Ibogaine

Ibogaine is a naturally-occurring psychoactive compound found in a number of plants in nature, principally in a member of the dogbane family known as iboga (Tabernanthe iboga). Ibogaine-containing preparations are used in medicinal and ritual purposes by African spiritual traditions of the Bwiti who claim to have learned it from the Pygmy. In recent times it has been identified as having anti-addictive properties. Ibogaine is an indole alkaloid which is obtained either by extraction from the iboga plant or by semi-synthesis from the precursor compound voacangine, another plant alkaloid. A full organic syntheis of ibogaine has been achieved, but is too expensive and challenging to produce any commercially significant yield.

In the early 1960s, ibogaine was accidentally discovered to cause sudden and complete interruption of heroin addiction without withdrawal in a matter of hours. Since that time it has been the subject of scientific investigation into its abilities to interrupt addictions to heroin, alcohol, and cocaine. Anecdotal reports also suggest that ibogaine may have potential to drive introspection that helps elucidate the psychological issues and behavior patterns that drive addiction or other problems. However, ibogaine therapy for drug addiction is the subject of some controversy. Due to its hallucinogenic properties as well as risks for patients with certain health problems, it has been placed in the strictest drug prohibition schedules in the United States and a handful of other countries.

While ibogaine's prohibition has slowed scientific research into ibogaine's anti-addictive properties, the use of ibogaine for drug treatment has grown in the form of a large worldwide harm reduction medical subculture ^[1]. Ibogaine is now used by treatment clinics in 12 countries on 6 continents to treat addictions to heroin, alcohol, powder cocaine, crack cocaine, and methamphetamine as well as to facilitate psychological introspection and spiritual exploration.

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Psychoactive effects

At doses of around 3-5 mg/kg of body weight, ibogaine has a mild stimulant effect. The high-dose ibogaine experience of 10mg/kg or greater, often called the "flood", most commonly occurs as two distinct phases: the visionary phase, and introspective phase.

The visual phase is characterized by open-eye visuals, closed-eye visuals, and dreamlike sequences. Objects may be seen as distorted, projecting tracers, or having moving colors or textures. With the eyes closed, extremely detailed and vivid geometric and fractal visions may be seen. Subjective reports often include a movie-like recollection of earlier life experiences as well as dreamlike sequences with symbolism of one's present or anticipated future. Other effects in the visionary phase may include laughing, sensations of euphoria or fear, and temporary short-term memory impairment. The visionary phase usually ends after 1-4 hours, after which the introspective phase begins.

The introspective phase is typically reported to bring elevated mood, a sense of calm and euphoria, and a distinct intellectual and emotional clarity. Subjects often report being able to accomplish deep emotional and intellectual introspection into psychological and emotional concerns. It is also during this period that opioid addicts first notice the absence of withdrawal cravings. The duration of the introspective phase is highly variable, usually lasting hours but sometimes lasting days.

Side effects and safety

One of the first noticeable effects of large-dose ibogaine ingestion is ataxia, a difficulty in coordinating muscle motion which makes standing and walking virtually impossible without assistance. Xerostomia (dry mouth), nausea, and vomiting may follow. These symptoms are long in duration, ranging from 4 to 24 hours in some cases. Ibogaine is sometimes administered by enema to help the subject avoid vomiting up the dose. Psychiatric medications are strongly contraindicated in ibogaine therapy due to adverse interactions. Some studies also suggest the possibility of adverse interaction with heart conditions. In one study of canine subjects, ibogaine was observed to increase sinus arrhythmia (the normal change in heart rate during respiration).[3] Ventricular ectopy has been observed in a minority of patients during ibogaine therapy. [4] It has been proposed that there is a theoretical risk of QT-interval prolongation following ibogaine administration. [5]

There are 12 documented fatalities that have been loosely associated with ibogaine ingestion. [6]. Exact determinations of the cause of death have proven elusive due to the quasi-legal status of ibogaine and the unfamiliarity of medical professionals with this relatively rare substance. No autopsy to date has implicated ibogaine as the sole cause of death. Causes given range from significant pre-existing medical problems to the surreptitious consumption of other drugs in conjunction with ibogaine. Most legal and illegal psychoactive drugs are strongly contraindicated during or immediately after ibogaine treatment, which presents a risk in undersupervised or self-treating subjects.

