Neither Snake Oil Nor Silver Bullet: Ibogaine for Opioid Use Disorder

    But as fascinating as the pharmacology of ibogaine [is], it is the chemistry of this alkaloid that is overwhelmingly awesome.” — Alexander and Ann Shulgin, Triptamines I Have Known And Loved


    In the midst of a devastating overdose crisis, the need for effective, tolerable and well-evidenced treatment for opioid use disorder (OUD) has never been higher. Incredibly, there is a plant, the shrub iboga, or Tabernanthe iboga, alkaloids in the roots of which seem to have a remarkable ability to interrupt addiction and ease withdrawal.

    “It was one of the most significant transformative experiences in my life,” Kevin Franciotti told Filter. He received treatment with ibogaine hydrochloride, the extract of this plant, for heroin addiction in 2011. “There are moments in your life that you think about every day, that you carry with you every day, and my ibogaine treatment certainly fits that standard.”

    Ibogaine is currently illegal in the United States. That could change. But in a society where ability to pay, racial and class disparities, and deep stigma interact intensely, the exact way it rolls out and who is responsible will determine who—and whether—it helps.

    Meanwhile, could the attraction of ibogaine for OUD damagingly distract from the vital need to improve access to methadone and buprenorphine, OUD medications proven to reduce mortality—or even from advocacy for safer opioid supply?

    As an extract of the bark of the iboga root, ibogaine, a tryptamine, appears to have the ability to substantially reduce withdrawal symptoms while providing insight or psychological relief for the feelings that may perpetuate OUD. It also seems to reduce the desire to use other drugs, and to help people seeking abstinence to maintain it for months or, with a second dose, even years.

    Tabernanthe iboga is native to West Central Africa, mostly Gabon and Cameroon, and has been used by the Mbiri and Bwiti tribes, among others, for centuries. High doses induce hallucinations in religious rites, while low doses have been used against hunger, fatigue and thirst.

    Although it’s a hallucinogen, ibogaine doesn’t work on the usual brain receptor targeted by psychedelics. It’s an oneiric, or dream-inducer, causing intense waking visions that only appear when the user’s eyes are closed.

    Ibogaine was isolated from the iboga root in 1901, and used in the West in the early 1900s to treat general weakness and as a neuromuscular stimulant. By 1955, researchers at the US Addiction Research Center in Lexington were trying it out on already-detoxified morphine users.

    “My body feels washed in a cleansing energetic blanket that completely removes the physical discomfort I’m feeling after 36 hours without heroin.”

    But ibogaine’s first prominent use in this country was by a man named Howard Lotsof, who at 19 was addicted to heroin and tried ibogaine in search of a new high. Instead, he quit drugs altogether, becoming an advocate for ibogaine treatment and the father of the “Lotsof method” still practiced by American-run ibogaine clinics.

    This method of quick detoxification through ibogaine emphasizes individual attention. Administration requires, Lotsof himself wrote as recently as 2009, “art, craft, and practice,” and “each person treated and each experience has unique characteristics that must be observed and responded to uniquely.”

    Ibogaine prohibition began in 1967; the FDA classed it as a Schedule I drug in 1970. Yet in 1986, Lotsof was awarded a patent for its use in opioid withdrawal. Later patents expanded its indications to dependence on cocaine and other stimulants, alcohol, nicotine and finally for “polysubstance abuse.”

    Its US legal status makes ibogaine challenging to use as a treatment, and challenging to research. But ibogaine is being used legally by Americans right now. Those with mobility and money are able to access it as a treatment for OUD—plus everything from alcohol, benzodiazepine or nicotine withdrawal to depression and stress. This happens at clinics in Mexico and other countries with different rules. Americans working with local staff in Mexican clinics, particularly, hope to bring legal ibogaine treatment over the border.

    Research substantiates the assertion that ibogaine has some remarkable properties for the treatment of addiction.

    “My body feels washed in a cleansing energetic blanket that completely removes the physical discomfort I’m feeling after 36 hours without heroin,” wrote Franciotti in 2015 testimony for the Multidisciplinary Association for Psychedelic Studies (MAPS) about his treatment, which was part of a 2011 MAPS clinical trial. Franciotti is now a psychotherapist and harm reduction advocate who has also written for Filter.

