Issue:
109
Page: 48-57
Iboga Root: Dynamics of Iboga’s African Origins and Modern Medical Use
by Jonathan Dickinson
HerbalGram.
2016; American Botanical Council
Introduction
The term iboga (sometimes
spelled eboga or eboka) refers to a small variety of African
plant species in the Apocynaceae family, principally Tabernanthe
iboga and T. manii.1 There are at least seven identified
species in Gabon alone, although variations are not always botanically
distinguished.2,3 These unassuming perennial shrubs are endemic to
equatorial West Africa, where they grow in the jungle understory in a region
encompassing the borders of Gabon, Cameroon, Angola, and the Republic of the
Congo (Congo-Brazzaville).1 Mature plants are typically one to two
meters (3.3 to 6.6 feet) in height but can grow up to ten meters (32.8 feet)
under certain circumstances, and they produce inedible, oblong orange fruits
after their first year.
Iboga has been translated as “to care for” or “to heal” in various tribal dialects*
of the Congo Basin where it plays an important cultural role, especially in
Gabon. There, it has been used for centuries as a medicine and sacrament,
particularly in the traditional spiritual discipline of Bwiti.4 The
plant’s medicinal alkaloids are concentrated in the inner layer of its
extremely bitter bark, which is peeled from the roots of mature plants — at
least three to five years of age, although older plants are preferred when
available. The harvesting process often involves uprooting the entire shrub,
but there are more time-consuming methods of harvesting root bark from living
plants that allow the plant to regenerate but stunt further growth.
Ibogaine (12-methoxyibogamine), the
primary active alkaloid produced by iboga, has shown promise in the treatment
of certain substance use disorders. Notably, the compound has been found to
reduce the symptoms associated with opioid withdrawal syndrome, post-acute
withdrawal syndrome (PAWS),5,6 and cravings for opioids, alcohol,
cocaine, and other stimulants.7 Existing pharmacological models of
addiction do not comprehensively explain these effects. Ibogaine interacts with
multiple neurotransmitter sites throughout the central nervous system8
and has neuroprotective effects on dopamine and motor neurons. It also leads to
increased levels of glial cell line-derived neurotrophic factor (GDNF), a
hormone that stimulates the growth of new dopaminergic neurons.9
Ibogaine’s primary metabolite, noribogaine (12-hydroxyibogamine), has a similar
pharmacological profile and is thought to support the long-term mitigation of
cravings for various substances.
The clinical use of ibogaine for
drug detoxification has not yet been accepted by mainstream medical practice.
This development has been complicated in large part by ibogaine’s powerful
psychoactive effects, which have resulted in its Schedule I status in the
United States, as defined by the US Drug Enforcement Administration (i.e.,
drugs with no currently accepted medical use and a high potential for abuse).
In lower doses, ibogaine acts as a stimulant, but in higher doses it is
characterized as an oneirogen — a substance that promotes “waking dream” states, primarily
through closed-eye visualizations, the retrieval of repressed memories, and
profound self-reflection.10 Although the effects of ibogaine differ
from those of “classical” hallucinogens such as DMT (dimethyltryptamine), mescaline,
psilocybin, and LSD (lysergic acid diethylamide), these compounds are also
commonly classified as psychedelics. Amid a recent resurgence of research into
the therapeutic value of psychedelic drugs, there is increasing medical and
academic interest in ibogaine-assisted detoxification.9
Between 2001 and 2006, there was a
reported four-fold increase in the worldwide use of ibogaine for the treatment
of substance use disorders.11 The subsequent proliferation of
therapy providers in countries like Mexico, Costa Rica, and Brazil is a sign
that this growth has continued. Some cite this increase in use, and the fact
that it takes place within a therapeutic context with no reported recreational
use or addictive potential,12 as evidence for the treatment’s safety
and potential efficacy. However, this development has also placed significant
pressures on wild populations of iboga. Iboga therapy advocates in Gabon have
reported that iboga may be threatened in its natural habitat and could
disappear from the Gabonese market as early as 2016.2 This review
will examine the ethnographic context of iboga’s traditional and modern uses, as
well as the sociological dynamics and international laws that impact its
cultivation and trade, and the manufacture of ibogaine for clinical use.
