Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes.

Deborah C Mash,Kathleen Allen-Ferdinand,Bryan Page,Linda Duque

doi:10.3389/fphar.2018.00529

Deborah C Mash, Kathleen Allen-Ferdinand + Show 2 more

Open Access

https://doi.org/10.3389/fphar.2018.00529

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Abstract

Ibogaine may be effective for transitioning opioid and cocaine dependent individuals to sobriety. American and European self-help groups provided public testimonials that ibogaine alleviated drug craving and opioid withdrawal symptoms after only a single dose administration. Preclinical studies in animal models of addiction have provided proof-of-concept evidence in support of these claims. However, the purported therapeutic benefits of ibogaine are based on anecdotal reports from a small series of case reports that used retrospective recruitment procedures. We reviewed clinical results from an open label case series (N = 191) of human volunteers seeking to detoxify from opioids or cocaine with medical monitoring during inpatient treatment. Whole blood was assayed to obtain pharmacokinetic measures to determine the metabolism and clearance of ibogaine. Clinical safety data and adverse events (AEs) were studied in male and female subjects. There were no significant adverse events following administration of ibogaine in a dose range that was shown to be effective for blocking opioid withdrawal symptoms in this study. We used multi-dimensional craving questionnaires during inpatient detoxification to test if ibogaine was effective in diminishing heroin and cocaine cravings. Participants also completed standardized questionnaires about their health and mood before and after ibogaine treatment, and at program discharge. One-month follow-up data were reviewed where available to determine if ibogaine’s effects on drug craving would persist outside of an inpatient setting. We report here that ibogaine therapy administered in a safe dose range diminishes opioid withdrawal symptoms and reduces drug cravings. Pharmacological treatments for opioid dependence include detoxification, narcotic antagonists and long-term opioid maintenance therapy. Our results support product development of single oral dose administration of ibogaine for the treatment of opioid withdrawal during medically supervised detoxification to transition drug dependent individuals to abstinence.

Highlights

Ibogaine is an indole alkaloid isolated from the roots of the West African shrub Tabernanthe iboga
The results demonstrated beneficial after effects of ibogaine detoxification on drug cravings in opioid and cocaine dependent subjects reported at 1-month assessments
Because of ibogaine’s oneiric effects and complex pharmacokinetics, we originally suggested that noribogaine should be advanced for opioid detoxification to promote a transition to abstinence (Mash et al, 2000, 2001; Mash, 2018)

Summary

Introduction

Ibogaine is an indole alkaloid isolated from the roots of the West African shrub Tabernanthe iboga. The therapeutic and oneirophrenic (dream-like) effects of iboga roots have been described in the ethnobotanical literature for centuries, where ingestion of Ibogaine root preparations ceremonial and medicinal use (Goutarel et al, 1993; Samorini, 1995). Ibogaine was marketed in France in the pharmaceutical preparation Lambarene (200 mg tablet). The root extract contained approximately 5 mg ibogaine and other minor iboga alkaloids. In the early 20th century, this preparation was marketed as a neuromuscular stimulant at a dose of 2–4 tablets/day (Goutarel et al, 1993). Academic researchers reported descriptions of robust effects of the drug in preclinical animal models and in vitro data were obtained which identified possible mechanism(s) of action (Glick et al, 1994, 2000; Popik et al, 1995; Mash et al, 1995; Staley et al, 1996; Baumann et al, 2001; for review, Belgers et al, 2016; Mash et al, 2016)

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