Iboga: Basic Info

Basic info

Tabernanthe iboga is a shrub of the Apocynaceae family native to Central Africa, whose root bark is traditionally used in initiatory rituals as a sacrament.

The root bark contains the principal alkaloid ibogaine and 11 other iboga alkaloids. Ibogaine is the most researched of the known iboga alkaloids. It is estimated that the plant’s other alkaloids could also have therapeutic properties.

There are several recognized species of plants that containe the alkaloid ibogaine: Taberntanthe iboga, Voacanga iboga, Tabernaemontana, Tabernanthe Manii. Tabernanthe iboga is the most commonly used among the different mentioned shrubs. The main part of the ibogaine used by treatment providers comes from Tabernanthe iboga, although ibogaine from Voacanga iboga, a more sustainable option, is increasingly available.
Iboga has been shown to be effective in reducing severity of substance use disorders, eliminating the withdrawal syndrome associated with opioid use, and in reducing the compulsive desire (craving) to consume a wide variety of drugs. The iboga experience can facilitate a deep review of one’s personal history and current situation as well as modification of behavior and perceived role in family and society.

Origin/History

Although iboga grows in several places in Central Africa, its strongest roots are in Gabon, where it is used in ceremonies and rituals. Its use has also spread among Fang com­munities of Equatorial Guinea and southern Cameroon. Importantly, in Gabon, iboga cannot be understood outside of its link to the spirit world through ancestral spiritual trad­itions, such as Bwiti, practiced by communities of about fifty ethnicities. Iboga – also known as bois sacré (meaning “sacred wood”) – is a sacred medicine that plays a role in traditional rites of passage as well as in traditional healing processes.

Spirituality and the use of traditional healers is a common and popular healing modality in Gabon, as it is all over Africa. A Nganga (spiritual practitioner) can help a person in any sphere of their life. In fact, in Gabon, modern Western medicine is often combined with trad­itional medicine. While the former deals mainly with the physical body, the latter specializes in matters of the spirit. Iboga and its spiritual traditions are key components to this approach.

Iboga is often defined as a person with her own soul who connects humans to the spirit world. Iboga does not heal directly, but rather supports healing. According to Ngangas, iboga’s healing properties regarding substance use disorders, for which it has become well known in Western countries, are because this plant purifies and heals the spirit. It does this by opening the door for constructive examination of past experiences, including those on the margins of consciousness. Iboga connects people to themselves, allowing deactivation of spirit-related pathologies, such as substance use disorders.

Ibogaine in Western society

In 1962, Howard Lotsof, a young man from New York with a heroin dependency, along with six other heroin-dependent friends, conducted an experiment. They ingested ibogaine and the next day, six of the seven friends stopped using heroin. They didn’t experience withdrawal nor have any desire to consume heroin. In the following years, efforts to ensure that ibogaine would be considered a valid alternative for the treatment of opiate use disorder obtained little response from the pharmaceutical industry. NIDA (National Institute of Drug Abuse) developed a 4,000-page Drug Master File (DMF), including 16 volumes of pre-clinical studies. In 1993, the FDA approved a Phase 1 clinical trial, which concluded after the first treatment due to patent disputes.

In 1995, NIDA decided not to continue supporting ibogaine research. But drug user groups and advocacy organizations promoted its use and made it available to the public in alternative non-clinical settings. The number of treatment providers and demand on behalf of those seeking to end drug dependency has grown exponentially in the last ten years. There are ibogaine clinics in several countries and treatment providers across the globe. In 2009, New Zealand was the first country in the world to accept ibogaine as a medication. In 2017, Health Canada added ibogaine to the Prescription Drug List (PDL), meaning that the drug can only be obtained legally with a medical prescription. However, this will not be possible until clinical trials have been completed.

Chemical composition and dosage

The root bark of Tabernanthe iboga contains the alkaloids ibogaine, ibogaline and ibogamine.

Extracts from the bark of the plant were legally used in the past for various purposes, including the treatment of asthenia (in doses of 10-30 mg daily), as a neuromuscular stimulant (in doses of 200 mg of extract, about 8 mg of ibogaine), and for the treatment of depression, fatigue and recovery from contagious diseases. These uses have not been properly investigated and there are currently no prescription medications containing ibogaine.

For the treatment of substance use disorders, with regards to withdrawal syndrome and avoiding cravings, Lotsof recommended a dose of 15-20 mg/kg of ibogaine, although the safety of these doses in clinical trial settings remains unknown. Ibogaine is considered to carry a notable cardiovascular risk because it can produce unforeseen physiological reactions, including fatality, so it is always recommended to consume ibogaine in controlled environments with health professionals trained in cardiac emergencies.

Another method that has been used to mitigate the withdrawal syndrome of methadone and other opioids and gradually reduce their use is the repeated dosing of small, increasing amounts of ibogaine. In one case, a total of five dosages were used, in amounts of 150, 300, 400, 500 and 600 mg of ibogaine. This dosing only produced mild psychological effects while allowing complete detoxification from methadone. Preliminary results from an ICEERS clinical trial currently underway indicate that following doses of 100 mg, patients experienced relief from methadone syndrome for several hours. There are currently no studies that provide similar results with such a low dose for short acting opioids, such as heroin or morphine.

