Ibogaine and Subjective Experience : Transformative States and Psychopharmacotherapy in the Treatment of Opioid Use Disorder
Thomas K. Brown, PhDa, Geoff E. Noller, PhDb, and Julie O. Denenberg, MAc
Journal of Psychoactive Drugs, 2019
This article examines the therapeutic potential of ibogaine, a powerful oneiric alkaloid derived from Tabernanthe iboga, through exploring the subjective experiences of 44 participants from two observational treatment studies for opioid use disorder. Following treatment with ibogaine HCl, the participants (Mexico, n = 30; New Zealand, n = 14) completed the States of Consciousness Questionnaire (SCQ) to quantify the magnitude of their psychotropic experience. Participants were asked to provide written transcripts of their experiences, with those supplied being analyzed thematically through an iterative process, to produce a set of coded themes. Mean SCQ scores in many domains exceeded 0.6, the cutoff score for a “complete mystical experience,” with 43% of participants achieving this in more than five of seven domains. Qualitative data described multiple phenomenological themes, including auditory and visual phenomena. Ibogaine’s strong oneiric action promoted cyclic visions leading to confronting realizations involving remorse and regret for participants’ actions towards others, but also release from feelings of guilt and worthlessness. Many participants reported feeling a sense of spiritual transformation. We propose that the reported experiences support the meaningfulness of ibogaine’s oneiric effects as a discrete element in its capacity for healing, which is distinct from pharmacological actions associated with reduced withdrawal and craving.
KEYWORDS : Ibogaine; opioids; hallucinogen; oneiric psychedelic drug treatment
What has become a global movement for ibogaine treatment began with a serendipitous discovery by a single person. In June of 1962, Howard Lotsof, then a 19-year-old heroin-dependent member of a group of lay drug experimenters living in Brooklyn, received some ibogaine from a friend, who told him to expect a 36-hour “trip.”
He took the ibogaine unsuspecting of the eventually profound implications. About 23 hours after the onset of the drug’s effects, and long after the intense visual hallucinations subsided, Lotsof slept. He awoke refreshed three hours later. And it dawned on him that he was not in withdrawal and his perception of heroin as a comforting drug had changed: “I now viewed heroin as a drug which emulated death. And the very next thought into my mind was ‘I prefer life to death’” (Lotsof 2007).
Soon, others in the drug experimentation group reported similar results. Eventually, Lotsof was granted
five patents for ibogaine treatment for dependence on a variety of substances and, by 1990, ibogaine treatment sites were being run by proponents involved with addict self-help groups in Amsterdam and New York City (Alper, Beal, and Kaplan 2001).
This nascent movement grew rapidly, with over 3,400 people receiving ibogaine treatment by 2006, most for opioid dependence (Alper, Lotsof, and Kaplan 2008). By 2017, there were about 80 treatment sites globally (Brown 2017). Several thousand ibogaine treatments have provided anecdotal evidence of ibogaine’s efficacy, and of its capacity to facilitate profound alterations of consciousness.
With three recent publications, the scientific evidence of the efficacy of ibogaine treatment is growing.
These include Schenberg et al. (2014), showing efficacy with increased periods of abstinence from problem substances, primarily cocaine, following detoxification. Two observational studies provided evidence that ibogaine is effective in treating opioid use disorder. Both Brown and Alper (2018) and Noller, Frampton, and Yazar-Klosinski (2018) found that ibogaine is useful in acute opioid detoxification, significantly reducing withdrawal symptoms as measured by the Subjective Opioid Withdrawal Scale (Handelman et al. 1987). Both also showed, using the Addiction Severity Index (ASI; McLellan et al. 1999), that Drug Use Severity scores were significantly reduced 12 months following
treatment. One study, based at treatment sites in Mexico (Brown and Alper 2018), also found significant
improvements in ASI Family and Social Status subscores at all follow-up time points from one to 12
months following treatment. The other study, based in New Zealand (Noller, Frampton, and Yazar- Klosinski 2018), showed that ibogaine treatment was associated with improvement in depression symptoms at one month and 12 months following treatment, as measured by the Beck Depression Inventory-II (BDI-II; Beck, Steer, and Brown 1996).
Despite the efficacy demonstrated by these studies, as well as numerous pre-clinical studies demonstrating that ibogaine ameliorates withdrawal-like symptoms and reduces drug self-administration in animal models (Baumann et al. 2001; Glick, Maisonneuve, and Szumlinski 2000), understanding ibogaine’s efficacy in treating substance use disorders is limited.
Numerous pharmacologically based theories have been offered to explain ibogaine’s efficacy (Alper 2001; Mačiulaitis et al. 2008; Popik et al. 1995). In this article, however, we examine the possibility that at least some of its efficacy is mediated through the intense hallucinogenic experiences that the drug often engenders.