An Agenda for Action III: Treatment, Evaluation, and Research
Barry Stimmel in Drug Abuse and Social Policy in America, 2014
There are a number of other drugs that are being studied for their effectiveness in allowing a person to remain free of illicit substances. These include appropriate psychotropic agents when an underlying psychologic disturbance exists regardless of the type of drug dependency. There are many drugs currently being tested for the ability to eliminate the cocaine craving. These include bromocryptine (Parlodel), amantadine (Symmetrel), and various antidepressants. Ibogaine, a hallucinogen extract from the African rain forest shrub Tabernathe iboga, has been promoted as a cure for heroin addicts, in that it eliminates craving and allows detoxification without withdrawal.18 However, this drug has also been shown to be neurotoxic and in high doses can produce tremors, loss of muscle control, and hallucinations. Antidepressants that inhibit serotonin uptake, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) have also been used to diminish alcohol consumption, as have dopamine agonists such as bromocryptine. Several antidepressants, especially fluoxetine, have also been suggested to be helpful in treatment of amphetamine and cocaine dependency. The effectiveness of any of these agents in well-controlled trials remains to be determined.
Nutraceutical Intervention for Treatment of Alcoholism and Drinking Problems
Raj K. Keservani, Anil K. Sharma, Rajesh K. Kesharwani in Nutraceuticals and Dietary Supplements, 2020
Both T. iboga and Voacanga africana are perennial shrubs innate to Central Africa and belongs to family Apocynaceae. They are largely used in customary African medicine. The root bark of T. iboga comprises ibogaine as its major alkaloid, although Ibogaine is one of some naturally occurring alkaloids found in V. africana. The psychoactive indole alkaloid known as ibogaine is used to treat cravings of alcohol, cocaine, heroin, and methamphetamine. Ibogaine is present in the root bark of Tabernanthe iboga that acts on the serotonin, dopamine, and opioid receptors to decrease substance cravings. The stimulating, fatigue-, thirst-, and hunger-ameliorating effects of ibogaine are well known since times immemorial. The preclinical evidence indicates that ibogaine considerably affect morphine and cocaine after self-administration in rodents. Recently, ibogaine has been testified to markedly decrease voluntary liquor consumption in alcohol-preferring rats. The dropping effect of ibogaine on alcohol intake was detected only when ibogaine was injected intraperitoneally or intragastrically and not subcutaneously, suggesting that the bioactive principle of ibogaine could be a metabolite produced by the liver. It has been found that ibogaine can be toxic in high doses, so an ibogaine analog, known as 18-methoxycoronaridine, has been developed to produce the same antiaddiction effects as ibogaine but without the toxic side effects. Iboga acts on the neurotransmitters that control drinking behavior and helps to reduce cravings and subdue extreme drinking (Carai et al., 2000).
Missed Opportunities? Beneficial Uses of Illicit Drugs
Ross Coomber in The Control of Drugs and Drug Users, 2020
Ibogaine is a psychedelic substance derived from the roots of an African plant, Tabernanthe iboga. Apparently it allows the user to “play back” visual memories using the eyelids or any surface as a sort of movie screen. Ibogaine was briefly used to enhance psychotherapy in the 1960s (Naranjo, 1969), but is now receiving attention mainly because of the claim that it can interrupt chemical dependency, greatly diminishing withdrawal symptoms and drug craving in heroin and cocaine addicts, and allowing them an opportunity to free themselves from addiction at least for a time. The interest was generated by Howard Lotsof, a heroin addict who found that the ibogaine experience interrupted his addiction. A number of addicts have undergone this experience under the supervision of Dr. Hans Bastiaans in the Netherlands, where use of ibogaine is not illegal. Among this small group of highly motivated addicts, some have remained drug-free without craving for at least six months. For these patients, ibogaine compares favorably with other forms of addiction treatment. A larger number have had their addictions interrupted but need other support to remain drug-free (Lotsof, 1990). These results have generated interest, and other researchers are beginning to explore the therapeutic potential of ibogaine. It has been found to reduce withdrawal symptoms in morphine-dependent rats (Dzoljic et al., 1988) and monkeys (Aceto et al., 1990), and it causes rats to self-administer less morphine (Glick et al., 1991) and cocaine (Cappendijk & Dzoljic, 1993). Animal studies have paved the way for clinical research that may determine whether or not ibogaine has the potential suggested by the anecdotal evidence.