In personal growth and self-exploration contexts, high doses of ibogaine, iboga or its extracts are commonly used, which produce an intense subjective experience. In these cases, the doses are often similar to those proposed by Lotsof.

Effects

Ibogaine induces an introspective experience that is often referred to as deeply psychotherapeutic. It is referred to as an “oneirophrenic” as it can induce a waking dream state, although this is not always the case. An experience with ibogaine is not considered hallucinogenic because the individual is usually aware of where he or she is. They are typically aware that the experience is caused by the ingestion of ibogaine and that the visions during the experience are internal projections, although there are exceptions to this.

The initial phase of the experience can often consist of intense visual introspection lasting between seven and 12 hours. It is often saturated with information that may be experienced more objectively, as an observer, while deeper psychological integration of the content is not accessible. During the following 24 hours of the experience, the visionary phase ends and the contents of the experience can be integrated in a cognitive process. Subsequently, this integration process may continue to develop in daily life for months as the individual re-defines their identity and interpersonal dynamics related to their environment.

Anti-addictive effects

Despite the existence of a vast quantity of animal studies, only limited evidence is available on the effectiveness of ibogaine in humans. However an increasing number of studies, case studies, and testimonies of substance-dependent people who have undergone this treatment support the findings regarding its potential as a tool for the treatment of substance use disorders. Iboga seems to be especially useful for opioid dependence, and to a lesser extent (and with greater risks) in the treatment of cocaine and amphetamines dependence. Ibogaine does not attenuate alcohol or benzodiazepine withdrawal syndrome, although it attenuated alcohol intake in animal studies and has been shown to be helpful anecdotally in humans.

Iboga has a multi-target profile and it has been named as an “atypical psychedelic,” due to its complex interactions with different neurotransmitter systems. Ibogaine regulates the dopaminergic and serotonergic systems. It binds to NMDA, opioid, and nicotine receptors, and increases the production of neurotrophic factors, such as GDNF or BDNF (proteins that promote neuroplasticity).

It is believed that this combination of effects reduces the desire to consume certain substances and promotes the tendency toward new behaviors. This makes it an effective tool for both substance and behavioral dependencies when used with the appropriate expectations and perspective.

Although some people are able to resolve their substance use disorder with a single administration of iboga or ibogaine, for many others this is unrealistic.  Habituations can be deeply embedded, and withdrawal symptoms and the desire to consume may persist.

Ibogaine can be a substance dependency interrupter and a catalyst for change and may provoke deep psychological insights and increased self-awareness.

Legal status

Since the discovery of the anti-addictive properties of ibogaine in 1963, the global acceptance of its therapeutic application and its development as a medicine has been very slow.

Ibogaine is not under control in the 1971 UN Convention on psychotropic drugs. Thus, in most countries, iboga and ibogaine are not scheduled substances. Ibogaine is currently illegal in 10 countries (the United States and nine European countries, namely, Belgium, Denmark, France, Hungary, Ireland, Italy, Norway, Switzerland, and Sweden). There are three countries where it is regulated (Australia, Israel and Canada); and three more countries where it is legal as a prescription pharmaceutical substance, “compassionate use,” or extended access (New Zealand and South Africa).

However, the lack of regulation does not necessarily imply that the use of iboga or ibogaine can be considered to be legal. Furthermore, even when there is no legal framework that regulates it, administering a substance without a license (particularly if making medical claims) may lead to criminal charges or administrative penalties according to domestic legal frameworks in a given country.

In Gabon, iboga is legal and was declared a “national treasure” in 2000. In 2019 the government suspended exportation of all iboga. Wild harvested iboga is prohibited for export and the only iboga permitted to be exported is that which has been cultivated and complies with the Nagoya Protocol.

Biocultural sustainability

Bio-cultural sustainability of iboga is of great concern. Tabernanthe iboga has traditionally grown freely and abundantly in the forests of the Congo Basin and therefore communities have never needed to cultivate it. The Union for Conservation of Nature’s Red List of Threatened Species has listed Tabernanthe iboga as a plant of “least concern”, however not as endangered.

The major factors in­fluencing the regenerative capacity of iboga in the wild and its availability in urban areas, are the extensive illegal harvesting for sale in international markets, the seizure of domes­tic shipments by police, and deforestation. Increased demand for iboga and ibogaine internationally is certainly having an impact and placing increased pressure on wild populations of the plants in Gabon.

Efforts to ensure sustainability for the plant include: cultivation by traditional communities, agroforestry cultivation initiatives, pressure to stop iboga poaching from the wild, and developing pathways for implementation of the Nagoya Protocol, which would ensure access and benefit sharing.

As noted above, in February 2019, the Gabonese government halted all exports, stating concerns for the sustainability of the plant. They are developing mechanisms for export in line with the Nagoya Protocol. It is important that traditional communities have their voices heard on this issue and that they receive benefits from sharing iboga with the world.

