The Treatment of Addiction with Ibogaine
- Introduction
Addiction manifests differently in every individual, which makes treating it far from an exact science. The sheer number of different addictive substances and behaviors, symptoms of the disorder, and uniqueness of goals that people have for their healing process make it a distinctively challenging field of medicine. For people addicted to heroin and/or other opiates, treatment is most commonly an inpatient detoxification program that lasts anywhere from 30-90 days (detoxification itself, however, lasts 3-7 days). During this time, their initial withdrawal symptoms are managed, followed by an abstinence (twelve-step) program or maintenance with Methadone. There’s nothing specifically wrong with Methadone itself as it has been observed to help patients abstain from heroin use for an extended period of time. The current providers of Methadone, however, have lost sight of the humanitarian nature of distributing medicine, opting instead for a notoriously indifferent or even aggressive mentality.Because the detoxification process is so unpleasant and tough on the body, there is a persistent interest in finding ways that help alleviate withdrawal symptoms for a faster recovery.
A relatively recent development in the treatment of addiction is Ibogaine, a naturally occurring substance found in the roots of a rain forest plant. African tribal peoples are aware of this substance and use it for various purposes. Ibogaine came into popular use in 1960s in the United States as a psychedelic/hallucinatory drug but was not recognized as helpful in curbing the negative side effects of healing from addiction. It’s difficult to make a perfect comparison between Ibogaine and conventional detox treatment largely because of the difference in timeframe. As noted above, conventional detox programs are typically 30-90 days long, whereas current Ibogaine therapy lasts anywhere from 5 days to 2 weeks.
Another challenge in comparison is that the results have been recorded differently up to this point. Ibogaine therapy success has been characterized by the subjects’ complete abstinence from the drug, whereas success of conventional treatment is measured more vaguely, such as reduction of drug use or improvement of related consequences (health, familial, social, economical) (3). Interestingly, the emergence of Ibogaine for addiction treatment has caused a feud between addiction self-help groups and drug activists who claim that making Ibogaine more readily available would hinder their efforts to legalize hard drugs (2). The general medical community and pharmaceutical industry, in turn, have wanted little to do with it thus far, despite initial positive indications that ibogaine is more effective in treating addiction to opiates than current treatments. There is evidence that its active ingredient, noribogaine, remains in the body for weeks or even months after initial administration, making it also a longer-lasting treatment option. This ingredient can also be combined with other chemically-compatible substances to further shorten the length of the detoxifying process.
- Methods
Ibogaine is believed to “act on a number of different neurotransmitter systems in the brain that may contribute to ibogaine’s ability to suppress the autonomic changes, objective signs, and subjective distress associated with opiate withdrawal” (1). A dysphoric mood (i.e. depression, anxiety) is believed to be a factor in whether an addict will relapse because cravings become more difficult to manage at this time. An aspect of the chemical makeup of Ibogaine, the 5-HT transporter, has been observed to have an antidepressant effect. Consequently, it seems to improve the mental state of drug-dependent test subjects while managing physical withdrawal symptoms. Because maintenance with Methadone typically has the goal of eventual complete detoxification, the use of medications to facilitate this transition is a clinically important treatment strategy. Anecdotal reports, which make up much of ibogaine research at this stage, suggest that Ibogaine has promise as an alternative medicinal approach for making this transition (1). Enough research by independent groups, both anecdotal and clinical, has been done on the chemical makeup of Ibogaine to determine that this drug has promise as a new tool for addiction treatment that promotes rapid detoxification- more so than any other observed substance of its kind.
In an Ibogaine study carried out by the Departments of Neurology and Pharmacology at the University of Miami School of Medicine, 32 individuals with active dependency on opiates were given a fixed dose of Ibogaine for 12-14 days. The patients’ withdrawal symptoms were evaluated by physicians at multiple points during treatment, then again by a psychiatrist to evaluate their mental state. Throughout their time at the treatment facility, the subjects performed self-assessment using several standardized formats which measured items like mood and substance cravings.
- Results
The physician ratings of withdrawal symptoms demonstrated that Ibogaine caused a rapid detoxification from opiates. Additionally, many of the subjects were able to abstain from the source of their addiction for months after treatment. There was also decreased prevalence of cravings, which is an important indicator of continued drug use or relapse. Ibogaine, after extensive testing on primates and other lab animals, has been deemed a safe substance, but patients with any history of cardiac abnormalities were barred from the study given that Ibogaine is known to have an impact on the cardiovascular system. This impact was investigated in the 1950s as a potential antihypertensive medication because, at certain doses, it may lower blood pressure and heart rate (1). Withdrawal, on the other hand, is associated with an increased pulse, blood pressure, and respiration. Of the 150+ drug-dependent subjects tested with Ibogaine by the University of Miami School of Medicine to date, no significantly negative side effects have been observed. Several cocaine-dependent subjects were observed to have a hypotensive response, which simply required closer monitoring of vitals; the cardiovascular changes were able to be remedied by a decrease in Ibogaine dosage. While it is encouraging that all effects of Ibogaine were well tolerated by the test subjects from this study, it doesn’t eradicate the possibility of other unusual medical risks that may come with a larger sample size.
- Conclusions
Based on verbal responses from test subjects, ibogaine appears to have added psychological benefits as compared to conventional treatment for addiction. Subjects undergoing Ibogaine addiction treatment displayed a trend of increased self-motivation and a more positive outlook on their healing process than patients undergoing traditional treatment. This could perhaps be related to the drug’s inception as a non-clinical self-help substance. Unlike most medicines, Ibogaine began its journey with individual users who felt empowered by its use as a self-help tool to treat their addiction. This doesn’t mean that Ibogaine will never make it as a clinical addiction drug, but the complexity of philosophies associated will likely cause unique issues as things move forward. As previously noted, addiction therapy is a constantly changing branch of medicine due to the many unusual variables it presents. Unfortunately, “the pharmaceutical industry for reasons of liability, perceived lack of profit, a lack of emphasis in the development of medications to treat chemical dependence, and a desire not to be associated with the stigma of the drug user population chose not to involve itself in ibogaine development” (2). Data suggests that Ibogaine can be highly effective in the detoxification of the human body following opiate-dependency; and, anecdotal evidence suggests that it may be effective in treating some psychiatric aspects underlying addiction. Up until this point, there has been a tendency towards a different medication for each individual type substance abuse (alcohol, heroin, methadone, etc.). Only recently has the medical community been driven to accept the possibility that one medicinal addiction drug can be effective in treating multiple forms of dependency. One would hope that, should Ibogaine prove to be the best effective treatment for drug addicts, that the politics and controversy surrounding the issue will not deter any progress in advancing the drug towards clinical use.
References:
- D. Mash, C. Kovera and J. Pablo. Ibogaine in the Treatment of Heroin Withdrawal (2001). http://www.iceers.org/docs/science/iboga/Ibogaine%20Proceedings/ch08_Heroin_Kamlet.pdf
- H. Lotsof and N. Alexander. Case Studies of Ibogaine Treatment: Implications for Patient Management Strategies (2001). http://www.iceers.org/docs/science/iboga/Ibogaine%20Proceedings/ch16_Case_Studies_Lotsof.pdf
- Global Ibogaine Therapy Alliance. Ibogaine Assisted Detox Efficacy (2012-2017).https://www.ibogainealliance.org/ibogaine/therapy/detox/efficacy/