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IBOGAINE IN THE TREATMENT OF CHEMICAL DEPENDENCE DISORDERS:
CLINICAL PERSPECTIVES
(A Preliminary Review)
H.S. LOTSOF
© 1994
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Dedicated to the work of J. Bastiaans and N. Adriaans
in memory of N. Kribus
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PART I
The primary purpose of this paper is to provide general
information to the
clinician who will be using the Lotsof Proceduresm (Goutarel,
1993)
developed by NDA International, Inc. in which Ibogaine
is administered to
treat chemical dependence disorders. This is a preliminary
report. The
patient base upon which my conclusions have been made
totals thirty-five
treatment episodes. All clinical observations conducted
after 1963 have been
made on patients treated outside of the United States.
Ibogaine is not a substitute for narcotics or stimulants,
is not addicting
and is given in a single administration modality (SAM).
It is a chemical
dependence interrupter. Retreatment may occasionally
be needed until the
person being treated with Ibo gaine is able to extinguish
certain
conditioned responses related to drugs they abuse. Early
data suggests that
a period of approximately two years of intermittent
treatments may be
required to attain the goal of long-term abstinence
from narcotics and
stimulants for many patients. The majority of patients
treated with Ibogaine
remain free from chemical dependence for a period of
three to six months
after a single dose. Approximately ten percent of patients
treated with
Ibogaine remain free of che mical dependence for two
or more years from a
single treatment and an equal percentage return to drug
use within two weeks
after treatment. Multiple administrations of Ibogaine
over a period of time
are generally more effective in extending periods of
abstinence. It is
noteworthy that twenty-nine of the thirty-five patients
successfully treated
with Ibogaine had numerous unsuccessful experiences
with other treatment
modalities.
A BRIEF HISTORY
Ibogaine, a naturally occurring alkaloid found in Tabernanthe
iboga and
other plant species of Central West Africa, was first
reported to be
effective in interrupting opiate narcotic dependence
disorders in U.S.
patent 4,499,096 (Lotsof, 1985); coc aine dependence
disorders in U.S.
patent 4.587,243 (Lotsof, 1986) and poly-drug dependence
disorders in U.S.
patent 5,152,994 (Lotsof, 1992). The initial studies
demonstrating
Ibogaine1s effects on cocaine and heroin dependence
were accomplished in a
series of focus group experiments by H. S. Lotsof in
1962 and 1963.
Additional data on the clinical aspects of Ibogaine
in the treatment of
chemical dependence were reported by Kaplan (1993),
Sisko (1993),
Sanchez-Ramos & Mash (1994), and Sheppard (1994).
Prior to Ibogaine1s evaluation for the interruption
of various chemical
dependencies, the use of Ibogaine was reported in psychotherapy
by Naranjo
(1969, 1973) and at the First International Ibogaine
Conference held in
Paris (Zeff, 1987). The use of Ibogaine-containing plants
has been reported
for centuries in West Africa in both religious practice
and in traditional
medicine (Fernandez, 1982; Gollnhofer & Sillans
1983, 1985) An overview of
the history of Ibogaine research and use was pu blished
by Goutarel et al.
(1993).
Claims of efficacy in treating dependencies to opiates,
cocaine, and alcohol
in human subjects were supported in preclinical studies
by researchers in
the United States, the Netherlands and Canada. Dzoljic
et al. (1988) were
the first researchers to p ublish Ibogaine1s ability
to attenuate narcotic
withdrawal. Stanley D. Glick et al. (1992) at Albany
Medical College
published original research and a review of the field
concerning the
attenuation of narcotic withdrawal. Maisonneuve et al.
(1991) determined the
pharmacological interactions between Ibogaine and morphine,
and Glick et al.
(1992) reported Ibogaine1s ability to reduce or interrupt
morphine
self-administration in the rat. Woods et al. (1990)
found that Ibogaine did
not act as an opiate, and Aceto et al. (1991) established
that Ibogaine did
not precipitate withdrawal signs or cause dependence.
Cappendijk and Dzoljic (1993) published Ibogaine1s effect
in reducing
cocaine self-administration in the rat. Broderick et
al. (1992) first
published Ibogaine1s ability to reverse cocaine-induced
dopamine increases
and later, on Ibogaine1s reduction of cocaine-induced
motor activity and
other effects (1994). Broderick et al.1s research supported
the findings of
Sershen et al. (1992), that Ibogaine reduced cocaine-induced
motor
stimulation in the mouse. Sershen (1993) also demon
strated that Ibogaine
reduced the consumption of cocaine in mice. Glick (1992)
and Cappendijk
(1993) discovered in the animal model that multiple
administrations of
Ibogaine over time were more effective than a single
dose in interrupting or
attenua ting the self-administration of morphine and
cocaine, supporting
Lotsof1s findings in human subjects (1985).
