A version of this public comment was submitted to the Washington Senate Health and Long-Term Care Committee on February 5, 2025.
Reason Foundation is committed to ensuring that health policies encourage innovation in addiction treatment, expand access to promising therapies and provide patients with alternative treatment options. Ibogaine represents a potential breakthrough in addressing the U.S. opioid crisis.
As noted in Senate Bill 5204, ibogaine has shown promising potential as a treatment for opioid use disorder (OUD) but remains largely understudied due to its Schedule I classification. Reason Foundation has comprehensibly reviewed the available scientific evidence regarding ibogaine’s effectiveness relative to existing treatment options and compiled this evidence into a guide for policymakers. Our work provides support for claims in the legislative findings section in S.B. 5204 that “ibogaine appears to have the unique ability to rapidly reduce withdrawal and craving symptoms associated with opioid addiction, often after just a single dose.” We find that this is particularly beneficial given the shortcomings of traditional treatments for OUD. Medication-assisted treatments (MATs), which typically involve either methadone or buprenorphine coupled with naloxone, for OUD are associated with high relapse rates following cessation and high mortality rates. In short, these treatments have small success rates.
MATs require daily clinical visits and a commitment to long-term treatment, which may not be feasible or effective for patients recovering from addiction. Existing MATs are not highly effective in reducing withdrawal and craving symptoms following the cessation of opioid use, leading to high relapse rates. Studies indicate that most patients relapse within one month of initiating buprenorphine maintenance therapy (BMT), with young adults and primary prescription opioid users experiencing high relapse rates. Similarly, a comparison of buprenorphine/naloxone vs. methadone results revealed that 50.9% and 41.1% of patients, respectively, had reverted to heroin or opiate use throughout the 15-month follow-up period.
Long-term retention of MAT patients remains a challenge. Patients must maintain treatment for around two years to be successful, but most methadone patients maintain treatment for less than one year and buprenorphine treatments average less than three months. Retention rates beyond six months are typically below 50%, and continuous abstinence for a year is generally no greater than 51% in large state-level programs.
Patients who stop or are disenrolled from MATs face a significantly higher risk of fatal overdose. Some long-term studies have reported alarmingly high death rates, reaching up to 50%. A large-scale review of 122,885 patients found that mortality rates were much higher for those receiving outpatient treatment compared to inpatient care. Specifically, the all-cause mortality rate was 36.1 deaths per 1,000 person-years for patients in outpatient methadone treatment, compared to 11.3 per 1,000 in inpatient programs. For buprenorphine, outpatient treatment had a mortality rate of 9.5 per 1,000 person-years, while inpatient treatment had a lower rate of 4.3 per 1,000.
Overdose-specific mortality followed the same pattern: 12.7 per 1,000 for outpatient methadone patients versus 2.6 per 1,000 for inpatient, and 4.6 per 1,000 for outpatient buprenorphine compared to 1.4 per 1,000 in inpatient care.
A major advantage of ibogaine treatment is that it demonstrates high success rates after only a single administration, unlike traditional MATs that require ongoing, long-term use. In a small-scale study, 75% of patients remained abstinent from opioids for an entire year following treatment. Ibogaine-assisted therapy has the potential to provide lasting anti-addictive effects with fewer doses, potentially reducing relapse rates and associated mortality rates. The U.S. opioid crisis is growing increasingly worse, and expanding research into ibogaine could provide an innovative treatment approach that addresses the shortcomings of MATs.