A review of the available literature and treatment experiences

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Ibogaine and methamphetamine

• A review of the available literature and
  treatment experiences
• by
• Jonathan Freedlander, MA Cand
• Towson University

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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

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Pharmacology

• dopaminergic agonist
• attenuate dopamine transporter (DAT) clearance
  efficiency, thereby increasing synaptic dopamine
  (DA) levels
• activates classical reward circuitry

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Methods of administration

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

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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

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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

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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

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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
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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

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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

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Ibogaine and methamphetamine

• Three treatment providers experiences

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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

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• 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

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• 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

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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 dont need therapy
• Ibogaine increases treatment readiness
• Less of the equation than with opiates
• Ibogaine seems to help with withdrawal related
  anxiety, but not hypersomnia

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• 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

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Sara Glatt

• Limited experience treating METH problems
• About 50 success rate
• Sees quicker recovery in those who eat nutriously
• phenylalanine
• melatonin
• soya proteins

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• 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 whos family paid for treatment didnt do
  as well
• lack of internal motivation?
• Long term outcomes unknown

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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

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• 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

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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

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For references, questions, or general
harrassment, email jfreed1_at_umbc.edu