So there I was, happily watching a “Law and Order” mini-marathon. In one episode, the psychiatrist who works with the SVU staff goes on a diatribe about how ibogaine, a hallucinogenic root, cures opioid addiction. He’s trying to help a heroin-addicted youth detoxify from opioids, to enable him to testify against a rapist. Dr. Huang, the TV doctor, says ibogaine works great, but the big nasty drug companies won’t market it because it won’t make money, and U.S. doctors are (paraphrasing) too cowardly to do what’s right, and use something that really works.
Sadly, some addicts are more likely to believe the words of a fictional character on a fictional TV program than their doctor.
The truth is that ibogaine hasn’t been proven a safe and effective treatment for any kind of addiction.
On the other hand, we don’t know for sure that it doesn’t work, either. NIH, the National Institute of Health, did laboratory studies with ibogaine in the mid-1990’s, but stopped work on the drug due to concerns about potentially fatal heart arrhythmias and neurotoxicity.
However, the NIH tends to be a rather conservative bunch, and other scientists have taken up further research on the drug. At least two reputable doctors have independent, ongoing research projects on the drug. (1)
So what is ibogaine? It’s a naturally occurring root found in Africa, and used in religious ceremonies there. In these ceremonies, rootbark from the plant Tabernanthe iboga is chewed to give a mild stimulant effect. With increased doses, this bark has hallucinogenic effects. Ibogaine is a sloppy drug, affecting at least three types of brain receptors. Ibogaine’s metabolite, noribogaine, has serotonin reuptake inhibition properties, like found in many antidepressants. It also has a weak opioid effect on the mu opioid receptors, and a stronger effect at the kappa opioid receptors, causing less dopamine to be released. It also has effects on at least two other receptor types.
Ibogaine’s supporters claim this drug can cure addiction to alcohol, cocaine, opioids, and nicotine. Limited studies show that since the drug does block the release of dopamine, it may have some benefit in the treatment of addiction to these drugs, but we just don’t have enough information now.
The drug’s reputation as a favorite of the drug culture may contribute to our government’s hesitation to approve studies of ibogaine in this country, but other countries are more permissive (or careless, depending on how you look at things).
It’s also been difficult to get pharmaceutical companies interested in ibogaine. That’s not just due to the drug’s reputation as a recreational drug. Pharmaceutical companies tend to view all anti-addiction drugs as having low profitability (addicts tend to lack both money and insurance) and of course there’s still – sadly – the stigma of addiction and its treatment. (OK, so maybe Dr. Huang was partially right!)
The limited data available so far suggest that at best, ibogaine may eventually prove to be another useful tool to use against addiction, but it’s unlikely to be the cure-all magic bullet that the fictional Dr. Huang claims.
I hope we can see some well-done clinical trials before we decide what, if any, benefit this potential medication may have in the treatment of addiction.