Ibogaine’s Success Rates in Addiction Treatment
One of the most common questions we receive is about the success rates of ibogaine in addiction treatment; however, it is a question that can be complicated to answer.
The main variable is what you consider to be success. Ibogaine is most effective at helping to transition from a dependent state to a non-dependent state. It is very effective at reducing short-term withdrawals and long-term depression. However, long-term abstinence is something that depends on many other factors that vary so much from person to person.
There are several observational studies that have documented the results of people who have gone through treatment. The results from these studies are very specific, but they may help to shape more realistic expectations about what ibogaine can do, as well as what other kinds of support are necessary afterwards.
In a MAPS funded study of 30 subjects from clinics in Mexico, Thomas Kingsley Brown, et al., showed:
- A significant reduction of opioid withdrawals.
- 50% of subjects reported no opioid use at 30 days post-treatment.
- 33% of subjects reported no opioid use at 3 months post-treatment.
- 40% of subjects were defined as having a “favorable outcome,” meaning retention in the study for at least 9-12 months, and at least a 75% reduction in Addiction Severity Index (ASI) Drug Use scores.
- Across the board reductions in ASI Drug Use scores. These changes were maximal at 1 month, and between 3-12 months the changes were sustained.
- Significant improvements in ASI Family/Social and Legal Status scores that were sustained over the 12 month follow-up.
- A notable reduction in Psychiatric Status scores.
In a MAPS funded study of 14 subjects from New Zealand, Geoff Noller, et. al. showed:
- A significant reduction of opioid withdrawals.
- 1 year of abstinence from opioids in 50% of participants, and overall, an 80% reduction on the Addiction Severity Index (ASI-Lite) Drug section.
- Increased motivation and pursuit of other health services post treatment.
- A significant reduction in post treatment depression.
- Some participants reported significant reductions in other drug or alcohol use.
In a private study of 88 patients from Mexico, Alan Koi Davis, et. al., showed:
- 80% of participants reported elimination or dramatic reduction of withdrawal.
- 50% reported reduction of opioid cravings, with 25% reporting reduction of cravings lasting at least 3 months.
- At 6 months 41% reported abstinence from opioids.
- 30% reported never using opioids again with half of these people interviewed at 1 year and almost a third at 2 years.
- Although 70% later reported relapse following treatment, 47% decreased use from previous levels and 11% eventually achieved abstinence.
- Long-term reductions in depression and anxiety, and increased subjective well-being.
On the Mexican MAPS study by Brown, it is important to consider that some subjects who entered residential treatment afterwards were lost to follow-up and their scores were counted as pre-treatment levels (no treatment effect).
Also, opioid maintenance programs, either buprenorphine or methadone, were counted as opioid use and scored accordingly, even though for some ending up on those programs may have been a major improvement, not considered a “relapse.”
How do these results compare to other Addiction Treatments?
In general, these results are very good compared to other existing treatments. Brown, et al., cite several recent studies that help to give a general idea:
- One study following subjects after a buprenorphine taper with no subsequent pharmacotherapy, which reported an 8.6% success rate defined as less than 4 days of self-reported opioid use in the previous month.
- Reviews looking at opioid detoxification with subsequent maintenance treatment report abstinence rates of 18% at one month with buprenorphine and 26% after 6 weeks with methadone.
- These numbers compare to 50% self-reported abstinence at 1 month and 33% at 3 months (Brown, et. al.), and 30% self-reported abstinence of at least a year (Davis, et. al.).
Does Ibogaine Treatment work for anything other than opioids?
One observational study from Brazil looks particularly at people who underwent ibogaine treatment and psychotherapy in a hospital setting for lifetime alcohol, cannabis, cocaine, and/or crack use. It may still be the only study looking at ibogaine treatment specifically at stimulant use.
- Of the 75 subjects that they followed, Shenberg, et. al., showed:
- 29% did not use again after the first ibogaine treatment, and another 23% used once but then remained abstinent. The median period of abstinence after a single treatment was 5.5 months.
- Of 33 who underwent a second session, 45% did not use again. The median period of abstinence after a second treatment was 8.4 months.
- Further, of 14 who underwent a third session, 57% did not use again. Of 5 who underwent a fourth session, one did not use again. And of two who underwent a fifth session, one did not use again.
