Addressing Ibogaine's Heart Risks

Ibogaine is a tryptamine psychedelic found in Tabernanthe iboga, a shrub native to Central West Africa. Some of the indigenous peoples of Gabon, Cameroon, the Democratic Republic of Congo, and the Republic of Congo use the root or bark of this plant (as these contain the highest concentrations of ibogaine) as part of Bwiti spiritual practices. (Bwiti is a syncretic religion, which combines animism with ancestor worship and Christianity.) These iboga-using tribes include the Punu and Mitsogo peoples of Gabon, and the Fang people of Gabon and Cameroon.

Some people from other countries travel to Central West Africa to participate in iboga ceremonies. This is because the ibogaine experience can be therapeutic in a number of ways. It is also possible to have ibogaine experiences outside the context of traditional use in Africa; one can use it in a more clinical setting in other countries. In this context, one doesn’t consume the whole plant but an extract of iboga or synthetic ibogaine.

Ibogaine treatment centres typically focus on the treatment of addiction; however, some ibogaine clinics have expanded the benefits they offer to clients. For example, Beond – based in Cancun, Mexico – also helps people with issues like trauma, depression, and anxiety. The treatment centre says, too, that ibogaine can optimise people’s lives by fostering personal development, psycho-spiritual growth, and life skills.

Tom Feegel, CEO of Beond, told The Guardian that he estimates 150 ibogaine providers are operating worldwide, but he says only 10 are correctly certified as accredited medical clinics. Ibogaine is unregulated in Mexico, which is why there has been a proliferation of clinics there, given its proximity to the US. (It should be noted that The Guardian article is nearly two years old and new ibogaine clinics have been emerging since then.)

The fact that many ibogaine clinics are not accredited medical clinics and don’t pay close attention to safety is concerning. Feegel has referred to some of these clinics as “drive-thru detoxes”. He explained:

They use ibogaine to offset or temporarily eliminate the symptoms of withdrawal, largely from opioids, and they are not in the business of healing. It is a psychedelic version of what we call the treatment model, where people have to come back.

Ibogaine is not in the same class as other psychedelics, partly because of its unique effects on the heart, and also due to its especially long duration (journeys can last 24+ hours). Psychedelic users seeking addiction or mental health treatment, or purported optimisation benefits, need to weigh up relative benefits and risks. In some cases – depending on one’s condition and its severity, underlying health conditions, and responses to other treatments (psychedelic or otherwise) – it may be wiser to opt for another psychedelic.

Ibogaine carries a heightened risk to heart health, not seen with other psychedelics, because it interacts with the heart’s electrical signals and also lowers the heart rate. The authors of a 2015 article published in Molecules note that “therapeutic concentrations of the alkaloid interact with cardiac ion channels, and these effects most likely determine ibogaine’s potentially life-threatening cardiotoxicity [damage to the heart muscle].”

The higher the dose of ibogaine, the more pronounced these effects on the heart will be. The indigenous peoples of Central West Africa belonging to the Bwiti tradition use a range of doses of iboga for varying purposes: low doses are said to aid hunting (because of their stimulating effect); small to moderate doses are used in various ceremonies; and large doses are used for Bwiti initiation ceremonies, in order to induce an intense spiritual experience.

At ibogaine clinics, strong doses are often used, as the aim is to manifest ibogaine’s mystical and visionary qualities, which are believed to be a core component of its therapeutic effects. While this may be the case, these higher doses do also carry greater heart-related risks.

While ibogaine’s lowering of the heart rate is clear in humans, the way it affects the heart’s signals is less clear in humans, as we’re relying on animal studies. Moreover, these animal studies do not conclusively show that these specific heart signal alterations are sufficient to cause heart arrhythmia. The authors of a 2024 paper published in Nature Communications state,

Preclinical assessment of the cardiotoxicity of experimental compounds is complicated by species differences in cardiac ion channel expression and pharmacology. Further, inhibition of the hERG [potassium] channel alone is not sufficient to predict delayed ventricular repolarization and cardiac pro-arrhythmia risk, as modulation of other ion channels involved in different phases of the cardiac action potential may mitigate or exacerbate the QT [heart rhythm] prolongation/pro-arrhythmia risk (for example by inhibition of L-type calcium channels), and there may be species differences in ion channel pharmacology…. This is particularly relevant for compounds like iboga alkaloids with complex pharmacology. As a result, preclinical in vivo tests in rodents or other non-human species may be misleading.

Kaitlin Sullivan, the author of The Guardian piece referenced earlier, writes that ibogaine’s:

[heart] risk is amplified by ibogaine clinics operating largely without regulation and the standards of medical care – such as monitoring heart rate and testing patients for drugs that might interact dangerously with ibogaine – that protect the safety of patients who take it.

Beond, for instance, is a fully certified Class 1 medical facility credentialed by the federal government of Mexico. The company is committed to providing safe experiences for clients, as evidenced by the training background and expertise of its medical team. If all ibogaine clinics were staffed, approved, and regulated according to these standards, there would be fewer cases of heart-related fatalities.

Using non-hallucinogenic could be another way to reduce these types of fatal reactions. UC Davis researchers have developed a synthetic analogue of ibogaine (tabernanthalog) that doesn’t produce psychedelic effects, and they found it has antidepressant and anti-addiction properties but without the heart risks. And from a practical point of view, this substance is also easier to manufacture than ibogaine.

It remains to be seen how using this kind of analogue benefits patients compared to ibogaine. The intense subjective effects of ibogaine – such as mystical experience, personal insights, and emotional catharsis – may translate into more substantial and longer-lasting therapeutic effects. However, if the benefits of the non-hallucinogenic analogue are still significant, then many patients may feel that using ibogaine is not worth the risks. There will be others, still, who want the psychedelic journey induced by ibogaine, despite the non-negligible physical risks, in light of its potential psycho-spiritual benefits.