Medical Editor: Dr. Lynn Marie Morski, MD, Esq
What are the risks of ibogaine treatment?
History of Ibogaine Treatment
Ibogaine is an alkaloid found in the root bark of the west equatorial Africa perennial shrub, Tabernanthe iboga. The root bark of Tabernanthe iboga has been used for millennia in west Africa, where its use is a sacred sacrament and for reasons of celebration, as well as a rite of passage and initiation into the Bwiti tribe for younger people.
In 1962, Howard Lotsof, who was dependent on heroin and interested in psychoactive substances, ingested ibogaine and came out of the experience with no dependency to heroin. He went on to give several friends ibogaine who had similar results. In the 1980s, Lotsof patented ibogaine for several substance abuse treatments and began administering ibogaine at a clinic in the Netherlands.
In the early 1990s, other ibogaine providers, such as Eric Taub, begin performing ibogaine sessions in other parts of the world and quietly in America. This eventually would lead to medically monitored, holistic, and therapeutic treatment centers launched in Mexico and Central America. This was the beginning of the ibogaine clinic movement that still exists today.
What is Ibogaine?
Ibogaine has a diverse and complicated pharmacological profile. Ibogaine inhibits serotonin and dopamine transporters, NMDA and nicotinic acetylcholine receptors, and binds to mu and kappa opioid receptors. There is also some evidence that ibogaine has antimicrobial properties, as well as neuroprotective properties. Ibogaine also produces neuroplasticity and may have neuroadaptive properties. This may be in relation to its ability to modulate neurotrophic factors GDNF and BDNF.
While scientists don’t fully understand the entirety of ibogaine’s mechanism of action, there are decades of anecdotal ibogaine “trip reports” hailing ibogaine as a “wonder drug”; a psychedelic that can tackle almost any mental health or substance use disorder. It’s important to remember ibogaine is not a cure or a magic bullet, although it may be a powerful catalyst for change in some individuals. Studies on many ibogaine enthusiast claims are lacking, but one anecdotal report that seems consistent is that ibogaine is incredibly individualized, meaning that the experience varies widely from person to person.
Though there is a lot of promise with the benefits of ibogaine, and studies on its utility for treating substance use are promising, the dangers are sobering. Ibogaine has a significant effect on the cardiac system, and fatalities and hospitalizations do occur, even in medically monitored clinics. Ibogaine-related complications are often due to previous medical conditions, substance intake, compromised physiology, and cardiac history. While complications can largely be avoided with proper screening, monitoring, and careful dosing, one should always weigh the risks of treatment and explore all options other than ibogaine before making a decision, and thoroughly vet the ibogaine center they choose to attend if ibogaine is the best solution for them.
What Makes Ibogaine Dangerous?
Ibogaine has a significant effect on the cardiac system. It is a potassium hERG channel blocker. Blocking these potassium channels can cause arrhythmias and QT prolongation. QT prolongation related to ibogaine can last several days.
The QT interval is the time it takes the heart to recharge between beats. This means that ibogaine makes the heart take longer to recharge between beats. QT interval prolongation increases the risk of a ventricular arrhythmia called torsades de pointes that often results in cardiac arrest. QT prolongation can also cause palpitations, lightheadedness, syncope, and arrhythmias. Ibogaine may cause bradycardia and hypotension, and in higher doses, may cause seizures. Vomiting, which may disturb electrolyte levels and lead to dehydration, can be common. Ibogaine is broken down in the liver and metabolized into its longer-acting metabolite noribogaine by the liver pathway CYP2D6. Those with impaired liver function may therefore have a higher risk of adverse effects from Ibogaine.
The population of people seeking out ibogaine tends to be a population of people who may have compromised physiology and are seeking out ibogaine to restore their health. However, if an ibogaine patient is young, isn’t taking any QT-prolonging substances, has a healthy liver and heart, and is monitored by a reputable clinic, the risk is lower. Regardless, anyone seeking out ibogaine treatment should be screened and prepped by a reputable ibogaine provider.
The exact number of ibogaine deaths is unknown. Due to the unregulated nature of the industry, many deaths go unreported. A study that reviewed 19 deaths from 1990 to 2008 found that people died anywhere from about one hour to three days after ingesting ibogaine. However, these deaths were attributed to prior medical conditions and other substances in relation to ibogaine and not ibogaine toxicity alone.
However, there are also reports of people suffering fatal and near-fatal events at ibogaine treatment centers and under the care of ibogaine providers. In New Zealand, during a study on ibogaine, one participant died during treatment. Additionally, the lack of regulation in the ibogaine industry allows anyone to call themselves a professional, and there can be dangerous consequences to the lack of oversight. Juliana Mulligan, an ibogaine integration specialist, suffered six cardiac arrests during her ibogaine treatment at an ibogaine center that didn’t follow safety protocols in Guatemala. Some estimate that up to 1 in 300 people who take ibogaine will suffer a fatal reaction. This emphasizes the importance of pre-screening and only taking ibogaine at a reputable and safe center.
Mental Health Risks
There are also psychological risks to consider, especially because the experience can last for longer than a day. Mental health conditions like schizophrenia and a history of mania may increase the risk of prolonged mania or psychosis following the ibogaine experience. Acute confusional states, also sometimes called fugue states, have also been reported in clients with a history of substance use.
Ibogaine may reveal underlying mental health conditions. Mental health diagnoses can often help providers make decisions for safe ibogaine therapy candidates, but specific behavioral patterns may help providers determine inclusion and exclusion criteria. People who have been hospitalized for bipolar disorder, borderline personality disorder, depersonalization, psychosis, or mania should share these experiences with their providers to determine if ibogaine is the best course of action. Before ingesting any ibogaine, it is recommended to undergo a full psychiatric evaluation with the ibogaine center one chooses.
