Ibogaine offers an alternative approach for treating opiate addiction
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Substance use disorders (SUDs) such as opioid addiction account for a large portion of the total global burden of disease. Nearly 5% of all disability-adjusted life years and 4% of overall mortality appear to be attributed to SUDs. An SUD, such as opioid use is often characterized by its addictiveness and frequent relapse among those who attempt quitting. Despite traditional methods of treatment, 5-year relapse rates are as high as 97% for opioid dependence. Alternative or novel forms of treating opioid addiction should be investigated and adopted, especially in countries which face an “epidemic” of opioid use and dependence, such as the United States. Ibogaine is a naturally occurring indole alkaloid that may be an effective alternative form of treatment for individuals struggling with opiate addiction and/or withdrawal. Preliminary research has found that iboga alkaloids such as ibogaine are effective at reducing morphine self-administration in rats. An elaborate history of human case reports has found ibogaine to be successful at reducing drug self-administration, withdrawal symptoms, and ceasing opioid cravings. The complex pharmacological profile of ibogaine is mediated by several classes of neurological receptors and transporters, including the sigma-2, kappa- and mu-opioid, 5HT2 and 5HT3 receptors, 34 nicotinic receptors, and the N-methyl-d-aspartic acid ion channel. Ibogaine’s combined interaction with all of these receptors has been suggested to reset or normalize neuroadaptation related to drug sensitization and tolerance. The resulting anti-addictive physiological and psychological properties appear to persist beyond pharmacokinetic elimination from serum or brain tissue, but may also cause unwanted side effects such as cardiovascular and neurologic toxicity. Developing a safe and effective standard dosing regimen has proven to be difficult in humans. The controversial therapeutic use of ibogaine in medical and nonmedical settings has been called a “vast uncontrolled experiment” or “medical subculture”, and ibogaine remains unscheduled in much of the world. However, ibogaine does not appear to have potential for recreational or other forms of abuse. During the 1995 Ibogaine Review Meeting, none of the consultants to NIDA were concerned about the abuse of ibogaine. Opiate users struggling with addiction and also interested in ibogaine therapy prompted the formation of “informal” treatment networks. Ibogaine therapy clinics catering to foreigners have also become more common in the Caribbean and Latin America. In order to clarify ibogaine’s clinical safety and therapeutic use against opiate dependence, the following thesis will investigate and analyze the ibogaine literature. Areas of focus for future ibogaine research will be identified, such as the invention of ibogaine congeners that retain efficacy against opioid dependence, but minimize unwanted toxic or psychological effects.