IBOGAINE-ASSISTED TREATMENT FOR OPIOID-RELATED DISORDERS: A SYSTEMATIC REVIEW AND SINGLE-ARM META-ANALYSIS
Palavras-chave:
Transtornos Relacionados ao Uso de Opioides, Alucinógenos, IbogaínaResumo
Introduction: Opioid use disorder (OUD) is a complex disease and public health threat, with challenging medical treatment as no specific treatment is considered universally effective. Ibogaine has been used informally as an active in drug-assisted treatment for OUD and shown positive results. However, current evidence regarding the drug’s efficacy remains inconclusive as no consensus has been well established in literature. Aims: We aimed to perform an updated systematic review and single-arm meta-analysis of ibogaine-assisted therapy in patients undergoing treatment for opioid abuse disorders. Methods: We used PubMed, Scopus and Cochrane Central for studies that used ibogaine as a main agent in drug-assisted OUD treatment. Outcomes of interest were reduction of withdrawal symptoms, decreased substance use, improvement of social functioning and improvement of psychological symptoms. Statistical analysis was performed using OpenMetaAnalyst. Heterogeneity was assessed with I² statistics. Results: Four observational studies were included in this review, totalling 120 patients. They were predominantly of male, Caucasian individuals, with a mean age of 33.52 years and an average of 4.26 previous treatment attempts. The Subjective Opiate Withdrawal Scale (SOWS) and the Addiction Severity Index (ASI) were employed as assessment instruments. When evaluating withdrawal symptoms, meta-analysis reported overall decrease of 12.62 (95% CI: 4.75–20.48%; p = 0.003; I² = 83.05%). Significant positive changes over one year in the social functioning and mental health of patients was also relevant. However, it is important to highlight the high heterogeneity of the results, which may be explained by the relatively small sample size and the absence of control groups. Conclusion: Our meta-analysis suggests that ibogaine demonstrates promising potential for the treatment of opioid use disorder, showing beneficial effects on opioid withdrawal symptoms, psychiatric outcomes, and social reintegration of affected individuals. However, given the risk of bias inherent to the observational methodologies of the studies included in this meta-analysis, it is essential that randomized clinical trials be conducted to establish the efficacy and safety of ibogaine in this context.
Referências
Taha S. Best practices across the continuum of care for the treatment of opioid use disorder. Place of publication not identified: Canadian Centre on Substance Use and Addiction; 2018.
Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry. fevereiro de 2022;9(2):137–50.
Winkelman M. Psychedelics as Medicines for Substance Abuse Rehabilitation: Evaluating Treatments with LSD, Peyote, Ibogaine and Ayahuasca. CDAR. 27 de janeiro de 2015;7(2):101–16.
Bouso JC, Fornís I, Vilamala MV, Loenen BD, Sainz-Cort A, Jiménez-Garrido DF, et al. An analytical study of iboga alkaloids contained in Tabernanthe iboga-derived products offered by ibogaine treatment providers. Arch Clin Psychiatry (São Paulo). abril de 2020;47(2):51–4..
Mendes FR, Costa CDS, Wiltenburg VD, Morales-Lima G, Fernandes JAB, Filev R. Classic and non‐classic psychedelics for substance use disorder: A review of their historic, past and current research. Addiction Neuroscience. setembro de 2022;3:100025.
Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions : Cochrane Book Series.
Borenstein M, organizador. Introduction to meta-analysis. Chichester, U.K: John Wiley & Sons; 2009. 421 p.
Malcolm BJ, Polanco M, Barsuglia JP. Changes in Withdrawal and Craving Scores in Participants Undergoing Opioid Detoxification Utilizing Ibogaine. Journal of Psychoactive Drugs. 2018;50(3):256–65.
Mash DC, Duque L, Page B, Allen-Ferdinand K. Ibogaine detoxification transitions opioid and cocaine abusers between dependence and abstinence: Clinical observations and treatment outcomes. Frontiers in Pharmacology [Internet]. 2018;9(JUN). Disponível em: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85048050801&doi=10.3389%2ffphar.2018.00529&partnerID=40&md5=5ad0eabf3f70c098afb8885f7ef884f0
Noller GE, Frampton CM, Yazar-Klosinski B. Ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational study. American Journal of Drug and Alcohol Abuse. 2018;44(1):37–46.
Brown TK, Alper K. Treatment of opioid use disorder with ibogaine: detoxification and drug use outcomes. American Journal of Drug and Alcohol Abuse. 2018;44(1):24–36.
