What is Ibogaine and how does it help with opioid addiction?
Ibogaine is a psychedelic drug, similar to psychoactive substances such as psilocybin mushrooms and LSD. It is a naturally occurring substance, found in various plants of the Apocynaceae family.
Tabernanthe iboga is a plant found in West Africa that is one source of iboga alkaloids, which include ibogaine, an indole alkaloid.
Another naturally occurring iboga alkaloid of interest is coronaridine. 18-methoxycoronaridine, or 18-MC, is a synthetic drug derived from coronaridine. 18-MC is being studied in the US as an alternate to ibogaine for addiction treatment.
The exact effects of ibogaine on the brain are poorly understood. It is known to have dissociative properties and effectively causes the brain to reset, erasing addictions, dependencies, and even chronic pain syndromes in as little as a single treatment.
Could ibogaine be the solution experts are looking for to address the ongoing opioid crisis? Could this psychoactive alkaloid be the answer addiction specialists are looking for to help people to overcome heroin addiction?
There are Mexican clinics marketing services online to people in the United States, promising freedom from opioid addiction. They are even claiming that an ibogaine clinic can help people to quit medication-assisted treatment drugs, such as Suboxone and Methadone.
However, you may want to think twice before visiting an international ibogaine treatment center. There are serious risks associated with ingesting ibogaine.
Unfortunately, ibogaine treatment can be unpleasant and even deadly. The drug can be neurotoxic and it is known to have possible dangerous cardiovascular adverse effects. The ibogaine experience sometimes ends with tragic consequences.
People who have successfully completed ibogaine therapy in regions where it is legal have described it as extremely unpleasant. One person recently reported to me that they would never undergo the treatment again for any reason.
Legal ibogaine clinics exist in places such as Amsterdam and Mexico, offering to treat the heroin addict or any other type of opioid addict. The drug is illegal in the US because it has not been adequately studied in the US to establish safety or efficacy in treating any medical condition.
And, as a hallucinogenic drug, it is classified as having no legitimate medical use, though that is quickly changing. Psychedelic drugs have been decriminalized in some regions of the United States. Scientists are also finally performing studies to show that certain psychedelics can be highly effective in treating various mental health conditions.
When will ibogaine be legally available as a prescription in the US?
While research is in high gear on psychedelic drugs with the goal of getting FDA approval, there is no guarantee that we will ever see legal ibogaine in the US. Psilocybin is a popular and well-known hallucinogenic drug found in certain mushrooms that may be the first to be legalized and approved.
Psilocybin is known to be relatively safe when administered under controlled conditions. It has been demonstrated to be effective in treating some conditions, including anxiety in terminally ill patients. There are multiple companies working towards FDA approval for various synthetic forms of the drug.
Ketamine is an anesthetic drug that is already legal and has some psychedelic properties. Off-label ketamine infusion clinics have been around for a while and there is now a legal nasal spray that contains a ketamine-like drug.
The nasal spray, Spravato, contains the drug esketamine. Yet, you cannot go to your family doctor and ask for a prescription for Spravato to be filled at your local pharmacy. The spray is administered under strict supervision by an approved psychiatrist on a weekly basis to treat depression.
Instead of ibogaine, we may see another drug, 18-MC, approved instead. 18-Methoxycoronaridine is a drug first derived from ibogaine in 1996 and is currently being studied as a possible treatment for substance abuse.
18-MC has some significant advantages over the naturally occurring ibogaine. It is not neurotoxic and it does not have the same hallucinatory effects as ibogaine.
If ibogaine were approved by the FDA tomorrow, would all addiction doctors stop prescribing Suboxone to detox their patients?
This is an excellent question. If there were a superior addiction treatment drug available, why bother keeping the others around? If ibogaine, psilocybin, or 18-MC is approved, should we shut down the methadone maintenance clinics and take Suboxone off the market?
Unfortunately, there is rarely a new pharmaceutical product that is superior in every way to existing products. People have wondered about why we need methadone anymore when we have Suboxone and other buprenorphine-based drugs.
