What is ibogaine, and what does it treat?

By Brenda Goodman, Jacqueline Howard and Michal Ruprecht, CNN

(CNN) — Ibogaine, a psychoactive compound made from the roots of an African shrub, has been gaining popularity as a treatment for opioid and cocaine addiction. There is a new emphasis on research into ibogaine, although it is currently illegal to possess or prescribe it in the United States.

It’s drawn more attention on social media too, including from Presley Gerber, a model, mental health advocate and son of supermodel Cindy Crawford, who died Sunday at age 27 at a rehabilitation facility in California. Gerber’s death is being investigated by the Santa Monica Police Department as a “suspected overdose,” according to a news release from the law enforcement agency. No cause or manner of death has been confirmed.

Gerber, who had been open about his struggles with substance use, mentioned ibogaine in an Instagram post in March, saying in the caption on the video, “Pre-Ibogaine Flood Dose – quiet moment before everything changed….praying it’s the last time I have to come back.”

Ibogaine is one of several psychedelic drugs that have been given serious attention by the Trump administration as potential treatment options for people with certain mental health conditions. And they could be getting closer to receiving approval from the US Food and Drug Administration.

President Donald Trump signed an executive order in April designed to fast-track research on and access to these drugs, including a $50 million investment in state governments to study how psychedelics might help people struggling with mental illnesses. The executive order specifically names “ibogaine compounds” as showing potential to address serious mental illness.

Dr. Marty Makary, who was then FDA commissioner, told CNN in April that ibogaine could receive FDA approval once the agency reviews data from late-stage clinical trials.

“These are potentially promising treatments,” he said. “We’ll see how the data reads out when we get the applications, but we don’t want to waste any time, because this is an urgent matter, given the mental health crisis.”

How the psychedelic is regulated

Ibogaine and some other psychedelics are classified as Schedule I substances by the US Drug Enforcement Administration, a designation the federal government uses for substances it considers to have no currently accepted medical use and a high potential for abuse.

In rare cases, it can also disturb the heart’s electrical rhythms, leading to cardiac arrest and sudden death.

But “the FDA has a system with the DEA by which, when a drug becomes FDA-approved and the FDA sets clear criteria, then it can be given with a transient de-scheduling that is exempt from those enforcement rules, because it’s given in a hospital setting or in a clinic setting under clinical supervision,” Makary said earlier this year. “If they do get approved, these are not the medications you’ll just pick up at a pharmacy. These are given in a controlled, supervised setting in a hospital.”

In April, the FDA accepted an investigational new drug application for a drug that uses an ibogaine derivative, which researchers hope will provide the benefits of ibogaine, but without the hallucinogenic trip or potential heart toxicity.

Dr. Kirsten Cherian, a researcher at Stanford University who led a landmark study on ibogaine, called the executive order a “great step,” adding that it may open the door to offering the treatment in US research facilities.

“The first step is to be able to do the research at home,” she said. “And it could open up a lot of research possibilities. It is kind of an exciting time.”

History of ibogaine

The compound, extracted from the iboga plant in Central Africa, has long been used to decrease opioid cravings and treat severe depression, anxiety and post-traumatic stress disorder symptoms in veterans.

Anthropologists trace its discovery to the Pygmy people in Central Africa, who viewed ibogaine as a sacred medium given by God that allowed them to reconnect with the divine and the dead. During the colonial period, as indigenous structures were disrupted, the compound provided communities in the region with a sense of unity and shared experience.

Years later, in 1962, ibogaine was introduced by researchers in the US as a potential treatment for substance-related disorders. Early results proved to be promising, but psychedelics were considered controversial, and broadly, researchers “abandoned” it, said Dr. Arnt Schellekens, who studies the compound at Radboud University in the Netherlands.

In 1967, the DEA classified ibogaine as a Schedule I controlled drug, making it illegal to use.

In recent years, ibogaine has garnered several high-profile supporters, including former Texas Gov. Rick Perry, former Sen. Kyrsten Sinema of Arizona and podcast host Joe Rogan.

When Trump signed the executive order this year, he invited Rogan to speak about the initiative.

“I want to tell everybody how this happened,” Rogan said from the Oval Office. “I sent President Trump some information.”

“The text message that came back,” Rogan said, “ ‘sounds great, do you want FDA approval? Let’s do it.’ ” He added that it was “literally that quick.”

How it works

Early research suggests that ibogaine may alter certain neural pathways, potentially leading to improvements in some mental health conditions, including PTSD, anxiety or depression.

People who have ibogaine treatment typically describe an initial “visual” phase that lasts one to four hours, followed by an “introspective” phase that can last several hours to days.

During that time, the brain becomes more malleable and can form new connections, Cherian says.

“It acts across multiple neurotransmitter systems,” Cherian said, adding that its effects are more intense than those of other psychedelics like psilocybin and LSD. “That’s contributing to sort of reorganizing brain networks.”

