Drug: Ibogaïne

What It Is

Ibogaine is a single compound, a monoterpene indole alkaloid, extracted from the root bark of Tabernanthe iboga, a shrub used ceremonially in West Central Africa. Researchers have studied it for one purpose above all: interrupting addiction, and opioid dependence most of all.

A single large dose is reported to ease withdrawal for days; standard opioid-agonist treatment, methadone or buprenorphine, is taken daily and indefinitely. Ibogaine draws attention for two reasons. One is an early, repeated signal that it helps some people whom other treatments have failed. The other is a documented danger of sudden death from a disturbed heart rhythm.

What It Does

In an observational study of 30 people dependent on opioids, a single dose dropped withdrawal scores from 31.0 to 14.0 on a 0-to-64 scale within about three days. At one month, half reported no opioid use in the previous 30 days. Drug-use severity was still improved out to 12 months, though below the one-month peak.

A separate 12-month study followed 14 people treated legally in New Zealand. A year later they used fewer opioids and scored lower for depression. One of the 14 died during treatment.

The strongest recent work is a 2024 Stanford study of 30 male Special Operations veterans, most with mild brain injury. A single treatment of ibogaine with magnesium was followed a month later by large gains in functioning, post-traumatic stress, depression, and anxiety.

All of this evidence is the same weak quality: small, open-label, no control group. No one was blinded, everyone chose and often paid to be there, and each study was small. That combination inflates the apparent benefit. It cannot separate the drug from expectation, from the detox care given alongside, or from the natural course of withdrawal. No adequate randomized controlled trial has been completed, and the field's own reviews call the results preliminary.

The Research & Studies

Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.

How it works

Iboga-alkaloïden blokkeren het hERG-kaliumkanaal, het mechanisme achter de QT-verlengingModerate · risk

In plain terms

Ibogaïne en zijn verwanten blokkeren een specifiek hartkanaal genaamd hERG, wat de biologische reden is waarom het middel het hartritme verstoort.

In detail

In celstudies blokkeren ibogaïne en verwante iboga-alkaloïden het hERG-kaliumkanaal dat het hart repolariseert. Het verliezen van die stroom verlengt het QT-interval en creëert het elektrische substraat waarop een gevaarlijk ritme kan beginnen. Measured in: hERG channels expressed in cell systems. Mechanistisch celwerk verklaart hoe het risico ontstaat, maar voorspelt op zichzelf niet de dosis of de persoon bij wie een gevaarlijk ritme zal optreden.

The study · 1

Alper et al., hERG blockade by iboga alkaloids · Cardiovasc Toxicol 2016;16(1):14-22

Addiction

Opioid withdrawal scores fell by more than half within three days, and half the group reported no opioid use a month laterPreliminary

In plain terms

In 30 people with opioid dependence, withdrawal symptoms dropped by more than half within three days of a single ibogaine dose, and one month later half reported no opioid use, but there was no comparison group.

In detail

In an observational study of 30 adults with opioid dependence, Subjective Opioid Withdrawal Scale scores fell from 31.0 to 14.0 on a 0 to 64 scale within about 76 hours of a single ibogaine dose, and at one month 15 of 30 (50%) reported no opioid use in the previous 30 days, with drug-use severity still improved from 3 to 12 months though below the one-month peak. Measured in: 30 adults with DSM-IV opioid dependence (25 men, 5 women) treated at a clinic in Mexico. What could explain it instead: Self-selection into a private overseas clinic, no comparison group, and concurrent detoxification and aftercare all sit between the drug and the outcome.. One group with no control and no blinding, in 30 self-selected patients, so the change cannot be separated from concurrent detoxification care, expectation, or the natural course of withdrawal.

