What is ibogaine, and why is it in the news?

[THEME MUSIC] FLORA LICHTMAN: Hey, it’s Flora, and you are listening to Science Friday.

Psychedelic news from the Oval Office.

DONALD TRUMP: If these turn out to be as good as people are saying, it’s going to have a tremendous impact on this country and other countries, too.

FLORA LICHTMAN: This month, Joe Rogan and RFK, Jr. stood behind President Trump as he announced his administration would set aside funding and loosen the bureaucratic process at the FDA to fast-track psychedelic therapy research. Joe Rogan name-checked one drug in particular, ibogaine. Rogan said he sent Trump information about ibogaine’s potential promise for addiction, and Trump replied.

JOE ROGAN: The text message that came back, “Sounds great. Do you want FDA approval? Let’s do it.” It was literally that quick.

FLORA LICHTMAN: So ibogaine comes from the root bark of the iboga plant found in Central Africa. And it has psychedelic properties. And besides its potential for curbing opioid addiction, veterans in the US have been advocates for this treatment because it’s shown some promise for treating PTSD and other conditions. But it also can be risky to take, especially if you have heart issues.

Now, if you have never heard of the drug ibogaine, you’re not alone. Compared to other hallucinogenic drugs like psilocybin or ketamine, ibogaine has not made it to the medical mainstream, yet. So what is the story with this drug?

Here to tell us about its history is neuroscientist and pharmacologist Dr. Deborah Mash, who’s been studying ibogaine since the ’90s, maybe as long as any scientist in the US. For full transparency, she’s also the founder and CEO of a company that’s developing a therapeutic drug based off of ibogaine. And here to tell us how ibogaine fits in with this growing interest in medical psychedelics generally is Jane Hu, journalist for The Microdose newsletter. Thank you both for being here, and welcome to Science Friday.

DEBORAH MASH: Thank you.

JANE HU: Thanks so much for having me.

FLORA LICHTMAN: Jane, it feels like ibogaine has burst into public consciousness really recently. Is that just my perception? And if not, why now?

JANE HU: No, it’s definitely not just you. I mean, like you mentioned, there have been researchers who have been interested in this since the 1990s, like Deborah here. But I feel like in the last couple of years, it’s definitely made a resurgence in the psychedelics world as a drug of interest.

And a lot of this actually started with Bryan Hubbard, who was also standing behind President Trump during that executive order signing. So Hubbard initially proposed in 2023, I believe, to spend $42 million of Kentucky’s opioid abatement fund to study ibogaine. Now, that didn’t end up going through. But over the last few years, Hubbard’s really been on this kind of campaign to really increase the profile of ibogaine.

And he was actually on Joe Rogan’s show with Rick Perry, former governor of Texas, who has also been very into ibogaine over the last couple of years. And the two of them were like, hey, Joe, can you call up Trump and see if he might be interested in doing something on this? And that takes us to today.

FLORA LICHTMAN: Deborah, you’re an ibogaine pioneer, and you’ve called the research into it a “vast underground experiment.” What do you mean by that?

DEBORAH MASH: The vast underground experiment of ibogaine goes back to the 1990s, when in 1992, late 1992, I got on an airplane and flew with a medical doctor from my department at the University of Miami, and we went to Amsterdam to see Addicts Helping Addicts. It was the International coalition of addicts self-help and the Dutch addict self-help movement.

And their people were administering ibogaine. And what was an unusual and certainly not a medically-safe setting, to people who were coming off, trying to detoxify off of hard drugs. And it was there that began my journey with ibogaine, because I saw three young men, two that were addicted to opioids, one that had been freebasing a lot of cocaine, take a single dose of ibogaine, and after a 24-hour period, transformed, no withdrawals.

But what was even more interesting to me, as a scientist, was the fact that their desire to go out and get high again was diminished. But then in the next days, because we were in residence with them over time, the cognition enhancement, the ability to think straight– how can I change my life? What’s going to be different this time? Their narrative, their personal narrative was being rewritten. And that was ibogaine.

I couldn’t do any research there because it literally was not– it was not a medical setting. But what I did do is, I asked them to sign a consent so that I could collect urine samples, because I reasoned at that meeting, at that very first time, that there could be potentially an active metabolite that was part of the beneficial effects of ibogaine. Because it was hard to imagine that all of this hard drug use could be reversed with only a single dose of a drug.

FLORA LICHTMAN: We’ve seen states pushing forward psychedelic therapies. What has kept ibogaine from going mainstream?

