Transcript Patient Medication Acceptability and Treatment Options:

Patient Medication
Acceptability and
Treatment Options:
•Ibogaine
•Methadone
•Buprenorphine
Howard S. Lotsof
DORA WEINER FOUNDATION
Background: Drug Control
• 1906 Pure Food and Drug Act
• 1914 Harrison Narcotic Act
• 1970 Controlled Substances Act
Background: Methadone
• 1937 synthesized by Max Bockmühl and
Gustav Ehrhart, I.G. Farbenindustries.
Patent issued 1941
• 1950 use in treatment of opioid
abstinence syndrome established in US
• 1964 use in opioid maintenance therapy
Methadone molecule
Methadone powder
Methadone diskets
Methadone liquid
Background: Buprenorphine
• 1965 synthesized by KW Bentley at Rickitt & sons, UK.
• 1975 - 1978 DR Jazinski et al. Indicate utility in treating
opiate addiction
• 1977 - 2003 John Lewis champions analgesic and
antiaddictive development
• 2000 Drug Addiction Treatment Act authorizes use in
opioid maintenance therapy
• 2002 FDA approves that use to Reckitt Benckiser
Buprenorphine molecule
Buprenorphine products
manufacturer, Reckitt Benckiser will not make
current product photographs available
Background: Ibogaine
An experimental medication
• Botanical source Tabernanthe iboga. Used for
100s of years in African medicine and religion
• 1901 ibogaine isolated by Dybowski and Landrin
• 1958 molecular structure determined Bartlett et
al.
• 1962 Lotsof discovers Antiaddictive effects
• 1993 - 2003 Mash & Glick develop second
generation ibogaine-like drugs
Ibogaine molecule
Noribogaine
Liver transforms ibogaine into
noribogaine
18-methoxycoronaridine molecule
18-MC
Synthetic molecule
Tabernanthe iboga shrub
Roots bark contain
ibogaine
Pharmaceutical ibogaine
experimental medication
Discovery of antiaddctive
effects
Methadone
NYC
1964
Doctors
administer to
drugs users
Ibogaine
NYC
1962
Drug users
administer to
drug users
Buprenorphine
Lexington, KY
1975
Pharmaceutical
industry/gov.
Development
Methadone
•The golden age of Dole
and Nyswander
•1966 - 1973
Drs. Dole and Nyswander ca 1976
Early generation methadone patients
• The program was administered or controlled
by doctors in a medical research environment
even at the clinic level.
• Nurses, counselors and patients believed in
opioid maintenance therapy and collaborated
to make it work. Patients and staff were a
team.
• There was no “us” and “them”. Patients were
treated like any other medical patients.
Early generation ibogaine patients
• A full collaboration between academic researchers,
pharmaceutical developers and user self-help groups with
mutual respect.
• Equal status between the parties. Users, doctors and drug
developers worked together to define the ideal
administration paradigm.
• There was no “us” and “them”. Patients were treated just
like any other medical patients, except when they were
treated like doctors.
Later generation ibogaine patients
• Drug users are no longer involved as equal participants in
ibogaine development.
• Drug users and self-help groups, no longer affiliated with
medical academics or drug developers, lost a level of
authority and control.
• Ibogaine patients are not dependent on clinic
administered drugs. Ibogaine providers generally leave the
field rather than control or abuse patients. This could
change in the future.
Later Generation Methadone Patients
What’s wrong with methadone today?
• Nothing is wrong with methadone.
• Almost something is wrong with many clinics that
administer and provide it to patients.
• Medical decisions are often not made by medical doctors.
• Many clinics practice control of patients rather than
providing them with ethical medical care.
Buprenorphine patients
• Buprenorphine patients never shared an important
role in the development of the drug.
• The manufacturer and the US government appear to
desire that stigma associated with chemical dependence
not be attached to buprenorphine.
• Whether this early generation or later generations of
buphrenorphine patients are well treated by the medical
community and society will have to be seen.
Two important issues in
chemical dependence
treatment
• Stigma
• Discrimination
Stigma
Focuses attention on the
victim
Discrimination:
Focuses attention on
those who produce
rejection and exclusion
The ibogaine advantage
Ibogaine removes the
stigmatized condition.
Why ibogaine is not available?
1. Industry deems ibogaine not to be
profitable.
2. Government, industry and academia
chose to place their interest in the
development of opiate drugs with
which they are familiar.
3. Ibogaine represents a new scientific
paradigm to the understanding of
addiction.
Ibogaine availability proximate
to United States
1. St Kitts West Indies
2. Vancouver, BC, Canada
3. Rosarito, Baja, Mexico
Ibogaine availability
Ibogaine resources
The Ibogaine Dossier
An internet library
http://www.ibogaine.org
http://www.ibogaine.desk.nl
Manual for Ibogaine
Therapy
Second Revision
Release date
Friday, May 9, 2003
http://www.ibogaine.org/manual.html