Tricia Eastman and Dr. Joseph Barsuglia advocate for a nuanced appreciation of stewardship when it comes to the use and drug development of ibogaine. Stewardship, as they explain in this Opinions piece, refers to both an appreciation of the responsibility we owe to “the cultures and ecosystems from which these substances are derived”, but also with regards to the safety of those who ingest it.
In just one week, the Attorney General’s Office in Kentucky announced that $42 million is slated to be allocated for research into ibogaine as a treatment for opioid use disorder. That same week, a California bill was announced that includes decriminalizing ibogaine, as well as the announcement of the debut of Lucy Walker’s film, Of Night and Light: The Story of Iboga and Ibogaine at Tribeca Film Festival.
This sudden rush of iboga and ibogaine popularity evoked a similar feeling to the Incilius alvarius “Toad” boom in recent years1, which led to the already-impoverished Comcaac or Seri people of Sonora Mexico to purportedly be threatened by drug cartels who are heavily profiting from the extraction of “toad medicine” and bringing more crime and chaos to their homelands. Such headlines and boom in demand seems to be an ongoing trend in the psychedelic movement, which popularizes the next natural psychedelic compound du jour, and then drives extraction and exploitation from limited and precious natural species.
The big question that comes to mind is, are we being responsible stewards of this movement, and respectful of traditional practices and medicines that do not belong to us? Stewardship here is twofold: referring to both the responsibility that we have to the cultures and ecosystems from which these substances are derived, as well as the safety of potential users of these substances.
We may be inspired by the healing potential of these natural compounds for the masses and feel pressure to meet the degree of need in the current mental health and addiction epidemics. However, a central concern is that the proper diligence and infrastructures have not been put in place to protect such a sacred and ecologically sensitive plant as iboga. Recent history has shown that newcomers seeking the psychoactive compounds featured in popular media have, to date, been unsuccessful in self-regulating extraction, commodification, or developing thoughtful strategies for stewarding and protecting such ancient and exceedingly potent natural medicines.
Iboga, from which ibogaine is derived, is being threatened by issues related to sustainability.2 The recent surge of interest in ibogaine is not matched by proper education from the media, governments, companies, or even the leaders in psychedelic movement itself. This is not to mention the seriousness of potential medical complications, harm and risk that individuals have experienced when attempting to take this plant on their own, including death or hospitalization.3
Iboga’s Natural Setting
Iboga is a plant native to the jungles of Gabon—a small country about the size of the state of Colorado, located on the West coast of equatorial Africa. Iboga can also be found in Cameroon and Congo, but it is uncertain to what extent as protection measures for iboga are only in place in Gabon, where Bwiti is the most common cultural practice. Recently, iboga has gained popularity due to its spread in Western culture through increased awareness of ibogaine being used in the treatment of substance use disorders, and posttraumatic stress and traumatic brain injury in military veterans4. As a result of increased demand for iboga and over-harvesting by poachers who sell iboga on the illegal market in the West, 200 Gabonese villages—some of which are practicing Bwiti and the initiatory rites of passage—are under threat.5
Iboga is a plant that takes a minimum of five to seven years to grow before the alkaloids mature and the root bark can be harvested for use in ceremonies, and older plants yield a greater prominence of iboga alkaloids.6 The plant is susceptible to its growing environment: Iboga is only known to successfully grow near sea level and in soil conditions found within the equatorial jungles on the planet. Some Bwiti elders dispute the ability to grow quality medicinal iboga outside of Gabon, due to iboga’s unique relationship to its ecosystem, and the assertion that the principal alkaloids such as ibogaine are only produced in certain growing conditions.
Iboga is a plant that is protected by the Gabonese government and the Nagoya Protocol. Its significance goes beyond its therapeutic benefits, as iboga has been deemed a cultural heritage and treasure of Gabon. Shipping iboga outside of Gabon is strictly illegal as of February 2019. Those caught attempting to export it may face severe consequences, including fines and potentially imprisonment.
An Illicit Market for Iboga
Unfortunately, the illegal market for iboga is real and is fueled by cartel-like groups who contribute to crimes of the destruction of precious ecosystems. A great deal of the illicit market product is improperly harvested, leaving nondigestible parts of the plant intact. Black market iboga has in some cases been shown to not be iboga at all, which poses additional safety risks for those seeking it out on the illicit market.
A kilogram of iboga can catch up to €4,500 ($4,900) on the illicit market. Unlike the US, the French customs authorities, for which all air packages pass through France as the first stop leaving Gabon, are hip to illicit iboga shipments. They are commonly intercepted and massive amounts of iboga root bark, declared as Gabon’s national treasure, are thrown away by French customs authorities every year.
We need to be cautious of any state or national legislation passed without mention of reciprocity or the Nagoya Protocol, which Gabon was the first country to sign in 2011. The Gabonese and Bwiti people desire to protect their cultural heritage and must be acknowledged. Moreover, individuals who seek out ibogaine must be aware that most ibogaine that is being utilized in clinical settings is not manufactured from iboga.