The study · 1

Brown & Alper, treatment of opioid use disorder with ibogaine: detoxification and drug use outcomes · Am J Drug Alcohol Abuse 2018;44(1):24-36

A single treatment tracked with reduced opioid use and lower depression scores held over 12 months, and one participant died during treatmentPreliminary

In plain terms

Among 14 people treated legally in New Zealand, opioid use and depression scores were lower a year after a single ibogaine treatment, but only 8 finished the study and one person died during treatment.

In detail

Among 14 New Zealanders given legal ibogaine for opioid dependence, drug-use severity on the Addiction Severity Index-Lite fell significantly from baseline to 12 months in the 8 who completed all interviews (p = 0.002), depression on the BDI-II also fell (p < 0.001), and withdrawal scores dropped acutely after treatment across all 14 (p = 0.015). One of the 14 died during treatment. Measured in: 14 adults with opioid dependence (50% female) treated legally in New Zealand. What could explain it instead: No comparison group, heavy dropout, self-selection, and treatment providers working alongside other health professionals mean the reduction cannot be attributed to ibogaine alone.. Slechts 8 van de 14 voltooiden de follow-up, er was geen controlegroep, en één deelnemer stierf tijdens de behandeling, dus het voordeel en het gevaar komen allebei uit dezelfde kleine serie.

The study · 1

Noller et al., ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational study · Am J Drug Alcohol Abuse 2018;44(1):37-46

Mood & stress

Bij veteranen met hersenletsel verbeterden functioneren, PTSS, depressie en angst een maand na magnesium-ibogaïnePreliminary

In plain terms

Dertig mannelijke veteranen met hersenletsel toonden na één behandeling met magnesium-ibogaïne grote verbeteringen in functioneren, PTSS, depressie en angst een maand later, maar er was geen controlegroep en iedereen wist dat ze het middel kregen.

In detail

Bij 30 mannelijke Special Operations-veteranen met overwegend mild traumatisch hersenletsel verbeterden invaliditeitsscores een maand na een enkele magnesium-ibogaïne-behandeling (Cohen's d = 2.20), samen met grote verminderingen in PTSS (d = 2.54), depressie (d = 2.80) en angst (d = 2.13). Magnesium werd mee-toegediend om het cardiaal risico af te zwakken, en er werden geen ernstige ongewenste voorvallen gerapporteerd. Measured in: 30 male Special Operations Forces veterans with predominantly mild TBI (Stanford MISTIC protocol). What could explain it instead: No comparison group, self-selected veterans who traveled abroad for treatment, complementary therapies given alongside the drug, and investigator financial interests all bear on the result.. Open-label, geen controlegroep, gegeven samen met andere therapieën, en uitgevoerd door een team dat gerelateerde patenten bezit, dus de zeer grote effectgroottes zijn voorlopig en ongeblindeerd.

Who this may not transfer to:Measured only in male Special Operations veterans. It has not been tested in women, and injury type, cardiac risk and hormonal factors differ by sex, so whether the same effect holds in women is unknown.

The study · 1

Cherian et al., magnesium-ibogaine therapy in veterans with traumatic brain injuries · Nat Med 2024;30(2):373-381

Evidence And Methods

Er is geen adequate gerandomiseerde gecontroleerde studie die ibogaïne heeft getest bij verslaving; het werkzaamheidsbewijs is open-label en ongecontroleerdPreliminary · mixed

In plain terms

Er is nog geen goede gerandomiseerde studie naar ibogaïne bij verslaving; alle bemoedigende resultaten komen uit studies waarbij iedereen wist dat ze het middel kregen en er geen vergelijkingsgroep was.

In detail

Vanaf 2024 komt het humane werkzaamheidsbewijs voor ibogaïne bij stoornis in middelengebruik uit open-label en observationele studies zonder blindering en zonder controlegroep. Er is geen adequate gerandomiseerde gecontroleerde studie voltooid, en de eigen reviews van het vakgebied noemen de bevindingen voorlopig en in behoefte van gecontroleerde studies. Measured in: the published human literature on ibogaine for substance-use disorder. Zonder gerandomiseerde controlegroep is de omvang van enig werkelijk effect onbekend, en verwachting en het natuurlijke beloop van verslaving kunnen niet worden gescheiden van het middel.

