Other Substance Use Disorders: Research Overview

Urgent safety note first

Ibogaine has been linked to deaths, mainly from a dangerous heart rhythm called torsades des pointes that follows a lengthening of the heart's QT interval. [1] Anyone who has taken a psychoactive substance and has chest pain, fainting, a racing or irregular heartbeat, or trouble breathing needs emergency care now (911 in the US). For overdose or poisoning in the US, Poison Help is 1-800-222-1222; see poisoning: what to do first. This page describes research. It is not advice to use any substance to treat addiction.

What this page covers

This page covers opioid and cocaine use disorders and related research. Alcohol and tobacco have their own pages: alcohol use disorder research and tobacco use disorder research. Evidence labels: promising but limited, mixed, insufficient evidence, evidence of harm (for safety signals). Ibogaine is a compound from the iboga plant, which is used in rituals of the Bwiti tradition, and it is not the same thing as the plant or its ceremonial use [1]; see the ibogaine guide and iboga and Bwiti traditions. Ketamine is not a classic psychedelic and is covered on its own page: ketamine.

Overall picture

A 2025 systematic review of clinical studies of psychedelics for opioid use disorder found few completed studies of serotonergic psychedelics, most studies involving ibogaine or ketamine, and many with weak designs. [2] Most had a high risk of bias, mostly from lack of randomization and blinding. [2] A separate 2025 review of 37 studies across substance use disorders found the best evidence for alcohol, and described the ketamine trials for cannabis, cocaine and opioid use disorders as high risk of bias with low-certainty evidence. [3] Label for opioid and cocaine use disorders: insufficient evidence.

Ibogaine and opioid use

• New Zealand observational study. Fourteen people received a single ibogaine treatment; eight completed all interviews over 12 months, and drug-use scores improved among those eight. One participant died during treatment. [4] One author was employed by MAPS, a psychedelic research charity. [4]
• Dutch hospital study. Fourteen people with opioid use disorder were monitored for at least 24 hours. Half reached a QTc (a measure of the heart's electrical recovery time) above 500 milliseconds. All had severe temporary ataxia, meaning they could not walk without support. No torsades des pointes occurred. [1]
• Systematic review of ibogaine. It covered 24 studies with 705 people, including two randomized double-blind trials and many open-label reports. It concluded that data suggest benefit on withdrawal and craving, but reported severe medical complications and deaths linked to nerve and heart toxicity. [5]

Open-label, small, mostly uncontrolled data cannot separate ibogaine's effect from the setting, expectations or other care. Label: promising but limited for withdrawal symptoms in small observational data; evidence of harm for cardiac and neurological risk.

Ibogaine in a veterans study

A 2024 prospective observational study of 30 male special operations veterans with mostly mild traumatic brain injury gave ibogaine with magnesium, because magnesium may reduce the heart-rhythm concern. [6] Participants improved on disability, PTSD, depression and anxiety scales a month later, and no unexpected or serious adverse events were reported. [6] The authors state that controlled trials are needed. [6] This was not a study of addiction treatment, and it had no control group.

Cocaine use disorder and ketamine

In a randomized trial of 55 cocaine-dependent adults, a single ketamine infusion followed by a mindfulness-based relapse prevention course was compared with the sedative midazolam. At the end, 48.2% of the ketamine group had stayed abstinent over the last 2 weeks versus 10.7%. [7] The authors call for replication in a larger sample. [7] A systematic review of psilocybin identified only one cocaine study and one opioid study among its 16 published studies. [8]

Proper evidence not found

For psilocybin, LSD or mescaline in opioid or cocaine use disorder, we found no randomized trial with published results in the reviews we read; we checked the 2025 psilocybin and opioid use disorder systematic reviews and a PubMed search on 2026-10-22. [8][2] For ibogaine as an approved medicine in any country we did not read a regulator page, so we state no approval.

Practical limits

The Dutch study monitored heart rhythm and balance in a university hospital for at least 24 hours [1]; that level of monitoring is not available in unsupervised settings. Three medications for opioid use disorder are approved by the US Food and Drug Administration, and a clinician can explain them. [2] Never change or stop prescribed medicines without talking to your prescriber. For support see substance use support and urgent help.