    The easing of opioid withdrawal symptoms is just one of ibogaine’s relevant properties.

    It was sold in France for many years as Lambarène, an antidepressant and stimulant post-infection or in cases of fatigue, before being removed from the market due to adverse effects (of which, more later). It has a profound impact on structural neuroplasticity in the brain’s cortex.


    It’s a Luxury Treatment

    Ibogaine Clinic and Research Center is a private facility of the type Franciotti first attended in northern Mexico, but located further south, at a spa-like beach resort in gorgeous, sunny Playa del Carmen, in the state of Quintana Roo.

    American founder David Dardashti’s colorful history, according to his LinkedIn profile, includes being cantor at the United Synagogue in Palm Beach, developing shopping malls in Florida, studying ethnomusicology, and “healing 7,000 individuals” (his clinic website states that 3,000 patients have undergone its “life-changing ibogaine retreat, rehab and detox experience”).

    The center offers ibogaine hydrochloride-assisted treatment for a remarkably wide range of indications: Suboxone dependence, sexual trauma and eating disorders are listed, as well as “executive burnout” and “chakra alignment” (according to the website, Dardasthi treats himself once a year for “anti-aging purposes”).

    Although this is just one of dozens of ibogaine clinics, its rhetoric and claims—even the offbeat life history of its founder—might be viewed as fairly typical. Its website freely mixes references to peer-reviewed scientific papers, New Age language and the promise of a detox experience that is easy but potent, safe but life-changing, specialized yet responsive to practically any condition, offered by staff trained at “prestigious institutions.”

    You can see a similar presentation—with a bit less New Age language but not without far-reaching claims, massage, and nutraceuticals pre- and post-treatment—at Clear Sky Recovery, in Cancun, Mexico. The facility boasts founders including Dr. Deborah Mash, a scientist who held the first FDA approval for clinical testing of ibogaine on humans with substance use disorder, and who remains perhaps the most prominent advocate for its medical use.

    Dr. Mash did not respond to interview requests, but Filter spoke by video call with Ibogaine Clinic and Research Center’s operations director, Cole Barressi.

    Barressi described ibogaine as a substance that touches the subconscious, making events, including traumas and shame going back to childhood, run like a picture reel through patients’ minds.

    “The brain is firing again on all cylinders after arriving in treatment, and in the long term it’s not something that wears off.”

    “We do use it for every substance,he said. “There’s a proper protocol for everything … our protocols are much different now depending on what they’re on. Even alcohol looks much different from opioids, stimulants—Adderall, methamphetamines. Cocaine is much different than the others. We’re treating people for neurological disorders, bipolar, schizophrenia, early stages of Alzheimer’s, Parkinson’s, neuropathy.”

    Barressi claimed that nerve pain is cured 100 percent of the time, while for dementia, the clinic can guarantee a 65 percent better lifestyle. “It’s a drastic improvement where … most people actually are declining at a rapid pace.”

    He also claimed that the therapeutic effects can be permanent: “What we do know is that the brain is firing again on all cylinders after arriving in treatment, and that in the long term it’s not something that wears off.”

    Unlikely though it soundsand indeed, there is no solid evidence to date that ibogaine is an effective treatment for aging, nor indications like Alzheimer’s, despite initial findings that it acts on a particular brain receptor implicated in this and other diseasesibogaine does indeed offer the possibility of finally having an effective medication-based treatment for addictions to substances other than opioids, such as cocaine or nicotine.

    “We do have options particularly for [opioid] use disorder and then to a lesser extent a few for alcohol use disorder, but we have nothing for stimulants. Benzodiazepines are brutal [to withdraw from] and the illicit drug market is constantly changing,” Franciotti noted.

    However, while anecdotal reports exist, there is currently little evidence, particularly human clinical trial evidence, supporting ibogaine for treatment of benzodiazepine or methamphetamine use disorders.

    At Ibogaine Clinic and Research Center, different substances, conditions and protocols come with different costs. For “stress management optimization” for “high-functioning executives,” professional athletes, singers and others, a four-day treatment costs approximately $6,500, roughly in line with similar clinics.