Traditional Origins and Ethnobotany
The traditional use of iboga is
principally concentrated in Gabon, a small country with a population of
approximately 1.7 million people, about 20% of which inhabit the capital city
of Libreville. Today, by some estimates, there are more than 100 mostly rural
communities throughout Gabon that continue to practice Bwiti in its various
forms.2 Bwiti is an animist ritual culture that incorporates iboga
into healing and ritual practices, such as the passage from youth to adulthood
and other important life transitions (e.g., assuming a leadership role or
recovering from extreme grief). This spiritual discipline involves, among other
elements: (1) complex oral traditions and cosmologies that vary among
practitioners; (2) a large pharmacopeia of plants that are used for their
medicinal, aromatic, or metaphysical properties; (3) a wide variety of
cleansing and healing practices3; and (4) several unique instruments
and distinct forms of music known for their complex overtones and polyrhythms.13
Although Bwiti is recognized as one of Gabon’s official religions, its
traditional practitioners have experienced political marginalization largely
due to the perception of Bwiti as primitive, or as a form of witchcraft.2
The emergence of Bwiti, at least
among the Fang people of West Africa, occurred around the turn of the 20th
century, at the height of early French colonization. The French occupation of
the region was largely fueled by rivalries with the British and an attempt to
suppress the slavery that was widely practiced by other colonial powers in
Africa. French colonizers hoped that the Gabonese, especially those that lived
near the inland trade routes, would develop a thriving economy under their
protection, one built on coastal crops and increased trade in ivory, rubber,
and other goods.3
Unfortunately, these hopes were not
realized. Colonizers sought to pacify the native population, but they
ultimately destroyed villages and displaced their inhabitants. This put the
Bantu population, historically a coastal-dwelling tribe, in contact with the
inland Pygmy people. Based on oral testimonies, the Pygmies, who have a much
longer history of using iboga, shared their practices with the Bantus, who
repeatedly attacked them and forced them further inland.3 The
Pygmies believed that by sharing the practice of Bwiti with the Bantus they
would lose interest in continued violence.4
The initiatory (ritualistic)
practice of Bwiti sprang from this exchange of knowledge. In its practice, many
Gabonese people found a fertile form of spiritual expression and empowerment,
as well as a non-violent form of colonial resistance. Although not the case in
many communities, among the Fang, Bwiti eventually became syncretized with
Christian imagery and beliefs.
Bwiti is sometimes translated
as “dead” or “ancestor,” but its etymology may be
rooted in the term Mbouiti, which is the more accurate name for the Pygmy people that
inhabit the region between Gabon and the Democratic Republic of the Congo (DR
Congo).14 While the practice remains central to Gabonese culture,
minor Bwiti temples have been established in the surrounding regions, including
Equatorial Guinea, Cameroon, DR Congo, and South Africa.15
There are many branches and schools
of Bwiti, as well as sister traditions such as Mbiri, which focuses more on
healing than initiation rituals.3 Early Pygmy practitioners of Bwiti
used iboga to help community members overcome compulsive behaviors, including
those related to the use of substances, such as traditionally prepared palm (Elaeis
spp., Arecaceae) wine.2 These treatments were aimed at better
integrating an individual into the community. Unlike other medicinal
plant-based traditions in which ceremonies are conducted by one or several
experienced practitioners, traditional iboga initiations involve the entire
community. The process centers around one or several of the community members
and involves elaborate rituals, music, and dances that last for days.
Many Bwiti practitioners consider
iboga to be the biblical tree of the knowledge of good and evil.15
It is said that it brings those who consume it into contact with their
ancestors and teaches them about the nature of life and death. More than simply
a medicinal plant, iboga is said to act as a kind of “truth serum.” The transformations
that result in an individual’s personality and physical body are seen as the
result of being brought into contact with universal truths. For this reason, it
is commonly believed that the uninitiated are unable to fully understand the
plant’s potential.1
Scientific Research
The first Occidental sample of T.
iboga was brought to Paris by Griffon du Bellay in 1864 and classified by
Henri Baillon in 1889.16 Ibogaine was first isolated in its
crystalized salt form in 1901, around the same time that Fang Bwiti is said to
have emerged in Gabon. The first studies that examined ibogaine’s
pharmacodynamics were conducted in the years that followed.
In 1939, ibogaine found its first
medical application as a neuromuscular stimulant. Sold in France under the
trade name Lambarène,
these 8-mg ibogaine tablets were recommended for “fatigue, depression, and recovery
from infectious disease.”8 Almost 30 years later, in 1966, the
product was removed from the market after the World Health Assembly (WHA)
classified ibogaine as a “substance likely to cause dependency or endanger human
health.”17 Before the WHA’s ruling, the US government had funded
research in the 1950s, which found that ibogaine potentiated the pain-relieving
effects of morphine. It is unclear whether any evidence was found supporting
ibogaine’s detoxifying effects.11,18
The discovery of ibogaine’s
potential for reducing symptoms of opioid withdrawal syndrome is attributed to
Howard Lotsof, whose first exposure to ibogaine was in 1962 as a 19-year-old
heroin user living in Staten Island, New York. Despite the intense discomfort
of his experience, he later claimed to have been freed from his chemical
dependency with no residual desire to use heroin. Transformed by his
experience, Lotsof conducted an informal experiment with 19 individuals, seven
of whom were opiate-dependent.19 Ibogaine had a similar effect for
all of them, at least insofar as its detoxifying effects were concerned. Five
of his seven heroin-dependent friends remained abstinent for periods ranging
from six to 18 months. The others, while they were no longer physically
dependent, simply reported that they did not have a desire to stop using
opioids permanently.18
In the late 1980s and early 1990s,
treatments were made available through a collaboration among the International
Coalition of Addict Self-Help, Dutch Addict Self-Help, and NDA International, a
company founded by Lotsof. Simultaneously, studies were initiated in the US and
the Netherlands that supported the anecdotal evidence from these treatments. In
the early 1990s, the US National Institute on Drug Abuse (NIDA) approved
funding for pre-clinical and early Phase I/II human clinical trials on
ibogaine. Despite promising early results,6 the trials were
complicated by litigation20 and finally lost support, in part due to
critical opinions expressed by representatives of the pharmaceutical industry.8
Since the mid-1990s, the use of
ibogaine has spread rapidly in a variety of settings. In some cases, use has
occurred in medical settings under the guise of compassionate access and even
some experimental legal frameworks. There has been some effort to monitor the
outcomes of this experimental use. One study in Brazil demonstrated that 61% of
patients who were treated with ibogaine for cocaine dependency during a 30-day
program remained abstinent for at least one year,21 a significant
finding in the absence of effective conventional treatments for cocaine use
disorder. Data collected by the Multidisciplinary Association for Psychedelic
Studies (MAPS) shows that 19-50% of participants in short-term detoxification
programs for opioid use disorder remain abstinent for at least one year.22,23
However, abstinence is not necessarily the most revealing measurement. In all
cases documented by these studies, clear improvements in the symptoms of
substance use disorder and quality of life were demonstrated.