Because of the risks of complications, the simplest thing one can do to reduce risk is to only use ibogaine with a skilled provider’s supervision.
What are the Side-Effects?
Ibogaine is known for its intense rapid-eye-movement dream-like visionary state that some say reveals life-changing epiphanies. However, the experience has also been described as unpleasant. Side-effects of ibogaine include ataxia, sweating, irregular heart rhythm, temperature changes, insomnia, nausea, chest pain, dry mouth, and tremors. Ibogaine can cause tachycardia and bradycardia, raise or lower blood pressure, and cause seizures. Anecdotal reports from clients suggest movement triggers vomiting and dizziness. Closed and open-eyed visuals have been reported as well as auditory hallucinations.
Ibogaine not only lowers tolerance to opiates but will potentiate opiates if introduced or still in the system. Ibogaine also lowers tolerance to alcohol and stimulants. Those who choose to use substances after ibogaine should assume they have returned to a pre-substance dependent state and be very careful.
Ibogaine can last a long time. Most people are under the effects for around 12-24 hours, but it is not uncommon to be in bed for over a day or to be experiencing side effects of ibogaine for 48 hours, and insomnia may persist for up to a week. Some people may have a challenging time holding down fluids for over a day. Choosing a center that can administer anti-nausea therapies in the case of prolonged nausea or vomiting will help eliminate the risk of depleted electrolytes during ibogaine treatment.
How to stay safe?
There is no shortage of risks when it comes to ibogaine treatment. And yet, people describe it as life-changing, and people around the world seek it out. The important question is whether it can be experienced safely and how?
Due to the QT-prolonging effects of ibogaine, medications that can affect regular heartbeat and/or prolong the QT need to be avoided for a period of time before ibogaine ingestion. Similarly, medications that inhibit the CYP2D6 liver pathway slow down the metabolism of ibogaine and may increase dangerous side effects. Other medications may also pose a treatment risk. Ideally, an ibogaine provider will be familiar with a client’s medication regimen and can give a thorough plan for tapering and cessation of medications if necessary.
Ibogaine is also contraindicated with cardiac medications (specifically beta-blockers and antiarrhythmic medications), SSRIs, antipsychotics, and other mood stabilizers. OTC meds such as omeprazole and Benadryl can prolong the QT interval, as well as quinine-based substances such as tonic water, grapefruit, bitter lime and lemon, and cranberry.
Some supplements and herbs should also be stopped before ibogaine treatment. As a general rule, the risk of cardiac, liver, or other dangerous side effects increases when ibogaine is taken with many different types of medications – prescribed or OTC, supplements, narcotics, and herbs. This is not a complete list of substances to avoid, and ibogaine should only be considered after being carefully screened by a reputable ibogaine provider or clinic.
Ibogaine and Substance Withdrawal
Ibogaine appears helpful in managing cravings associated with several addictive drugs, however is only helpful in the management of withdrawal symptoms in the case of opioids. Due to risks associated with withdrawal from some substances, persons wishing to use ibogaine for management of other drug addictions may be asked to detoxify prior to ibogaine use. Stimulants are an example due to their effect on the cardiac system and alcohol is an example due to its risk of seizure during withdrawal.
Persons using benzodiazepines might want to taper off this medication before their ibogaine therapy sessions due to the claim that benzodiazepines may dampen the visual experience. However, benzodiazepine cessation and ibogaine both carry a risk of seizures. To avoid this risk with ibogaine, one needs to be away from benzodiazepines for an extended period of time. Benzodiazepine withdrawal can be dangerous and should be done under medical guidance. As a result, it may be recommended that benzodiazepine-dependent individuals stay on benzodiazepines for their ibogaine experience and taper off afterward. While benzodiazepines aren’t specifically contraindicated with ibogaine, side-effects of benzodiazepines can pose some risk to ibogaine treatment if not administered safely and monitored consistently throughout treatment. Individuals who are using benzodiazepines are safest with experienced ibogaine providers who have a medical set-up, medical staff, and are experienced with benzodiazepines.
Ibogaine Treatment Center Safety
When in-depth pre-screening, preparation, protocols, medical monitoring, an emergency plan, and follow-up are put into place, ibogaine can be experienced in a much safer way. However, even with precautions, ibogaine treatment carries some level of risk to it in all doses. Ibogaine is not a DIY substance. It should never be taken at home alone due to the risk of fatality, even in small doses. Fatalities have occurred in doses as low as 3mg/kg, and adverse events have been reported in doses as low as 3mg and 10mg.
The best way to experience ibogaine safely is to book a stay at a reputable ibogaine treatment center. However, finding a reputable center can be overwhelming.
The internet is full of Google ads, forums, testimonials, recommendations from anonymous people, and websites for ibogaine centers. Ibogaine is a Schedule I substance in America and illegal in a handful of other western countries. As a result, internet searches often lead to centers around the world where ibogaine therapy is an unregulated industry. There is no across-the-board training program, certification, or medical oversight that anyone working with ibogaine is required to abide by. This allows for many different types of centers and methods of providing the medicine. It also provides access to something many have reported being life-saving that is illegal in America and other places. However, the lack of regulation also means that centers do not have to follow any sort of medical, ethical, or professional standard for their clients. This is why finding a safe, ethical, and reputable center is imperative and is vital for one’s healing process and safety.