Prescription narcotics and heroin are opioid drugs derived from the opium poppy plant.

In order to understand opiate addiction treatment, it’s important to understand how opiates work in the body. These drugs bind to opioid receptors in the brain, effectively blocking pain and producing a calming and pleasant result. When abused, users may experience a euphoric effect, or “high,” when dopamine (one of the neurotransmitters responsible for pleasure) levels are increased in the brain.

Ibogaine is among the substances that may be used to address opioid addiction. There is some controversy surrounding its use, due to its illegal status in the US.

Opioid Abuse

Opioids are considered highly addictive, as users develop a tolerance and even physical and psychological dependency to them when they are used regularly over a period of time. Opioids may quickly become the focus of obsession, negatively affecting health, work, school or family obligations, and interpersonal relationships.

The Centers for Disease Control and Prevention (CDC) calls prescription drug abuse an epidemic, as 44 people die in America every day from a prescription opioid overdose. In fact, drug overdose is the leading cause of injury death in the United States.

Drug abuse costs American society $181 billion a year in health care and legal costs as well as lost workplace production, the National Institute on Drug Abuse (NIDA) reports. Over 2 million American adults aged 12 or older were addicted to opioid prescription drugs in 2012, and another 467,000 were addicted to heroin, as published by NIDA.

Addiction is a chronic, complex and relapsing brain disease that is highly treatable. Opioid abuse and dependency are commonly treated with psychotherapies and 12-step programs, often after a period of detox. Opioid drugs make chemical changes in the brain, and the first step in recovery is to reach a healthy and stable physical balance, often with the aid of medications during detox.

Medically Assisted Detox

Medically assisted opioid detox is performed in a safe and supervised environment and it seeks to manage the uncomfortable flu-like symptoms and emotional side effects, including anxiety, insomnia, restlessness, depression, and irritability, that accompany opioid withdrawal. During medical detox, partial opioid agonists such as buprenorphine or long-acting opioid narcotics like methadone are commonly used, in order to slowly taper off opioid drugs in a controlled manner.

At appropriate doses, partial agonists and opioids with long half-lives can help keep cravings and opioid withdrawal symptoms to a minimum. These drugs are still opioid narcotics, however, with the potential for diversion and abuse. Researchers have long been searching for alternative medications or methods to aid in substance abuse treatment. Ibogaine is potentially a drug that may help circumvent compulsive drug use behaviors, essentially resetting the brain as it relates to substance abuse and staving off withdrawal symptoms.

Ibogaine in the United States

Commonly used in initiatory ceremonies in western Central Africa and harvested from the Tabernanthe iboga plant, ibogaine is a psychoactive alkaloid. In the United States, the Drug Enforcement Administration, or DEA, currently considers ibogaine a Schedule I controlled substance with no accepted medicinal uses and a high potential for abuse and dependency due to its hallucinogenic properties.

While ibogaine has been around and used for many purposes over the years, it was Howard Lotsoff who is first attributed with using it to attempt to treat heroin addiction on himself in the 1960s, as reported by the New York Times. Lotsoff became an advocate for the drug, claiming it stops drug cravings and promotes detox without withdrawal symptoms. In 1986, he received a patent for ibogaine in capsule form and worked with European psychiatrists and doctors to treat cocaine and opioid addiction with ibogaine.

Lotsoff’s drug seemed to be working as two-thirds of 30 patients worldwide remained abstinent from drugs for several months and even years in contrast to the general 75 percent relapse rate within six months with traditional methods. Initially, NIDA was interested in ibogaine, and the U.S. Food and Drug Administration (FDA) approved clinical trials for using the drug in opioid dependency treatment; however, a lack of funds and the death of a patient using ibogaine in the Netherlands effectively halted research in the mid-1990s and ibogaine remains a banned substance in America today.

Around the time the United States declined to further ibogaine research, private clinical trials and ibogaine treatment clinics sprang up in other parts of the world. Deborah Mash, an addiction specialist, and neuroscientist from the University of Miami, opened a private research center in the Caribbean in the 1990s where she tested ibogaine on 300 addicts. According to Mash, and published by BBC World Service, all patients showed an effect on their addiction from the ibogaine treatment and 70 percent remained in recovery for months and years after treatment. However, it is unclear if Mash compared her results to patients using an alternative treatment.  Researchers today are attempting to isolate noribogaine, one of the metabolites of ibogaine, and hoping to test its effectiveness as a potential legal alternative to ibogaine for addiction treatment.

How Ibogaine works

Ibogaine remains controversial in part due to its mind-altering and hallucination-inducing effects. While scientists are still studying exactly how ibogaine works in the brain, it seems to prevent excitotoxic damage to neurons. Certain drugs of abuse, like opiates, can cause excitotoxic damage.

When used for opioid detox, ibogaine generally follows the following timeline according to the journal Current Drug Abuse Reviews:

  • Acute phase: This starts within 1-2 hours of ingestion and lasts 4-8 hours. Visions and hallucinations occur in a “waking dream” format that can be emotionally intense.
  • Evaluative phase: This starts within 4-8 hours of ingestion and lasts 8-20 hours. Personal reflection, introspection, and contemplation of life and behaviors likely occur during this stage.
  • Residual stimulation phase: This starts within 12-24 hours and lasts at least 24-72 hours and sometimes longer. Attention turns from internal to external stimuli, and effects can linger before returning to normal.
  • Recovery: This is a period after ibogaine treatment wherein substance abusers remain abstinent as drug cravings may be erased, although self-destructive thought and behavior patterns still need to be addressed through counseling and therapy.

Ibogaine detox should be performed in a quiet and secluded location with medical care and supervision available around the clock. Ibogaine is likely to keep you awake and alert for up to a few days during treatment, and users may need extra sleep after treatment. It is important to remember that ibogaine is not a magic “cure,” and a successful recovery will include follow-up care, therapy, and learning new coping mechanisms in order to avoid relapse.

Ibogaine risks

Ibogaine’s legal status in the United States means that it is largely untested and unregulated, meaning that there may be potential side-effects to its use that are not fully understood. Nineteen sudden deaths within 76 hours of ingesting ibogaine have been reported between 1990 and 2008, although 12 of the 14 for which enough data were available had underlying medical conditions, such as heart conditions or liver disease, or they had additional substances in their bloodstream, as published by the Journal of Forensic Sciences. Ibogaine can cause cardiac arrhythmias and liver damage, and it can have lethal interactions with other illicit substances.

Long-term potential side-effects of ibogaine have yet to be discovered and one of the prominent non-profit research organizations looking to rectify that is the Multidisciplinary Association for Psychedelic Studies or MAPS. Current research on ibogaine is being done by MAPS in New Zealand and Mexico, where it is not an illegal substance. Currently, MAPS estimates that ibogaine has a mortality rate of one in every 300 patients.

There is no “magic bullet” when it comes to substance abuse treatment, although scientists make advances and new discoveries every day. For more information on the most up-to-date and safest scientifically-based opioid dependency treatments, contact an admissions counselor at The Recovery Village today.

Conor Sheehy
Medically Reviewed By – Dr. Conor Sheehy, PharmD, BCPS, CACP
Dr. Sheehy completed his BS in Molecular Biology at the University of Idaho and went on to complete his Doctor of Pharmacy (PharmD) at the University of Washington in Seattle. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.