Popik et al. (1994) determined Ibogaine to be a competitive
inhibitor of
MK-801 binding to the NMDA receptor complex. MK-801
has been shown to
attenuate tolerance to opiates (Trujillo & Akil
1991) and alcohol (Khanna et
al. 1993). MK-801 has also s hown a blockade of 3reverse
tolerance2 of
stimulants (Karler et al. 1989). Ibogaine1s effects
on dopamine, a substance
hypothesized to be responsible for reinforcing pleasurable
effects of drugs
of abuse, and the dopamine system were foun d by Maisonneuve
et al. (1991),
Broderick et al. (1992) and Sershen et al. (1992). Ibogaine
binding to the
kappa opiate receptor was reported by Deecher et al.
(1992). Thus we begin
to see a broad spectrum of mechanisms by which Ibogaine
may moderate us e of
substances so diverse as opiate narcotics, stimulants
and alcohol.
CLINICAL PRACTICE
The effects of Ibogaine treatment are viewed in three
categories: acute,
intermediate and long-term. The acute and intermediate
effects have
sometimes been referred to as the effects and aftereffects.
The two major
effects of Ibogaine are A) the abil ity to interrupt
narcotic and stimulant
withdrawal and B) the attenuation or elimination of
the craving to continue
to seek and use opiates, stimulants and alcohol (Lotsof
1985, 1986, 1989).
Knowledge concerning the use of Ibogaine in treating
alcohol de pendence is
limited to: 1) a single alcohol-only dependent patient
and 2) the
attenuation and, in some cases, cessation of alcohol
use in persons treated
for poly-drug dependence disorders. Ibogaine1s ability
to treat nicotine
dependence (Lotsof, 1991) has been seen in poly-drug
dependent subjects
treated primarily for opiate and/or cocaine use .
First, there are some general considerations. The primary
obligations of the
treatment team are four-fold: 1) to earn the trust of
the patient, 2) to
maintain the comfort of the patient, 3) to assist the
patients in
interrupting their chemical depen dence and 4) to supply
the psychosocial
support network needed by the majority of patients to
enable them to develop
a sense of personal accomplishment and the ability to
function as productive
members of society. This is a process the Dutch treatment
com munity refers
to as normalization.
In the Lotsof Proceduresm, for which a manual is now
being prepared, the
sense of conflict seen in most treatment modalities
between the doctor and
patient over the immediate ceasing of drug use does
not exist. The patients
have been allowed, if narcoti c-dependent, to continue
their use of
narcotics until a certain time prior to treatment with
Ibogaine. There is no
conflict over opiate use before treatment as our position
has been that
Ibogaine will either work to interrupt chemical dependence
or i t will not.
Patients dependent on stimulants are not maintained
on stimulants and this
has not created a problem for the patients or the medical
staff.
Prior to our conducting Ibogaine treatments in hospitals,
addicted patients
were allowed to use their personal supply of narcotics
until the evening
before treatment. However, during hospital-administered
Ibogaine sessions,
the narcotic-dependent patient is maintained on medications
prescribed by
the principal investigator during the three to five
day intake process
preceding their treatment with Ibogaine. Even under
these circumstances,
patient distrust of the medical establishment and their
extreme fear of
going into withdrawal has resulted in the smuggling
of narcotics into
hospital environments. In order to protect the patient
from possible
overdose due to narcotics, stimulants or other drugs,
a thorough physical
examination is performed on all patients upon their
admission to hospital
environments. The examination and a search of the patients1
possessions
prior to treatment with Ibogaine serve two important
functions. The first,
is to limit the possibility of accidental overdose from
secreted drugs. The
second, is to provide a complete understanding of the
patient1s physical
health, since many of the people seeking treatment for
chemical dependence
have masked various and often numerous medical problems
for years or even
decade s by self-medicating with illicit drugs.
ACUTE EFFECTS
REGIMEN
The acute effects of Ibogaine are dramatic. The initial
reaction is usually
noted within forty-five minutes after the oral dose
and full effects are
generally evident within two to two and a half hours.
The earliest
subjective indication by patient s of Ibogaine1s effects
is the report of a
pervasive oscillating sound. The patient tends to lie
down and, if asked to
stand or walk, shows signs of ataxia.
The protocol for the Lotsof Proceduresm stipulates that
the patient remain
in bed with as little movement as possible from the
time of Ibogaine
administration, as nausea associated with Ibogaine use
has proven to be
motion-related or, in later stages (th ose longer than
four hours after
administration), possibly to be a psychosomatic reaction
to previously
repressed traumatic experiences. In addition to keeping
the patient as still
as possible, we use a non-phenothiazine anti-nauseant,
as phenothiazines may
interfere with the psychoactive properties of Ibogaine.
If the patient
vomits in less than two and a half hours after the administration
of
Ibogaine, an examination of the regurgitated material
should be made to
determine how much Ibogaine may hav e already been absorbed
by the patient.
A rectal infusion of Ibogaine to supplement the lost
portion of the dose may
be provided if it is not possible for this dose to be
administered orally.
The rectal administration should occur only if the patient
ha s previously
consented to this mode of dosing.
VISUALIZATION
One of Ibogaine's principal effects during its first
phase of action is to
produce a state which emulates dreaming, aside from
the fact that the
subject is fully awake and has the ability to respond
to the treatment
staff1s questions. In most case s, people under the
influence of a
therapeutic dose of Ibogaine do not wish to speak. They
prefer instead to
pay close attention to the visual presentation of memories
or phenomena they
are experiencing, that have been noted to have both
Freudian and Ju ngian
connotations.
