A psychedelic plant from Africa holds promise for addiction and trauma — but it's not for everyone

Most mornings, Sean, a Marine Corps and Air Force veteran who served three times in Iraq and twice in Afghanistan, would wake up with an overwhelming feeling of dread. After losing his son to suicide in 2017, he knew he had to process his grief. But all of those feelings had been mounting for so long, he wasn’t sure how. And the longer time went on, the more impossible it seemed to climb that emotional mountain and find peace on the other side. 

“The way we handled things in the military was, you put things in your pack, you deal with them, and you keep pressing forward,” Sean, who is only using his first name for privacy reasons, told Salon. “That’s kind of what I did when my son passed away, and it kept building up and building up. … I was trying to figure out how I would process it, but I just got lost.”

In the next few years, distance grew in his relationship with his daughter and conflicts in his marriage led to a divorce. Then in 2021, in a chance encounter in a grocery store, he became connected with a nonprofit called Veterans Exploring Treatment Solutions (VETS) that presented him with an opportunity to try a psychoactive substance called ibogaine at a clinic in Mexico. 

“It was really touching on some nerves on things I was struggling with, the suicidal ideation, stress and a potential traumatic brain injury,” Sean said. “It would end up being the worst thing and the best thing I have ever done in my life.”

Ibogaine, an alkaloid extracted from the iboga root native to Central Africa, is illegal in the U.S., but not in Mexico and the Caribbean. Clinics and retreat centers there offer the drug for sessions that typically cost thousands of dollars. Researchers at Ohio State University are collecting survey data from any of the estimated 10- to 20,000 people who are thought to have already taken ibogaine, but due to regulatory restrictions and a lack of funding, research at this point in the U.S. is mostly limited to leveraging data from existing international clinics.

“We are collecting data on people who have sought ibogaine treatment all around the world so we can start to collect a very robust database of any risks, any benefits and what's going on in that space,” said Dr. Stacey Armstrong, associate director of the Center for Psychedelic Drug Research and Education at OSU. “That way we have something to provide when we go forward, maybe with an [Food and Drug Administration] submission for a clinical trial in the United States.”

The therapeutic potential of ibogaine

Ibogaine seems to work like a rapid-acting antidepressant that improves cognition and promotes neuroplasticity. What distinguishes it from other psychedelics like psilocybin or LSD is that it also acts on a protein in the brain that helps neurons survive and regenerate called the glial-derived neurotrophic factor, or GDNF. This regulates the neurotransmitter dopamine, which could explain why it has been reported to reduce cravings and help people with substance use disorders, said Dr. Deborah Mash, a lead ibogaine researcher who has been studying it since the 1990s.

“If this molecule could help reset the neurotransmitter signaling pathway for dopamine, this would be a major significant pharmaceutical advantage,” Mash told Salon in a phone interview. “We could actually have a molecule to finally treat the underlying disorder that puts patients at risk for addiction and keeps them locked in to an intractable cycle of disease.”

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In small studies, ibogaine has been shown to improve symptoms of traumatic brain injury, substance use disorders, and post-traumatic stress disorder (PTSD). Earlier this month, Stanford University published a study in Nature Medicine of 30 veterans with TBI in which Sean participated. It found 88% of participants had reduced PTSD symptoms, 87% had fewer depressive symptoms, and 81% had alleviated anxiety symptoms in addition to improved TBI measures.

Tom Feegel, co-founder of Beond Ibogaine, a retreat center in Cancun, Mexico, said about half of people who attend treatments there are seeking help for substance use, 40% come to treat depression, anxiety, TBI or PTSD, and the remainder come for emotional and spiritual development purposes.

Indeed, the drug has a long history of use. Indigenous people from the Bwiti religion in Gabon have been using iboga shrubs for thousands of years for coming-of-age ceremonies and healing rituals. 

“Ibogaine is an autobiographical, deeply introspective experience about you and it’s a very long journey compared to other psychedelics that lasts 8 to 12 hours,” Feegel told Salon in a video call. “You’re basically in a dream-like state, observing the most meaningful memories of your life, which tends to change our perspective on our past.”

The path forward in research

In 1993, the FDA approved a clinical trial to test ibogaine’s safety and how it was metabolized in the body. However, the National Institutes of Drug Abuse decided not to fund it, citing safety concerns.

High doses of ibogaine can carry a risk of cardiac arrhythmia and other heart-related side effects. Between 1990 and 2020, 33 deaths have been associated with ibogaine use, most commonly in spaces where cardiac monitoring did not occur, doses were too high, or people ingesting it were on other prescription or non-prescription drugs that were contraindicated, according to a 2021 editorial co-authored by Mash in Drug Metabolism & Toxicology.