Profile of the Ibogaine Medical Subculture
The term medical subculture” has been used to
describe the diverse, global community of people who began providing ibogaine
therapy after the termination of the NIDA’s clinical trials. Alper et al.
outlined four primary categories of therapy providers: the “medical model,” “lay provider/guide,” “activist/self-help,” and “religious/ceremonial.”11
Medical Model
There is a long history of medical
use of ibogaine outside the US, and today it is used by some conventional and
integrative physicians in private practices, in some licensed medical centers,
and occasionally in hospital settings in various countries like Mexico, Brazil,
and Argentina. Medical screening and monitoring during treatment can
dramatically reduce the risks of ibogaine therapy, as discussed later.24 Therapy providers from other backgrounds increasingly
incorporate medical support as well.
Lay Provider/Guide
Lay practitioners who offer
detoxification services out of private homes, spas, retreats, and clinical
spaces perhaps make up the largest group of therapy providers. Although they do
not have formal medical training, many of these therapy providers have had
personal experiences with addiction, and often have had personally
transformative experiences with ibogaine. Knowledge of proper clinical use
among this community has developed, and at least some level of medical support
is increasingly integrated by these practitioners.
Activist/Self-Help
A subset of the lay provider
category, activist providers pursue the legalization and/or regulation of
ibogaine therapy and may provide treatments as a form of civil disobedience.
This group includes, among others, lay providers who offer underground services
in the US and other countries where ibogaine is listed as a controlled
narcotic.
Underground practices are not as
common as they once were, in part, because of the proliferation of more
established practices outside the US that are available to interested patients.
(For example, in 2007, there were a total of two ibogaine centers in Mexico
providing detoxification services for medical tourists. Today, there are closer
to 20 clinics that offer ibogaine treatments in a range of settings and
prices.) Another reason underground practices are not as common is the
increased availability of ibogaine marketed as a “self-treatment” option by online
vendors that frequently provide minimal instruction about proper preparation
methods and dosage for detoxification purposes. For those individuals who
decide not to seek clinical supervision, obtaining medicine online offers a
much riskier but more affordable option.
Religious/Ceremonial
Outside of the substantial community
of Bwiti practitioners in Gabon, there are other individuals who use ibogaine
for ceremonial reasons. These include those who have been inspired by the
traditional practice of Bwiti but overlap with one of the other categories, and
those who provide ibogaine in some other eclectic spiritual setting. Some of
these providers may also incorporate the medical model into the ceremonial
context.
Preparations of Iboga and Ibogaine
The general classifications of the
medical subculture are helpful to understand the spectrum of worldviews and
approaches among therapy providers. These various perspectives affect not only
how iboga and ibogaine are administered, but also the dynamics of how they are
produced and distributed.
There are three important
preparations of ibogaine: purified ibogaine hydrochloride, total alkaloid (or
full-spectrum) extracts that include each of iboga’s 13 alkaloids, and raw
iboga root bark. These preparations have different physiological and
psychological effects depending on which alkaloids are present.
Ibogaine Hydrochloride
Purified preparations of ibogaine
hydrochloride are the most easily standardized, and their effects have been
studied extensively. Historically, these have been prepared by extracting the
compound from iboga root bark, but, since 2010, ibogaine hydrochloride
increasingly has been semi-synthetically produced from voacangine, an alkaloid
readily available from the bark of the voacanga tree (Voacanga
africana,
Apocynaceae). Voacanga-sourced ibogaine is considered sustainable due to the
tree’s cultivation in other parts of West Africa. Also, due to the laboratory
processes used for its extraction and semi-synthesis, it is often available in
a form more purified than iboga-sourced ibogaine hydrochloride.
Ibogaine hydrochloride is generally
metabolized more quickly than other forms, and thus has a noticeably rapid
effect. For ease of use, standardization, and sustainability, many therapy
providers exclusively use ibogaine hydrochloride, particularly those practicing
the medical model.
Total Alkaloid (Full-Spectrum) Extracts
Anecdotal reports suggest that total
alkaloid (TA) extracts are somewhat gentler and have a slower onset than
ibogaine hydrochloride, which can make physical and psychological experiences
easier to handle. TA preparations are sometimes used simultaneously with
ibogaine hydrochloride, as supplemental (or “booster”) doses after the acute
detoxification period, and, rarely, as a completely independent treatment in
large doses.
Purified TA extracts have
higher-than-normal concentrations of ibogaine and retain the other alkaloids as
well. These purified preparations have been reported to have a stronger effect
than ibogaine hydrochloride, presumably due to the other alkaloids that
potentiate ibogaine’s effects. While some iboga alkaloids have been shown to
impact the self-administration of
cocaine and morphine in rats, some also produce tremorgenic (tremor-inducing)
effects similar to those of cocaine and morphine. Iboga alkaloids act on a
number of the same neurotransmitter systems as ibogaine,25 although
the extent of these interactions is not clear.