The experiencing of visual material is rapid. Some patients
have described
it as a movie run at high speed; others as a slide show,
each slide
containing a motion picture of a specific event or circumstance
in the
viewer1s life. In either case , the presentation of
visual material is so
compressed and fast moving that distracting the patient
for even a moment
may interfere with the process of abreaction. Therefore,
in treatment, the
intrusion of the medical staff should be kept to a minimum
d uring
Ibogaine's primary phase.
AUTONOMIC RESPONSES
During the first through the fifth hour there is a moderate
rise in blood
pressure of ten to fifteen percent and, in some cases,
an associated decline
in the pulse rate. The most significant autonomic changes
occur between one
and a half and two and a half hours after administration
of therapeutic
doses of Ibogaine. In many cases the patients1 pulse
rates are elevated due
to anxiety prior to the administration of Ibogaine.
On two occasions, persons with transient hypertension
were treated. In one
of those instances the patient1s blood pressure dropped
to normal levels
during the primary and secondary stages of treatment.
The second
hypertensive exhibited little chan ge at a 23mg/kg therapeutic
dose, but
showed significant changes on two occasions when provided
with only a
1.6mg/kg test dose. The two 1.6mg/kg doses were supplied
due to our concern
over the patient1s hypertension. He had been previously
treate d with an
18mg/kg dose by Dutch Addict Self-Help (DASH) with no
apparent negative
results. This alleviated somewhat our concern for the
patient1s safety.
Variation in individual patient reactions should be
anticipated.
FEMALE PATIENT SAFETY
One 24-year-old female patient treated with Ibogaine
for chemical dependence
died from undiagnosed causes in the Netherlands. Although
her autopsy did
not determine the cause of death, it reported Ibogaine
levels of
0.75mg/liter in blood. This level ha s not been seen
to be toxic in animal
research or in our prior human studies. Subsequent to
this death and to a
previously reported death of a Swiss woman who received
Ibogaine during a
psychotherapy session in Europe, totally unrelated to
NDA1s re search
program, the FDA excluded women from the present clinical
trials taking
place at the University of Miami. However, the FDA decision
is contrary to
the gender guidelines of the National Institutes of
Health. The guidelines
with regard to women call for the inclusion of women
at the earliest stages
of clinical trials, as this would provide the greatest
determination of
safety for women. Thirty percent of NDA International1s
patients have been
women who have shown no negative effects from taking
Ibogaine either during
or after treatment. However, considering all of the
circumstances, the
Procedure should be administered only in a hospital
or clinic with the
patient under continuous staff observation and electronic
monitoring.
An ongoing international research program is developing
evidence to
determine a hypothesis for the cause of death of the
woman in the
Netherlands. We are additionally seeking Swiss government
cooperation
concerning the death of the Swiss woman. The resul
IBOGAINE IN THE TREATMENT OF CHEMICAL DEPENDENCE DISORDERS:
CLINICAL PERSPECTIVES
PART II
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COGNITIVE EVALUATION
The second phase of Ibogaine's action during the Lotsof
Proceduresm is one
of the patients' intellectual evaluation of their previous
experiences and
decisions. This occurs after the visualization phase,
which generally ends
abruptly in three to five ho urs. However, individual
reactions and
variations are the norm and not the exception within
the parameters of the
Procedure.
Regarding this process of evaluation by the patient,
in many cases, when
various decisions were made by the patient in the past,
those decisions
appeared to be the only options available at the time.
However, due to
Ibogaine's ability to allow the reev aluation of one1s
life, actions and
behavior , it is possible for the patient to understand
that alternatives to
their original decisions were available, and this knowledge
appears to allow
the patient to modify their current behavior and cease
thei r drug
dependence.
BEHAVIORAL IMMOBILITY
During the periods of visualization, and extending into
the stage of
cognitive evaluation, patients will demonstrate a state
of behavioral
immobility (Depoortere, 1987) during which brain wave
patterns associated
with dreaming and sleep, but distinct fro m those states,
are represented by
rhythmic slow activity of 4-6 Hz. These EEG patterns
are associated with a
state characterized by a lack of movement. Some early
observers of the
Lotsof Proceduresm (Kaplan, 1990) initially believed
that the condition
represented paralysis, but when patients were asked
to stand and move
around, the patients were able to do so, albeit with
difficulty.
ATTENUATION OF NARCOTIC WITHDRAWAL
One of the major acute effects experienced with Ibogaine
treatment is the
attenuation or elimination of narcotic withdrawal in
opiate-dependent
patients. This is extremely important to the narcotic-dependent
patients who
live in fear of going into withdr awal.
The treatment team1s experience in the field is of the
utmost importance in
dealing with this aspect of the Procedure as withdrawal
symptoms are a
combination of physical and, in many cases, psychosomatic
manifestations
that are anxiety-driven. The refore, it is imperative
for the medical and
paramedical staff to have experience in identifying
and distinguishing
between these varieties of symptoms. Provided below
are examples of
psychosomatic withdrawal manifestations demonstrated
by two of the pa tients
treated outside the United States.