Summary and Important Lessons from the Research:
Be prepared for some discomfort:
- Some people report a complete elimination of withdrawal, but that is not always the case. For others it is a partial reduction. There can still be PAWS and other discomfort even though most report dramatic improvements in all these areas.
- Similarly, not everyone experiences a sustained reduction in cravings. From the results it is fairly clear that people generally notice the largest change between 1-3 months, but not everyone does to the same extent.
Have some additional support set up:
- Even though these results show that ibogaine treatment has obvious benefits, it is also clearly not a magic bullet. Having realistic expectations going into treatment, planning around situations that may present ongoing challenges, and resourcing other forms of support all play a significant role.
- Several of the studies, particularly the Brazilian one above, show that one or more follow-up ibogaine treatments in the future may be beneficial. Ceiba works with clinics during detox, but also has partnered to provide post-treatment psychospiritual treatments at a reduced rate (as long as you remain abstinent prior) in order to make this more feasible. Get in touch for more information.
How does Ibogaine Treatment work?
When you ingest ibogaine it is fairly rapidly converted into its primarily metabolite, noribogaine. Both the short-term and long-term effects around treatment involve both ibogaine and noribogaine, which have many properties in common. Nor-ibogaine is estimated to remain in the body for at least a number of days following a flood dose of ibogaine.
The mechanism of action of ibogaine and noribogaine are complex and multifaceted, and only partly understood. What is known is that, unlike many pharmacotherapies, they have a chorus of effects that touch numerous neurotransmitter systems. These include:
- Mu-opioid receptors play a role in reward and euphoria. Ibogaine is a potential mu-opioid receptor agonist, which many believe describe its effects on opioid withdrawal. Moreover, even aside from potential agonist activity ibogaine has been shown to increase the activity on mu-opioid receptors, and to reduce tolerance to opioids.
- Kappa opioid receptors play a role in reward and mood. Ibogaine has potential interactions with kappa opioid receptors, other examples of which have also been shown to reduce cocaine and morphine self-administration.
- Serotonin has a complex function including influencing cognition, reward, learning, memory, and numerous physiological processes. Ibogaine may block uptake of serotonin, similar to many anti-addictive agents, and noribogaine may do so to an even greater extent.
- Ibogaine’s activity on 5-HT2a receptors, similar to other psychedelics, may account for a significant portion of its oneirogenic effects.
- NMDA plays an important role in synaptic plasticity and memory function. Ibogaine is a weak competitive NMDA antagonist, somewhat similarly to ketamine. This activity may be responsible for some of ibogaine’s therapeutic effects, including its effects on drug dependence, and its potential for neurogenerative disorders like Parkinson’s.
- Dopamine has a complex function including motivation, pleasure, cognition, memory, learning, and fine motor control. There is evidence that ibogaine decreases dopamine levels, particularly in people who have exposure to drugs of abuse, returning them from elevated levels to baseline levels. This may play an important role in ibogaine’s persistent effect on drug cravings.
Another significant effect of ibogaine is that it stimulates the production of glial cell-derived neurotrophic factor (GDNF) as well as brain-derived neurotrophic factor (BDNF), hormones that stimulates the production of dopaminergic neurons.
While BDNF is more common, ibogaine is relatively unique in its ability to stimulate GDNF. These factors are significant in stimulating neuroplasticity, assisting in the brains ability to recover and to transition from a dependent state relatively painlessly.
The production of GDNF may be a contributing factor in ibogaine’s potential for reversing the symptoms associated with Parkinson’s disease. While it is not approved or researched for this purpose, there are some anecdotal cases of people using microdoses (8mg+/day) of ibogaine over time and noticing increased motor coordination, reduced depression, and improvement in a number of areas associated with Parkinson’s. Because Parkinson’s involves a degeneration of dopamine neurons in the mid-brain, this may provide an image of the longer-term benefits of ibogaine on the dopamine system.
The road ahead is paved with both challenges and opportunities, but one thing remains certain: the exploration of ibogaine’s full potential in addiction treatment and possibly aiding in Parkinson’s disease and a host of other neurological conditions is a pursuit that holds promise for the future of medical science and the betterment of many lives.