Therapeutic uses

Addiction Interruption

The most studied long-term therapeutic effect is that ibogaine seems to catalyze partial or complete interruption of addiction to opioids. An integral effect is the alleviation of symptoms of opioid withdrawal. Research also suggests that ibogaine may be useful in treating dependence to other substances such as alcohol, methamphetamine, and nicotine, and may affect compulsive behavioral patterns not involving substance abuse or chemical dependence.

Proponents of ibogaine treatment for drug addiction have established formal and informal clinics or self-help groups in Canada, Mexico, the Caribbean, Costa Rica, the Czech Republic, France, Slovenia, the Netherlands, Brazil, South Africa, the United Kingdom and New Zealand where ibogaine is administered as an experimental drug. Although the full nature of Ibogaine is still emerging, it appears that the most effective treatment paradigm involves visionary doses of ibogaine of 10 to 20 mg/kg, producing an interruption of opiate withdrawal and craving. Many users of ibogaine report experiencing visual phenomena during a waking dream state, such as instructive replays of life events that led to their addiction, while others report therapeutic shamanic visions that help them conquer the fears and negative emotions that might drive their addiction. It is proposed that intensive counseling and therapy during the interruption period following treatment is of significant value. Some patients require a second or third treatment session with ibogaine over the course of the next 12 to 18 months as it will provide a greater efficacy in extinguishing the opiate addiction or other drug dependence syndrome. A minority of patients relapse completely into opiate addiction within days or weeks. A comprehensive article (Lotsof 1995) on the subject of ibogaine therapy, detailing the procedure, effects and aftereffects is found in, "Ibogaine in the Treatment of Chemical Dependence Disorders: Clinical Perspectives".^[2]

Chronic pain management

In 1957, Jurg Schneider, a pharmacologist at CIBA, found that ibogaine potentiates morphine analgesia.^[3] Further research was abandoned and no additional data was ever published by Ciba researchers on ibogaine/opioid interactions. Almost 50 years later Patrick Kroupa and Hattie Wells released the first treatment protocol for concomitant administration of ibogaine with opioids in human subjects indicating ibogaine reduced tolerance to opioid drugs.^[4] Kroupa, et al., published their research in the Multidisciplinary Association for Psychedelic Studies (MAPS) Journal demonstrating that administration of low "maintenance" doses of ibogaine HCl with opioids decreases tolerance.

Psychotherapy

Ibogaine has been used as an adjunct to psychotherapy by Claudio Naranjo, documented in his book The Healing Journey.^[5]

Recreational use

Casual use of ibogaine in a social or entertainment context is nearly unknown due to its high cost, constrained availability, long duration of effects, and uncomfortable short-term side effects. In the clandestine markets, ibogaine is typically sought as a drug addiction treatment, for ritual spiritual purposes, or psychological introspection.

History

It is uncertain exactly how long iboga has been used in African spiritual practice, but its activity was first observed by French and Belgian explorers in the 19th century. The first botanical description of the T. iboga plant was made in 1889. Ibogaine was first isolated from Tabernanthe iboga in 1901 by Dybowski and Landrin^[6] and independently by Haller and Heckel in the same year using T. iboga samples from Gabon. In the 1930's, ibogaine was sold in France in 8mg tablets under the name "Lambarene". The total synthesis if ibogaine was accomplished by G. Büchi in 1966.^[7] Since then, several further totally synthetic routes have been developed.^[8] The use of ibogaine in treating substance use disorders in human subjects first observed by Howard Lotsof in 1962, for which he was later awarded U.S. Patent 4,499,096  in 1985. In 1969, Claudio Naranjo was granted a French patent for the use of ibogaine in psychotherapy.