Example One
On one occasion I was called into the room by a colleague
about twenty hours
after Ibogaine had been administered to a twenty-five
year old male
heroin-dependent patient. The patient had been using
approximately 1/4 gram
of heroin a day, but soon increa sed his daily intake
to two grams while in
the Netherlands.
I was informed that the patient was complaining of muscle
spasms; I asked
the patient if this was true, and he concurred. I asked
if I might see these
spasms and the patient agreed, showing me the calf of
his leg. The patient
was exhibiting what app eared to be involuntary movements.
I checked his
pupils and observed that they were not dilated, nor
was he exhibiting any
other form or manifestation of withdrawal. When I turned
to my colleague for
discussion I noticed the patient1s spasms had ce ased.
When I turned to the
patient and once again examined his calf, the spasms
returned. I turned away
once again, but continued to watch him and the spasms
ceased again. I
informed the patient that I believed the spasms to be
psychosomatic in orig
in. I placed a pillow under the patient1s calf to give
it support and
covered the patient with a blanket. The spasms did not
occur again.
Example Two
On another occasion I received a call from a person"involved
with Dutch
Addict Self-Help (DASH) groups who had been observing
a number of
treatments. She informed me that a Yugoslavian woman
in her mid to late
twenties had been complaining of na rcotic withdrawal
during Ibogaine
treatment, but the DASH observer did not believe this
to be the case as
there were no observable signs of withdrawal..
When I arrived, the patient was sitting on a couch.
I checked her pupils and
observed they were not dilated and asked her if she
were in withdrawal. The
patient said she was.
'How are you in withdrawal? What are its manifestations?'
I asked.
'I1m sick,' she said.
I asked her if her eyes were tearing.
'Yes,' she said, but her eyes were not tearing.
'Is your nose running?'
'Yes,' she said, but her nose was dry.
'Do you have goose bumps?' I asked.
'Yes,' she said, but I pointed out to her that she did
not have goose bumps,
and finally I said, 'Do you have diarrhea?'
'Yes,' she said, but I had no way to determine the validity
of her
statement.
The patient requested that I provide her with funds
to return home, and I
told her I did not think it wise for her to leave at
this time, but would
give her carfare in the morning. The following day the
DASH observer
informed me the patient left about four hours after
I did, informing the
observer as she left that she had not been sick, but
had only said she was.
This example should further demonstrate the importance
of hospital
administered treatments with a full medical staff of
psychiatrists, ne
urologists, internists, therapists, nurses, peer counselors
and patient
advocates capable of evaluating and responding to any
aspects of the
patient1s condition at all times.
DELAYED WITHDRAWAL
The complaint of experiencing narcotic withdrawal after
leaving the
treatment environment has been reported in three cases.
We have provided
additional treatments six months to a year after the
initial treatment to
patients who were re-addicted and st ated they had experienced
some form of
withdrawal within a week of their first Ibogaine treatment.
Our working
group decided to keep patients making such complaints
under observation for
periods equal to the number of post treatment days during
which the patients
stated they previously experienced withdrawal symptoms.
Our findings have been that, under the above conditions
of monitoring, the
reported withdrawal signs are usually symptoms of anxiety
or anxiety related
conditions that the patients characterized as withdrawal,
i.e., nausea,
diarrhea or increases in blo od pressure in one hypertensive
patient.
There have been two incidents which did not appear anxiety
related, in which
diarrhea occurred five to seven days after treatment
in patients using one
gram of heroin a day. These episodes were easily controlled
with a single
administration of an ap propriate medication and did
not occur again.
AFTEREFFECTS
INTERRUPTION OF CRAVING
The acute interruption of craving to seek and use drugs
of abuse is unique
to the Lotsof Proceduresm as a treatment modality for
chemical dependence
disorders. This effect is generally not noticed by the
patient until the
principal actions of Ibogai ne (visualization, cognitive
evaluation,
behavioral immobility and significant residual stimulation)
are no longer
evident and the patient has had the opportunity to sleep.
The initial
recognition of lack of craving is usually noticed forty-eight
to sev
enty-two hours after Ibogaine administration. In a minority
of treatments,
recovery and the absence of craving may be evident to
the person being
treated in as little as twenty-four hours. The medical
staff, on the other
hand, usually notes the absence of craving in the patient
in forty-five
minutes to one and a half hours after Ibogaine administration.
Our experience gained in recent years through the treatment
of twenty
persons outside the United States has shown that the
majority of patients
may need a series of treatments before the conditioned
responses (craving)
to a long history of chemical d ependence can be extinguished.
However, for
three of these patients a single treatment interrupted
chemical dependence
for a minimum of two years. The advantage of Ibogaine
is that it begins to
allow patients time periods free of craving during which
th e psychiatrist,
social worker, therapist, paraclinician and the patient
often bond into a
cohesive working group to accomplish a state of long-term
non-dependence by
the patient to the drug(s) of abuse for which the patient
is under
treatment.
