Underground ibogaine use for the treatment of substance use disorders: A qualitative analysis of subjective experiences

Ibogaine is an indole alkaloid present in plants used traditionally by the Bwiti culture and, since the 1960s, has been applied experimentally to treat substance use disorders (SUD), particularly opioid, alcohol and stimulant dependence. Earlier work suggests a multi-target pharmacology (including modulation of opioid, nicotinic and glutamate receptors and induction of neurotrophic factors) that may reduce withdrawal and cravings, but limited research has also pointed to substantial psychological and subjective effects — autobiographical recall, transpersonal visions and meaningful insights — that could contribute to therapeutic benefit. A debate exists in the field over whether altered subjective experience is necessary for clinical benefit from hallucinogens or whether pharmacological actions alone suffice. This study aims to explore underground (non‑medical or non‑official) ibogaine use for SUD from the perspective of people who self‑treated with the compound. Rodríguez‑Cano and colleagues set out to characterise the acute subjective psychological effects that participants experienced, to identify psychological processes (for example autobiographical recall, abreactive processes and transpersonal experiences) that may be relevant to recovery, and to document physical adverse effects, after‑effects on substance use and factors (such as motivation and aftercare) that participants judged important for longer‑term outcomes. The authors argue that subjective effects are an important component of ibogaine's therapeutic potential but that motivation and supportive aftercare determine lasting change.

The researchers conducted semi‑structured, individual interviews with 13 participants who had used ibogaine and whose primary or comorbid motivation for treatment included a substance use disorder; two participants had used ibogaine primarily for anxiety or depression but reported substance‑related issues. Recruitment occurred via the International Center for Ethnobotanical Education, Research and Service network and social media, yielding an international sample (Armenia, Canada, Mexico, Russia, South Africa, the United States and the United Kingdom). Interviews took place between February and April 2016, mostly via audio‑only Skype calls, and averaged 117.7 minutes. Ten respondents were interviewed within three months of their last high‑dose experience; three were interviewed one year or more after their last high dose. All participants gave informed consent and anonymity was ensured by randomised ID numbers; the Ethics Committee of Universidad Autónoma de Madrid approved the study. Data analysis used a grounded theory approach carried out by three researchers (Rodríguez‑Cano, Maja Kohek and Genís Ona). Open coding labelled semantically similar segments with multi‑word codes, followed by review and categorisation into major themes and unusual events. Physical, cognitive and emotional aspects of the experiences were compared across the dataset to derive three main categories of subjective psychological effects relevant to SUD treatment: an abreactive process, autobiographical and interpersonal experiences, and transpersonal experiences. The investigators also quantified several somatic outcomes reported by respondents (nausea, vomiting, arrhythmia, withdrawal symptom reduction, cravings, and reductions or cessations of substance use), and recorded whether participants would take ibogaine again and whether they characterised the overall experience as pleasant or unpleasant. Where dosing or compound details were unclear due to clandestine settings, the authors noted this limitation and did not claim precise dose data for most participants. The interviews combined a structured checklist of effects drawn from the literature with an unstructured section allowing participants to narrate their experiences in their own words, and transcripts were produced manually by one researcher.