And, when the monthly injectable buprenorphine product, Sublocade, came out, doctors asked if we would need Suboxone anymore. The issue is that there are always trade-offs with any effective medical treatment for drug addiction.
For example, while Suboxone is generally superior to methadone for most patients, there are still many cases where methadone is the best choice initially. With more powerful street opioids, such as fentanyl and carfentanil, methadone has become more important than ever as a life-saving treatment.
Sublocade, the monthly Suboxone shot, does have many advantages, but it is certainly not perfect. There are many good reasons why a patient would be better served to continue the Suboxone sublingual films rather than switch to the monthly injection.
So, imagine that we suddenly have legal ibogaine HCL, or a similar drug that can be administered to drug addict patients in any outpatient clinic for addiction treatment. We may discover through further research and clinical experience that there are many cases where Suboxone treatment is preferable, even if ibogaine treatment can work effectively in a short period of time. For example, I have seen patients who have gone for ibogaine treatment and quit all opioids, only to later relapse. While addiction, or substance use disorder, can go into remission, there is no cure. Relapse is always possible.
While relapse after ibogaine treatment may be less likely, it certainly still does occur. On the other hand, for a patient who continues with long-term Suboxone therapy, the risk of relapse is very low.
It takes time to fully evaluate a newly approved treatment drug. Even when a drug performs well enough in studies to gain FDA approval, it still takes a long time on the market to see what issues might come up that limit its usefulness.
Could a psychedelic drug eventually replace Suboxone as the gold standard of therapy for opioid addiction?
While pharmaceutical products rarely go away, unless they are found to cause a serious adverse reaction, they do sometimes lose their prominence as first line treatment. For example, methadone was long considered to be the gold standard of treatment for opioid dependence.
After about twenty years of experience with Suboxone therapy, treatment with Suboxone and other buprenorphine drugs is considered to be the gold standard, even over methadone. Suboxone simply has too many advantages over methadone.
However, it has taken a long time for us to get to this point. It can take many years of clinical experience for doctors to agree that a treatment is superior to an older treatment that was previously the standard of care.
When one or more psychedelic drugs are finally approved for use by the FDA for treating addiction, we may still see that Suboxone remains the preferred treatment for some time. Of course, having more options available benefits everyone.
Different people will respond best to different treatments.
Have you ever heard of someone having a bad trip? The word “trip” is often used to describe the psychedelic drug experience. A good trip can be an enlightening, spiritual experience. A bad trip can be a complete nightmare.
In fact, it is possible for a bad trip to lead to long-term psychiatric problems, though this is probably more likely for people who are already at risk for developing mental health conditions. More often, a bad trip is an unpleasant experience because the person is not in a good setting for the experience.
One reason for psychedelic research being so far behind is because of the reckless use of these drugs in the 1960s. Unfortunately, people with strong academic credentials who should have been more responsible were recommending uncontrolled recreational use of psychedelics.
Psychedelic drugs have the potential to cause a very negative experience. Patients must be carefully screened, prepped, and guided through the experience. In some cases, psychedelic therapy will not be appropriate.
If ibogaine or psilocybin therapy were available today for opioid addiction, Suboxone treatment might still be the best option. Suboxone is very safe and effective with minimal risks.
It is very important that researchers take their time in properly studying the effects of ibogaine ingestion, defining all possible side effects and adverse reactions. They must also determine if ibogaine administration is consistently beneficial in treating opioid addiction.
Once the patient is stable and past the induction period of the first few days, it is very straightforward to have a positive recovery experience with Suboxone. While psychedelics, such as ibogaine, 18-MC, and others will certainly only be available from a highly qualified psychiatrist, any family doctor, or even nurse practitioner, can prescribe Suboxone with minimal additional training.
While some people may point out that Suboxone is technically an opioid and therefore carries the dangers of most opioids, this is simply not true. Buprenorphine, the opioid ingredient in Suboxone, is more of an opioid with training wheels, a safe way to bring people down off of dangerous opioids, such as heroin, fentanyl, oxycodone, and others.