PSYCHOSOCIAL SUPPORT
All aspects of treatment for chemical dependence disorders
common to other
treatment modalities are common to the use of Ibogaine.
The patient1s
characteristics in terms of psychopathology, behavior,
societal
accomplishments, as well as the skill s of the treatment
team are
significant to treatment outcomes.
In rare cases, when the patient already has the occupational,
educational
and skills needed to succeed in society, the task may
be somewhat easier. In
cases where the patient does not have those societal
skills, or lacks
medical care for disorders ot her than chemical dependence,
care and
training must be provided through psychosocial support
structures.
Trauma suffered by the patient during childhood appears
to play an important
part in the drive for love and the fear of abandonment
that is common to
many of the patients we have treated (Bastiaans, 1991).
All psychosocial support paradigms should be available
for the patient after
the completion of an Ibogaine treatment. Their use should
be contingent upon
the evaluation of the patient1s needs and progress.
One of the primary differences that social workers,
counselors or therapists
offering psychosocial support notice in post-Ibogaine
treated patients, as
compared to untreated subjects, is the rapidity with
which the support can
and must be provided to ai d the patient in accomplishing
goals and making
decisions. Ibogaine presents a symptom-free window of
opportunity which the
patient and therapist must take advantage of. One patient
put it this way:
3Ibogaine and 12-Step (groups) both help you to get
in touch with your soul.
Ibogaine is like rocket fuel for that process (Village
Beat, 1990).2 It is
imperative that ground control remain in contact with
the patient, and this
means moving quickly and dramatically to assist the
patient to est ablish
goals while the patient has the ability and desire to
do so.
Ibogaine generally expedites the placement of the patient
in receptive
psychological state. This produces a relationship between
the patient and
the therapist which is mutually rewarding and beneficial,
but requires the
person providing psychosocia l support to work both
harder and faster than
is the norm for other treatment modalities. Prior to
the use of Ibogaine in
the treatment of chemical dependence, it may have taken
the therapist three
to twenty-four months (Judd, 1993) using traditional
met hods to assist the
patient in reaching a state of well-being free of drug
craving (Kaplan et
al., 1993). This advantage that Ibogaine treatment provides
enables the
psychosocial support staff to assist the patient in
making decisions to
allow their norm alization and integration into society
as self-fulfilled
and productive human beings.
Many of the accepted parameters of distance between
the therapist and the
patient are not effective in Ibogaine treatment. Patients
will require
closer and more intensive guidance, and generally be
more open to it. They
will require faster intervent ion to learn societal
skills and to overcome
and objectively understand various traumas experienced
during their lives.
Therefore, Ibogaine is not a treatment modality for
clinicians whose
preference is to simply administer a pill or tablet
and then dis tance
themselves from their patients.
REDUCTION OF THE NEED FOR SLEEP
In all cases, Ibogaine temporally reduces the patient1s
need for sleep to as
few as three or four hours a night. This effect may
last a month or more,
gradually returning to normal. Two theories have been
put forth concerning
this effect. One theory suggests the long-lasting bioavailability
of
Ibogaine or one of its metabolites. This is in keeping
with the
pharmacokinetic studies conducted at the University
of Miami (Mash, 1995).
The second theory suggests the cause is the decrease
in the p sychological
requirements for sleep associated with the necessity
to dream. Evidence
supporting this theory is that Ibogaine promotes an
intense emulation of
dreaming that lasts for many hours during its acute
stage of activity.
The reduction in the need for sleep is viewed by the
majority of patients as
a discomfort, since they have used drugs and sleep as
an escape mechanism.
These patients may require some mild form of sedation
during the first days
after treatment with Ibo gaine. Normal precautions should
be taken in
providing sedatives to persons with a history of chemical
dependence. In a
minority of cases, patients have used this newly available
time to advantage
in their busy work schedules.
LONG-TERM EFFECTS
Long-term are those which may be noticed from one to
twenty-four months
after treatment, and in some cases even longer. I have
provided three
examples.
Example One
A heroin-dependent couple was treated. The woman of
26 was a relatively new
addict of three months while her 27-year-old husband
had a history of over
ten years of heroin use. At the time of their treatment
a protocol of
treating one patient at a time was followed. These were
early treatments and
the medical and medical support staff were familiarizing
themselves with
what might be expected during such episodes.
Portions of the treatment episodes were observed by
Dr. Carlo Contoreggi,
Deputy Medical Director of the Addiction Research Center
of the National
Institute on Drug Abuse in Baltimore and Dr. Lester
Grinspoon of the Harvard
School of Medicine.
The husband was treated first, and his wife was completely
cooperative and
helpful during his treatment. The following day, when
the wife was
administered her dose of Ibogaine, her husband demanded
that he be allowed
to leave his room and remain in bed w ith her. He informed
the medical and
paramedical staff present that unless he got his way
he would create a
disturbance to interfere with his wife1s treatment.
Rather than deal with a
belligerent and angry patient, we decided it would be
less harmfu l to let
him have his way. He continuously disturbed his wife
during her treatment.
This resulted in a policy of treating couples simultaneously
in separate
rooms.
