Ibogaine therapy is emerging as a potential alternative to opioid treatments among seriously ill patient populations seeking pain and symptom relief. But palliative care providers need a wider window into the laws that limit utilization.
Ibogaine is a plant-derived psychoactive alkaloid drug with hallucinogenic properties. It is among the federally controlled psychedelic substances being explored in therapeutic- and medically-guided palliative care patient experiences.
Ibogaine has the potential to assist patients seeking psychological, physical and spiritual relief from a range of chronic symptoms, said Gaetano Lardieri, special executive advisor at Future Entheogenic Medicines (F.E.M.). Lardieri is also the New Jersey State Director of Minorities For Medical Marijuana.
“Ibogaine may provide relief from chronic pain by resetting neural pathways associated with pain perception,” Lardieri told Palliative Care News. “There’s also an opportunity for emotional healing in that it offers terminally and seriously ill patients an opportunity to confront and process their existential fears, grief and anxiety about the end of life. So there’s these three areas of pain management, emotional healing and relief from substance dependency.”
Understanding the risks, benefits of ibogaine palliative therapy
Researchers have increasingly dug into the potential range of effects associated with ibogaine utilization. Thus far, much of ibogaine therapy research has centered on the drug’s potential to treat opioid and methamphetamine substance abuse addictions and to treat chronic conditions.
Ibogaine utilization was associated with improvements in depression, post-traumatic stress disorder (PTSD), anxiety and overall functioning within one month of use among 30 veterans with traumatic brain injury in a recent study published in Nature Medicine.
Ibogaine has a “very powerful” future when it comes to managing patients with dementia and Alzheimer’s, Lardieri said.
Metabolic proteins found in ibogaine can potentially help address conditions such as dementia and Alzheimer’s, Parkinson’s, Huntington’s and the brain diseases such as chronic traumatic encephalopathy (CTE), according to a 2020 study published in ACS Pharmacology & Translational Science Journal. The drug may help to treat cognitive decline in patients with these conditions, the research found.
Ibogaine utilization comes with both potential benefits and risks for patients, according to a recent analysis published in Elsevier’s Journal of Substance Abuse Treatment. The research spanned 24 clinical trial studies and found that ibogaine utilization may be an effective therapeutic intervention. The drug helped to alleviate a range of symptoms among patients, though utilization can come with cardiac and neurological risks, the analysis found. Ibogaine treatments have been associated with instances of fatal cardiac arrhythmia.
“Data point toward a beneficial impact on depressive and trauma-related psychological symptoms,” researchers stated in the analysis. “However, studies have reported severe medical complications and deaths, which seem to be associated with neuro- and cardiotoxic effects of ibogaine.”
More clinical trial research is needed to assess the potential utilization of ibogaine treatment in the United States, according to Lardieri. But current laws have stymied progress, he stated.
Patients seeking ibogaine treatment encounter a lack of regulations to establish safety and efficacy guidelines, according to Juliana Mulligan, licensed clinical social worker and psychotherapist at Chrysalis Integrative Psychotherapy. Mulligan is also owner and therapist at Inner Vision Ibogaine Coaching.
Ibogaine treatment centers are operating without laws that set standards for training and education, quality, drug administration and dosing methodology, Mulligan stated. This leaves patients at greater risk of having poor experiences and negative adverse health reactions, among other issues, she said.
“The biggest danger of ibogaine treatment right now is untrained, unsafe and unethical practices,” Mulligan said in a recent town hall meeting. “Majority of the ibogaine clinics around the world are not operated safely because there’s no way to ensure that the clinics are following safety protocols. There is no way to ensure that people working at these clinics have trauma-informed training. While I wholly believe in ibogaine … There are a lot of problems. We have a big safety and ethics issue.”
An important part of providing safe, quality experiences for patients is the integration of a team of interdisciplinary professionals, Lardieri stated. Ibogaine therapies involve pretreatment patient assessments on different physical and emotional levels to determine the safest and most effective methods, he added.
Palliative care providers have much to offer in helping patients to navigate ibogaine treatments, according to Lardieri. Palliative professionals can help patients manage spiritual, practical, physical and emotional needs of patients, he stated.
“Greater integrated care is needed with ibogaine [utilization],” he said. “Therapists, experts in ibogaine compounds should work together with the palliative care provider to help the patient. The palliative care provider is another team member to help that person on a regular basis on more than a medical level.”
