third at 2 years.
- Although 70% later reported relapse following treatment, 47% decreased use from previous levels and 11% eventually achieved abstinence.
- Long-term reductions in depression and anxiety, and increased subjective well-being.
On the Mexican MAPS study by Brown, it is important to consider that some subjects who entered residential treatment afterwards were lost to follow-up and their scores were counted as pre-treatment levels (no treatment effect). Also, opioid maintenance programs, either buprenorphine or methadone, were counted as opioid use and scored accordingly, even though for some ending up on those programs may have been a major improvement, not considered a “relapse.”
So how do these results compare? In general, they are very good compared to other existing treatments. Brown, et al., cite several recent studies that help to give a general idea:
- One study following subjects after a buprenorphine taper with no subsequent pharmacotherapy, which reported an 8.6% success rate defined as less than 4 days of self-reported opioid use in the previous month.
- Reviews looking at opioid detoxification with subsequent maintenance treatment report abstinence rates of 18% at one month with buprenorphine and 26% after 6 weeks with methadone.
- These numbers compare to 50% self-reported abstinence at 1 month and 33% at 3 months (Brown, et. al.), and 30% self-reported abstinence of at least a year (Davis, et. al.).
One observational study from Brazil looks particularly at people who underwent ibogaine treatment and psychotherapy in a hospital setting for lifetime alcohol, cannabis, cocaine, and/or crack use. It may still be the only study looking at ibogaine treatment specifically at stimulant use.
Of the 75 subjects that they followed, Shenberg, et. al., showed:
- 29% did not use again after the first ibogaine treatment, and another 23% used once but then remained abstinent. The median period of abstinence after a single treatment was 5.5 months.
- Of 33 who underwent a second session, 45% did not use again. The median period of abstinence after a second treatment was 8.4 months.
- Further, of 14 who underwent a third session, 57% did not use again. Of 5 who underwent a fourth session, one did not use again. And of two who underwent a fifth session, one did not use again.
Finding an Ibogaine Clinic
Ibogaine treatment is offered in a number of countries. The most accessible and affordable options for US residents are located in Central America, mostly Mexico, which has a well-established history as a center for medical tourism.
The detox process can last between 5 days to 14 days and can cost anywhere between $5500 to $8000 or more, depending on a number of factors.
When you are ready to discuss potential treatment options please call
Keep in mind that any drug detox, including ibogaine treatment, is a process that requires medical support. There are some risks involved in treatment that, in the past, have resulted in medical complications and a number of fatalities when certain precautions were not taken.
In 2016, as Director of the Global Ibogaine Therapy Alliance (GITA), I spearheaded the development of Clinical Guidelines for Ibogaine-Assisted Detoxification. The process included numerous medical professionals and treatment providers, and developed, for the first time, lessons from the both clinical practice and medical research about how to ensure safe screening and monitoring for ibogaine treatment.
Here are a few important questions to ask when looking for an ibogaine clinic:
- What kind of medical screening will be required?
- The most basic screening tests include a full blood panel and an electrocardiogram. Without these tests, simply do not go through treatment. Who will be reviewing the application and what qualifications and experience do they have? Both are necessary! Qualifications without experience do not provide someone with what is necessary to provide treatment safely.
- What kind of medical monitoring will be conducted on-site?
- Many clinics now provide an ACLS-certified medical team and cardiac monitoring during the treatment. They have a full crash cart on-site and are ready to respond to a variety of medical emergencies.
- How long will you be under medical supervision before and after treatment? Many clinics offer 24-7 medical supervision, and are located close to a hospital.
- What kind of safety record does the clinic have?
- Have they had any medical emergencies? Have they experienced any fatalities? Under what conditions would they decline treatment to someone? How often do they have to decline treatment and for what reasons?
- What other kinds of support and resources does the clinic offer?
- Do they have a therapist available before you arrive or during the treatment process? It is often not the time for intensive psychotherapy, but discussing the treatment process, and making a realistic assessment of plans for afterwards can be very important. What other resources do they have available?
