Ibogaine therapy for substance abuse disorders

Introduction Ibogaine is a naturally occurring psychoactive indole alkaloid derived from the roots of the rainforest shrub Tabernanthe iboga.Ibogaine is used by indigenous peoples of Western Africa in low doses to combat fatigue, hunger, and thirst, and in higher doses as a sacrament in religious rituals (Goutarel et al., 1991). The use of ibogaine for the treatment of drug dependence was based on anecdotal reports by groups of self-treating addicts that the drug blocked opiate withdrawal and reduced craving for opiates, cocaine, and other illicit drugs for extended time periods (Shepard, 1994; Alper et al., 1999). Preclinical studies supported these early claims and provided proof-of-concept in animal models (Dzoljic et al., 1988; Glick et al., 1992). Addiction is a behavioral pattern of drug abuse characterized by compulsive use, loss of behavioral control, and a high tendency to relapse. An integrated medical, psychosocial, and spiritual treatment is often needed to achieve recovery in addicted patients. Ibogaine is a unique pharmacotherapy for the treatment of substance abuse disorders because it fosters a life change or may work as a transition-based therapy similar to the goals set in the 12-step fellowship programs. While ibogaine's effects on behavior are complex, the beneficial actions of the drug on withdrawal symptoms and cravings are because of an interaction of the active metabolite noribogaine with neurotransmitters in the brain reward and addiction circuit.