    All of this is financially out of reach for most people.

    An eight-day program for someone “in psychosis, completely disconnected from reality” due to excessive cannabis smoking along with antidepressants or other psychiatric medication—Barressi’s example—might involve two ibogaine treatments at $9,500.

    The center also offers to help people to quit effective, relatively cheap OUD treatments that are demonstrated to prevent death.

    A program involving withdrawal from buprenorphine, methadone, fentanyl or other opioids might involve three treatments, 10-to-12 days in the clinic, and a cool $11,500-$13,000.

    Some treatments, such as for dementia, might require a month-long stay.

    All of this is financially out of reach for most people. The clinic does offer discounted rates for repeat guests, and Barressi, whose commitment to his patients is palpable—he postponed the interview twice to attend to new arrivals—said he’d be delighted if they could work with insurers to reduce costs to patients (or to the parents who often foot the bill for younger clients). 


    It’s Often Tied to Abstinence

    One of the advantages of ibogaine is that it’s not an ongoing treatment. However, it’s not clear just how long its effects may be relied upon, which poses important questions about the safety of the technique.

    People who use opioids will have lowered tolerance if they become abstinent; in a dangerous, unregulated opioid market, they run a high risk of overdose if they return to use.

    A mentee of Howard Lotsof and an early underground provider of ibogaine in the early 2000s, New York City harm reductionist Dimitri Mugianis has since become highly critical of forms of ibogaine advocacy that he sees as putting people at risk through a focus on abstinence.

    “The vast majority of people go back to using, making them susceptible to overdose, but also to a lot of shaming.”

    “These folks who would call themselves harm reductionists are actually operating from an abstinence-based place,” he told Filter in a video interview. “That’s the only measure of success, particularly with ibogaine and opiates. So you go through an arduous process, which sort of interrupts the addiction … a lot of cases you go through hell and then … the vast majority of people go back to using, making them susceptible to overdose, but also susceptible to a lot of shaming.”

    Mugianis himself received successful ibogaine treatment in the Netherlands in 2002, for addiction to substances including heroin and cocaine. “Then you look at a lot of people’s lives and the least of their problems is the actual drug use,” he said. “There’s structural issues.”

    Franciotti, whose first ibogaine treatment took place in 2011, began using heroin again in 2017, following his father’s sudden death. He avoided overdose and ultimately self-tapered back to abstinence.

    Faced with another family tragedy in 2022, Franciotti felt that it was only a matter of time before he risked resuming heroin use. To preempt this, he took part in a traditional iboga grief ceremony in Costa Rica, and is once again doing well.

    Franciotti, who advocates for US ibogaine access, is acutely conscious of how expense, as well as laws, impede this, although he does see value in intensive programs or rituals accompanying ibogaine use.

    “It’s complicated, particularly in the United States,” he said, “because when I imagine what it would actually take to bring a medicine like ibogaine into a regulated environment, we’re no longer talking about, you know, a $30,000 stay at a 30-day inpatient facility. We’re talking about $30,000 a week.”


    It’s a “Dirty Drug”

    Ibogaine is “a dirty drug because it activates or inhibits a bunch of different receptors especially in the central nervous system,” Brian Shoichet told Filter. A professor in the Faculty of Pharmaceutical Chemistry at the University of California-San Francisco, Shoichet seeks out new methods of drug discovery by synthesizing molecules and modeling the way biological molecules work together.

    Dirty, when applied to drugs in this context, isn’t a pejorative term; for toxicologists and others, it just describes how ibogaine works on our kappa-opioid receptors, on our nicotine receptors and on one of our serotonin receptors, among other targets.

    This property, technically called polypharmacology—promiscuous is another term applied non-pejoratively—may be helpful to treat conditions that involve behaviors, like depression, schizophrenia or, yes, addiction. But these drugs are hard to dose correctly because of great variability in how different people metabolize them.

    Ibogaine has additional major drawbacks. It may be neurotoxic, is definitely cardiotoxic, and has been associated with deaths—although very few, relatively speaking, and with “advanced preexisting medical comorbidities” often present in those cases.