He recovered before his wife, as she had been administered
Ibogaine
twenty-four hours after his treatment. He complained
that he was getting
bedsore and was no longer able to stay in bed and asked
for permission to go
for a bicycle ride. Upon his lea ving, his wife broke
down and cried in the
arms of a female paraclinician, stating she did not
know if she could remain
with her husband, but she was afraid he would die if
she left him. This was
a concept he continuously stressed to her during their
tr eatment.
After treatment, he followed a pattern of controlling
his wife1s contacts
with other persons including the treatment team, which
was denied access to
either of them. We later learned that they both returned
to heroin use.
However, three months la ter the wife determined that
her husband was
incapable of loving himself or her and this was not
the life she wished. She
stopped using heroin, enrolled in nursing school, filed
divorce proceedings
against her husband, and is now specializing in psychiat
ric nursing.
While initially she did not recognize that her decision
to stop heroin use
was due to her Ibogaine treatment, as the months went
by she realized that
her determination to change her life was catalyzed by
her experience with
Ibogaine.
Example Two
A cocaine/cocaine-base dependent patient was treated
with the Lotsof
Procedure and experienced an acute interruption of his
drug use. During his
Ibogaine treatment he had a strong impression that if
he continued drug use
God would punish him. He remai ned drug-free for about
thirty days, after
which he increased his drug use over the next months
and was retreated. The
dose he received proved to be inadequate due to his
vomiting of the oral
dose and to a bowel movement immediately after the rectal
ad ministration of
Ibogaine, which he requested to remedy the loss of his
oral dose. His drug
use continued, but far below his original pretreatment
levels.
About six months after his retreatment, the first Ibogaine
therapy group
sponsored by the International Coalition for Addict
Self-Help, directed by
psychotherapist Barbara Judd, CSW, was established in
New York. The patient
attended these sessions un til fifteen months after
his
original treatment, when he recognized that he had to
move away from his
drug-infested neighborhood. Thereupon he moved to Florida.
In Florida, he has remained drug-free, even though he
had access to cocaine.
He is employed in the construction industry by a business
with strict
non-drug use guidelines that is owned and run by former
drug users.
Example Three
One of the most important concepts learned by persons
treated with Ibogaine
is that addiction can be reversed. Persons dependent
on drugs such as
opiates or cocaine are not able to recognize that chemical
dependence is a
reversible phenomenon.
This third example is of the only chemically-dependent
person from the
1962-1963 study to receive a series of treatments at
therapeutic levels with
Ibogaine. The individual remained free of addiction
for approximately three
and a half years as a resu lt of his series of treatments.
During that period he moved to California, married,
and worked in
pharmaceutical sales. He later lost his job and, when
offered a ride back to
New York, accepted it and returned to a life of minor
drug dealing and use
that resulted in his arrest and im prisonment.
After his release, he worked for a while as a machinist,
then slowly fell
back into heroin use and addiction in 1969. Luckily,
this was a period when
methadone programs were expanding, and he was able to
enter one of the
better programs run by Beth Isra el Hospital. At that
time, the programs
were well-staffed with doctors, nurses and adequate
counselors, and the
patient reached a point in his life when he recognized
that the life of a
heroin addict was not what he wanted. It was not just
the heroin, b ut the
scene itself, wherein a human life was without value,
where sometimes a
human being would be murdered for two cents worth of
an innocuous powder in
a glassine envelope. The patient was ready to quit heroine,
but was a slave
to the craving to use opiates for the anxiolytic relief
they provided.
Over a period of more than two years, the patient stabilized
himself on
methadone. He tried heroin once, two weeks after starting
methadone, was
satisfied with the level of blockage that methadone
offered, and never used
heroin again.
During the next few years the methadone programs changed.
Many of the
competent counselors were unable to continue in their
positions due to the
stress and sense of frustration in their work, a condition
common in the
treatment community. The Federal g overnment placed
more and more
restrictions on methadone patients1 freedom of movement
and, though
methadone is anticipated to maintain the methadone client
for a period of
twenty-four hours, in many cases it does not. For this
patient withdrawal
sig ns were setting in at eighteen hours and not twenty-four.
The patient
began a slow detoxification process from 100mg of methadone
per day that
took approximately eighteen months.
The final stage of detoxification was followed by the
patient1s entry into
University-level training after he obtained a scholarship
to a prominent
university. At the time of the detoxification, the philosophy
among
methadone patients was that you could not get off methadone,
but having
previously had the Ibogaine experience, the patient
stated that he knew
addiction was reversible, and that knowledge allowed
him to successfully
leave addiction behind.
CURRENT TREATMENTS: A SELF REPORT (personal communication,
1994)
The following report is from the type of patient we
had been seeking for
years: a medical doctor who needed to be treated with
Ibogaine. The subject
was chemically dependent on 600mg of Demerol a day and
had attempted to stop
his drug use a number of t imes without any lasting
success. Our particular
interest in this subject was the hope that, as a medical
doctor, he might
provide us with some professional insight into the results
of his treatment.