These mechanisms are thought to underlie some of the benefits that come with treatment. But Schellekens warns that much is still unknown about ibogaine and that evidence for its use remains “modest.”

“We are just not there yet,” he added, emphasizing that mainstream mental health treatments such as therapy and prescription medications are preferred.

Risks of ibogaine

The hallucinogen is known to raise the risk of abnormal heart rhythms and rates and could cause vomiting. Several deaths have been associated with the ingestion of ibogaine, though it’s not always clear whether the drug itself, underlying health conditions or other factors were the direct cause.

“It is sort of romanticized,” Schellekens said. “But going for ibogaine treatment can be very dangerous. As a scientist and as a doctor, I always am very cautious about this type of substance.”

That’s why he says more research is needed to shed light on the safety profile.

For patients, families and clinicians navigating the realities of mental health, questions remain around whether ibogaine’s potential benefits outweigh its risks — and for whom.

Who’s using it

A growing number of military veterans have turned to ibogaine, many seeking treatment for traumatic brain injuries. The treatment is often done in Mexico — where it is unregulated — and is the last resort for many who have found traditional treatments ineffective.

“Anecdotally, we hear about veterans traveling abroad to ibogaine clinics when they feel like conventional treatments have been ineffective for their conditions,” Dr. Fayzan Rab, a physician resident at the Emory School of Medicine, wrote in an email earlier this year.

Charles Graham Jr., a veteran who was diagnosed with an unspecified depressive disorder, had treatment with ibogaine in Mexico.

“I’ve never felt peace like this in my life,” Graham told CNN two days later. “I won’t say it healed everything overnight, but it gave me the ability to break free of the cycles that were holding me prisoner.”

The popularity of the treatment among veterans has spawned advocacy groups like Veterans Exploring Treatment Solutions, co-founded by Amber Capone seven years ago. She says her organization has funded and supported ibogaine treatment — which can cost upward of $5,000 — for over 1,300 veterans.

“Veterans are given outdated treatments for their invisible wounds,” Capone said. Her husband, a veteran who experienced PTSD and suicidal ideation, received the treatment in 2017. “It truly felt like a Hail Mary, and overnight, our life was completely transformed.”

Overall, experts are hoping to learn more through additional research to better understand the risks and benefits of ibogaine.

“We are enthusiastic [about] any federal attention toward developing new treatments for people struggling with PTSD and opioid addiction. These are populations that are often underserved by what we currently have,” Rab said. “Novel treatments deserve rigorous examination and time to prove their efficacy.”

What the future could hold

The general response to Trump’s executive order was a “mixed bag,” because while experts have expressed excitement, others have concerns about the need to conduct more research on psychedelics’ risks and benefits, and concerns that the $50 million that the order allocates to state governments to advance research may not be sufficient, said Melissa Lavasani, founder and chief executive of the advocacy group Psychedelic Medicine Coalition, which works to pave the way for safe, effective psychedelic medicines to enter mainstream health care.

“The $50 million is a great starting point. But we know that psychedelic studies in general are really expensive to execute on, because the psychedelic experience is time-intensive. You have to be in a clinical setting,” she said, adding that most states typically don’t have the bandwidth or the resources to conduct large-scale studies in the same way the federal government does.

“So many states don’t necessarily have the capacity to run large-scale studies that need to be done for psychedelics, and really, those have to be coming out of the federal government, just because they cost so much,” Lavasani said. “Hopefully, the $50 million will jump start other agencies that are grant-making agencies to go out and start funding larger-scale studies.”

The executive order also directed the FDA to provide national priority vouchers to certain psychedelic drugs. The FDA Commissioner’s National Priority Voucher pilot program, which was announced last year, was developed as a pathway to speed the review process for certain drugs and biological products seeking approval.

“This is to grease the wheels internally within government to make things move a little quicker and get some of these reviews out the door much faster, so that we can work towards FDA approval,” Lavasani said, adding that prior to the executive order, psychedelic companies tried to get fast-track reviews and were denied.

Days after the executive order, the FDA issued national priority vouchers to companies studying psilocybin for treatment-resistant depression and major depressive disorder and metylone for post-traumatic stress disorder.

“This is significant in that it speeds up access. It speeds up these drugs being available on the market, and it can advance dialogues about what insurance coverage is going to look like and what health care infrastructure needs to be,” Lavasani said. “There’s not a question of if the Trump administration will allow FDA approvals for psychedelics, it’s ‘when this happens, what do we need to do to be prepared for this?’ So that this can get rolled out properly, so that folks can have access, so that insurance can eventually cover this and we can come up with some training and credentialing and protocols.”

She added that “it’s going to be a trial and error process, and it’s not going to happen overnight. Even with an executive order, this stuff takes a lot of time.”

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