Slow Drug Development Drives Underground Demand
Western clinical trials of ibogaine are still in early stages. The U.S. company DemeRx is currently conducting a Phase 1 safety trial in the UK.7 With known cardiac risks and the need for phase 2 clinical trials to begin demonstrating safety and efficacy in opioid use disorder, ibogaine is far earlier in its development, and will likely face a longer approval process than compounds like MDMA or psilocybin. This creates a huge accessibility gap, in which time significant strain could be put on iboga, Bwiti, and Gabon, which is the primary avenue of access to iboga until ibogaine is approved by the FDA.
Ibogaine is typically derived from either Voacanga africana or Tabernanthe iboga plant sources. The process of making ibogaine from Voacanga africana involves extraction, and a two-step chemistry semi-synthesis process of basic hydrolysis followed by acid decarboxylation8. Most standing ibogaine clinics utilize ibogaine derived from voacangine extracted from the Voacanga africana plant, which takes less time to grow and yield voacangine than iboga takes to yield ibogaine.
Most controlled studies to date have utilized ibogaine from voacangine-based sources. DemeRx holds patents9 on manufacturing noribogaine (the active metabolite of ibogaine) from voacangine, thus it is suspected (though not confirmed) that this would be the source from which an FDA-approved drug product would be produced. If so, this would make either ibogaine made from voacangine or iboga produced outside of Gabon the only source until DemeRx, or another drug sponsor, gets approval. Ibogaine derived from iboga would put stress on Gabon, unless it is obtained in compliance with the UN Nagoya Protocol (sustainable iboga), which was recently first accomplished by Terragnosis, Inc. and Filament Health10.
What is important to clarify as companies continue to develop intellectual property (IP) around iboga-derived alkaloids and ibogaine related protocols is that both plants come from Africa, and the path through which it was originally discovered is via Bwiti. Therefore, iboga must be globally acknowledged as the biocultural heritage of Gabon, Africa, and Bwiti. We cannot continue to ignore this fact as we move forward, and we must include the voices of these stakeholders in the conversation and decision-making process.
The UN Nagoya frameworks of Free, Prior and Informed Consent (FPIC) and Access and Benefit-Sharing (ABS) agreements11 must be initiated prior to commercial development of ibogaine. We must be proactive to mitigate consequences from the underground use and black market as a side effect to increased media exposure of ibogaine. With a shared understanding of the explicit origins of the human use of this compound, we all must be held accountable for how we move forward from here.
Ibogaine at High Altitudes
Although early in its developmental process, Colorado has stated plans to move forward with legalising ibogaine services as soon as 2026.12 Although Colorado’s plans are early, such initiatives should not progress without gathering relevant biocultural information and conducting research in advance, in order to understand safety risks, set-up extensive safety protocols, ensure ethical and regulated supply, and create expert-informed therapeutic frameworks. Failure to address such critical issues early on could result in unintended consequences, which may include safety risks, or overharvesting and exploitation of iboga. Colorado has already had one prosecution for an ibogaine-related death.13
One major oversight has yet to be addressed regarding the potential safe use of iboga or ibogaine in Colorado. The average altitude elevation in Colorado is 6,800 feet above sea level. Working with ibogaine or iboga in high elevations increases medical risk, with severe risks at around 8-9,000 feet. At 5,000 feet, the risk of altitude sickness is amplified, which includes common symptoms of headache, nausea, trouble sleeping, and lethargy. Research from Swacon International Hospital in Nepal has found that exposure to altitudes of 5,400 feet (roughly that of Denver) could lead to an increase of 14 mmHg in systolic blood pressure and 10 mmHg in diastolic blood pressure within a 24-hour period. Moderate to high altitudes are also associated with increased risk of arrhythmia. 1415Ibogaine causes QT prolongation, which means that it increases the time between QT intervals, which can lead to fatal arrythmias. Elevation decreases the oxygenation in the blood which can amplify this effect. These factors would theoretically increase the risk of medical complications of administering ibogaine in many regions of Colorado.
To our knowledge, there is no research on individuals ingesting iboga at high altitudes. According to David Nassim, Co-Director from Blessings of the Forest, the iboga plant grows best at sea level and currently it is not known if it can even grow far above that elevation. In decriminalizing or promoting ibogaine, a central element of responsibility and stewardship with this powerful medicine is informing the public of the added risks that high elevation may create, although medical supervision can help reduce some of these risks. High altitudes are not the historic location for administration of iboga.
We are confident that the Colorado Natural Medicine Advisory Board will address such topics once they have built a trusted board of diverse advisors who understand the complexities, origins, and best practices surrounding this powerful medicine. Although we are supportive of Colorado and its desire to help increase access to ibogaine, there are added safety concerns based upon elevations in this particular jurisdiction. Ultimately, we need to be looking at such considerations and a myriad of other contextual factors well in advance, before creating policy, not as an afterthought.
We need to take steps towards educating the public on safety and sustainability, which includes clarifying that iboga is not meant to be used without medical supervision. As Bwiti initiates, and iboga and ibogaine providers with nearly a decade of experience, the level of training and the understanding required is a steep learning curve that might take many new practitioners in the West far too long to catch up based on the currently proposed trajectory for implementation in 2-3 years, and current dire need for healing, especially given the opioid epidemic.