FLORA LICHTMAN: A lot.

JANE HU: Yeah, I mean, for many years– and I think Deborah can speak to this more, as well– some of the researchers that I spoke with said that they really didn’t see it moving forward in FDA trials because there are heart risks associated with it. And there are other psychedelics like we were just talking about that have less of a risk profile in that sense. So they had a lot of questions about whether there would be enough buy-in from our federal agencies to actually even get them started in clinical trials.

DEBORAH MASH: Well, and I can tell you straight away that, I’ve been an NIH-funded investigator my entire adult life, and I’ve held uninterrupted NIH funding over three decades. And every single grant application that I submitted for consideration regarding ibogaine were just, shut down. I mean, those doors slammed tight on me.

However, the other thing is that while the NIH didn’t want to discuss it, didn’t want to discuss tax dollars going for psychedelic research, the FDA, back in 1993, authorized clinical testing. The FDA acknowledged the potential and importance of testing the drug.

So, yes, is ibogaine very exciting and transformative and maybe can help bring about behavioral change and make differences in patients’ lives? Yes. Do we have all the facts on the table from good clinical practice, the FDA gold standard, which is required to ultimately get to a label? No, we do not.

FLORA LICHTMAN: Deborah, why is it more dangerous than other psychedelics? Is it the mechanism of action, or is it that you have to get the dosing exactly right? What is it?

DEBORAH MASH: Both. So there are, what we call, on-target effects. These are what mediate the beneficial effects– blocking opiate withdrawals, helping to treat symptoms of PTSD, et cetera. The off-target effect is the hERG channel-blocking effect. And what is the hERG channel? hERG is potassium channel in the heart that regulates the refractory period of the heart. And if that gets prolonged, it means that your electrical signaling in the heart goes sideways, and that can predispose to a fatal arrhythmia. You have to know what you’re doing.

Also, ibogaine has complex pharmacokinetics. What does that mean? It means that you’re either genetically a fast, slow, or intermediate metabolizer. So going back to what you said about the dose is very important. We need to very tightly monitor and the target dose that’s going to be safe in patients.

Next, risk mitigation. You need to be able to screen patients. Some people are not going to be candidates for ibogaine. And people who are going offshore to take ibogaine, there’s no package insert. All right. They’re taking it with people who may or may not be subject matter experts or knowledgeable about administering an investigational medicinal product. I would say most of them are not. And I have said that in peer-reviewed literature.

So desperate people will go into desperate settings for treatment. That’s why, again, the ability to get ibogaine through a completed, well-designed phase I study into phase II will open up patients right to try. And this is something I have wanted to see for a very long time. And the patients are waiting.

FLORA LICHTMAN: So we can learn, Deborah? So we can learn if they work.

DEBORAH MASH: Again, I’m a scientist. I’m not an evangelical advocate for ibogaine. That’s not my role here. My role is to simply say either the drug works or it doesn’t. But we, in the community, looking at the number of suicides, looking at the scourge of addiction, the failure of addiction meds to advance, need to turn every stone over. And now, we have a champion in President Trump to put some wind in our sails, finally.

JANE HU: So, Deborah, I had a question for you, which is that your company, DemeRx, just got an investigational new drug application through, approved by the Trump administration, very recently for noribogaine, which is a metabolite of ibogaine. Does that have a different risk profile than ibogaine?

DEBORAH MASH: We received FDA authorization, safe to proceed, with clinical testing of noribogaine, the active metabolite of ibogaine. Noribogaine and ibogaine have very different profiles, not only safety. For one, noribogaine is not an oneiric hallucinogen.

FLORA LICHTMAN: No trip, is what that means?

DEBORAH MASH: No trip. And so the big question mark is, what? Do you need the trip to reach the destination? We will test that in phase II.

FLORA LICHTMAN: Speaking of the trip, what is it like for patients to take ibogaine? We had a listener, Craig, from Eugene, Oregon, who tried it and told us about his experience.

CRAIG: I went down to Mexico, Baja, in December, and did an iboga ceremony. And people say it’s the Mount Everest of psychedelics. It’s very difficult. Yes, true. But also, nothing’s more difficult than living with trauma. And I, for five years now, six years maybe, have been working with different plant medicines and psychedelics, and I’ve kind of tried them all. And it’s all chipped away at childhood abuse and trauma and neglect and abandonment. But nothing has really brought it all together, like my iboga ceremony.

