Tabernanthe Iboga

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.