- Why are the providers doing what they’re doing?
- Understanding personal motivations for involvement in the work can be a big factor. Many people have been through treatment themselves and changed their lives completely. If so, are their thoughts about treatment and its potentials still grounded in reality? If not, what other motivations could be going into shaping the environment and the experience?
Ceiba offers case management and coaching services through a number of clinics both in the Tijuana area and remotely. Even if you are not planning on attending these clinics you are more than welcome to explore these services and schedule an orientation call.
Suboxone and Methadone maintenance programs are a large part of the standard care for opioid treatment. Unfortunately, it is not recommended to use ibogaine to detox directly off of either of these medications because their effects are long acting.
Ibogaine works by sensitizing opioid receptors, effectively reducing tolerance. In most cases, an ibogaine treatment involves taking the final dose of opioids in the morning or midday on the day of treatment, and then beginning ibogaine treatment in the evening once withdrawals have begun to set in. For short-acting opioids this is enough time for the opioids to mostly leave the system, in which ibogaine can have the intended effect.
However, if opioids are still in the system, as is the case with long-acting opioids, then generally people notice an increased analgesic effect. Basically, they feel very good during the treatment but when the ibogaine wears off they may go back into withdrawals. For long-acting opioids these withdrawals can be quite prolonged and uncomfortable, especially after long-term use.
As a result, standard practice prior to ibogaine treatment is to switch to a shorter acting opioid until those medications have left the system. For methadone this can take anywhere between 2-4 weeks depending on dosage and duration of use. For Suboxone this can be anywhere from 3-6 weeks depending on the same factors.
For some people this creates a significant barrier to treatment. Doctors can be reluctant to prescribe short-acting opioids, particularly to patients with a history of substance use. One of the options that people have opted for in the past is to look for black market opioids, however, going from a stable maintenance program, this can introduce a number of significant risk factors and life-style instability that many people and their families would prefer to avoid at all costs.
Ceiba has begun collaborating with Bumble Bee Botanicals, expert kratom retailers in Chula Vista, California, on a solution that is both legal and stabilizes the preparation process. Kratom is legal in all but six US states. Although it is not an opioid, some people have noticed that its action on opioid receptors has allowed them to switch from various kinds of opioids with a dramatic reduction in withdrawal symptoms. Ceiba has collaborated on a protocol that includes mixtures of white, green and red leaf kratom varieties as well as extracts that help to manage energy and sleep throughout the day.
You can purchase weekly supplies of kratom through Ceiba. Please call for more information about this process 1-888-848-7972 and to discuss other helpful resources that assist with this process.
While ibogaine has been shown to manage withdrawal and cravings to a number of substances, this is not the case for benzodiazepines. Benzos and z-class drugs work on the body’s GABA receptors, which are not affected by ibogaine.
Additionally, benzo-related withdrawal can present a risk factor during ibogaine treatment. For long-term benzo users who have developed a tolerance and dependency, one severe withdrawal symptom can be seizures. Even if you have never experienced seizures during benzo withdrawal ibogaine can make you more prone to seizure. Since seizures can catalyze changes in cardiac rythyms, it constitutes a major risk factor during ibogaine. Thus benzo withdrawal is contraindicated with ibogaine treatment.
The standard protocol for benzo users who are planning to take ibogaine is to stabilize the benzo dose and to continue with benzos throughout treatment. Other resources exist that can help with benzo withdrawal, but the standard protocol, depending on dosage and duration of use, is a long-term taper post-ibogaine treatment.
Anatomy of an Ibogaine Treatment
Many people often ask what an ibogaine treatment looks like. This will vary from clinic to clinic, and depend on the length of your stay and the protocols that they use. However, there are a number of similarities that will be fairly common from place to place.
