Psychoactive plant derivatives (ayahuasca, ibogaine, kratom) and their application in opioid withdrawal and use disorder - a narrative review.

People with opioid use disorder and withdrawal are increasingly using plant-based substances like ayahuasca, ibogaine, and kratom to self-treat, often due to limited access to standard care. A narrative review of evidence from 2012 to 2022 indicates these substances may help through unique pharmacodynamic effects, ritual practices, and increased neuroplasticity. However, the supporting evidence comes mainly from small observational studies or animal research. High-quality, long-term studies are needed to determine their safety and effectiveness for treating opioid withdrawal and opioid use disorder.

Study at a glance

Abstract

The opioid epidemic and limited access to treatment for opioid withdrawal (OW) and opioid use disorder (OUD) has led individuals to seek alternative treatments. This narrative review aims to educate clinicians on the mechanisms of action, toxicity, and applications of psychoactive plant-based substances patients may be using to self-treat OUD and OW. We specifically discuss ayahuasca, ibogaine, and kratom as they have the most evidence for applications in OUD and OW from the last decade (2012-2022). Evidence suggests these substances may have efficacy in treating OW and OUD through several therapeutic mechanisms including their unique pharmacodynamic effects, rituals performed around ingestion, and increased neuroplasticity. The current evidence for their therapeutic application in OUD and OW is primarily based on small observational studies or animal studies. High-quality, longitudinal studies are needed to clarify safety and efficacy of these substances in treatment of OW and OUD.