In general, TA extracts that reflect
the root bark’s natural balance are preferred. There continues to be a
significant demand for these preparations for their reported therapeutic
benefits despite the current lack of sustainable sources.
Iboga Root Bark
In the ibogaine medical subculture,
raw iboga root bark is used as an adjunct treatment, as an introduction to the
plant, or as a booster dose after the acute treatment episode. Root bark is
digested and metabolized more slowly than extracts, and, as a result, the
therapeutic experience has a more gradual onset and longer duration. There
remains a high demand for raw iboga root bark, although sustainable sources are
lacking.
Despite iboga root bark’s extremely
bitter taste, some practitioners administer large doses of it independent from
the use of extracts. This is widely considered to be impractical for substance
detoxification purposes due to the discomfort of ingesting such quantities. The
practice is more common among the religious/ceremonial set (e.g., Bwiti) and is
used almost exclusively for non-medical “psychospiritual” treatments.
Clinical Risk Management
The lack of regulation of ibogaine’s
clinical use where it is permitted, and lack of standardization for extracts,
have been cited as sources of increased risk for patients.11,20 A
number of ibogaine-related fatalities have been reported, and other adverse
event reports have been published by emergency room physicians, who described
arrhythmias, seizures, and psychological distress after administration.26-28
However, the cases that have been fully assessed have been attributed to
factors such as pre-existing heart conditions, complications from the
withdrawal or administration of other medications, or use of illicit substances,20
suggesting that risk factors are identifiable and manageable.
Ibogaine has been shown to block
hERG (human ether-à-go-go-related gene), which codes for a protein involved in regulating
the flow of potassium ions in heart cells. Potassium is an electrolyte required
for cardiac repolarization, which is measured by the QT interval (the time
between the start of the Q wave and the end of the T wave in the heart’s
electrical cycle) in electrocardiography. QT interval prolongation can lead to
various arrhythmias, a concern for patients who have low electrolyte levels,
abnormal QT intervals, or who are taking other QT-prolonging medications.
Although reported fatality rates for
ibogaine therapy are comparable to those for other forms of addiction
treatment, such as methadone maintenance,29,30 clinicians and researchers have
emphasized the need for standardized risk management through screening and
medical monitoring during ibogaine administration. The Global Ibogaine Therapy
Alliance (GITA),** a not-for-profit organization dedicated to supporting the
responsible therapeutic use of iboga and its alkaloids, has published Clinical
Guidelines for Ibogaine-Assisted Detoxification. The document describes an
in-depth risk management strategy that includes initial screenings (e.g.,
electrocardiograms, liver panels, electrolyte tests, and thyroid tests) to
check for certain pre-existing conditions, as well as protocols for cardiac
monitoring during treatment and emergency response readiness.24 In
addition to these guidelines, GITA offers an Advanced Cardiac Life Support
(ACLS) certification course, which covers the screening and monitoring of
potential cardiac issues during the therapeutic administration of ibogaine.
These resources may be helpful for medically equipped therapy providers,
clinical research, and policy development, but they are inadequate to prevent
adverse events in the absence of regulatory support.
Legal Status and Trade Regulation
Unlike other traditional plant
medicines, such as ayahuasca† (Banisteriopsis caapi,
Malpighiaceae) and peyote (Lophophora williamsii, Cactaceae), which hold
similar cultural relevance for native peoples in South America and the region
from Central Mexico to South Texas, respectively, iboga and ibogaine are not on
the United Nations’ (UN’s) International Narcotics Control Board’s (INCB’s) “List of Psychotropic Substances
under International Control.”31 However, the INCB’s 2010 Annual
Report reviewed several plant materials known to contain psychoactive
substances, including iboga. The report states that psychoactive plants “are often used outside of their
original socio-economic context to exploit substance abusers” and suggests
that, in the case of problematic use, “Governments should consider controlling such plant
material.”32
Ten countries have enacted policies
restricting ibogaine use: the US, Ireland, Belgium, Denmark, Sweden,
Switzerland, France, Hungary, Israel, and Australia.33 Elsewhere, in
the absence of regulation, ibogaine exists in a legal gray area. However, in
2009, the New Zealand Medicines and Medical Devices Safety Authority listed
ibogaine as a “non-approved
prescription medicine,” which has allowed it to be administered with a
physician’s order, at least on an experimental basis.34
In the majority of places where
ibogaine is used, its importation and therapeutic administration are
unregulated. Increased demand for iboga and ibogaine has greatly increased
pressure on the biodiversity and wild populations of iboga species in Gabon. As
a result, the country has made an effort to place iboga under the jurisdiction
of the UN’s 1992 Convention on Biological Diversity (CBD)35 and, by
extension, the Nagoya Protocol on Access to Genetic Resources and the Fair and
Equitable Sharing of Benefits Arising from their Utilization to the Convention
on Biological Diversity, which came into effect more recently, in October 2014.36
In 2000, Omar Bongo, then the president
of Gabon, declared iboga to be a “cultural heritage strategic reserve,” ordering his
administration to “take all necessary steps to protect this product on an international
level and to eradicate its illegal exportation.”37 This effectively
placed iboga under the control of Gabonese Law No. 2/94 for the Protection of
Cultural Goods, which makes it illegal to export the plant without a license
issued by the Ministry of Culture.38 This law may be supported by
the CBD’s stipulation that access to genetic resources is dependent on the “free, prior and informed consent” of
the country of origin. Because of the reported threat to iboga’s
sustainability, all nations that are party to the CBD (196 total)39
are required under Article 3 “to ensure that activities within their jurisdiction or
control do not cause damage to the environment of other States or of areas
beyond the limits of national jurisdiction.” Although further research of
environmental impacts would be beneficial, the CBD clearly states that where there
is a threat to the environment, “lack of full scientific certainty should not be used as a
reason for postponing measures to avoid or minimize such a threat” — a
provision known as the precautionary principle.