Ibogaine was placed in US Schedule 1 in 1967 as part of the US government's strong response to the upswing in popularity of psychedelic substances, though iboga itself was scarcely known at the time. Ibogaine's ability to attenuate opioid withdrawal confirmed in the rat was first published by Dzoljic et al. (1988).^[9] Ibogaine's use in diminishing morphine self-administration in preclinical studies was shown by Glick et al. (1991)^[10] and ibogaine's capacity to reduce cocaine self-administration in the rat was shown by Cappendijk et al. (1993).^[11] Animal model support for ibogaine claims to treat alcohol dependence were established by Rezvani (1995).^[12]

The name "indra extract" in strict terms refers to 44kg of an iboga extract manufactured by an unnamed European industrial manufacturer in 1981. This stock was later purchased by Carl Waltenburg, who distributed it under the name "Indra extract". Waltenburg used this extract to treat heroin addicts in Christiana, Denmark, a squatter village where heroin addiction was widespread in 1982.^[13] Indra extract was offered for sale over the internet until 2006, when the Indra web presence disappeared. It is unclear whether the extracts currently sold as "Indra extract" are actually from Waltenburg's original stock, or whether any of that stock is even viable or in existence. Ibogaine and related indole compounds are susceptible to oxidation when exposed to oxygen^[14] as opposed to their salt form which is stable. The exact methods and quality of the original Indra extraction was never documented, so the real composition of the product remains uncertain.

Data demonstrating ibogaine's efficacy in attenuating opioid withdrawal in drug dependent human subjects was published by Alper et al. (1999)^[15] and Mash et al. (2000).^[16]

Formulations

Pure crystalline ibogaine hydrochloride is the most standardized formulation dosing and typically must be produced by the semi-synthesis from voacangine in commercial laboratories. In Bwiti religious ceremonies, the rootbark is pulverized and swallowed in large amounts to produce intense psychoactive effects. In Africa, iboga rootbark is sometimes chewed, which releases small amounts of ibogaine to produce a stimulant effect. Ibogaine is also available in a total alkaloid extract of the Tabernanthe iboga plant, which also contains all the other iboga alkaloids and thus has only about 1/5th the potency by weight as standardized ibogaine hydrochloride.^[17]

Total alkaloid extracts of T. iboga are often loosely called "Indra extract". However, that name actually refers to a particular stock of total alkaloid extract produced in Europe in 1981. The fate of that original stock (as well as its original quality) is unknown.

Pharmacology

The pharmacology of ibogaine is quite complex, affecting many different neurotransmitter systems simultaneously.^[18][19] Because of its fairly low potency at any of its target sites, ibogaine is used in doses anywhere from 5 milligrams per kilogram of body weight for minor effect to 30 mg/kg in the cases of strong polysubstance addiction. It is unknown whether doses greater than 30mg/kg in humans produce effects that are therapeutically beneficial, medically risky, or simply prolonged in duration.

Mechanism and Pharmacodynamics

Among recent proposals for ibogaine mechanisms of action is activation of the glial cell line-derived neurotrophic factor (GDNF) pathway in the ventral tegmental area (VTA) of the brain. The work has principally been accomplished in preclinical ethanol research where 40 mg/kg of ibogaine caused increases of RNA expression of GDNF in keeping with reduction of ethanol intake in the rat, absent neurotoxicity or cell death.^[20]

Ibogaine is a noncompetitive antagonist at α3β4 nicotinic receptors, binding with moderate affinity.^[21] Several other α3β4 antagonists are known, and some of these such as bupropion (Wellbutrin or Zyban), and mecamylamine have been used for treating nicotine addiction. This α3β4-antagonism correlates quite well with the observed effect of interrupting addiction. Co-administration of ibogaine with other α3β4-antagonists such as 18-MC, dextromethorphan or mecamylamine had a stronger anti-addictive effect than when it was administered alone.^[22] Since α3β4 channels and NMDA channels are related to each other and their binding sites within the lumen bind a range of same ligands (e.g. DXM, PCP),^[23] some "older" sources suggested that ibogaine's anti-addictive properties may be (partly) due to it being an NMDA receptor antagonist.^[24] However, ligands, like 18-MC, selective for α3β4- vs. NMDA-channels showed no drop-off in activity.