The study · 1

Cherian et al., psychedelic therapy: a primer for primary care clinicians, ibogaine · Am J Ther 2024;31(2):e133-e140

The same studies that report benefit also record deaths.

A review of all known fatalities outside West Central Africa from 1990 to 2008 found 19 people who died within 1.5 to 76 hours of taking ibogaine, most of them with preexisting heart disease or other drugs also present.

How It Works

Ibogaine does not act on one clean target. It binds serotonin and opioid receptors, NMDA glutamate receptors, sigma receptors, and nicotinic receptors. The liver converts it into a long-lived metabolite, noribogaine, that stays active for days and carries much of the drug's continuing effect. No single one of these actions has been shown to be why craving falls, so the mechanism behind the addiction signal is still open.

The cardiac action is better understood. Ibogaine and its metabolite block the hERG potassium channel, the current that resets each heart cell after a beat. Cut that current and the electrical recovery lengthens, seen on an electrocardiogram as a prolonged QT interval. A long QT is the setting where a chaotic, sometimes fatal rhythm called torsades de pointes can start. The effect grows with the dose and worsens when the heart is already stressed or potassium or magnesium is low. That dose-related danger is why the Stanford protocol pairs ibogaine with magnesium.

What Happens in the Body

1The acute experience

A large dose produces many hours of a dreamlike, waking state, often with vivid imagery, over roughly a day, followed by a long period of reduced sleep. This is the window in which withdrawal is reported to ease. It also overlaps the window in which the dangerous heart-rhythm changes occur, which is why the research settings that use it keep a person on continuous cardiac monitoring.

2The lingering metabolite

Because noribogaine persists for days, part of any lasting effect on craving is attributed to it. The hERG blockade, and the QT prolongation with it, also continues past the acute experience.

3The heart under load

A prolonged QT is where a fatal arrhythmia can start. The danger is greatest with existing heart disease, low potassium or magnesium, other QT-prolonging drugs on board, or a large or repeated dose.

The Legal Position

Ibogaine is Schedule I in the United States, the most restricted category. Outside authorized research its use is illegal, and it is not an approved treatment anywhere in the country.

Most human experience comes from clinics in Mexico, in parts of Central America and the Caribbean, and a few other countries. They operate with little or no medical regulation, varying widely in whether they screen the heart before treatment or monitor it during. New Zealand is unusual in permitting ibogaine under a controlled arrangement, which is why one of the better follow-up studies could be done there.

Go Deeper

• Psychedelics in mental health: the wider group of supervised, trial-stage compounds that ibogaine sits within, from psilocybin to MDMA.
• Meditation and mindfulness: a low-risk way to work with a craving or distressed mind that you can start on your own, and the grounding practice the Chinese medicine view points to first.
• Purpose and meaning: the sense of meaning that steadies a person through recovery, approached as a practice in its own right.

The Chinese Medicine View

Chinese medicine has a long-standing frame for intense altered states and for the pull of a substance, and it treats both with caution. The Heart is said to house the Shen, the spirit and consciousness. Clear thought, steady emotion, and settled sleep are read as signs of a rooted Shen. A mind overwhelmed by vivid imagery, disoriented or agitated, is read as a disturbance of the Shen. The classical instinct is to calm and anchor such a state.

A long, overwhelming drug experience could be seen as forcibly stirring the Shen. The tradition would approach that with great care, especially in someone depleted by years of addiction, and especially where the Heart itself carries the physical risk. Addiction, in this frame, is often read as an empty state a person tries to fill, and the classical response is to nourish and root it. The wider preventive tradition of Yang Sheng, nourishing life, would put grounding practices and steady support first.

Cautions For This Practice

Everything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.

