Evaluating the toxicity and therapeutic potential of ibogaine in the treatment of chronic opioid abuse

Abstract

Ibogaine is a psychoactive indole alkaloid isolated from the West African shrub Tabernanthe iboga. It has been used by indigenous cultures to combat fatigue, hunger, and thirst, and to induce hallucinations during religious ceremonies. First isolated in 1901, ibogaine was initially recommended for use in asthenia at doses of 10 to 30 mg per day [1,2]. Semi-synthetic ibogaine came into use in 1939 and was marketed in France through 1970 under the trade name Lambarène as a ‘neuromuscular stimulant’ in 8-mg tablets for indications including fatigue, depression, and recovery from infectious illnesses [1]. Anecdotal reports concerning the beneficial effects of ibogaine for the treatment of opioid abuse and other drug dependencies appeared starting in the early 1960s [2], while the World Health Assembly classified ibogaine as a ‘substance likely to cause dependency or endanger human health’ and the Food and Drug Administration (FDA) assigned ibogaine to Schedule I classification. Despite these restrictions, ibogaine became available as an ‘addiction interrupter’ in countries that had not specifically prohibited its use. Although the benefit-risk ratio in opioid withdrawal management appears to be favorable if ibogaine is administered under qualified medical supervision [1], reports on drugrelated deaths and other safety concerns in the published literature continue to hinder drug development.