In addition, Article 24 in the 2007
UN Declaration on the Rights of Indigenous Peoples states, “Indigenous peoples have the right to
their traditional medicines and to maintain their health practices, including
the conservation of their vital medicinal plants, animals and minerals.”40
Because of iboga’s status as an important cultural resource and its
well-documented traditional uses, the plant may also fall under the
requirements of the CBD to ensure the “fair and equitable sharing of the benefits arising” from
its use, although it is questionable to what extent Occidental use draws from
this traditional knowledge. These requirements are expanded in the Nagoya
Protocol, which does not have the same international support (there are 68
party countries, including several where ibogaine is commonly used).41
Sustainability Challenges
Yann Guignon, a French ecological
consultant and author of a 2012 report commissioned by the Gabonese government,
has predicted that iboga may disappear from the Gabonese public domain as early
as the end of 2016.2 In the report, Guignon outlines several factors
contributing to the sustainability issue, including increased international
demand, political marginalization of “traditional knowledge holders,” urbanization, climate
change, deforestation/habitat destruction, poaching of animals that spread
iboga seeds, and lack of traditional agriculture, among others.
The sharp increase in the global
consumption of iboga and iboga-derived products has caused the price of raw
plant material to rise to almost 10 times what it was less than a decade ago,
incentivizing poaching in the absence of adequate agricultural production.
Decreasing availability in Gabon has led to the gradual emergence of alcoholic
spirits being incorporated into iboga initiation ceremonies, or, in some cases,
completely replacing iboga as a sacrament.
A side effect of iboga’s value in an
unregulated marketplace is the problem of economically motivated adulteration
of iboga’s second (inner) layer bark material. The ibogaine-concentrated second
layer of root bark is sometimes supplemented with the non-ibogaine-containing
first (outer) layer of bark, or shavings of the inner rootstock, which
increases the product’s weight but dilutes its medicinal value. Even more
concerning, unknown plant materials have been added to iboga preparations, or
replaced it completely. This intentional adulteration has reportedly led to
adverse reactions, such as nausea, headaches, palpitations, and fever, among
others. Consumers who purchase iboga products online have few means to ensure
the purity of the root bark or extracts they are purchasing.
The report also includes oral
accounts from members of communities throughout Gabon who have had difficulty
in finding iboga for their own uses. One particularly dramatic case came from
Mayumba National Park on the far southern coast of Gabon, which was once famous
for the abundant population of iboga that covered the forest understory. Today,
the park reportedly has only several hundred plants. Climate change may be a
factor in this decline. Rainy seasons in Gabon have become shorter and
temperatures have increased, imposing stress on the entire rainforest
ecosystem, which is the natural habitat of iboga and the symbiotic animal and
plant life.
During his presidency, Bongo
reserved 17% of the country’s landmass as an extensive network of national
parks, which are part of the world’s second largest rainforest. However,
outside of this protected area, the lumber trade has caused deforestation of
iboga’s natural habitat and has deeply affected traditional villages. Despite
the controls established by the national park system, illegal poaching of
elephants and other animals remains a significant problem in Gabon and other
parts of Africa. Forest-dwelling tribes often tolerate poaching because
elephants can be destructive to villages and crops. However, because elephants
consume iboga fruits, resulting in the spread of the plant near elephant
trails, iboga has become a secondary target for some involved in the poaching
and smuggling of ivory. Gabonese authorities have made a number of arrests in
connection with the smuggling of iboga from Gabon into Cameroon, which is where
the majority of iboga on the market is thought to originate, drawing into
question material of Cameroonian origin.
Gabon is a country with relatively
little agriculture. Traditional communities are accustomed to hunter-gatherer
subsistence, and agriculture is limited mostly to the cultivation of cassava,
or manioc (Manihot esculenta, Euphorbiaceae), grown for its
edible leaves and roots. The vast majority of the country’s produce is imported
from neighboring countries. In rural villages where Bwiti is practiced, iboga
is commonly planted around temples, usually to supplement local use. In one
Mitsogo village, an elder nganga (Bwiti practitioner) noted that they do
not use the iboga that comes from deep in the jungle (C. Laurance personal
communication, September 10, 2015). Those plants, he explained, are for use by
the spirits. Instead, villagers collect their seed-containing fruits and plant
them closer to the village to be used in rituals. In that particular Mitsogo
village, those iboga plants are the only ones used during ceremonies. Outside
of this limited mode of cultivation, there are few attempts to produce
quantities that can meet the demand of urban Bwiti practitioners, let alone the
international community. Notably, the urbanization and modernization of Gabon
also has contributed to the erosion of these traditional lifestyles and the
self-sufficient communities that contained them.
