A 26 year old man with past medical history of obstructive sleep apnea and oxycodone abuse presented to the emergency department after cardiac arrest. According to family members, the patient was seen ingesting an unknown quantity of ibogaine at home with the main purpose of treating his opioid addiction. Shortly after ingestion, the patient developed ataxia, nausea and clear emesis. This was followed by lip edema which prompted family to contact EMS. Upon EMS arrival, patient was noted to have generalized tonic-clonic movement and was administered 10mg of diazepam which unfortunately was followed by PEA arrest. After several cycles of cardiopulmonary resuscitation and the administration of naloxone, epinephrine, sodium bicarbonate and D50, patient was found to be in ventricular arrest and ROSC achieved after cardioversion. He was taken to an outside facility where for the second time went into cardiac arrest but again achieved ROSC and was subsequently transferred to our hospital. The initial EKG indicated normal sinus rhythm with QTc prolongation of 575-625 ms.
At our medical center, hypothermia protocol was started. He was volume resuscitated and started on norepinephrine for labile blood pressure. Poison control was contacted and only supportive therapy was recommended. He developed multiorgan failure with cardiogenic shock. After hypothermia protocol was completed, examination revealed no brain stem function or cortical function. CT head showed diffuse anoxic brain injury and cerebral edema. On physical exam, ocular-vestibular reflexes were absent and Neuron Specific Enolase was found to be 183.0 ug/l. Patient was declared brain dead on day 7 post cardiac arrest after undergoing nuclear cerebral brain flow study demonstrating absence of intracranial blood flow, which was consistent with clinical brain death.
Discussion:
We report a case of an overall healthy young man with opioid abuse and his tragic end after ingesting ibogaine. This drug is a naturally occurring alkaloid found in the roots of the rain forest shrub Tabernanthe iboga. This plant is primarily found in West and Central Africa, and is used for medicinal and ritual purposes. In alternative medicine, ibogaine is used for the treatment of drug addiction.
In an era where opioid addiction is an epidemic and 78 people die a day from prescription opiods, many look for solutions to treat substance abuse. Ibogaine, may be appealing to those suffering from addiction. Although this substance has been used in other countries experimentally, ibogaine has been associated with sudden cardiac death thought to be due to blocking of repolarizing hERG potassium channels and the slowing of the repolarizing phase of the ventricular action potential which lead to prolongation of the QT interval which ultimately causes life-threatening arrhythmias.
Conclusions:
Given the current opioid crisis, it is of extreme importance of to be aware of the adverse effects of ibogaine and to educate the medical community about the dangers of this alternative medicine. Even though ibogaine is not a licensed drug for the treatment of addiction, we may see a rise in its use as opioid abuse increases.