The sample comprised 13 participants (nine males, four females) aged 23–50 years (mean 37, SD 7.7). Educational attainment ranged from high school (n = 5) to undergraduate (n = 4) and university graduate (n = 4). Ibogaine was consumed in varied settings: at home (n = 6), in ibogaine clinics (n = 4), in rented motel rooms (n = 2) and in a truck (n = 1). Five participants obtained ibogaine via work contacts, four sourced it from the internet or friends, and clinics provided it in the remaining cases. Participants reported experiencing acute effects for a mean of 46 hours (SD 30.41). Acute physical effects were common. Most respondents experienced nausea; a minority vomited and only two reported no nausea. One participant reported prolonged intense vomiting that required antiemetic medication. Cardiovascular signs such as accelerated heartbeat and raised blood pressure were reported and typically resolved during the session. One respondent required hospitalisation for arrhythmia and seizures, an event she attributed to a high dose combined with poor baseline health. On the psychological level, participants described a characteristic ‘‘waking dream’’ involving vivid autobiographical imagery, processing of personal and interpersonal issues, and transpersonal or mystical visions. The investigators identified three interrelated psychological domains. Autobiographical and interpersonal experiences involved revisiting memories and relationships, leading to insights about how substance use developed and how it affected self and others; several participants described shifts from guilt and worthlessness to forgiveness and self‑acceptance. The abreactive process — a cathartic release of intense emotions — commonly featured surrendering to fear, after which distressing imagery abated and more positive, often archetypal or visionary content followed. Transpersonal experiences included mystical feelings of oneness, encounters with archetypal beings, travel through time or space, and spiritual or cosmological visions; many participants reported these as profoundly meaningful and associated with optimistic shifts in life perspective and coping capacity. Regarding after‑effects related to SUD outcomes, ibogaine's pharmacological action reportedly reduced or abolished withdrawal symptoms in eight participants treated for opioid use disorder. Cravings were reported eliminated in 11 of the 13 respondents, though cravings commonly resurfaced days or weeks later for most. Participants described a sense of cognitive restructuring or a ‘‘subconscious reset’’ that opened the possibility of lifestyle change, but emphasised that these subjective insights alone did not guarantee sustained abstinence. Prior treatment attempts were common: six participants had tried approaches including 12‑step programmes, buprenorphine, benzodiazepines or methadone maintenance, with limited success. Ten participants stated they would take ibogaine again for therapeutic reasons; three declined due to the intensity and difficulty of the experience. Overall, respondents characterised the bodily experience as physically exhausting or taxing, the psychological experience as ranging from harrowing to transcendent, and the spiritual component as valuable and humbling.

Rodríguez‑Cano and colleagues interpret their findings within a biopsychosocial framework for SUD, arguing that both ibogaine's pharmacology and its subjective, hallucinogenic effects plausibly contribute to therapeutic outcomes. The study participants' frequent reports of autobiographical recall, abreactive emotional release and transpersonal or mystical experiences are presented as psychological processes that can catalyse new patterns of thought, feeling and behaviour, and thereby support abstinence for months after administration. The authors situate these observations alongside previous qualitative work on ibogaine and comparable findings from other classic hallucinogens (for example psilocybin and ayahuasca), which also report meaningful, often mystical, experiences that foster connectedness, creativity and self‑reflection. Safety risks are emphasised: challenging psychological reactions (paranoia, anxiety, panic) occurred in five respondents, and one participant experienced a life‑threatening physical event requiring hospital care. Cardiotoxicity and other adverse effects cited in the interviews underline the authors' view that administration in controlled medical settings would better protect participants and provide environments conducive to integration and psychosocial aftercare. The investigators note that ‘‘flood’’ high doses (visionary doses) are commonly used to achieve initial benefit but carry greater safety risks; they report that a flood dose is often considered to be 800–1000 mg in human studies, while occasional low or threshold boosters (reported as 1–5 mg/kg) are used by some to prolong effects, although there is no consensus on optimal dosing. The authors acknowledge several limitations: clandestine use prevented reliable dose documentation; heterogeneous settings and international, culturally diverse respondents make it difficult to generalise findings to clinical practice; volunteer and researcher–participant bias likely skewed the sample toward favourable accounts; and the study was focused on relatively short‑term subjective effects, limiting inference about long‑term abstinence — only three participants had been SUD‑free for several years. The paper also notes ongoing work, including a clinical trial (NCT04003948) evaluating safety and efficacy of repeated low doses in methadone dependence, which the authors suggest may clarify the role of subjective effects and safer dosing strategies. Overall, the investigators conclude that while ibogaine can acutely reduce withdrawal and cravings and often provokes psychologically meaningful experiences that participants find therapeutic, enduring recovery depends on personal motivation, integration work and psychosocial support rather than on ibogaine administration alone.

The authors conclude that ibogaine's anti‑addictive potential appears to derive from both its complex pharmacology and the subjective experiences it elicits, particularly autobiographical recall and personal insights that help individuals confront the origins and consequences of their substance use. Given the perceived limitations of conventional treatments for some people with SUD, participants viewed ibogaine as a valuable alternative, but the authors stress the need for further controlled research to evaluate efficacy, safety and the role of subjective experience in sustained recovery.