The only drug singled out by name in President Trump’s recent executive order on psychedelic therapies is ibogaine — a compound most Americans have never heard of, but one that veteran groups and podcasters have been pushing for years. The April 18 order, which aims to expand research, streamline FDA approval, and allocate $50 million for state-level psychedelic research, represents one of the boldest federal actions on psychedelics to date. And right at the center of it is a drug with a complicated reputation.
Kannan Rangaramanujam of Johns Hopkins Medicine spoke with the Wyoming Star about what the executive order actually means, where ibogaine research stands, and why safety concerns are not being ignored, even as the White House fast-tracks the conversation.
Asked how significant the inclusion of ibogaine is in the executive order, Rangaramanujam said it reflects a genuine policy shift.
“I believe that the executive order is a clear signal from the government that mental health and addiction are major societal issues, and the recognition of the positive later stage clinical trial results in this space from ibogaine and other psychedelic drugs,” he said. “The shift in the policy is a combination of both these factors and will allow for detailed scientific evaluation of these compounds, with broader access and support.”
He noted that the order enables priority review, funding support, veteran participation in trials, and eventual consideration of rescheduling Schedule I drugs after Phase 3.
“These changes bode well for careful consideration of ibogaine and other psychedelics for challenging mental health disorders.”
So what does the actual research say about ibogaine’s potential, particularly for veterans suffering from depression, anxiety, and PTSD?
Rangaramanujam pointed to recent findings.
“Recent research and clinical trial results on the use of ibogaine in veterans showed that it was a fast acting therapy and produced rather large decreases in PTSD and depression symptoms and suggested a strong possibility that the drug may improve brain activity through enhanced neuroplasticity and emotional regulation,” he said. “There were minimal serious side effects reported. Even though these were early stage, small in size, and observational, the improvements appear to be broadly seen with ibogaine and a few other psychedelics, warranting careful consideration.”
That said, bringing ibogaine into mainstream clinical use is not a simple matter. The challenges are real.
“We have ways to go before making ibogaine mainstream,” Rangaramanujam said. “The key challenges include safety (especially cardiotoxicity), a narrow therapeutic window between a safe and a dangerous dose, and high-quality scientific evidence that it helps with neuroplasticity and emotional regulation.”
He explained that when these issues are addressed, large-scale clinical trial data could convince regulators. To enable high-quality science, regulations should be relaxed to allow controlled access research.
“The current executive order enables and highly encourages deeper and high quality research and clinical trials,” he said. “One could envisage appropriately tailored ibogaine and psychedelic drugs come mainstream, not necessarily in the current form, but in improved formulation that address the safety and therapeutic window challenges.”
That is where drug delivery technology enters the picture. Rangaramanujam believes advances in getting drugs to the brain and keeping them away from the heart could be transformative.
“I feel that major steps in addressing the risks relating to ibogaine and psychedelics can be addressed by using ‘precision’ drug delivery systems, which could: reduce the dose required, reduce the off-target effects and cardiotoxicity, and deliver the drugs to only the regions of the brain affected by depression and PTSD,” he said.
He offered examples: a delivery system could keep the drug away from the heart, reducing cardiotoxicity, or away from the liver, reducing drug-drug interactions. These systems can also improve solubility.
“Our group at Johns Hopkins Medicine and start-up Samata Therapeutics uses such delivery systems made of dendrimer nanoparticles for ibogaine and other psychedelic drugs, to enable these important advances. Even though these are in preclinical stages, there is significant promise.”
More broadly, Rangaramanujam sees neuropsychiatric treatment entering a genuinely new phase.
“I definitely think so,” he said. “The recent executive order is an important catalyst, that could eventually lead to renewed scientific emphasis/rigor, investment from both government and funds, that could spawn new formulations of ibogaine and psychedelic drugs for treating depression and PTSD symptoms, which have largely been intractable for many decades.”
Trump signed the executive order on April 18, and it has drawn praise from a diverse coalition including psychedelic research organizations, medical professionals, veterans groups, and podcaster Joe Rogan. In fact, it was a text message from Rogan to the president about ibogaine that reportedly served as a catalyst for the order. The order directs the FDA to provide priority review vouchers for eligible psychedelic therapies with Breakthrough Therapy designation, allocates $50 million through ARPA-H to match state investments in psychedelic research, and explicitly includes experimental psychedelic therapies within the scope of the federal Right to Try Act. It also directs the Attorney General to prepare for rescheduling of specific drugs as soon as possible after successful Phase 3 trials.
Not everyone is celebrating without reservation. Some experts have expressed caution about expedited FDA approval, warning that speeding up testing could shortchange rigorous safety analysis. And ibogaine itself carries unique risks. Unlike classic psychedelics such as psilocybin or LSD, ibogaine acts on multiple systems including opioid receptors, and it has been linked to cardiac arrest and fatal arrhythmias. A 1993 FDA-approved trial had its funding withdrawn after safety questions arose.
Since then, periodic reports of deaths associated with ibogaine have appeared in the scientific literature. The drug has not yet received Breakthrough Therapy designation, unlike psilocybin and MDMA, which are further along in the approval pipeline.
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