Suboxone does not carry the risk of most opioids because of its unique properties. Buprenorphine is more of a blocker than an activator of the opioid receptors. It has a built-in safety feature known as the ceiling effect, protecting patients from opioid overdose on Suboxone.
Where would the best place be for psychedelic drug treatment to be used in treating opioid addiction?
If you started out reading this article thinking that ibogaine, or other similar drugs, might replace Suboxone or methadone, consider the state of the typical person who wants to quit heroin or fentanyl. Often, that person is living a very stressful existence in which they are trying their best to survive in the midst of an active opiate addiction.
They may have some difficult feelings to confront as the haze of opioid use is lifted as cravings and withdrawal symptoms subside. There may be guilt, regret, anger, frustration, anxiousness, and depression due to what has happened during their period of drug abuse. Therapy is an important component of medication-assisted treatment with Suboxone to help the patient address these feelings.
Suboxone is also ideally suited to help patients through this transition. The medication has antidepressant and anti-anxiety properties, and it prevents heroin withdrawal and it suppresses drug craving thoughts. It helps the patient return to a feeling of normalcy and improved function, while at the same time, making the psychological transition more tolerable.
Imagine taking someone in that fragile state and throwing them into a potentially traumatic psychedelic trip. What if they are confronted with difficult thoughts, memories, and emotions, magnified by the drug experience? While the guidance of a trained therapist will help, you can imagine that the jolt from active addiction to street narcotics into an intense psychedelic trip might not be the best way to get off of opioids.
In fact, if the emotional pain of the experience is strong enough, the patient may feel more driven to go back to using illicit opioids rather than continue with treatment. There is no guarantee that ibogaine or psilocybin will magically erase the addiction from the patient’s brain.
On the other hand, Suboxone, or methadone, are proven medications that, when used as part of an MAT program, are highly effective in helping a patient to smoothly transition off of opioids, so they can get started in their recovery process. These medications are safe when administered properly, and they are effective in eliminating opioid withdrawal symptoms and opioid cravings. While on an MAT program, patients tend to no longer exhibit addictive behavior.
Once the patient is stable on medication-assisted treatment with Suboxone for a period of time, they may be more prepared for psychedelic assisted therapy. As their life approaches a state of stability and normalcy, they may be ready to confront deeper issues that may have led them to addiction in the first place.
Psychedelic treatment may be ideal near the end of Suboxone treatment.
One part of Suboxone treatment that is difficult is the final stages, where the patient is ready to stop taking their medication. There is a physical withdrawal syndrome that occurs as the patient reduces their dosage and then stops.
Ibogaine has been promoted as a treatment to help people get off of Suboxone without the prolonged physical opioid withdrawal syndrome. If ibogaine, or a similar drug, could be legally administered in the United States, it might be best used for patients who have been on Suboxone for over a year and are ready to finally make the transition off of it.
In fact, patients who have been on Suboxone for years, may find some comfort in the fact that research is being done with the intent to introduce new FDA approved therapies that can help them reach the next important stage of their recovery, where they are able to stop taking long-term treatment medication.
While this plan will not be right for all patients on Suboxone, it will be good to have more tools to help patients who may benefit from these additional therapies. One of the more difficult aspects of Suboxone treatment is helping patients to finally complete treatment and adjust to life without Suboxone.
Visiting an ibogaine provider after a patient has been stable on Suboxone treatment for some time may be acceptable in the future. Ibogaine hydrochloride derived from the iboga plant, or a similar drug may be used someday to provide ibogaine detoxification to reduce or eliminate the opiate withdrawal associated with discontinuing Suboxone.
We may learn, through further research and then clinical experience, that these novel medications can play an important role in the overall treatment plan for many patients overcoming opioid addiction. Comparing ibogaine to Suboxone to see which is best is not a fair comparison.
It is likely that we will find that not only are they both important alternatives, but they may also work well together as part of a comprehensive treatment plan for treating opioid use disorder. Addiction recovery programs will benefit from as many effective tools as possible to use in helping to end the opioid epidemic.