It can take ten years and often longer to learn the complex and exhaustive rites and rituals which have been established over centuries in Bwiti which create physical, psychological, and ceremonial safety. One simple historic example is that the polyrhythmic beats found in Bwiti ceremonial music help to regulate the cerebellum and avert medical risk, whereas psychedelic playlists of European classical music could have a contraindicated effect.16
Western medical parameters are also foundational to safely administer iboga or ibogaine, such as addressing pharmacological interactions, medication tapers, and emergency medical supervision and monitoring. While there is a long tradition of use and initial consensus medical guidelines for ibogaine providers17, extensive research still needs to be done to establish robust safety guidelines for proper use. There are established medical guidelines for ibogaine administration which greatly reduce cardiac risks and are quite effective in harm reduction, such as administering IV fluids, electrolytes and magnesium.
A recent article in Bloomberg about how legal ketamine is fuelling illicit use explained that, “The amount of illicit ketamine seized from 2017 through 2022 rose 1,100%, according to a recent study — hinting at how bubbles in the drug business can have unintended impact on the black market.” This very same result could happen with ibogaine and iboga. But sadly, we cannot grow more plants if iboga is over-harvested to the point of extinction. Gabon is too small of a country and has too scarce of a supply of iboga to take that risk.
Due to the nature of ibogaine’s history, which is clearly connected to the Bwiti tradition, it is crucial to understand that Bwiti is an initiatory tradition with lengthy and complex initiatory rites. Becoming an initiate is a lifelong commitment and a responsibility to the tradition, including protecting Tabernanthe iboga and the Bwiti culture. Work with ibogaine is not to be treated lightly. In Gabon, preparatory and purification rites often take several weeks before ingestion of the plant. The process is and should be treated with the highest respect and consideration.
To this end, a council has been created in Gabon that consists of the elders of many branches of Bwiti. It will take time for their presence to be made public, as this group will establish guidelines of how Bwiti is shared with the rest of the world, according to the wishes of the Bwiti and Gabonese people. It is important that the nascent psychedelic movement and interest in iboga and ibogaine does not outpace or eclipse the burgeoning council of indigenous elders or the collective counsel of longstanding informed and ethical practitioners.
Ibogaine is biocultural intellectual property of Gabon, Africa, Bwiti, and the path through which it was discovered is via Bwiti. Under Nagoya, all traditional stakeholders need to be honoured and take part in the reciprocity frameworks that are established such as FPIC and ABS. As of now, Blessings of the Forest is leading this effort for the Gabonese villages, but what is lacking is the inclusion of the Bwiti or Blessings of the Forest, and other community stakeholders in this conversation on decriminalization and drug development of ibogaine and iboga.
It is important to note, iboga is not just another commodity, but part of complex ecological and cultural systems that we have a deep responsibility to protect and respect. Successful legalization and policy change is about more than just access, but involves creating a sustainable, respectful, and safe relationship with these powerful substances. We need to support groups like Blessings of the Forest, who have been working with the local villages in Gabon for over 20 years.
It is important to note Blessings of the Forest is not selling or planting iboga. They provide the resources to local villages to plant and sustainably grow iboga through their fundraising efforts, managing the sustainable pathway for Iboga and Gabon. All resources go directly to these participating Bwiti villages and how the funds are used is determined by the local traditional Bwiti stewards, as per the Nagoya Protocol. Blessings of the Forest is advocating for policy that provides benefits directly to the Bwiti cultural heritage and as such is a Non-Governmental Organization (NGO) in Gabon. Individuals are encouraged to contribute to ensure the future of the Bwiti culture and sustainable iboga.
Tricia Eastman is an initiated medicine woman and founder of nonprofit Ancestral Heart, which is focused on the reciprocity and preservation of ancestral wisdom traditions and biocultural heritage. As founder of Psychedelic Journeys, she draws from her mestiza ancestral roots, initiations and nearly a decade of experience with the Bwiti tradition of equatorial Africa and has led international psychedelic retreats and ushered many through profound journeys of self-discovery— including global leaders and Special Forces veterans. Eastman’s forthcoming book, Seeding Consciousness: Plant Medicine, Ancestral Wisdom, and the Path to Transcendence will be available through Inner Traditions in 2024.
Dr. Joseph Barsuglia is a psychologist, psychedelic researcher, and advisor with expertise in iboga, ibogaine and 5-MeO-DMT. He is the former research director and CEO of Crossroads Treatment Center, which administered ibogaine and 5-MeO-DMT in Mexico and transitioned into The Mission Within program, which utilizes this sequential psychedelic protocol in treating US military veterans. He is an initiate of Bwiti and has led international retreats with iboga and 5-MeO-DMT with Psychedelic Journeys since 2016. He was a co-investigator in the phase 2 MAPS-sponsored MDMA-assisted therapy for PTSD trials in Los Angeles, and now serves as an advisor to multiple clinics, retreat centers, non-profits, investment funds, and legislative initiatives at the forefront of psychedelic innovation, stewardship, and integrative mental healthcare.