Transcript Exploratory Outcome Study of Ibogaine Therapy in Subjects with

Exploratory Outcome Study of
Ibogaine-Assisted Therapy in 20
Chemically-Dependent Persons
Valerie Mojeiko
Multidisciplinary Association for
Psychedelic Studies (MAPS)
www.maps.org
Tabernanthe Iboga
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Howard Lotsof
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Subjective Effects
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Psychedelic that produces a dreamlike state
Review of memories
Experience lasts several days
Many find it unpleasant, not a recreational drug
Some experience psychological material related to
addiction
• Greatly reduces physical and psychological
withdrawal symptoms from heroin, methadone, other
drugs
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Neurotransmitter Activities
• Novel mechanism of action
• Complex interactions between multiple
neurotransmitter systems
• Mu-opiod agonist; NMDA antagonist; kappa opioid
agonist; serotonin 5ht2a agonist; serotonin uptake
inhibitor; 5ht3 agonist; dopamine uptake inhibitor;
sigma opioid receptor agonist…
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Where do addicts take
ibogaine?
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Hotel Rooms
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At Home
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Iboga Therapy House, Canada
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Ibogaine Treatment Options
Tribal
Bwiti
Underground
Hotel Rooms
Medical/Therapeutic
At Home
Bwiti-Inspired
Clinics
Iboga Therapy House
Govt is supportive
Harm Reduction Model
Others
No regulations on ibogaine in Canada
Applied for grant
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Existing treatment facilities providing detoxification--not
collecting information…
• How well does it work? How safe is it?
• What percentage of people benefit and
to what degree?
• How can these treatments be
improved?
• Should formal studies be conducted?
MAPS’ Role: Evaluating program, providing feedback, and
collecting data for research
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Preliminary Data: June 2004: Iboga Therapy
House: 2wks-1yr after tx (avg. 6 months)
• 20 subjects
• 6 of 7 treated for
Cocaine/Crack
abstinent (86%)
• 3 of 8 treated for
opiates abstinent
(38%)
• 4/5 treated for other
substances
abstinent (80%)
6
5
4
3
Abstinent
Using
2
1
0
COC Opiate Alcohol Pot
Meth Comb.
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Exploratory Outcome Study
• Seeking to obtain basic preliminary data
• Not a controlled study, but is representative
since including 20 Subjects treated
consecutively
• One-year series of questionnaires and
interviews from 20 subjects verified by
interview with significant others
• Harm reduction model: looking at abstinence
as well as non-abstinence outcomes, trying to
differentiate between abuse and controlled
use
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ASI-Addiction Severity Index
• Semi-structured 1 hour interview
• Scores on 7 subscales: medical status,
employment and support, drug use,
alcohol use, legal status, family/social
status, and psychiatric status
• Been used extensively on a wide variety
of outcome studies
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Peak Experience Profile (PEP)
• Measures the psychedelic
experience
• 180 items; one composite
score; 16 subscores
• Scores for peaks (highs) and
nadirs (lows)
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Measures
• Addiction Severity Index (primary
variable)
• Peak Experience Profile
• Beck Depression and Anxiety
Inventories
• Subjective and Objective Opiate
Withdrawal Scales (SOWS/OOWS)
• Pain and Craving Scales
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Process
• All interviews are conducted by
evaluation coordinator
• Baseline in person; follow-up by phone
• Each interview takes about an hour or
two
• Valerie organizes and analyzes data
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Schedule for Outcome Measures
ASI
BDI/BAI
PEP
O/SOWS
Pain/Cra
SO
check
i P W1
2
X
X
X
X X
X
X X X
X X X X
X X X X
2 3 4 5 6 7 8 9 1
0
X X X X X X X X X
X X X X X X X X X
1
1
X
X
1
2
X
X
X X X X X X X X X X X
X X X X X X X X X X X
i=Intake; P=Post-treatment; W2=Week 2; 1-12=Months 1-12
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Challenges
• No drug testing
• Difficulty of remaining in contact during
follow-up
• Check-in with significant other
addresses these concerns
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Progress
• End of protocol design and training phase
• Began study at Ibogaine Association; ended
prematurely
• Assisting Iboga Therapy House in obtaining
grant from Health Canada
• Partial funding obtained from private donors
for study, Iboga Therapy House seeking
additional funding for operating costs
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Goals
• Obtain basic information about outcomes in
underground clinics
• Provide feedback to improve services; help
win funding from Canadian government;
increase safety
• Ideally lead to placebo-controlled double-blind
studies
• Ibogaine available to drug addicts in a safe,
supportive, and humane setting
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