Ibogaine and methamphetamine
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Ibogaine and methamphetamine. A review of the available literature and treatment experiences by Jonathan Freedlander, MA Cand Towson University. Methamphetamine epidemiology.

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Ibogaine and methamphetamine

Ibogaine and methamphetamine

A review of the available literature and treatment experiences

by

Jonathan Freedlander, MA Cand

Towson University


Methamphetamine epidemiology

Methamphetamineepidemiology

  • According to the 2002 National Survey on Drug Use and Health, 12.4 million Americans age 12 and older had tried methamphetamine (METH) at least once in their lifetimes (5.3 % of the population)

  • Up from 3.8 million (1.8 %) in 1994

  • Majority of past-year users between 18 and 34 years of age

  • In 2003, 6.2 % of high school seniors had reported lifetime use

  • From 1999-2002, METH related visits to hospital emergency departments (EDs) rose from 12,496 to 21,644


Pharmacology

Pharmacology

  • dopaminergic agonist

  • attenuate dopamine transporter (DAT) clearance efficiency, thereby increasing synaptic dopamine (DA) levels

  • activates classical reward circuitry


Methods of administration

Methods of administration

  • METH can be insufflated (snorted), injected, smoked (“ice”), taken orally (uncommon)


Acute effects

Acute effects

  • euphoria

  • increased activity and alertness

  • decreased need for sleep

  • appetite reduction

  • reduced behavioral dishinibition

  • increased heart rate and blood pressure

  • anxiety/paranoia

  • increased aggression

  • grandiose thinking

  • hyperthermia and convulsions, can result in death


Long term effects

Long term effects

  • damage to blood vessels

  • stroke

  • irregular heartbeat

  • respiratory problems

  • anorexia

  • cardiovascular collapse

  • withdrawal syndrome following abrupt cessation in chronic users

    • anxiety

    • craving

    • sleep disturbances


Neurocognitive issues

Neurocognitive issues

  • After chronic drug abuse and during withdrawal, brain dopamine function is markedly decreased

    • can result in pre-Parkinsonian symptoms

  • dysfunction of prefrontal regions

    • problems with attention

    • deficits in episodic verbal memory

  • decreased serotonergic function

  • altered EEGs correlated with neurocognitive deficits

  • neurocognitive impairment may be especially pronounced in HIV+ individuals

  • neuropathology may reverse somewhat following prolonged abstinence


Ibogaine and methamphetamine

Brain images for (11C)d threo-methylphenidate, which show the concentration of dopamine transporters in a control and in a methamphetamine abuser tested 80 days after detoxification


Psychological issues long term users may experience

mood disturbances

depression and sucicidality

anxiety and panic attacks

sleep disturbances

insomnia/hypersomnia

reduced slow wave sleep

poor sleep continuity

paranoia

problems controlling anger and violent behavior

hallucinations and psychosis

Psychological issuesLong-term users may experience:


Iboga alkaloids and meth scientific research

Iboga alkaloids and METH – scientific research

  • Iboga agents augment both the locomotor and stereotypic effects of METH in a manner consistent with previous reports for cocaine

  • Reverse the behavioral disinhibiting and corticosterone effects of acute meth in rats

  • Reduces IV METH self-administratration in rats, but least effective compared to other drugs tested


Ibogaine and methamphetamine1

Ibogaine and methamphetamine

Three treatment providers’ experiences


Jeffrey kamlet md

Jeffrey Kamlet, MD

  • Has treated many people for methamphetamine dependency and abuse

  • Estimates about 50% are able to achieve long-term abstinence with effective aftercare

  • Long-term abstinence unlikely without aftercare

  • More receptive to treatment/therapy following ibogaine


Ibogaine and methamphetamine

  • Recommend individualized therapy following treatment

    • Different patients respond better to different kinds of treatment/therapy based on their particular needs

  • Be aware of physical health – METH addicts frequently in poor shape

    • cardiac problems

    • pre-Parkinsonian symptoms

  • Some METH users may not be able to take full advantage of “spiritual experience” because of poor health


Ibogaine and methamphetamine

  • Since METH withdrawal symptoms are less tangible than opiates, more difficult to say how ibogaine affects them post treatment

  • Suggests a week of stabilization prior to treatment, at least 5 days

    • off METH

    • good nutrition and hydration

    • cardiac work-up

  • Proper nutrition very important to restore physical and psychological health

  • Patients should be informed they are likely to feel “unwell” for 3 - 6 months


Eric taub

Eric Taub

  • Has treated several stimulant users, 2 or 3 for METH specificially (most have been for cocaine)

  • Stimulant users usually younger (under 35)

    • have lost less compared to older addicts

    • less responsibility

    • feeling of invincibility - “I don’t need therapy”

  • Ibogaine increases treatment readiness

  • Less of “the equation” than with opiates

  • Ibogaine seems to help with withdrawal related anxiety, but not hypersomnia


Ibogaine and methamphetamine

  • 70 – 80 % success with effective aftercare

  • New environment very important post-ibogaine

    • 90% relapse rate if they return home to same environment

    • Visual and behavioral cues more salient than with opiates

  • Must engage in therapy of some kind post-ibogaine

    • address issues that led to dependence

      • abandonment (real or emotional) by same-sex parent

    • must admire and respect therapy provider

    • explore emotions that have been repressed


Sara glatt

Sara Glatt

  • Limited experience treating METH problems

  • About 50% success rate

  • Sees quicker recovery in those who eat nutriously

    • phenylalanine

    • melatonin

    • soya proteins


Ibogaine and methamphetamine

  • People with external motivations (job, drug test) faired better in short term

    • addictions research shows external motivation unlikely to produce long-term success without internal motivation

  • People who’s family paid for treatment didn’t do as well

    • lack of internal motivation?

  • Long term outcomes unknown


Discussion

Discussion

  • Ibogaine seems to be an effective tool in the treatment of METH dependence, though not as effective as for opiates

    • The suppression of opiate withdrawal symptoms may give opiate users more of a feeling of a “clean break” from their habits

  • Aftercare is important in all ibogaine treatment, but this seems especially true for METH

    • Behavioral cues or triggers seem more of a challenge

      • Makes sense as stimulants act primarily on pleasure-reward system involved in classical and instrumental conditioning


Ibogaine and methamphetamine

  • METH users tend to have different demographic characteristics

    • younger

    • typically newer dependent

    • may be more treatment resistant, ibogaine seems to help with this

  • Nutrition especially important

    • reverse effects of anorexia-related malnutrition

    • stimulants more physiologically damaging than opiates


Future research

Future research

  • Effect of ibogaine on salience of visual and behavioural cues

    • Classical conditioning:

      • suppresion ratio following ibogaine

    • Instrumental conditioning:

      • response rate following ibogaine

  • Effect of ibogaine on withdrawal symptoms

    • polysomnograph to measure sleep disturbances

    • measures of craving and anxiety


Ibogaine and methamphetamine

For references, questions, or general harrassment, email:

[email protected]


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