“For most of the reports, there was no toxicology done, and some people predict they had other drugs on board, which means you’d have a risk for drug-drug interactions. Or some people had a potassium imbalance, a magnesium deficiency, or their electrolytes were off,” Mash said. “You have to have the labs, you have to have the cardiogram, and you have to have a qualified clinician look at your labs and your cardiogram to make sure you are a candidate for this.”

Some have said the decision to not prioritize ibogaine is rooted in stigma that pervades psychedelic research, and there has been relatively little interest from the pharmaceutical industry over the years to invest in research studying its effectiveness.

Yet in the context of the co-occurring mental health and overdose crises, in which more than 130 and 200 people die by suicide and overdoses each day, many argue that more efforts should be made to understand this substance’s therapeutic potential. 

The criminalization of drugs often does not stop people from taking these substances, but makes them instead seek out less safe ways to use them. As larger clinical trials continue to be pursued in the U.S., many continue to try ibogaine in other countries, where it’s largely up to the individual to make sure there is medical supervision and safety protocols in place.

Patients at Beond meet with staff virtually before enrolling in treatment to shared their complete health histories and make sure they do not have any contraindicated conditions. They also talk with medical staff who ensure they are not on any contraindicated medications. Upon arrival, they undergo EKG and lab testing to make sure all vitals are stable before taking ibogaine and are constantly monitored during the process, said Dr. Eduardo Ramirez, an emergency medicine physician and Beond’s medical director. 

“You’re hooked up to a blood pressure cuff and a pulse oximeter, and we put on electrodes on your chest so we can see your cardiac rhythm and vital signs in real time,” Ramirez told Salon in a video call.

In a study Mash published in 2018 with 191 people who were given ibogaine to treat opioid and cocaine use, no adverse events were reported with the proper dosing and monitoring in place. At one month follow-up post-ibogaine treatment, drug cravings and depressive symptoms were significantly lower for participants in this study.

“More recent research with ibogaine has suggested that there have been no adverse effects or significant adverse effects with healthy individuals who use ibogaine with no other substances,” Armstrong told Salon in a phone interview. 

Researchers are also investigating the use of noribogaine, the principal psychoactive metabolite of ibogaine, which has been shown to carry its anti-addictive effects and could also be taken in a pill or a patch daily, without the need for extensive monitoring, Mash said.

“People could go to work and not need to take off and go to a psychedelic retreat or go to a hospital to be under a full medical monitor,” Mash said. “Noribogaine will help people who are recently detoxified from drugs or alcohol to transition to sobriety.”

In the past few years, there has been a renewed interest in ibogaine treatments. Congressional lawmakers have advocated for more research on it, and the pharmaceutical company ATAI Life Sciences is researching it as a therapy for opioid use disorder.

Various researchers are trying to make ibogaine-similar molecules without some of the side effects, and NIDA has even returned to funding some animal studies to test ibogaine analogs. Thus far though, these types of molecules have only been tested in rodents.

A transformational experience

When taking ibogaine, people often report transformational experiences that curb substance use when other attempts have not and lead to recovery that persists years after ibogaine is ingested. Those who have tried it also often report transcendental experiences where they understood the connectivity of all things, experience visions, or encounter God. 

But it’s a challenging experience, too. People report nausea and vomiting or impaired psychomotor coordination. In Sean’s case, he felt his fingers and toes curling inward, as if he were collapsing into himself. Then came the purging. 

“I do believe that was part of the healing process,” Sean said. “That it was actually getting something out.”

Sean experienced a TBI when an explosive device fell off a truck in Iraq and hit his head. During his time there, 48 Marines in his unit died and another 120 were sent home with injuries. Through his experience with ibogaine, he was able to start to process all of the loss he experienced during his time in service, along with starting the process of grieving his son.

"At its core, there was a spiritual, emotional change, which I think is more permanent and more lasting than just the physical," Sean said. "You understand a little bit more about what love is and how love presents itself and how love is connected to everything.”

Ibogaine didn’t give him all of the answers, but it gave him a clarity of mind that, in the integration process afterward, allowed him to make decisions that helped him move toward healing. That clarity also helped with his TBI, which before had made accessing parts of his memory tough. 

Sean started exercising and eating better, and his relationship with his daughter improved. He still struggles with feeling down sometimes, but he doesn’t feel depressed. He feels anxiety, but it didn’t threaten to consume him like it did in the mornings before trying ibogaine. And today, he finds himself with a general openness to life that wasn't present before and is willing to try practices like meditation that help him maintain the benefits of his experience. 

“It doesn’t make everything carnations and roses and you come back and start seeing rainbows and unicorns everywhere,” Sean said. “Life still happens … But I guess the biggest thing I found coming out is that I wanted to become a better person.”