Executive Summary
The last decade has seen an explosion of opioid addiction and overdose deaths, a public health crisis fueling demand for medical and governmental intervention. This brief is a comprehensive overview of the reported results of studies investigating the potential of ibogaine, a psychoactive compound derived from the Tabernanthe iboga plant, in treating opioid addiction.
Existing Medication-Assisted Treatments (MATs), also referred to as Medications for Opioid Use Disorder (MOUD), are examined as a frame of reference. Outcome measures examined include withdrawals and craving, retention, relapse, abstinence duration, mortality, adverse events, risk of diversion, short-term abstinence, long-term abstinence, program costs, and depression.
A consistent theme emerges from the research conducted to date into ibogaine as a prospective treatment for opioid use disorder (OUD): Ibogaine and ibogaine analogues are the only known treatments that consistently and immediately reduce both physical withdrawal symptoms from opioid addiction and psychological dependence without the need for ongoing medication. However, there are no large-scale studies of ibogaine, and more research is needed to understand if it could satisfy patients’ medical needs.
Existing challenges of MATs include increased mortality rates following treatment cessation, high relapse rates, low retention rates, adverse events that include respiratory depression and QT prolongation, risk of diversion, and limited access. Some studies suggest ibogaine treatment is more effective than MATs in combating these existing challenges.
Based on existing research, ibogaine therapy shows the potential to be an effective alternative treatment method for OUD. Its ability to reduce and eliminate opioid withdrawal and craving symptoms plays a key role in the reduction and abstinence of illicit opioid use. Hence, ibogaine can help users achieve lasting anti-addictive effects at fewer doses, whereas traditional MATs just abate dependence. Policymakers should consider ibogaine as a potential alternative treatment for opioid use disorder.
Nonetheless, it is still important to acknowledge the existence of potential safety risks associated with ibogaine treatment. More serious risks include cardiotoxicity and death. However, mitigation strategies have proven successful when administered in clinical settings.
For example, Deborah Mash’s ibogaine clinic in St. Kitts, West Indies, conducted 257 treatments from 1996 to 2004 without any related deaths or serious adverse events. Hence, professional oversight and proper clinical procedures are necessary conditions.
Several states participated in lawsuits against manufacturers and distributors of prescription opioids and received large settlement funds that are largely restricted for programs intended to abate the impact of opioid addiction. One potential avenue for doing this is to advance the development of a therapy that may allow individuals to overcome opioid addiction in as little as one treatment.
Based on the clinical and academic studies reviewed here, traditional abatement mechanisms present many challenges for recovering addicts and have demonstrated only limited success in helping opioid-addicted persons overcome their addiction. By contrast, early research shows ibogaine treatment may be a far more promising approach that enables rapid and sustained recovery from addiction.
The state of Kentucky was the first to consider this possibility. Kentucky received $842 million in settlement proceeds from its participation in a multistate lawsuit. Former Attorney General Daniel Cameron then established a Kentucky Opioid Abatement Advisory Commission to direct the allocation of these funds toward abatement programs.
Throughout a series of public hearings in 2023, the commission considered allocating $42 million—roughly 5% of Kentucky’s share of opioid settlement proceeds—toward Food and Drug Administration-supervised clinical trials that could lead to approval of ibogaine or its derivatives as a treatment for opioid use disorder. In December 2023, Russell Coleman succeeded Daniel Cameron as Kentucky Attorney General and pressed the commission for a change in direction. Chair Bryan Hubbard said he was asked to resign due to his support for funding ibogaine trials, and he was replaced with a former agent of the federal Drug Enforcement Administration.
However, the initiative first launched in Kentucky now continues elsewhere. In February 2024, Hubbard was retained by the Reaching Everyone in Distress (REID) Foundation, an Ohio-based nonprofit to advance FDA-supervised clinical trials for ibogaine. The REID Foundation will engage in broad based statewide advocacy for the creation of a public-private partnership to advance ibogaine or an ibogaine therapeutic through the FDA. ResultsOHIO has also retained Hubbard to explore projects related to the research, development, and delivery of novel therapeutics like ibogaine for treatment of traumatic brain injury and post-traumatic stress disorder. Despite the change of venue, Ohio is poised to capitalize on the materials accumulated by and on behalf of the Kentucky Opioid Abatement Advisory Commission, including the compilation of research presented here.
Based on the existing evidence, Reason Foundation concludes that the development of ibogaine as a pharmaceutical treatment for opioid use disorder may be the most cost-effective use of funds earmarked for mitigating the harms of the opioid epidemic.
Full Policy Brief: Ibogaine Treatment for Opioid Use Disorder