Transcript Ibogaine and methamphetamine

Ibogaine and
methamphetamine
A review of the available literature
and treatment experiences
by
Jonathan Freedlander, MA Cand
Towson University
Methamphetamine
epidemiology
• 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
• dopaminergic agonist
• attenuate dopamine transporter (DAT) clearance
efficiency, thereby increasing synaptic dopamine
(DA) levels
• activates classical reward circuitry
Methods of administration
• METH can be insufflated (snorted), injected,
smoked (“ice”), taken orally (uncommon)
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
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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
• 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
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
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
methamphetamine
Three treatment providers’
experiences
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
• 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
• 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
• 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
• 70 – 80 % success with effective aftercare
• New environment very important postibogaine
– 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 postibogaine
– 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
• Limited experience treating METH
problems
• About 50% success rate
• Sees quicker recovery in those who eat
nutriously
– phenylalanine
– melatonin
– soya proteins
• 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
• 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
• 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
• 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
For references, questions,
or general harrassment,
email:
[email protected]