I have a lot that I struggle with, and all of it was able to be kind of witnessed and dealt with in my iboga ceremony and session. I really think there’s a ton of healing potential. But yeah, it was really life-changing for me.

FLORA LICHTMAN: It’s really these kind of stories that have made ibogaine a drug of interest despite serious risks. We’ll hear more about what an ibogaine trip is like after the break, so don’t go away.

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Deborah, describe what ibogaine therapy is like. What is the experience like for a patient?

DEBORAH MASH: Well, first off, let me say, I’ve never taken ibogaine, so I can’t tell you from a first person. But what the patients report is that ibogaine comes on quite intense in about anywhere from 45 to 90 minutes after oral dose administration, depending on their genetics. The visionary phase of the drug patients liken to a waking dream state. And for many of the patients, the insights that they gained from this, what they say, is important. It’s important in helping them to see bad behavior. It’s important for them to reconnect to their higher power, to reconnect with their family, to see traumas that may have occurred at points in their life, whether childhood or adult, that they can now figure out and make sense.

So when the noribogaine comes up to what we call a maximal concentration in the blood– because it’s metabolized. Ibogaine is an oral dose. It’s metabolized through the liver. So you get the peak in the ibogaine first, and then it’s followed by noribogaine delayed by hours afterwards. When the noribogaine reaches its peak, the visions abruptly stop.

You would watch the patients sitting at the bedside, and all of a sudden the eye shields would go up, the headphones would go off, and they’d look around the room. And I’d go, oh, noribogaine just came on.

And so the noribogaine phase was a deep phase of cognitive introspection. So there would be some heart opening. They would describe that. They felt love for family and children and just, God, whatever was in part of their journey. And that would continue on through the evening. And we would usually get them up to eat something. And then you could see they were still processing. So we put them back in the bed. And by the next morning, they were fine. But that’s the journey.

FLORA LICHTMAN: How does ibogaine complement the psychedelics that are already out there? Why would someone potentially opt for ibogaine over psilocybin therapy?

DEBORAH MASH: It’s a great question. They’re going to have different indications. Right now, psilocybin has an indication for treatment-resistant depression. And there’s also major depressive disorder, right? So patients who have been on SSRIs, Paxil, and others will have an option if those are not working for them. If you’re going through opioid withdrawals, psilocybin is not going to benefit you.

So I think we need to– what we will see is that there will be indications for use that will have gold standard FDA review and data-driven evidence for how that label is written. Now, if people use them off-label, that’s another story. Jane, do you have a comment?

JANE HU: This is an empirical question, essentially. Whether we think that there are specific indications that specific psychedelics are better at treating. And I think you’re right. There aren’t a ton of psilocybin studies looking at addiction specifically, although I do believe there are a few. But I’ve talked to a lot of historians of science, and one thing that has really struck me in my conversations with them is how much our decisions about drugs and our use of drugs are very much social and cultural, as well.

And I think that part of the reason why a lot of folks with addiction issues or veterans with PTSD are really seeking out ibogaine as well is that there’s a culture developing around it. Especially, there are all veterans, non-profits, groups that are connecting people with these ibogaine retreat centers in Mexico. And people hear about their buddies going down there, and they want to go experience that themselves, as well. So I think that there’s a pipeline being created for that.

And, of course, there’s still empirical data that we need, whether ibogaine is really superior to other psychedelics in treating this. But regardless, I think that social and cultural piece of things also gets tied up in how people have an experience, as well.

In talking to researchers, I’ve talked to some who think that one of the biggest contributions of psychedelics to people’s healing is the potential to provide hope. That these are folks who have really tried so many different things, and they haven’t tried this, but they’ve heard that it’s worked for others, and that carrying that hope with them actually contributes to their healing in some way.

DEBORAH MASH: This is something so dear to my heart. I really am– the patients are waiting, and we need the data. We need– as Jane says, we need the evidence that these drugs are safe, who will benefit, who’s not a candidate for them, and let’s bring them. The patients need to have access to better meds. And the mental health of our country, we want to Make America Healthy Again, and we want our mental health to be right on the top of that list.

FLORA LICHTMAN: Dr. Deborah Mash is an emeritus Professor of Neurology at the University of Miami School of Medicine, and Jane, who is a journalist for The Microdose. Thank you both for taking the time to talk today. This was fascinating. This episode was produced by Dee Peterschmidt, with a critical assist from John Dankosky. I’m Flora Lichtman. Thank you for listening.

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