He kept notes and provided a report on the four di fferent
doses he
received, which is presented in its entirety. This subject
proved to be more
sensitive to Ibogaine than any other individual in our
studies conducted
outside the United States, and had a full-blown experience
from a 10mg/kg
dose. The pa tient had participated in a research protocol
which called for
an intermediate dose of 10mg/kg of Ibogaine, which was
administered as part
of a pharmacokinetic study and was not expected to have
a therapeutic
effect, but it did. As part of the protocol, patients
would then be
administered a known therapeutic dose of 20mg/kg.
1st day - 100mg (test dose #1)
I1ve taken my Ibogaine dose and went to bed, and stayed
laying down. I felt
nothing, until the medical staff arrived to do the 1
hour tests. I was
surprised because in my mental measurements, I thought
I had taken Ibogaine
about 20 minutes ear lier. When I stood up, I felt a
little drowsiness, and
it was difficult to walk in a straight line. I was feeling
photophobia and
every little noise seemed to be much louder than in
reality. The sounds were
very disturbing to me.
During the two hour testing, symptoms were worse. It
was very difficult to
walk in a straight line, and the room seemed to beat,
like a heart. I felt
very tired, and the only thing I wanted was to rest
in bed. Each head
movement seemed to make things worse.
When I stood up for the 3 hour test I felt that the
symptoms were
disappearing. I was very hungry and ate. After eating,
I was a little
nauseated. For the following hours I felt nothing, except
for sensation that
my mind images were richer in details than before, like
a 3-D movie.
I ate with no nausea, slept very well, and awakened
in very good condition.
2nd day - 25mg (test dose #2)
After this dose of Ibogaine I felt nothing different
from my normal state.
3rd Day - 10mg/kg (experimental dose)
For the first two hours I felt a little different, like
I had smoked
marijuana. I was very calm and relaxed and all the tension
of the beginning
of the procedure was gone. The room seemed to be a little
different and the
colors around me sharper than n ormal. The lights and
sounds were disturbing
to me, like the first time. Suddenly, with my eyes closed
I began to see
images that appeared in screens, exactly like TV or
cinema screens. These
screens were appearing in small sizes and then they
would ge t bigger as I
focused my attention on them. Sometimes they appeared
small and would then
begin to grow, like I was walking in their direction,
and sometimes they
were going from left to right, in a continuous way.
The images on the screens were moving in slow motion
and were very sharp and
well defined. I saw trees moving with the wind, a man
with bells in his
hands, various landscapes with mountains and the sunset.
At this time I was
a little nauseated, and whe n the doctors asked me to
stand up for some
tests, I vomited. From all of the hundreds of images
I saw this day, I
recognized only two: the first, an image of myself as
a child, static like a
photo. This image began to approach me and get bigger,
but s omething in the
room happened and I opened my eyes, losing the image.
The second image I
recognized was one of some horses dancing in a circus.
It was a TV show that
I had seen two days before. The time seemed to go very
quickly, because
after about fo ur hours (in my mind), they told me I
had taken Ibogaine nine
hours earlier! It was very difficult for me to speak
in English or in
Spanish. I was only able to speak in my native language.
At this time the
images started to appear at a slower rate and for another
two hours I saw
only screens with no images on them. About 10-11 hours
after the beginning
of the experiment they disappeared.
I ate very well and stayed awake all night long, falling
asleep only about 7
AM, almost 24 hours after the medication had been administered.
During the
night I had some insights about my life and about the
things I realized I
was doing wrong. I stayed all the following day very
tired, sleepy, but very
happy and relaxed, in a way I never was before.
5th day - 20mg/kg (therapeutic dose)
The first 3 hours were similar to the last time; photophobia
and a bad
sensation with little noises. After that the images
began to appear, in a
slower rate than the other time. There were less images,
but I was
recognizing all of them as part of m y childhood. I
saw myself playing in my
father1s farm, riding a motorcycle, playing with a cousin,
feeding a fish
and other things. I saw some recent images, like one
of my father, laughing
in the living room of my house. This happened about
a ye ar ago. I
understood that I had a happy childhood, and there was
no one to blame for
my addiction, only myself. I felt their love coming
from my parents and
relatives. I was feeling the same time distortion that
I felt the other day,
and after many hou rs I suddenly had an insight. It
was that my mind and the
universe were the same thing, and that all the people
in the universe and
all things in the universe are only one. I saw many
mistakes I was doing in
my life, so many attitudes I could not have, and this
helped me to decide
very strongly that I will never use Demerol again. Now
I can see very
clearly that I don1t need Demerol to live my life. And
I feel better if I
don1t use it. During the first 8 hours after taking
the Ibogaine I v omited
4 or 5 times, always when I tried to move. I was able
to sleep about 4 AM,
and to eat only about 9 AM the following day. I awakened
feeling weak, tired
and drowsy. As the hours were going, I slept a lot and
began to feel better
and in the mornin g of the following day I was normal.
Differences in day-by-day life after the experience.
I returned to my normal life with absolutely no cravings,
with better
appetite than before, and highly self-confident. Now
I can see differences
in some aspects of my personality, things are changed.
For example, I used
to avoid driving at night, becau se it reminded me of
a car accident I had
years ago. Now I can drive anytime, day or night, without
anxiety. I1m sure
that this is caused by Ibogaine, because now I1m not
the same very anxious
person I was. I1m not as shy as I used to be , too.