    Of greatest concern is its risk to the heart, particularly by causing arrhythmias. At the Dardashti clinic, according to the website, they screen for cardiac risk and spend a lot of time checking people’s cardiac response.

    “Ibogaine is a really exciting molecule that teaches us a lot, and you can develop molecules that are more selective.”

    It’s a measure that Shoichet doesn’t think would be adequate, partly because the cardiac risk comes from ibogaine’s effect on a particular potassium ion channel in the heart, not something you can test for. This ion channel poses a particular problem that often leads the FDA to tell drug developers a given drug is not safe, according to UC Davis chemist David Olson, who also spoke with Filter about his ibogaine research.

    “I think that ibogaine is a really exciting molecule that teaches us a lot, and you can develop molecules that are more selective,” Shoichet said.

    In fact, that’s exactly what he and his team have done by discovering two SERT inhibitors, which block the brain’s serotonin transporter similarly to ibogaine and SSRI drugs like Prozac. These molecules, they report, are potent, less promiscuous than ibogaine, and not problematic for the heart.

    In 2020, meanwhile, Olson and his colleagues engineered tabernanthalog, or TBG, a synthetic molecule that’s again like ibogaine, but without the hallucinogenic aspect.

    “Essentially what we did is we took the structure [of ibogaine] and we sliced off different parts of it,” Olson said. To use a car analogy, “we chopped off the door, we removed the windshield, and we found that we still had something that produced everything like therapeutic effects, but was a lot easier to manufacture.”

    The new drug is licensed to Delix Therapeutics Inc., a company Olson started, and is still at a preclinical stage, having been tested on zebrafish so far and confirmed to not bind to the ion channel of concern in the heart. Promisingly, the researchers also found that it encouraged formation of new dendrites, or branches, on rat neurons—and new spines on the dendrites. This suggests effects like the neuroplastic and brain cell regenerating property of psychedelics such as ketamine, LSD and DMT.

    Such neuroplasticity may be an important aspect of ibogaine’s effect on addiction, re-establishing synaptic connections in the prefrontal cortex that appear to be damaged in people with substance use disorder.

    Core to these explorations is the notion that one day, drugs with ibogaine-like properties could—in the absence of substantial risks—be take-home medications for far more people than will ever access ibogaine itself.


    And It’s illegal

    Ibogaine is illegal in the US and several other countries. But its sale is decriminalized in Portugal, and it’s unregulated in Germany and Mexico. It’s controlled in other places and can be prescribed, for example, in Australia and New Zealand. In the Netherlands, where it’s not regulated but also not criminalized, there are many ibogaine treatment centers, the same situation as in Costa Rica.

    Hopes of bringing ibogaine to the US rest largely on the growing interest in psychedelics and on initiatives to decriminalize or medically regulate drugs in this class.

    States like Colorado and Oregon seem like the most immediate prospects for progress.

    There’s certainly no shortage of people ready to launch businesses selling ibogaine or ibogaine treatment the minute it’s legal to do so. Barressi said his clinic works with veterans organizations and others in the US, including MAPS, who want to see an expansion of access to the addiction treatment.

    States like Colorado and Oregon seem like the most immediate prospects for progress. Ibogaine made it onto Colorado’s Proposition 122, which squeaked into law last year; so licensed “psychedelic healing” facilities, and perhaps addiction treatment centers, should be able to offer ibogaine, among three plant-based psychedelics, in the state as of 2026.

    At the federal level, Rick Doblin, founder of MAPSwhose drug development subsidiary has just submitted an application to the FDA for medical approval of MDMAexpects ibogaine to eventually receive a similar nod.

    In 2022, the Substance Abuse and Mental Health Services Administration said it would explore creating an interagency psychedelics task force to investigate possible use and deployment of psychedelic medicine and therapy. It’s possible, but not guaranteed, that ibogaine could be included by such a task force, which has yet to be announced.

    Perhaps more surprisingly, in July, the Kentucky Opioid Abatement Advisory Commission discussed possible use of opioid settlement money to fund development of a safer, ibogaine-based OUD treatment, possibly to the tune of $7 million over six years.


