Indication-stratified mortality risk of ibogaine treatment under contemporary safety protocols: a multisite analysis of 19,071 patients and updated systematic review of fatalities
Martijn Arns, Kenneth Shinozuka, Joseph Barsuglia
Research Square June 17, 2026 DOI: 10.21203/rs.3.rs-9966269/v1 via OpenAlex
Summary
AI-generated from the abstractIbogaine, a substance showing early promise for treating substance use disorders and PTSD in veterans, carries a risk of cardiac arrhythmia and death. A retrospective multisite study of 19,071 patients treated under safety guidelines at 11 international clinics found that all six deaths occurring within 72 hours were among patients treated for opioid use disorder (6 out of 10,382), with no deaths among 8,689 non-SUD patients. A systematic review of ibogaine-associated fatalities mirrored this pattern: 41 of 44 fatalities with known indication involved substance use disorder, predominantly opioid detoxification. The findings indicate that ibogaine-associated mortality is largely confined to opioid detoxification and rare in non-SUD indications.
Study at a glance
| Characteristics | Retrospective multisite study with systematic review Peer reviewed |
|---|---|
| Sample size | 19,071 |
| Population | Patients treated at 11 international ibogaine clinics |
| Intervention | Ibogaine treatment |
| Topics | Addiction |
| Keywords | Detoxification alternative medicine Poison control Mortality rate Injury prevention |
| Key finding | Ibogaine-associated mortality is largely confined to opioid detoxification and rare in non-SUD indications. |
Abstract
Abstract Ibogaine has shown early therapeutic promise for substance use disorders (SUD) and post-traumatic stress disorder in veterans, but concerns about treatment-associated cardiac arrhythmia and death have constrained clinical development. Whether this risk is uniform across indications or concentrated in specific populations is unknown. We conducted a retrospective multisite study of 19,071 patients treated under established safety guidelines at 11 international clinics, with an updated systematic review of ibogaine-associated fatalities. Six deaths occurred within 72 hours, all among patients treated for opioid use disorder (6/10,382), with none among 8,689 non-SUD patients. This was mirrored in the review, where 41/44 fatalities with known indication involved SUD, predominantly opioid detoxification (P=1.6×10⁻⁹). The absolute rate represents a lower bound, given voluntary participation and non-adjudicated deaths; sensitivity analysis showed the conclusion robust to plausible unobserved deaths at non-participating clinics. These findings indicate that ibogaine-associated mortality is largely confined to opioid detoxification and rare in non-SUD indications.