While there are those in Gabon who
have seen the increase in iboga demand as a financial opportunity for the
country, their hopes have gone unrealized due to the political influence of
various evangelical religious groups. The resulting marginalization of the
Bwiti has worked against not only commercial iboga efforts, but also those
intended to protect wild populations or cultivation by traditional
practitioners. Certain projects that aim to provide iboga for export have also
met resistance from more conservative practitioners of traditional medicine who
believe that iboga should not be sold.
Iboga cultivation also occurs in
areas surrounding Gabon, where traditional practice is less prevalent and less
rooted in conservative values. Recent reports from Cameroon suggest that after
a temporary global shortage of iboga in 2009, many villages and small
landowners planted small crops of iboga. Although its scale is unconfirmed,
this limited cultivation has apparently resulted in a network of small-scale
farms consolidated by traders, whose products are shipped overseas. With no
reliable documentation or way to verify the origin of iboga plant material, the
extent to which smuggled iboga contributes to this international trade is
unknown.
Sustainable Alternatives
With these sustainability challenges
in mind, clinical practitioners are increasingly embracing the semi-synthetic
production of ibogaine hydrochloride from V. africana. This semi-synthesized compound
provides an important ecologically and economically viable alternative to
ibogaine sourced entirely from plants.
Although not studied in humans, the
synthetic ibogaine derivative 18-methoxycoronaridine (18-MC) has shown promise
in animal models of addiction, and further research may validate its use as a
sustainable ibogaine substitute. 18-MC was developed in 1996 in an attempt to
avoid certain undesirable effects of ibogaine (e.g., those related to the
cardiovascular system).42,43 18-MC reportedly does not possess the
psychoactive effects44 or the same neuroprotective effects of
ibogaine45 that are believed to contribute to its therapeutic
benefits. However, in experimental models with rats, 18-MC has shown
long-lasting reductions in the self-administration of ethanol, nicotine,
morphine, cocaine, and methamphetamine, as well as the attenuation of symptoms
of opioid withdrawal syndrome.46
Even if these alternatives show
comparable success in the treatment of substance use disorders, neither 18-MC
nor voacanga-sourced ibogaine can produce TA extracts or iboga root bark
material, which remain in demand for their therapeutic potential. It is not
likely that either of these options is capable of fully addressing the existing
impacts of iboga demand on traditional communities. The most obvious solution
to these problems is to promote sustainable alternatives and advance
cultivation efforts. However, iboga cultivation is limited by the amount of
time it takes for a plant to mature — at least five to six years, according to
the Plant Resources of Tropical Africa Foundation.47
Discussion
Iboga and ibogaine show promise as
medicines; however, a lack of resources, regulation, and coordination among
treatment providers has led to challenges in clinical risk management, as well
as significant ecological and social pressures. Iboga is a keystone in the
relationship between traditional communities and the forests of the Congo
Basin. This is especially important to consider in light of the fact that
social dislocation from traditional values and contexts, driven in part by
globalization and deregulated capitalism in the modern world,48,49
has historically been followed by increases in addiction, a fact
well-documented among indigenous populations.
The global therapeutic community has
benefited from knowledge derived from traditional sources and benefit-sharing
efforts with traditional practitioners, particularly those from Pygmy
communities that exclusively hold claim to pre-colonial practices.
Practitioners also have benefited from partnerships in botanical research,
ecological protection efforts, and wild repopulation efforts, as recommended by
various international treaties.
It may be necessary for iboga
therapy providers who are dedicated to continuing clinical work with raw plant
material and whole plant extracts to build deeper relationships with
traditional practitioners, and to engage in small-scale cultivation efforts,
which can easily be integrated into a holistic framework of permaculture and
ecopsychology.
The UN Office on Drugs and Crime has
noted certain “unintended
consequences” of international drug prohibition, including negative health and
social impacts on drug users, significant environmental damage, and a criminal
black market.50-52 There are significant economic and political
barriers to the approval of prescription medicines, including those derived
from plants, but as iboga’s medicinal potential continues to drive demand, the
continued prohibition and failure to effectively coordinate ibogaine’s
production and use may lead to some of the same negative consequences.
Jonathan Dickinson is the executive director of the
Global Ibogaine Therapy Alliance (GITA). Since 2009, he has worked with
ibogaine in therapeutic and sacramental contexts in Canada, Mexico, Costa Rica,
and Panama, and has published and presented on his work globally. He acts as a
liaison among academics, government officials, researchers, not-for-profits,
and care providers in regard to ibogaine research and practice. He has
organized two international conferences on ibogaine in Vancouver and South
Africa, and, in 2014, he was initiated into Bwiti in Gabon.
Disclosure
The author is not involved in either
for-profit or not-for-profit commercial ventures that collect, market, or
extract iboga, ibogaine, voacanga, etc.
* Fernandez3 says that eboga and eboka
are Fang derivatives of the term iboga, which has roots in several other
tribal dialects, such as Galwa-Mpongwe and Miene. Other names have been
recorded, such as dibuyi among the Yipunu of Gabon, liboka among
the Vili of the Democratic Republic of the Congo, and others.1
However, “iboga”
has taken prevalence in almost all of the Occidental discourse, and is the term
used commonly among the Dissoumba, Pygmy, and Fang communities known to the
author.
** The author is the executive
director of GITA.
