Nearly 10 years ago, I stepped out on a Saturday night to meet a friend for a movie in Davis Square. The movie, I’m Dangerous with Love, was playing as part of a special event. As I settled into the Somerville theater, I wasn’t quite sure what I was in for, or how this documentary would end up informing me of a revolution in medicine to come nearly a decade later.
Living Dangerously through Clandestine Healing
The film followed Dimitri Mugianis, a former musician and recovering addict, as he bounced back and forth between his NYC base to treat people across the nation and in Canada. While the opioid epidemic is all around us in 2019, back then, the vernacular of addiction was still relegated to those taking illicit drugs like heroin. With zero medical training, Dimitri set out to heal those addicted to drugs with an alkaloid from a traditional plant native to West Africa: ibogaine.
His clandestine healing sessions intrigued me immediately. This former rocker who treated his addiction using this very method was traveling to people’s homes to administer a plant that, in the majority of cases, almost immediately “cured” people. As a neuroscientist-in-training, every cell in my brain lit up.
How could this plant be so effective? How could no one in the West have heard of this “miracle”?
I watched captivated as Dimitri administered the plant, cared for people as they went through agonizing, albeit, brief detox. Then, as they awoke, he talked them through their new life. Of course, not everyone was able to maintain their abstinence long-term, but most people in the film did get a chance to live without drug dependency for a significant amount of time.
Nevertheless, this treatment was not without harm. In fact, ibogaine can cause severe cardiac side effects, which is extremely dangerous when treating people without a medical license at their homes with a drug that is not exactly mentioned in medical textbooks. After one such case, Dimitri realized he was treating patients without proper knowledge of the plant in its entirety. Therefore, he set out to Gabon to learn more about how the plant is traditionally used to better inform his practice.
After a brief discussion following the movie, I left the theater buzzed. As a good little scientist, I immediately pulled up PubMed (the science version of Google) when I got home to search for studies on ibogaine. While there were many studies using preclinical models, I could find very little information for its use in humans.
I filed ibogaine away as one of the cool things I would study when I had my own lab and could start pursuing (funding permitting) my own research passions, and that’s where ibogaine sat for many years—a paper in the accordion file of my brain—that is, until a few years ago.
The Pharmacology of an Ancient Root
One night, I happened upon a study while numbly scrolling through social media. Researchers found that ibogaine enhances neuroplasticity in the brain. “I knew it!” I exclaimed to no one. My heart started to race, and images appeared of the movie I had seen years before. Could this be how ibogaine helps people rapidly recover from addiction?
The part of the film that really struck a chord involved a scene with a woman who had taken ibogaine. The day after her treatment, she reported feeling as though her senses were “renewed”: Food tasted different, colors were brighter, and everything had changed overnight.
Neurogenesis occurs in the hippocampus, a part of the brain essential to memory and the region I happened to be studying in graduate school, as well as the olfactory regions in adults. The woman’s report following ibogaine made me think of neurogenesis and neuroplasticity immediately because a supply of new neurons and connections flooding the brain would likely cause these perceptions. Of course, I still didn’t know the first thing about the chemical properties of ibogaine, so I got to work.
Getting to Know Ibogaine
Ibogaine comes from the roots of Tabernanthe Iboga, a shrub native to West Africa. Lower doses are used to help alleviate fatigue, while higher doses are used in religious ceremonies. Noribogaine is the drug's active metabolite.
Ibogaine works by inhibiting the reuptake of neurotransmitters (brain chemicals), including serotonin, which may induce hallucinogenic experiences similar to other psychedelic substances. As I accidentally discovered one night, ibogaine also contributes to neuroplasticity, which is the brain’s ability to reorganize itself when presented with new information.
A preclinical study showed that ibogaine increases glial cell line-derived neurotrophic factor, a substance that promotes the survival and differentiation of cells in the brain. Additionally, noribogaine changes the structure of brain cells, affecting how they interact with other cells.
Clinical studies have found that a single oral dose of ibogaine can significantly reduce cravings for cocaine and heroin, as well as symptoms of depression, for up to 30 days following treatment. While long-term effectiveness of the treatment varies, a survey of patients who received ibogaine treatment in Mexico showed that 30 percent abstained from opioid use for up to two years, with 41 percent reporting abstinence for more than six months, across a three-year follow-up period. There is also some evidence that ibogaine may help those with alcohol addiction.
A Blocked Path to Progress
While the Food and Drug Administration (FDA) entertained the idea of approving a clinical trial for ibogaine in 1993, they decided against it due to safety concerns, despite the fact that people were getting treated in droves at clinics outside the U.S.
In 2005, a few years before the movie came out, the director of anti-addiction drug development at the National Institute on Drug Abuse (NIDA) referred to ibogaine as a "vast, uncontrolled experiment"—a pretty accurate description at that time—but times have changed.
Traditional medicines like cannabis and psilocybin finally started to hit the mainstream (i.e., in the West) a few years ago and are making significant strides toward legalization through rigorous clinical trial studies. Essentially, we are finally realizing their potential after thousands of years of anecdotally documented benefits.
Flash-forward to today, and we now have quite a surplus of data on ibogaine. In fact, a current search on ibogaine produces more than 450 hits, a far higher number than when I originally started on my expedition. Yet, it still begs the question of the true effectiveness of ibogaine and, most importantly, its safety.
While ibogaine remains illegal in the U.S., people continue to travel to clinics throughout the world in an attempt to break the cycle of addiction. Despite a decade of additional research, safety concerns remain significant.
Ibogaine treatment can be deadly. Administration of the drug can cause serious cardiac effects since ibogaine decreases the heart rate. Unfortunately, these effects can come on quite quickly. While a small clinical trial identified the time it takes to clear a small dose of ibogaine from the body, additional study is needed to better understand how to safely dose ibogaine.
While there is evidence that low-dose administration of ibogaine can effectively reduce withdrawal symptoms and cravings, it’s not possible to guarantee the safety of ibogaine treatment. People who take ibogaine do so at their own risk. Ibogaine remains an illegal substance in the U.S., so, is there any hope for ibogaine? Yes, with more research, of course.
A Phase 2 clinical trial is currently underway evaluating ibogaine for alcohol addiction. The Multidisciplinary Association for Psychedelic Studies (MAPS) has conducted two observational studies in Mexico and New Zealand. U.S. state legislators are also proposing new bills to fund research for ibogaine, and one Republican lawmaker in Iowa just filed a state bill to legalize its medical use.
Ten years later and there is still a lot of work to be done, but I’m Dangerous with Love opened my eyes to the immense potential of using an ancient plant to solve a modern health crisis, and for that, I thank you, Dimitri.
Photo credit: Bart Wursten/Flickr.