From booking to your arrival at the clinic you should be equipped with the basic information that you need to best prepare yourself for treatment, and work to develop an understanding of where you will be going afterwards. The important things to remember here are:
- You will have to refrain from stimulant use prior to treatment. You can’t take ibogaine while you still have cocaine, crack, or methamphetamine in your system. Some clinics will offer time to stay at the clinic prior to treatment and many can assist the flushing process with IV saline and vitamins, but consider that this extra time will have an added cost.
- There are things that you can do to stabilize and even lower your opioid dose prior to treatment. If you can reduce the rush to enter treatment quickly, and focus on taking measures to prepare physically, this can reduce your discomfort during and after the treatment.
Intake & Stabilization
When you arrive at the clinic you should undergo a medical intake and a series of tests that include a blood panel and electrocardiogram. If you are taking opioids, you will be stabilized on morphine sulfate or a similar short-acting opioid medication. The duration will depend on the clinic. Some clinics prefer to do this longer for people coming off of kratom, fentanyl, or other synthetic opioids. You can discuss the specifics with your treatment provider. The general philosophy here is that you can be comfortable and stable prior to taking ibogaine. It is recommended to have slept well, to have eaten recently, to have dealt with any other medical issues such as abscesses, and to have had regular bowel movements prior to treatment.
On the day of your treatment you will take the last doses of any medications in the morning or by midday. Many places also encourage fasting by at least midday. A small number of places prefer to do treatment in the morning to make the fasting easier, but many places do treatment by the evening. If you are taking opioids you should expect to start to go into withdrawal prior to taking ibogaine. This is necessary to ensure the opioids are leaving your system. Usually this comes on a bit slower than usual because morphine sulfate has a bit of a longer effect than heroin or fentanyl, and also because the usual anxiety around withdrawal should be relaxed by the treatment environment.
Most places offer flood dose ibogaine treatments, which are efficient and rapid ways of detoxing. These generally begin with a test dose, and followed by subsequent doses every few hours. This makes the onset of the experience more gradual and manageable, and allows your providers to gauge your response. Usually people start to feel relief from withdrawal a short time after taking the test dose. The remainder of the dosages will be designed to increase the level of noribogaine, ibogaine’s primary metabolite, so that the withdrawal relief and long-term benefits are sustained.
Ibogaine’s oneirogenic effects were described by Ken Alper as passing through three distinct phases:
- Acute effects
- Many people notice a relief of opioid withdrawal relatively soon, between 30 minutes and two hours after taking an intial test dose.
- Ibogaine’s acute effects generally take up to two hours to come on, and last between 4-8 hours. During this phase many people experience alterations in cognitive processes, alterations in perspective or visual perception that can include open or closed eye visuals, or kinesthetic or audio experiences. Although this is not always the case, sometimes these experiences can take on elements of significant personal or transpersonal meaning.
- These effects can be quite different from other psychedelic compounds. Although some people find these effects can be quite intense, there is generally not a strong emotionally reaction to the experience.
- Once the acute effects wear off most people notice a reduction in visual alterations. What remains can be light visual tracers and a feeling of reduced coordination. However the dominant effect that follows is usually an evaluative phase that involves a lot of cognitive processing. Sometimes people think about the experience, perhaps to memories from their life, perhaps about people or situations, and sometimes about their place in the world or in the future. This phase can last as long as another 8 to 20 hours depending on dose and individual metabolism.
- Residual Stimulation
- The after-effects can include changes in perspective and sensitivity to sensations such as light, sound, temperature, or other physical sensations. Generally during this phase people continue to rest physically. These residual effects can last 24-72 hours more, during which time people generally notice a return of their energy.
- Long-term effects
- Some of ibogaine’s effects can play out over weeks, months or years that follow. Some people notice these to a greater extent than others because they generally have less to do with the physiological effects of taking ibogaine, and more to do with integrating the experience that has happened, or adjusting to living without drug dependence, etc. These changes can range from physical recovery to things like returning to a stable sleep schedule, time for physical energy and motivation to recover, or lasting reductions in cravings to drugs. It can also include changes in perspective that influence other areas of life such as important relationships, life decisions, or subtler changes to worldview and personal identity.
