Transcript A Historical Comparison of Patient Status and Advocacy Issues.

Methadone and Ibogaine
A Historical Comparison of
Patient Status and
Advocacy Issues
Howard S. Lotsof
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: 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
Ibogaine molecule
Tabernanthe iboga shrub
Roots 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
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.
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.
Two important issues in
methadone today
• Stigma
• Discrimination
Stigma
Focuses attention on the
victim
Discrimination:
Focuses attention on
those who produce
rejection and exclusion
Attention patients, counselors
or methadone providers
If you are a methadone counselor or provider,
please think for a moment and write on a
piece of paper the words that come to mind
when you think of methadone patients.
If you are a methadone patient, please think for
a moment and write on a piece of paper the
words that come to mind when you think of
methadone counselors, administrators or
providers.
Methadone 1.3 Internet
program. Runs only on PCs
will not run on a mac.
Whether you are a patient, counselor
or methadone provider, now write
the words that come to mind when
you view the methadone internet
program.
Workshop Manual
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Lotsof/Dole letters
Early Dole methadone paper
History of Methadone
Methadone patient reports
Methadone physician reports
Methadone research bibliography
Review of Stigma and Discrimination
Ibogaine patient experience
History of ibogaine
Ibogaine pharmacology