Psychedelic Treatments for Substance Use Disorder and Substance Misuse: A Mixed Methods Systematic Review
Published in Journal of Psychoactive Drugs, 2023
Raman Sharma, Rachel Batchelor, Jacqueline Sin
Ibogaine is a psychoactive indole alkaloid found in the African rainforest shrub Tabernanthe iboga root bark (Cloutier-Gill et al. 2016) which has affinity for a range of neurotransmitter systems (Mačiulaitis et al. 2008). Noribogaine, the active metabolite in ibogaine, exhibits similar receptor characteristics, however, has a high affinity for mu and kappa opioid receptors. Its complex receptor profile, in addition to its relatively long half-life, contributes to its effects in improving opioid withdrawal symptoms and decreasing opioid craving (Malcolm, Polanco, and Barsuglia 2018). Previous research on ibogaine for opioid detoxification reported positive effects in individuals’ ability to cope with stress, and subjective feelings of inner peace, joy, and heightened spiritual awareness (Davis et al. 2018). However, Ibogaine has been banned in some countries due to safety concerns related to its cardiac effects (Cloutier-Gill et al. 2016).
On Addiction, Complexity, and Freedom: Toward a Liberation-Focused Addiction Treatment
Published in Journal of Psychoactive Drugs, 2019
In recent years, there has been an increased interest in the use of ibogaine as a method for treating opiate and other addictions (Brown 2013). Derived from Tabernanthe iboga, a plant used in sacred ceremonies by practitioners of the Bwiti religion in West Central Africa, ibogaine is now understood to be an “addiction interrupter” (Lotsof 1995). Increasingly being used as a treatment for addictions, this healing plant also has the potential to increase the capacity for freedom among those who are successfully treated with it. Amanda, who built on her ibogaine experience to transform her life, reflected on her journey: I’ve been clean ever since, a year and a half now…. I’ve got a job that I love, an amazing new boyfriend, my relationships with my family are healed; my life is totally different than it was. I’m healthier and happier than I can ever remember being. I have no craving or desire for the drugs that used to control my life…. I’ve been given a chance to hit the reset button, to begin my life again. Ibogaine is not a miracle drug. You have to really want it, and you have to be willing to do the work, and it is some of the most challenging work I’ve ever done in my life.” (Heyes and Carlander 2014)
Changes in Withdrawal and Craving Scores in Participants Undergoing Opioid Detoxification Utilizing Ibogaine
Published in Journal of Psychoactive Drugs, 2018
Benjamin J. Malcolm, Martin Polanco, Joseph P. Barsuglia
Ibogaine, a psychoactive and psychedelic alkaloid found in the root bark of Tabernanthe iboga or bark of Voacanga africana, has a complex pharmacokinetic and pharmacodynamic profile that is not completely understood (Jenks 2002). Ibogaine exhibits significant affinity for targets in many neurotransmitter systems. Affinities and Ki values less than 10 μM were found at κ opioid receptors, N-methyl-d-aspartate (NMDA) glutamatergic receptors, dopamine and serotonin reuptake pumps, σ-1 and σ-2 receptors, as well as nicotinic receptors (Litjens and Brunt 2016). Ibogaine is converted to noribogaine by the cytochrome P450 isoenzyme CYP2D6. There is significant heterogeneity within humans regarding metabolic capacity of CYP2D6. There are also drugs that inhibit the enzyme’s metabolic capacity, creating potentially significant drug-drug interactions. One study found a 26-fold increase in peak plasma concentrations of ibogaine and a 66-fold increase in the area under the curve (AUC) or total drug exposure in patients that took ibogaine after being pretreated with a CYP2D6 inhibitor (paroxetine 20 mg) compared with a placebo (Glue et al. 2015b). This study exemplifies the role of CYP2D6 in the pharmacokinetics of ibogaine and its likely impact on efficacy and safety parameters of ibogaine use (Glue et al. 2015b; Litjens and Brunt 2016). In persons exhibiting the most common CYP2D6 phenotype (extensive metabolizers), the half-life of ibogaine was found to be 7.45 hours (Mash et al. 2001).
Related Knowledge Centers
- Alkaloid
- Hallucination
- Ibogaine
- Indole
- Toxicity
- Traditional African Medicine
- Opioid
- Prescription Drug
- Chili Pepper
- Tabernaemontana