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Because these statistics are provided by ibogaine clinics themselves rather than independent third-parties, it’s possible that they are biased. The negligible abuse potential associated with ibogaine has to do with the fact that the principal action of its chief metabolite, noribogaine, involves agonizing kappa-opioid receptors. Moreover, even when conventional interventions are combined with psychotherapy, outpatient sobriety programs, and/or lifestyle changes – a subset of individuals will derive insignificant benefit, and predictably, will relapse whereby they revert back to illicit opiate/opioid administration. Acute symptoms associated with opiate/opioid cessation can include: vomiting, diarrhea, nausea, sweating, aches/pains, etc. These contraindications may be perceived as a drawback such that they limit the number of persons who can safely utilize ibogaine to overcome opiate/opioid addictions. Considering that ibogaine usage could prove fatal, this may be reason enough to avoid it. Unestablished professional dosing guidelines makes it difficult to ensure the safety of ibogaine recipients, as well as to maximize the likelihood that ibogaine will effectively treat an opiate/opioid addiction.
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While some may derive good return on investment from the ibogaine treatment as a result of protracted opiate/opioid abstinence (saving in spending on opiates/opioids and/or bolstered occupational productivity), others will find ibogaine clinics to be downright unaffordable. While it is recommended to avoid operating motor vehicles, heavy machinery, and any activities that require peak coordination in the days following ibogaine treatment, not everyone will follow this recommendation. Based on these findings, it’s reasonable to suggest that, like any drug, ibogaine is not universally effective for the treatment of opiate/opioid addiction. These complications may last for weeks, months, or in rare cases, indefinitely after ibogaine treatment. Because most individuals won’t like the idea of [potentially] sacrificing their brain cells and/or brain structures to attain sobriety, ibogaine may be perceived as a suboptimal intervention. That said, acknowledging this case report, it’s possible that ibogaine could provoke seizures among individuals with a history of seizures and/or who use relatively large doses to treat opiate/opioid addiction. Some may claim that their cravings only remain suppressed for a short-term such as a few days or weeks – after ibogaine administration.
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Moreover, there are a myriad of other pharmaceutical medications such as clonidine and gabapentin that have stronger evidence to support their usage in the treatment of opiate/opioid withdrawal symptoms – as compared to ibogaine. Once tolerance is established, it’s possible that users will resort to using higher doses of ibogaine to suppress their cravings, which might provoke adverse reactions. Because antinociceptive effects of morphine are mediated by the mu-opioid receptor, it’s possible that ibogaine’s short-lived interaction with the mu-opioid receptor yields neurochemical changes that reduce or reverse preexisting opiate/opioid tolerance. Though these additional mechanisms of ibogaine’s action may yield modest or negligible physiologic effects, each warrants consideration as potentially contributing to its alleged efficacy in the treatment of addiction and withdrawal.
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For reference, delta-opioid receptors are densest within the basal ganglia and neocortical areas of the brain and are thought to influence arousal, mood, nociception, and regulate aspects of drug reward. To be clear, alterations in brain energy metabolism that are observed post-ibogaine administration are likely a secondary or downstream effect stemming from its primary interactions with neurotransmitter systems. During the acute phase, most individuals report psychedelic dream-like visuals. During this phase physiology will undergo more substantial homeostatic reversion, thus exhibiting homeostasis to a greater extent than in the evaluative phase. However, despite this preliminary evidence, no systematic reviews had been conducted to critically examine the quality of existing human studies and their findings.
The aim of the trial was to evaluate the safety, tolerability, and pharmacokinetics of noribogaine, as well as its ability to treat opioid withdrawal symptoms. Although these findings cannot be extrapolated to humans, this study provides preliminary evidence that ibogaine could prove efficacious as an intervention in the management of alcohol dependence. Although there were some notable flaws associated with this randomized controlled trial, the fact that it implemented a randomized controlled design strengthens the quality of its finding. Considering the animal model data, case reports in peer-reviewed journals, and numerous anecdotes suggesting that ibogaine is safe and effective for the treatment of opiate/opioid addiction and/or withdrawal symptoms – as well as the fact that it makes logical sense that specific mechanisms of ibogaine’s action would treat addiction – it’s reasonable to suspect that a subset of persons with opiate/opioid addiction and/or withdrawal symptoms will derive benefit from ibogaine. Understand that the answers to these questions may be incomplete and should not be considered professional medical advice.