The day after a flood dose of ibogaine people generally need a lot of rest and relaxation. Some people feel a huge amount of relief, a sense of calmness, a general sense of well being, and a sensitivity to the environment. For others, this day can be challenging, including some lingering withdrawals, exhaustion from the lack of sleep. In a lot of cases there is some mixture of the two. Spending the day in reflection, getting bodywork, soaking in hot water or a steam room, or otherwise taking good care of yourself are recommended, if you feel inclined to leave the bed at all.
After a good night of sleep people generally start to feel their energy return. This can happen in stages as well, over the next few days. Sometimes during this period people feel that they sleep less, but also need a bit less sleep. For people who have been using opioids in order to manage sleep not being able to sleep on command or for as long as you are used to can feel a bit uncomfortable, but this gradually returns. There are plenty of natural sleep aids that people have found helpful including melatonin, valerian root, chamomile, passionflower, skullcap, magnolia bark extract, kava kava, and the Herbal Assist blend that Ceiba offers.
It is not uncommon for it to take 7-10 days for your energy to fully return even after a psychospiritual treatment. When you are detoxing, take into consideration how you would have felt without ibogaine, and how long it would have taken for your body to recover otherwise. Even though most people experience major improvements, sometimes some of the PAWS, lack of sleep, or other symptoms can last for a few more weeks, even months.
During the post-treatment period at the clinic many will offer booster doses of ibogaine, smaller doses that are similar or smaller than the test dose. The purpose of these is to deal with any additional withdrawal, to further sustain the long-term benefits, or later to deal with cravings or PAWS.
It is generally recommended to take enough time at the clinic to leave rested, and having planned for the following things:
- What supportive environment are you entering now?
- What aftercare resources are available to you and do you plan to access right away?
- How will you deal with any lingering post-acute withdrawal or discomfort?
- How will you deal with other challenging situations that may be a factor for you such as pain, lack of sleep, or acute stress?
Planning for Aftercare
As a number of the studies that are mentioned above make clear there was some benefit for people who sought out additional recovery support post treatment. Particularly for treatments that have a shorter duration looking into residential post treatment for those who have time and resources to do so can be a major benefit.
These plans can range from ibogaine-centered aftercares, other kinds of residential programs or transitional living environments, outpatient programs local to you, developing your own recovery plan with Ceiba recovery coaching, and participating in any number of recovery focused group meetings, either in person or on-line. There is a full list of the most relevant services on Ceiba’s Options for Ibogaine Aftercare.
One resource that is freely available to everyone regardless of involvement in in-patient or any other kind of recovery program is Ceiba’s Life After Ibogaine on-line SMART-Recovery meetings. These meetings take place twice a month via the Zoom video conferencing platform, with an option to call-in by phone as well. This is a facilitated discussion group that covers recovery-related topics specific to people post-ibogaine, and occasionally brings in guest speakers on various topics.
How does ibogaine treatment work?
When you ingest ibogaine it is fairly rapidly converted into its primarily metabolite, noribogaine. Both the short-term and long-term effects around treatment involve both ibogaine and noribogaine, which have many properties in common. Nor-ibogaine is estimated to remain in the body for at least a number of days following a flood dose of ibogaine.
The mechanism of action of ibogaine and noribogaine are complex and multifaceted, and only partly understood. What is known is that, unlike many pharmacotherapies, they have a chorus of effects that touch numerous neurotransmitter systems. These include:
- Mu-opioid receptors play a role in reward and euphoria. Ibogaine is a potential mu-opioid receptor agonist, which many believe describe its effects on opioid withdrawal. Moreover, even aside from potential agonist activity ibogaine has been shown to increase the activity on mu-opioid receptors, and to reduce tolerance to opioids.
- Kappa opioid receptors play a role in reward and mood. Ibogaine has potential interactions with kappa opioid receptors, other examples of which have also been shown to reduce cocaine and morphine self-administration.