† Ayahuasca is a ritual beverage used
in various forms of traditional Amazonian shamanism. The mixture is primarily
composed of the ayahuasca vine and the leaves of the chacruna (Psychotria
viridis, Rubiaceae) shrub, which are not independently psychoactive. It
frequently contains admixtures from a multitude of other medicinal and
psychoactive plants.
References
- Tonye Mahop M, Asaha S, Ndam N, Blackmore P. State of Knowledge Study on Tabernanthe iboga Baillon: A Report for the Central African Regional Program for the Environment. Washington, DC: United States Agency for International Development (USAID); 2000. Available at: http://pdf.usaid.gov/pdf_docs/Pnads957.pdf. Accessed February 2, 2016.
- Guignon Y. Ecological report on Tabernanthe iboga. Presented at: 4th International Ibogaine Therapy Provider’s Conference; May 19, 2014; Durban, South Africa. Available at: www.ibogainealliance.org/files/GITA-Durban-2014-Event-Summary.pdf. Accessed February 2, 2016.
- Fernandez JW. Bwiti: An Ethnography of the Religious Imagination in Africa. Princeton, NJ: Princeton University Press; 1982.
- Ravelec V, Mallheler A. Iboga: The Visionary Root of African Shamanism. Rochester, VT: Park Street Press; 2007.
- Alper KR, Lotsof HS, Frenken GM, Luciano DJ, Bastiaans J. Treatment of acute opioid withdrawal with ibogaine. Am J Addict. 1999;8(3):234-242.
- Brown TK. Ibogaine in the treatment of substance dependence. Curr Drug Abuse Rev. 2013;6(1):3-16.
- Popik P. Facilitation of memory retrieval by the “anti-addictive” alkaloid, ibogaine. Life Sci. 1996;59(24):PL379-PL385.
- Alper KR. Ibogaine: a review. Alkaloids Chem Biol. 2001;56:1-38.
- He DY, Ron D. Autoregulation of glial cell line-derived neurotrophic factor expression: implications for the long-lasting actions of the anti-addiction drug, ibogaine. FASEB J. 2006;20(13):2420-2422.
- Kaplan CD, Ketzer E, de Jong J, de Vries M. Reaching a state of wellness: multistage explorations in social neuroscience. Social Neuroscience Bulletin. 1993;6(1):6-7.
- Alper KR, Lotsof HS, Kaplan CD. The ibogaine medical subculture. J Ethnopharmacol. 2008;115(1):9-24.
- Kleber H. Foreword. In: Alper KR, Glick SD, eds. Ibogaine: Proceedings of the First International Conference. San Diego, CA: Academic Press; 2001:xv-xvii.
- Maas U, Strubelt S. Polyrhythms supporting a pharmacotherapy: music in the iboga initiation ceremony in Gabon. In: Aldridge D, Fachner J, eds. Music and Altered States: Consciousness, Transcendence, Therapy and Addictions. London, UK: Jessica Kingsley Publishers; 2006:101-124.
- Świderski S. La Religion Bouiti. Vols. 1-5. Ottawa, ON, Canada: Legas; 1991.
- Samorini G. The Bwiti religion and the psychoactive plant Tabernanthe iboga (Equatorial Africa). Integration. 1995;5:105-114.
- Goutarel R, Gollnhofer O, Sillans R. Pharmacodynamics and therapeutic applications of iboga and ibogaine. Psychedelic Monographs and Essays. 1993;6:70-111.
- reedlander J. Ibogaine: a novel anti-addictive compound. Journal of Drug Education and Awareness. 2003;1:79-98.
- De Rienzo P, Beal D, and Members of the Project. The Ibogaine Story: Report on the Staten Island Project. New York, NY: Autonomedia; 1997.
- Lotsof HS, Alexander NE. Case studies of ibogaine treatment: implications for patient management strategies. Alkaloids Chem Biol. 2001;56:293-313.
- Alper KR, Stajić M, Gill JR. Fatalities temporally associated with the ingestion of ibogaine. J Forensic Sci. 2012;57(2):398-412.
- Schenberg EE, de Castro Comis MA, Chaves BR, da Silveira DX. Treating drug dependence with the aid of ibogaine: a retrospective study. J Psychopharmacol. 2014;28(11):993-1000.
- Brown TK. Results of the long-term outcomes study of ibogaine treatment in Mexico. Presented at: Psychedelic Science 2013; April 21, 2013; Oakland, CA.
- Noller G. Notes on progress in the New Zealand ibogaine study. Presented at: Psychedelic Science 2013; April 21, 2013; Oakland, CA.
- Dickinson J, McAlpin J, Wilkins C, et al. Clinical Guidelines for Ibogaine-Assisted Detoxification. Montreal, QC, Canada: The Global Ibogaine Therapy Alliance; 2015.
- Popik P, Skolnick P. Pharmacology of ibogaine and ibogaine-related alkaloids. In: Cordell GA, ed. The Alkaloids. Vol. 52. San Diego, CA: Academic Press; 1998:197-231.
- Koenig X, Hilber K. The anti-addiction drug ibogaine and the heart: a delicate relation. Molecules. 2015;20(2):2208-2228.
- Houenou J, Homri W, Leboyer M, Drancourt N. Ibogaine-associated psychosis in schizophrenia: a case report. J Clin Psychopharmacol. 2011;31(5):659.