    What About the Masses?

    Like other researchers focused on the active molecules in the iboga plant, Shoichet argues that the goal of addiction medicine is to scale up to treat millions of people in need.

    His and Olson’s approaches—and similar molecule-based ventures, like the isolation of ibogaine analog 18-methoxycoronaridine, or 18-MC, which works on nicotinic receptors and appears to offer ibogaine’s anti-craving properties without the downsides—all aim to satisfy that requirement. What they’re looking to produce must be easy to administer, not require heavy clinical oversight, be relatively safe, be cost-effective to produce, and be standardized.

    The contrast to the current, Lotsof-inspired ibogaine model of unique, individualized experiences couldn’t be greater.

    How are we to assess the relative merits of a small, attentive clinic setting, where part of the therapy is kind attention, psychotherapy, massage and individual tweaking of the program—or a traditional, time-honored ritual, where it’s impossible to separate out the different components—versus the merits of a relatively safer, cheaper, easy-to-administer take-home treatment that can be implemented at scale?

    Each comes with the potentially corrupting profit motive. Each has a natural philosophical appeal: A synthetic can be made accessible to most people, and avoids the environmentally and culturally destructive aspects of illicit sales of iboga from Gabon (fair trade is so far not a major component of iboga sales, and it’s usually smuggled out of its country of origin). A small treatment center provides holistic supervision in a pleasant environment with a break from regular life.

    But again, these options share a critical caveat in the real-life context of mass opioid-involved overdoses and deaths: the risk of a person returning to use with increased vulnerability.

    “It won’t move the needle on the so-called opioid crisis or the overdose crisis. It won’t move the needle.”

    Unlike with the gold-standard OUD medications, methadone and buprenorphine, this risk is not mitigated by the person having maintained a level of opioid tolerance. Where abstinence is held out as the overriding goal, OUD patients will be required to put great faith, with limited evidential backing, in the long-term ability of ibogaine or similar drugs to protect them from the statistically extremely high risk of returning to use in a deadly unregulated market.

    When I asked some of the people quoted in this article about the risk of letting a person detox without providing a safety cushion in case of resumed use, various responses acknowledged but downplayed it. They pointed to ibogaine patients’ lack of desire to use again, thanks to newly gained insight into the causes of their substance use; or denied it’s like other forms of opioid detox and abstinence treatment, which raise the risk, compared to methadone and buprenorphine, of overdose death and emergency room admission.

    “It won’t move the needle on the so-called opioid crisis or the overdose crisis. It won’t move the needle,” Mugianis said of ibogaine.

    Kentucky’s overdose crisis, he argues in a recent op-ed, demands urgent action on proven large-scale responses targeted directly at the most marginalized people, instead of “diverting [opioid settlement] funds to an exotic research project.” As well as funding opioid agonist treatment, this could include housing, job training, childcare or covering transportation costs so that people can access evidence-based OUD treatment.

    “There’s an idea,” Mugianis told Filter, “that psychedelics will somehow magically transform society and will somehow lead to the … destruction of structural issues around class and race and gender … It’s just absolute fetishism, and harmful fetishism. We need to do the hard work of change.”

    It doesn’t have to be a zero-sum game.

    The promise of ibogaine is indeed enticing. It has been genuinely transformative for people like Franciotti. And it is emphatically worthy of further investigation—particularly in the form of a cheap, accessible pill, and particularly for addictions that don’t already have a medication-based treatment.

    But with improvements to dosing, convenience, side-effect management and dignified, equitable access, our existing OUD medications might turn from “liquid handcuffs” to something just as amenable to either spa resort treatment or a simple-to-take pill.

    It doesn’t have to be a zero-sum game. After all, a diversity of treatment options is good, and abstinence from opioids is a valid goal for people who choose it. But an opioid strategy that diverted either public awareness or resources away from methadone and buprenorphine in favor of ibogaine would be a costly mistake.  



    Photograph of Tabernanthe iboga by Scamperdale via Flickr/Creative Commons 2.0

    R Street Institute supported the production of this article through a restricted grant to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

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