It is suspected that ibogaine's actions on the opioid and glutamatergic systems are also involved in its anti-addictive effects. Persons treated with ibogaine report a cessation of opioid withdrawal signs generally within an hour of administration.

Ibogaine is a weak 5HT_2A receptor agonist^[25] and although it is unclear how significant this action is for the anti-addictive effects of ibogaine, it is likely to be important for the hallucinogenic effects.^[26] Ibogaine is also a sigma₂ receptor agonist.^[27]

Metabolites

Ibogaine is metabolized in the human body by cytochrome P450 2D6, and the major metabolite is noribogaine (12-hydroxyibogamine). Noribogaine is most potent as a serotonin reuptake inhibitor and acts as moderate κ- and weak µ-opioid receptor full agonist and has therefore also an aspect of an opiate replacement similar to compounds like methadone. Both ibogaine and noribogaine have a plasma half-life of around 2 hours[7], although the half-life or noribogaine is slightly longer than the parent compound. It is proposed that ibogaine is deposited in fat and metabolized into noribogaine as it is released.^[28] Noribogaine shows higher plasma levels than ibogaine and may therefore be detected for longer periods of time than ibogaine. Noribogaine is also more potent than ibogaine in rat drug discrimination assays when tested for the subjective effects of ibogaine.^[29] Noribogaine differs from ibogaine in that it contains a hydroxy instead of a methoxy group at the 12 position.

Analogs

A synthetic derivative of ibogaine, 18-methoxycoronaridine (18-MC) is a selective α3β4 antagonist that was developed collaboratively by the neurologist Stanley D. Glick (Albany) and the chemist Martin E. Kuehne (Vermont).^[30]

Research

An ibogaine research project was funded by the US National Institute on Drug Abuse in the early 1990s. The National Institute on Drug Abuse (NIDA) abandoned efforts to continue this project into clinical studies in 1995, citing other reports that suggested a risk of brain damage with extremely high doses and fatal heart arrhythmia in patients having a history of health problems, as well as inadequate funding for ibogaine development within their budget. However, NIDA funding for ibogaine research continues in indirect grants often cited in peer reviewed ibogaine publications.

In addition, after years of work and a number of significant changes to the original protocol, on August 17, 2006, a MAPS-sponsored research team received "unconditional approval" from a Canadian Institutional Review Board (IRB) to proceed with a long-term observational case study that will examine changes in substance use in 20 consecutive people seeking ibogaine-based addiction treatment for opiate dependence at the Iboga Therapy House in Vancouver.

Legal status

Ibogaine and its salts were regulated by the U.S. Food and Drug Administration in 1967 pursuant to its enhanced authority to regulate stimulants, depressants, and hallucinogens granted by the 1965 Drug Abuse Control Amendments (DACA) to the Federal Food, Drug, and Cosmetic Act. In 1970, with the passage of the Controlled Substances Act, it was classified as a Schedule I controlled substance in the United States, along with other psychedelics such as LSD and mescaline. Since that time, several other countries, including Sweden, Denmark, Belgium, and Switzerland, have also banned the sale and possession of ibogaine.

In early 2006, a non-profit foundation addressing the issue of providing ibogaine for the purpose of addiction interruption within establishment drug treatment care was formed in Sweden.^[31]

Further reading

• Ibogaine: Rite Of Passage is a documentary film about the use of ibogaine in Bwiti tradition and addiction medicine. [8]
• Daniel Pinchbeck writes of his own experience with ibogaine (among other psychoactives) in Breaking Open The Head [9]

See also

• Oneirophrenia

References