- Marta CJ, Ryan WC, Kopelowicz A, Koek RJ. Mania following use of ibogaine: A case series. Am J Addict. 2015;24(3):203-205.
- Is ibogaine therapy safe? Global Ibogaine Therapy Alliance website. Available at: www.ibogainealliance.org/ibogaine/therapy/safety/. Accessed February 2, 2016.
- Gibson AE, Degenhardt LJ. Mortality related to pharmacotherapies for opioid dependence: a comparative analysis of coronial records. Drug Alcohol Rev. 2007;26(4):405-410.
- International Narcotics Control Board. List of Psychotropic Substances under International Control. 26th ed. New York, NY: United Nations; 2015. Available at: www.incb.org/documents/Psychotropics/greenlist/Green_list_ENG_2015_new.pdf. Accessed February 2, 2016.
- International Narcotics Control Board. Report of the International Narcotics Control Board for 2010. Vienna, Austria: United Nations; 2011. Available at: www.incb.org/documents/Publications/AnnualReports/AR2010/AR_2010_English.pdf. Accessed February 2, 2016.
- Ibogaine legal status. Global Ibogaine Therapy Alliance website. Available at: www.ibogainealliance.org/ibogaine/law/. Accessed February 2, 2016.
- Minutes of the 42nd meeting of the Medicines Classification Committee. Medsafe - New Zealand Medicines and Medical Devices Safety Authority website. Available at: www.medsafe.govt.nz/profs/class/mccMin03Nov2009.htm. Published November 3, 2009. Updated May 23, 2013. Accessed February 2, 2016.
- Convention on Biological Diversity. Rio de Janeiro, Brazil: United Nations; 1992. Available at: www.cbd.int/convention/text/. Accessed February 2, 2016.
- Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Biological Diversity. Montreal, QC, Canada: Secretariat of the Convention on Biological Diversity, United Nations; 2011. Available at: www.cbd.int/abs/text/default.shtml. Accessed February 2, 2016.
- Larson A. Une plante hallucinogène suscite l’intérêt du Gouvernement. Eboga.fr website. Available at: www.eboga.fr/Revue-de-presse/Famafrique.html. Accessed February 3, 2016.
- Gabon: Law no. 2/94 on the protection of cultural property [in French]. World Intellectual Property Organization website. Available at: www.wipo.int/wipolex/en/details.jsp?id=9195. Published December 10, 1994. Accessed February 2, 2016.
- List of parties. Convention on Biological Diversity website. Available at: www.cbd.int/information/parties.shtml. Accessed February 2, 2016.
- United Nations Declaration on the Rights of Indigenous Peoples. New York, NY: United Nations; March 2008. Available at: www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf. Accessed February 2, 2016.
- Parties to the Nagoya Protocol. Convention on Biological Diversity website. Available at: www.cbd.int/abs/nagoya-protocol/signatories/. Accessed February 2, 2016.
- Glick SD, Kuehne ME, Maisonneuve IM, Bandarage UK, Molinari HH. 18-methoxycoronaridine, a non-toxic iboga alkaloid congener: effects on morphine and cocaine self-administration and on mesolimbic dopamine release in rats. Brain Res. 1996;719(1-2):29-35.
- Glick SD, Maisonneuve IM, Szumlinski KK. 18-methoxycoronaridine (18-MC) and ibogaine: comparison of antiaddictive efficacy, toxicity, and mechanisms of action. Ann N Y Acad Sci. 2000;914:369-386.
- Glick SD, Maisonneuve IM, Szumlinski KK. Mechanisms of action of ibogaine: relevance to putative therapeutic effects and development of a safer iboga alkaloid congener. Alkaloids Chem Biol. 2001;56:39-53.
- Carnicella S, He DY, Yowell QV, Glick SD, Ron D. Noribogaine, but not 18-MC, exhibits similar actions as ibogaine on GDNF expression and ethanol self-administration. Addict Biol. 2010;15(4):424-433.
- Glick SD, Maisonneuve IM, Dickinson HA. 18-MC reduces methamphetamine and nicotine self-administration in rats. Neuroreport. 2000;11(9):2013-2015.
- Schmelzer GH, Gurib-Fakim A, eds. Plant Resources of Tropical Africa: Medicinal Plants. Vol. 11 No. 1. PROTA Foundation; Wageningen, Netherlands; 2008.
- Alexander BK. The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press; 2010.
- Alexander BK. Addiction, environmental crisis, and global capitalism. Talk presented at: Dalhousie University College of Sustainabililty; February 26-27, 2015; Halifax, Nova Scotia, Canada. Available at: www.brucekalexander.com/articles-speeches/283-addiction,-environmental-crisis,-and-global-capitalism. Accessed February 2, 2016.
- United Nations Office on Drugs and Crime. Confronting unintended consequences: drug control and the criminal black market. World Drug Report. 2009:163-184.
- Count the Costs, Transform Drug Policy Foundation. The War on Drugs: Causing Deforestation and Pollution. Available at: www.countthecosts.org/sites/default/files/Environment-briefing.pdf. Accessed February 2, 2016.
- Count the Costs, Transform Drug Policy Foundation. The War on Drugs: Threatening Public Health, Spreading Disease and Death. Available at: www.countthecosts.org/sites/default/files/Health-briefing.pdf. Accessed February 2, 2016.
|