An ideal future for iboga is one where iboga and the sacred practices that surround it contribute to the spiritual and economic emancipation of traditional communities in Gabon. This means building widespread recognition of the value of iboga, honoring the communities who have stewarded these teachings and practices, and supporting efforts to ensure traditions and knowledge are passed on from generation to generation.

Health and risk reduction

The greatest concern about the known risks of taking iboga or ibogaine is that it decreases the heart rate (bradycardia) and prolongs the QT interval, a measurement of the time between the onset of the Q wave and the end of the T wave in the electrical cycle of the heart. Therefore, people with a history of myocardial infarction, murmurs, arrhythmias, heart surgeries or severe obesity should not take ibogaine. An electrocardiogram (ECG) is the absolute minimum test required, but a stress test and/or 24-hour monitoring with a Holter increases the possibility of detecting important abnormalities. The presence of a skilled physician (preferably a specialist in cardiology and emergency medicine) during the session, who monitors variations in heart rhythm and other vital signs, significantly increases the safety of this treatment.

Another risk factor is pulmonary embolism. This occurs when there are blood thrombi in the veins, such as those that can occur during prolonged immobility during airplane travel, car accidents, or blood-related diseases. When these clots circulate through the body during an ibogaine session, they can reach the lungs, where they can cause an embolism with the risk of suffocation. The risk of pulmonary embolism can be reduced by doing sports or exercise after long, sedentary trips and by avoiding initiation of treatment immediately after arrival at the destined treatment location. People with bleeding problems, chronic blood clots, or people who have recently been involved in accidents that have caused bruising and bleeding should be excluded from treatment.

Another cause of adverse effects is the interaction of iboga or ibogaine with other drugs or pharmaceuticals. Before taking ibogaine, the recipient should avoid consuming drugs for a sufficient period of time to ensure that the drug has been eliminated. This depends on the half-life of the drug, and is different for each substance. On the other hand, foods and substances that are metabolized by the enzymes CYP2D6 (an enzyme involved in the metabolism of many drugs) should be avoided, since they could interact with ibogaine, and potentiate its effects of bradycardia and QT prolongation. There are lists of such substances available on the Internet. Quinine and grapefruit belong to this group and should be avoided before and during treatment.

Given that iboga is offered in such a variety of forms, taking a material whose chemical composition and potency are unknown is another risk factor. It is important to know the exact dose and composition of what is being consumed to avoid overdose or complications.

Psychological risks

Although some centers accept people with psychiatric disorders such as bipolar, borderline personality disorder, etc. – and certain patients do report an improvement in their condition – nothing is known about the effects of ibogaine on such disorders or the risks that it involves. It is a dangerous landscape. In general, people with psychiatric disorders such as those mentioned above, as well as those suffering from schizophrenia and a history of psychosis, must be excluded from this treatment, since ibogaine could cause the reappearance or worsening of symptoms. Similarly, the interaction of ibogaine with certain psychotropic drugs can be dangerous. An in-depth psychiatric review as well as the supervision of a psychiatrist is important before engaging in treatment in case of the existence of a psychiatric disorder or the use of certain medications.

In addition to psychiatric risks, iboga and ibogaine are powerful psychoactive practices that can induce an introspective experience that is not always easy to manage. Episodes of extreme anxiety can occur, and in more serious cases, paranoia. A skilled facilitator should be able to offer necessary support to the individual and assist with difficult episodes. Proper preparation with the guidance of a therapist can help greatly in improving self-confidence, going into the experience with an appropriate mental state and being prepared for possible difficult experiences.

Prevalence of use

Iboga and ibogaine practices have gained popularity, particularly with regards to treatment of substance use disorders and, more recently, psychospiritual exploration. It is usually administered in centers or clinics that specialize in the treatment of substance use disorders. The range of these centers is extremely varied, from legal clinics that openly advertise their services and have medical equipment and personnel, to individual providers that administer ibogaine in apartments or rural homes to those seeking treatment for substance use. Growing rates of opioid use disorder, particularly in North America, has led to increasing interest in the potential of iboga for supporting detoxification and healing.

Further, in a survey conducted by ICEERS in 2019, we learned that there are increasing numbers of people who are microdosing with iboga (taking small, imperceptible doses regularly). The motivations for this practice of microdosing are diverse, and may include wanting cer­tain health benefits or to seek insights into issues of concern. When iboga is consumed in small doses it is said to reduce tiredness, hunger, and sleep, and increases attention spans.

Increasingly there are groups who are engaged in psychospiritual practices with iboga outside of Central Africa, some of them drawing on Bwiti and other spiritual iboga traditions. They incorporate elements of traditions into their sessions, such as music, plant baths and ritual offerings. These types of practices appear to be growing in popularity. However, it must be noted that too often practitioners are not providing adequate screening or integration support. Care must be taken to ensure the risks outlined above are taking into consideration in both clinical and ceremonial settings.

In a 2018 ICEERS survey (conducted as part of the scope of a European Union funded project), out of 593 respondents, all with experience with psychoactive plants, only 60 answered yes to having ever used iboga. This percentage is one of the lowest, along with khat, Argyreia nervosa, Incilius alvarius and the Daturas.