Ibogaine: Promise and Practicalities for Transforming Addiction Treatment

Ibogaine: Promise and Practicalities for Transforming Addiction Treatment

Ibogaine is rapidly garnering attention as a potentially revolutionary treatment for addiction and related mental health disorders—a beacon of hope in landscapes often characterized by despair and systemic inadequacy. In a recent Fluence webinar, leading experts Dr. Bruno Rasmussen (Brazilian physician and ibogaine clinician) and Brian Hubbard (CEO, Americans for Ibogaine) shared experiences from the clinical, policy, and personal frontlines of ibogaine advocacy and treatment. Their candid dialogue, moderated by Lauren Okano, illuminated the intersection of science, systems, and humanity in the evolving world of psychedelic-assisted therapy.

Reimagining the War on Addiction

Dr. Gabor Maté’s observation, quoted at the outset—“The war on drugs is cultural schizophrenia... stressing people chronically and mercilessly can in no way promote their capacity for healthy transformation”—frames the journey ahead. Both guests outlined how ibogaine offers a radically different approach, grounded in science and compassion rather than punishment and stigma.

What is Ibogaine? Lessons from Brazil and Beyond

Dr. Rasmussen has administered over 2,500 ibogaine treatments since the 1990s, operating in a context where the substance is legal and regulated as a medicine. Ibogaine, an alkaloid extracted from the African Tabernanthe iboga plant, has long played a sacred role in Bwiti initiation ceremonies, facilitating profound self-insight and personal transformation.

Clinically, Rasmussen described ibogaine as both a biochemical intervention—swiftly reducing cravings and withdrawal symptoms—and a catalyst for psychological reflection. Patients often experience vivid introspection, revisiting formative memories and confronting life choices. Notably, Rasmussen reports a success rate exceeding 70% for ibogaine in treating stimulant addiction, a marked departure from the high recidivism rates of conventional programs.

PODCAST EPISODE (17 min)

Bridging Policy and Practice: The U.S. Struggle

By contrast, the U.S. remains at the starting line in terms of ibogaine therapy, constrained by regulatory barriers (Schedule I status) and the inertia of existing systems. Brian Hubbard, leveraging experience from public health policy and social services, characterized the current American addiction treatment model as both exorbitant and inefficient—with 75% failure rates and ballooning costs.

Hubbard’s vision is transformative. He champions a framework where ibogaine treatment is not a silver bullet but the gateway to comprehensive, longitudinal support—psychological, social, and medical. He highlighted the extraordinary actuarial and human savings possible if ibogaine’s clinical efficacy is validated and accessible, envisioning a “Manhattan Project” scale-up for ibogaine, especially for populations at highest risk, such as veterans.

Ensuring Safety and Respect for Potency

Both presenters emphasized that ibogaine is no ordinary psychedelic; it carries real risks, particularly of cardiac arrhythmia. Rasmussen insisted on the necessity of hospital-based administration, thorough pre-treatment screening, and multi-day supervision, adding: “We have never seen a death from ibogaine in Brazil because we are very strict about patient selection and safety protocols.” He warned against any “drive-through” mentality or recreational use outside medical oversight.

Toward Systemic Integration: Values, Economics, and Equity

A recurring theme was the juxtaposition of ibogaine’s restorative potential against the commercial and bureaucratic forces shaping healthcare. Hubbard and Rasmussen both condemned the prevailing incentives toward “chronicity”—the management, rather than resolution, of suffering. In their view, widespread adoption of ibogaine would challenge entrenched business models that rely on the endless cycling of patients through ineffective treatments.

Yet, overcoming stigma—both at the regulatory and social levels—remains a formidable hurdle. Addiction is still widely misunderstood and stigmatized, fueling hesitancy from both government and industry. The path to full integration and insurance reimbursement hinges on robust clinical trials and regulatory approval, but also public and professional education to shift mindsets.

Sustainability and Cultural Responsibility

As Western interest in ibogaine swells, questions of ethical sourcing and respect for indigenous knowledge grow urgent. Both speakers advocate for synthetic, GMP-grade ibogaine or biosynthetically produced derivatives to supply clinical demand, preventing over-harvesting of the wild iboga plant and ensuring sustainability. Simultaneously, they call for reciprocal relationships and the honoring of the plant’s cultural origins, not simply extraction and commercialization.

Beyond the Medicine: Preparation, Integration, and Community

Central to ibogaine’s success is the pairing of the medicine with preparatory and integrative psychotherapy. Rasmussen underscored that patients refusing psychotherapy are not offered ibogaine in his clinic. Both panelists called for training U.S. therapists and providers in ibogaine’s unique properties, ensuring that the deep insights catalyzed by the medicine can become lasting transformation.

How to Get Involved and What Lies Ahead

While direct clinical access for ibogaine remains limited in the U.S., Hubbard encouraged interested individuals to join advocacy efforts, connect with organizations like Americans for Ibogaine, or support veterans and recovery initiatives that are pushing for change. Dr. Rasmussen emphasized the importance of building capacity, sharing knowledge, and preparing for the day when regulatory and societal barriers give way.

Conclusion: An Emancipation Mission

Ibogaine’s potential runs far deeper than addiction interruption; in the words of Brian Hubbard, the movement for ibogaine access is an “emancipation mission,” a campaign not just for medical innovation, but for the re-humanization of those whom the system has failed. As new data and advocacy converge, ibogaine may herald a new era in treating—and ultimately healing—the diseases of despair that have plagued society for decades.

Author’s note: This article synthesizes a Fluence webinar transcript featuring Dr. Bruno Rasmussen and Brian Hubbard. For the full conversation, see Fluence's archives.

