Psychoactive plant derivatives (ayahuasca, ibogaine, kratom) and their application in opioid withdrawal and use disorder - a narrative review.
Journal of addictive diseases – January 01, 2024
Source: PubMed
Summary
Natural plant-based compounds show promise in addressing the opioid crisis. Ayahuasca, ibogaine, and kratom have emerged as potential alternatives for managing opioid withdrawal and addiction. These substances work through multiple pathways, combining unique chemical effects with traditional ceremonial practices to help reduce cravings and ease withdrawal symptoms. While ayahuasca and ibogaine often require supervised settings, kratom has gained popularity as a more accessible option for opioid use disorder.
Abstract
The opioid epidemic and limited access to treatment for opioid withdrawal (OW) and opioid use disorder (OUD) has led individuals to seek alternative treatments. This narrative review aims to educate clinicians on the mechanisms of action, toxicity, and applications of psychoactive plant-based substances patients may be using to self-treat OUD and OW. We specifically discuss ayahuasca, ibogaine, and kratom as they have the most evidence for applications in OUD and OW from the last decade (2012-2022). Evidence suggests these substances may have efficacy in treating OW and OUD through several therapeutic mechanisms including their unique pharmacodynamic effects, rituals performed around ingestion, and increased neuroplasticity. The current evidence for their therapeutic application in OUD and OW is primarily based on small observational studies or animal studies. High-quality, longitudinal studies are needed to clarify safety and efficacy of these substances in treatment of OW and OUD.