Ibogaïne is gevolgd door fatale hartritmestoornissen; een review vond 19 sterfgevallen kort na inname

Een systematische review van alle bekende sterfgevallen buiten West-Centraal-Afrika van 1990 tot 2008 vond 19 mensen (15 mannen, 4 vrouwen, 24 tot 54 jaar) die stierven binnen 1.5 tot 76 uur na het innemen van ibogaïne. Pre-existente medische aandoeningen, voornamelijk cardiovasculair, en/of een of meer misbruikte middelen verklaarden of droegen bij aan de dood in 12 van de 14 gevallen met adequate postmortemgegevens. Een case-serie telt sterfgevallen zonder een noemer, dus het kan geen rate geven, maar het stelt vast dat fatale uitkomsten voorkomen, het vaakst wanneer hartziekte of andere middelen aanwezig zijn.Alper et al., fatalities temporally associated with the ingestion of ibogaine

Ibogaïne verlengt het QT-interval en kan levensbedreigende hartritmestoornissen veroorzaken

Een review van de cardiale effecten van ibogaïne rapporteert dat het het QT-interval verlengt en wordt gekoppeld aan accumulerende meldingen van levensbedreigende aritmie en plotse dood, een effect teruggevoerd op blokkade van het cardiale hERG-kaliumkanaal, waarbij de langlevende metaboliet noribogaïne dezelfde werking heeft. Een narratieve review verzamelt bestaande meldingen, test het risico niet in een gedefinieerde groep, dus het beschrijft het gevaar zonder te kwantificeren hoe vaak het optreedt.Koenig & Hilber, the anti-addiction drug ibogaine and the heart: a delicate relation

Ibogaine has caused fatal cardiac arrhythmias

Anyone with a heart condition, a long-QT tendency, low potassium or magnesium, or other QT-prolonging medication is at serious risk. This page carries no dosing, no sourcing, and no instructions for use.

The interactions that raise the danger

The cardiac risk climbs when ibogaine is combined with other drugs that prolong the QT interval, including some antidepressants, antipsychotics, and antibiotics, and when potassium or magnesium is low. Because ibogaine also acts on serotonin and opioid systems, combining it with opioids or serotonergic medication carries its own hazards. Anyone on medication is in territory where these interactions have caused deaths.

The evidence is a signal, not a settled treatment

The results that draw people to ibogaine come from small, uncontrolled studies, so the true size of the benefit is unknown. Treatments with a randomized-trial base exist, and clinical trials are recruiting.

Ibogaine shows an early signal for a problem that current treatments often fail, and it carries a documented risk of sudden cardiac death. Weigh the evidence at its real, preliminary strength. Treat the cardiac risk as the central fact. For your own care, talk to a qualified clinician.

Common Questions

Does ibogaine work for opioid addiction?

The early evidence points that way, with one heavy caveat: it has never been through a randomized trial. A single dose can interrupt use for months in some people, even where standard treatments have failed. But the studies are small and uncontrolled. That leaves ibogaine a preliminary signal, well short of a proven treatment.

Why is ibogaine dangerous?

Because it can stop the heart. Ibogaine lengthens the heart's electrical recovery, and in the wrong conditions that can tip into a fatal rhythm. The danger climbs in anyone with existing heart disease, in anyone whose potassium or magnesium runs low, in anyone on other QT-prolonging medication, and at higher doses.

Is ibogaine legal?

Not in the United States, where it is Schedule I and no clinic may offer it as treatment. That status does more than bar patients. It makes the controlled trials the field keeps asking for slow and costly to run, so the evidence stays thin in part because of the law itself. Most use happens in clinics abroad with little oversight.

What is the Stanford veterans study, and does it change the picture?

It is the most rigorous recent work, and it is still preliminary. In the 2024 Stanford study, 30 veterans given ibogaine with magnesium improved markedly a month later. What it cannot do is settle the question. With no control group and no blinding, expectation cannot be separated from the drug. For now ibogaine is still just a serious signal: the randomized trial that would confirm it has not been run.