 

What is Ibogaine and what are its historical roots?​

Ibogaine is a psychoactive compound found in certain African plants, primarily Tabernanthe iboga and Voacanga africana. Historically, it has been used for millennia in Africa, particularly within the Bwiti religion, where it is consumed in ceremonies to mark the transition from adolescence to adulthood. The plant is considered sacred and the ceremonies can last three days, facilitating a deep introspective experience. In 1962, Howard Lotsof, an American addicted to heroin, self-experimented with ibogaine and experienced a profound psychedelic journey that eliminated his withdrawal symptoms and cravings, leading him to become a lifelong activist for its medical development.

How does Ibogaine differ from traditional addiction treatments, and what are its potential benefits?​

Ibogaine's unique mechanism of action sets it apart from conventional addiction treatments. Unlike medications such as methadone or Suboxone, which are opioids themselves and primarily manage symptoms, ibogaine biochemically interrupts withdrawal and cravings, making it significantly easier for individuals to stop drug use. It induces a psychedelic, introspective state where patients can reflect on their lives, understand past behaviors, and make conscious decisions for change. This holistic approach, addressing mind, body, and potentially the "soul," aims for curative and restorative outcomes rather than just symptom management. While traditional treatments for opioid addiction can cost over $100,000 for 120 days with a 75% failure rate, ibogaine has demonstrated efficacy rates above 70% for conditions like crack cocaine addiction in Brazil.

What are the main safety considerations and current challenges in Ibogaine administration?​

The primary concern with ibogaine is its potential for cardiac toxicity, which can lead to life-threatening arrhythmias if not managed correctly. To mitigate this risk, it is crucial to administer ibogaine in a controlled environment, such as a hospital or a well-equipped clinic with access to an Intensive Care Unit (ICU) if needed. Pre-treatment medical evaluations, including blood tests and EKGs, are essential to identify and address any pre-existing conditions. Bruno Rasmussen, who has overseen over 2,500 treatments in Brazil without a single death, emphasizes that ibogaine is a strong medicine requiring physical and psychological preparation, a 24-48 hour observation period post-treatment, and ongoing support from a care team. It is explicitly stated that ibogaine should not be taken in uncontrolled settings like homes or garages.

What is the current regulatory and policy landscape for Ibogaine in the USA and Brazil?​

In the United States, ibogaine is classified as a Schedule I substance, the most rigorous scheduling, similar to heroin. This classification significantly hinders research and widespread medical adoption. Efforts are underway to achieve FDA approval as a breakthrough therapeutic for substance use disorder and other mental health/neurological conditions. This process is expected to be lengthy and expensive but could be expedited with breakthrough designation status and potential federal reforms. In Brazil, ibogaine is not scheduled, making it legally easier to work with. The goal in Brazil is to register ibogaine with ANVISA (the Brazilian FDA) and then convince the government to provide it for free, particularly for individuals in "cracklands" – areas with high open drug use. Both countries face bureaucratic hurdles, but there is synergy, as approval in Brazil could influence FDA's perspective in the US.

What are the proposed approaches for developing and sustaining Ibogaine-based treatments?​

For FDA approval in the US, ibogaine will likely be developed as a synthesized version, potentially paired with other molecules (e.g., magnesium) to mitigate cardiac risks and meet regulatory requirements for unique chemical signatures. Researchers are also exploring artificial intelligence to deconstruct the ibogaine molecule to create targeted alkaloids that retain therapeutic benefits while eliminating cardiac risks. For sustainability, alternatives to wild harvesting the iboga plant are being pursued, such as replicating the alkaloid through engineered yeast or algae. This ensures a stable supply chain without impacting the natural environment or culturally significant plant resources in West Africa. Reciprocal cultural and economic cooperation with indigenous communities is emphasized as crucial.

How important is psychological preparation and post-treatment support for Ibogaine therapy?​

Psychological preparation and post-treatment support are considered crucial for maximizing the long-term benefits of ibogaine. The treatment is viewed as a "psychotherapy facilitator." In Brazil, patients undergo approximately four preparatory psychotherapy sessions before treatment and four follow-up sessions afterward. Refusal to participate in psychotherapy may lead to refusal of treatment, as experience shows that without psychological support, the benefits of ibogaine are short-lived. This integrated approach helps patients process the deep introspective experience facilitated by ibogaine and rebuild their lives effectively. In the US, the aim is to develop a treatment system that places long-term support around individuals, involving friends, family, neighbors, and trained mental health professionals.

What are the underlying values driving the push for Ibogaine's wider adoption?​

The core values driving the advocacy for ibogaine revolve around human restoration and emancipation, contrasting with existing systems that often perpetuate chronic conditions and monetize suffering. Advocates believe ibogaine offers a curative and restorative solution to addiction and mental health issues, aiming to free individuals physiologically and psychologically from dependency. There's a strong belief in addressing the root causes of suffering rather than just managing symptoms. Furthermore, activists aim to combat the stigma associated with addiction, which has historically led to a lack of pharmaceutical interest and funding for research. The movement seeks to challenge economic models that profit from chronic treatment and instead prioritize a more humane and science-based approach to care.

How can individuals get involved in the movement to make Ibogaine more accessible?​

For individuals interested in joining the movement, there are growing opportunities due to increased awareness and ongoing projects. In the United States, organizations like Americans for Ibogaine (americansforibogaine.org), chaired by former Texas Governor Rick Perry, are building a broad-based "unity coalition" to advocate for policy changes and accelerate medicalization. They encourage engagement through their website, social media, and by spreading awareness to build a mass movement. In Brazil, where ibogaine is legal, individuals can look for clinics or research initiatives working with psychedelics. Both Bruno Rasmussen and Brian Hubbard emphasize the need for help and support for this "big work" that aims to fundamentally shift how society approaches addiction and mental health care.