A systematic literature review of clinical trials and therapeutic applications of ibogaine.

Ibogaine and its alkaloids reduce withdrawal symptoms and craving in substance use disorders, and may also improve depression and trauma-related symptoms. However, severe medical complications and deaths have been reported, linked to neuro- and cardiotoxic effects. Two fatalities occurred among 705 individuals across 24 studies, which included two randomized controlled trials and 17 open-label studies. Ibogaine's distinct psychoactive and somatic effects set it apart from classic hallucinogens like LSD and psilocybin. Rigorous medical monitoring is needed for safe application.

Study at a glance

Abstract

Iboga and its primary alkaloids, ibogaine and noribogaine, have been of interest to researchers and practitioners, mainly due to their putative efficacy in treating substance use disorders (SUDs). For many SUDs, still no effective pharmacotherapies exist. Distinct psychoactive and somatic effects of the iboga alkaloids set them apart from classic hallucinogens like LSD, mescaline, and psilocybin. The study team performed this systematic review focusing on clinical data and therapeutic interventions involving ibogaine and noribogaine. The team conducted a search for all publications up to December 7, 2020, using PubMed and Embase following PRISMA guidelines. In total, we identified 743 records. In this review, we consider 24 studies, which included 705 individuals receiving ibogaine or noribogaine. This review includes two randomized, double-blind, controlled clinical trials, one double-blind controlled clinical trial, 17 open-label studies or case series (including observational or retrospective studies), three case reports, and one retrospective survey. The published data suggest that ibogaine is an effective therapeutic intervention within the context of SUDs, reducing withdrawal symptoms and craving. Data also point toward a beneficial impact on depressive and trauma-related psychological symptoms. However, studies have reported severe medical complications and deaths, which seem to be associated with neuro- and cardiotoxic effects of ibogaine. Two of these fatalities were described in the 24 studies included in this review. Treatment of SUDs and persisting comorbidities requires innovative treatment approaches. Rapid-onset therapies such as the application of ibogaine may offer novel treatment opportunities for specific individuals. Rigorous study designs within medical settings are necessary to warrant safe application, monitoring, and, possibly, medical intervention.