Clinical and forensic aspects of ibogaine

Ibogaine, a natural alkaloid from the African shrub Tabernanthe iboga, has been used to treat substance abuse but is illegal in several countries due to hallucinogenic and cardiotoxic effects. It acts on multiple sites in the central nervous system and heart, which may explain its efficacy in reducing drug-seeking behavior and opioid withdrawal symptoms. However, over 30 deaths since 1990 are linked to ibogaine, likely from cardiac effects. Contributing factors include the long half-life of its active metabolite noribogaine, accumulation in adipose tissue, and poor metabolizer status. Further study of ibogaine's medical uses and adverse effects is needed.

Study at a glance

Abstract

Ibogaine is a natural indole alkaloid derived from the African shrub Tabernanthe iboga used in the treatment of psychoactive substance abuse. There has been made an extensive search regarding ibogaine's historical context, clinical and forensic features. Ibogaine's consumption was made illegal in several countries due to its hallucinogenic and cardiotoxic effects. It has shown to act on a variety of sites in the central nervous system and in the heart. Most of these mechanisms seem to explain ibogaine's efficacy in decreasing drug-seeking behavior and opioid withdrawal symptoms. However, it has been related to more than 30 deaths since 1990 which seem to be caused by the effects in cardiac receptors. Many factors appear to explain ibogaine late effects including the long half-life of its active metabolite, noribogaine; accumulation of ibogaine in adipose tissue; and the existence of poor metabolizers. Therefore, it is necessary to further study the potential medical uses of ibogaine as well as its adverse effects.