Will Ibogaine Fit into the Medicalized Psychedelic Landscape? 

Ibogaine has been making U.S. headlines since the 1990s for its efficacy in treating opioid dependency. More recently, interest in ibogaine as an addiction treatment has been amplified by the growing awareness of psychedelics’ therapeutic potential. 

So where does this compound derived from the African plant shrub Tabernanthe iboga and used ceremonially by the Bwiti people of Gabon stand in the ever-evolving landscape of psychedelic research and policy in the U.S.?

Scarce research. Much of what we know about ibogaine’s anti-addictive properties is substantiated by “a large number of uncontrolled and anecdotal case studies” conducted at clinics in places where ibogaine is unregulated, like Mexico, New Zealand, the Netherlands, and Panama, write the authors of a new review of ibogaine’s legacy within the current psychedelic renaissance

Clinical research into ibogaine has been scarce due to safety concerns. But according to the review, ibogaine has joined “the current landscape of psychedelic medicines in clinical development” after being granted regulatory approval for human testing. In 2020, ICEERS launched the first ever Phase II clinical trial to study ibogaine as a treatment for opioid dependence. 

Unique hurdles. The prospect of ibogaine-assisted therapy faces unique hurdles that MDMA and psilocybin therapy doesn’t. There’s the length of the experience itself, which can last anywhere from twelve to eighteen hours, says Dimitri Mugianis, a harm reduction activist who was a prominent underground ibogaine provider in the 2000s. “How long it lasts makes it really difficult to contextualize within a medical framework,” adding that it can be “incredibly costly.” 

“If you have to pay between three and five thousand dollars to get ibogaine treatment in Mexico, can you imagine what that would be in the States?” says Mugianis, who now runs Cardea, a therapeutic ketamine clinic in Lower Manhattan. “How are we going to insert it into a system that’s working very efficiently at creating a lot of money for private corporations, and for medical oligarchy?”

Ibogaine also carries inherent cardiac risks that aren’t present with other naturally occurring psychedelics. Many complications can arise during the course of treatment, says Mugianis. 

The advent of “trip-free” psychedelics may be one way to bypass the lengthy experience and safety risks while integrating ibogaine into the medical landscape. One biotech company, Delix Therapeutics, is developing a synthetic compound derived from ibogaine that the company claims will eliminate the psychedelic experience and not cause cardiac arrhythmia, while preserving its anti-addictive effects.

Ibogaine decrim. In parallel, some cities in states like California and Massachusetts have decriminalized ibogaine along with other natural plant medicines. California Senator Scott Wiener’s proposed statewide psychedelic decrim initiative SB 58, which includes ibogaine, is also in the works. 

Last December, Proposition 122 passed in Colorado. In addition to decriminalizing personal use and possession of naturally occurring plant medicines, including ibogaine, it will create a regulatory framework for the therapeutic usage of these substances in medicalized contexts. 

In a recent Lucid News article, Kevin Franciotti argues that it is crucial for those in Colorado planning to administer ibogaine through licensed facilities to assemble a team of qualified medical professionals who know how to navigate ibogaine’s cardiotoxicity and properly assess patients for risk factors. That certainly will drive up costs.

Harm reduction. Inevitably, there will be people who opt to do ibogaine outside of regulated frameworks, and reliable harm reduction information should be made available to them, says Mugianis. “This information has to be accessible, because whether it becomes decriminalized or medicalized, most people are not going to be able to afford it,” he says. “I doubt Medicaid or other insurance will cover it. Maybe they will. But there’s still going to be a segment of people that want to do this at home on their own.”

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^{Image: By Nicki Adams, using an adapted photo by Dick Culbert}