A systematic literature review of clinical trials and therapeutic applications of ibogaine

Patrick Köck; Katharina Froelich; Marc Walter; Undine Lang; Kenneth M Dürsteler

doi:10.1016/j.jsat.2021.108717

A systematic literature review of clinical trials and therapeutic applications of ibogaine

J Subst Abuse Treat. 2022 Jul:138:108717. doi: 10.1016/j.jsat.2021.108717. Epub 2021 Dec 30.

Authors

Patrick Köck¹, Katharina Froelich², Marc Walter², Undine Lang², Kenneth M Dürsteler³

Affiliations

¹ University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland. Electronic address: phatrick@gmx.at.
² University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
³ University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.

PMID: 35012793
DOI: 10.1016/j.jsat.2021.108717

Abstract

Background: Iboga and its primary alkaloids, ibogaine and noribogaine, have been of interest to researchers and practitioners, mainly due to their putative efficacy in treating substance use disorders (SUDs). For many SUDs, still no effective pharmacotherapies exist. Distinct psychoactive and somatic effects of the iboga alkaloids set them apart from classic hallucinogens like LSD, mescaline, and psilocybin.

Aims: The study team performed this systematic review focusing on clinical data and therapeutic interventions involving ibogaine and noribogaine.

Methods: The team conducted a search for all publications up to December 7, 2020, using PubMed and Embase following PRISMA guidelines.

Results: In total, we identified 743 records. In this review, we consider 24 studies, which included 705 individuals receiving ibogaine or noribogaine. This review includes two randomized, double-blind, controlled clinical trials, one double-blind controlled clinical trial, 17 open-label studies or case series (including observational or retrospective studies), three case reports, and one retrospective survey. The published data suggest that ibogaine is an effective therapeutic intervention within the context of SUDs, reducing withdrawal symptoms and craving. Data also point toward a beneficial impact on depressive and trauma-related psychological symptoms. However, studies have reported severe medical complications and deaths, which seem to be associated with neuro- and cardiotoxic effects of ibogaine. Two of these fatalities were described in the 24 studies included in this review.

Conclusion: Treatment of SUDs and persisting comorbidities requires innovative treatment approaches. Rapid-onset therapies such as the application of ibogaine may offer novel treatment opportunities for specific individuals. Rigorous study designs within medical settings are necessary to warrant safe application, monitoring, and, possibly, medical intervention.

Keywords: Cocaine; Hallucinogen; Opioid; Psychedelic; Substance use disorder; Treatment.

Publication types

Case Reports
Systematic Review

MeSH terms

Alkaloids* / therapeutic use
Hallucinogens* / adverse effects
Humans
Ibogaine* / adverse effects
Observational Studies as Topic
Randomized Controlled Trials as Topic
Retrospective Studies
Substance Withdrawal Syndrome* / drug therapy
Substance-Related Disorders* / drug therapy

Substances

Alkaloids
Hallucinogens
Ibogaine