Abstract
Background
Ibogaine is a psychoactive indole alkaloid that has been investigated for use as a
treatment for opioid addiction. While not commercially available in the United States,
it is available via Internet suppliers. Ibogaine use has been associated with significant
cardiac and neurologic effects, such as QT-segment prolongation, cardiac dysrhythmias,
hallucinations, seizures, and central nervous system depression. We present a case
of verified ibogaine exposure with associated QTc prolongation and torsade de pointes
with qualitative analysis of the ingested substance, and examine the history, social
context, availability, and perceptions of ibogaine's effects and safety.
Case Report
A 34-year-old white woman with medical history significant for heroin and cocaine
use disorder presented with reported seizures 1 day after ingestion of 2 g ibogaine
powder purchased from an Internet supplier. Shortly after ingestion, she experienced
hallucinations and was reported by family to have four to five seizure-like episodes,
at one point becoming apneic. In the emergency department, she was noted to have QTc
prolongation and several episodes of torsade de pointes. Qualitative analysis confirmed
the presence of ibogaine in the empty foil packages containing the ingested substance.
Why Should an Emergency Physician Be Aware of This?
As increasing numbers of opioid-dependent patients attempt to curtail their substance
use disorders, we anticipate a rise in ibogaine exposures, necessitating awareness
by front-line clinicians in recognizing and treating a drug exposure that can rapidly
become life-threatening.
Keywords
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Article info
Publication history
Published online: October 17, 2019
Accepted:
June 29,
2019
Received in revised form:
March 10,
2019
Received:
January 19,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
