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

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.

Keywords:

• Opioid withdrawal
• ayahuasca
• ibogaine
• kratom
• opioid use disorder

Acknowledgments

Thank you to Agatha Hinman for her assistance with formatting and preparation of this manuscript.

Disclosure statement

The authors have no conflict of interest The remaining authors have no declarations.

Additional information

Funding

Dr. Campbell has received grant support from the National Institute on Drug Abuse and the Food and Drug Administration, as well as support managed through her institution from the Industry PMR Consortium, a consortium of companies working together to conduct post marketing studies required by the Food and Drug Administration that assesses risks related to opioid analgesic use.