- Serotonin has a complex function including influencing cognition, reward, learning, memory, and numerous physiological processes. Ibogaine may block uptake of serotonin, similar to many anti-addictive agents, and noribogaine may do so to an even greater extent.
- Ibogaine’s activity on 5-HT2a receptors, similar to other psychedelics, may account for a significant portion of its oneirogenic effects.
- NMDA plays an important role in synaptic plasticity and memory function. Ibogaine is a weak competitive NMDA antagonist, somewhat similarly to ketamine. This activity may be responsible for some of ibogaine’s therapeutic effects, including its effects on drug dependence, and its potential for neurogenerative disorders like Parkinson’s.
- Dopamine has a complex function including motivation, pleasure, cognition, memory, learning, and fine motor control. There is evidence that ibogaine decreases dopamine levels, particularly in people who have exposure to drugs of abuse, returning them from elevated levels to baseline levels. This may play an important role in ibogaine’s persistent effect on drug cravings.
Another significant effect of ibogaine is that it stimulates the production of glial cell-derived neurotrophic factor (GDNF) as well as brain-derived neurotrophic factor (BDNF), hormones that stimulates the production of dopaminergic neurons. While BDNF is more common, ibogaine is relatively unique in its ability to stimulate GDNF. These factors are significant in stimulating neuroplasticity, assisting in the brains ability to recover and to transition from a dependent state relatively painlessly.
The production of GDNF may be a contributing factor in ibogaine’s potential for reversing the symptoms associated with Parkinson’s disease. While it is not approved or researched for this purpose, there are some anecdotal cases of people using microdoses (8mg+/day) of ibogaine over time and noticing increased motor coordination, reduced depression, and improvement in a number of areas associated with Parkinson’s. Because Parkinson’s involves a degeneration of dopamine neurons in the mid-brain, this may provide an image of the longer-term benefits of ibogaine on the dopamine system.
Where does ibogaine come from?
Ibogaine is known primarily because of its presence in Tabernanthe iboga and sister species that are collectively referred to by the common name iboga. Iboga species are perennial shrubs that are endemic to the low-lying Central African rainforest, particularly the small coastal country of Gabon. There, iboga has a history of use that goes back before written record. However, today it used in the spiritual practice of Bwiti, as well as other similar ritual healing and initiatory practices, which have a more recent history.
Iboga is currently illegal to export from Gabon. Recently, the country has been making efforts to try to control this export having recognized it as a “cultural heritage strategic reserve,” to protect the local access and to attempt to benefit from the international use of ibogaine.
In the past, ibogaine was primarily sourced from Tabernanthe iboga, much of which was exported from Gabon. While there has been more effort recently to cultivate iboga it is still believed that most, if not all, of the root bark and total alkaloid extracts available are being exported the same way. This has created a number of problems in the region from potentially diminished natural population to increased prices on the local market that have made access difficult for traditional practitioners. I have written a number of articles and a peer reviewed paper for the Journal of the American Botanical Council covering this issue, all of which are available here.
In the past few years another plant, Voacanga africana, has emerged as the most important source of ibogaine. Voacanga is cultivated agriculturally elsewhere in Africa, which makes its supply renewable. Ibogaine is produced from voacanga by semi-synthesis from its primary alkaloid voacagine. The isolated ibogaine hydrochloride that comes as a result is a stable and consistent product, and the majority of ibogaine treatment centers depend on this for purity as well as for ethical and sustainability reasons.
Some people who go through ibogaine treatment later develop an interest in iboga, and even in traveling to Gabon for initiation into Bwiti. Others may only be interested in understanding how they can give back to the original source of iboga and to the benefit of the communities there. The organization Blessings of the Forest is involved in important conservation and development work in Gabon to assist communities in self-sustaining their own supply of iboga for traditional use, as well as developing future potentials for some form of export market.
If you are interested in supporting Blessings of the Forest and the work that they are doing you can sponsor an iboga tree for the price of 30 euros (roughly $36 USD).