It1s easier now to
contradict people when I think they are wrong, and to
make them know what I
want and what I think. I used to accept all that other
people said only to
avoid a discussion, even when I was sure that my point
of view was the
correct one.
These are the main happenings in my Ibogaine experience
and the main
differences I can perceive in these few days.
Some Months Later
The most important thing I learned with all that happened
is that I can
never underestimate the power of the addictive personality
I have inside. I
can never say I1m cured because if I do this, I will
forget to protect
myself from drug using though ts. I must know I have
a chronic disease that
will be quiet in its place until I decide to give it
a chance to grow. This
decision, and that1s the point, is a conscious decision.
If I give in,the
disease will be out of control in a few days. But, if
I could be strong to
take real and honest control of my Demerol using thoughts,
I will be free
forever.
A few days ago, because of professional needs, I had
to keep two Demerol
doses with me, in my house, all night long. To protect
myself, I gave them
to my wife. But, it was amazing to see how I was not
anxious to use them
but, to give them to the patien ts that needed them.
I clearly felt that
Demerol was a strange thing in my environment. I wasn1t
curious about the
place my wife had put them, I wasn1t feeling any craving.
I was only looking
forward to the moment I could give them to the pat ient
and say: I1ve done
it. And I did it, because of all of you from NDA.
I don1t want to be boring, but I have no words to say
how grateful we, my
family and I, are. I will remember you for a lifetime.
Needless to say, this patient provided particular advantages
in terms of his
treatment outcome. He had a career, was highly motivated,
and did not
require the significant psychosocial support needed
by so many others who do
not have his background.
IBOGAINE IN THE TREATMENT OF CHEMICAL DEPENDENCE DISORDERS:
CLINICAL PERSPECTIVES
PART III
----------------------------------------------------------------------------
SUMMARY
The follow-up for observations in patients we have been
able to track, a
significant minority, possibly twenty-five percent is
short. In many cases
we have maintained direct contact with the patients
for only two months
after treatment. In a single case, for five years. The
difficulty concerning
patient contact has been one of geographic distances,
both national and
international as our patients have come from diverse
cities and countries.
This factor, as well as the normal problems in tracking
a chemically
dependent population must be taken into consideration
in evaluating the
findings of this paper.
General conclusions based on study observations are
that a single
administration of Ibogaine is an interrupter for chemical
dependence
disorders. A series of treatments given over a period
of time will produce
more significant results and may allow some of the persons
treated to free
themselves completely from dependence to, or the use
of, opiates and
stimulants including cocaine and nicotine for years.
Data on alcohol
dependence treatment in human subjects is minimal.
Ibogaine has the ability to significantly attenuate
opiate withdrawal in all
patients and, in ninety percent of cases treated, to
interrupt an
individual1s craving to continue drug use for periods
of time ranging from
as short as two days to as l ong as two and a half years
from a single
treatment. Concurrently, Ibogaine has demonstrated the
quality of
precipitating the release of repressed memories and
of fostering a process
of abreaction that I believe to be an important aspect
of Ibogaine's ab
ility to interrupt chemical dependence.
In order to obtain the greatest benefit for those treated
with Ibogaine, a
psychosocial support structure should be in place. Providers
of the
Procedure should be knowledgeable in the field of chemical
dependence
treatment, and patients should shown ki ndness and respect.
In many cases,
such an approach will be the first attentions of this
kind the patient may
have experienced in decades.
Patients are deserving of kindness and respect, and
such care is an
important part of the healing process. Ultimately, physicians
and support
staff should be specifically trained in the Lotsof Proceduresm
to fully
understand the physical and psychologi cal transformation
of the patient,
the advantages of the Procedure, and the providers1
responsibilities in
administering Ibogaine to treat chemical dependence
disorders. Eventually,
the understanding of Ibogaine1s actions may yield important
data on memory,
learning, dreams and sleep, as well as chemical dependence,
tolerance and
abuse.
----------------------------------------------------------------------------
ACKNOWLEDGEMENTS
The author acknowledges the editorial assistance of
Norma E. Alexander; Rick
Doblin; William J. Gladstone; David Goldstein; Barbara
E. Judd, CSW; Daniel
Luciano, MD; Piotr Popik, MD; Bruce H. Sakow; Bob Sisko;
Sylvia Thyssen;
Boaz Wachtel and Rommell Washington.
The author thanks N. Adriaans; N. Alexander; Z. Amit,
Ph.D; J. Bastiaans,
MD; P.A. Broderick, PhD; C. Contoreggi, MD; M.R. Dzoljic,
MD; E. Della Sera,
MD; G. Frenken; W.J. Gladstone; S.D. Glick, MD; O. Gollnho
fer, PhD; R.
Goutarel, MD (deceased); C. Grudzinskas, PhD; B.E. Judd,
CSW; J.S. Kahan,
Esq; C.D. Kaplan, PhD; D. Luciano, MD; D.C. Mash, PhD;
G.J. Prud1homme, Esq;
L. Rolla, PhD; B.H. Sakow; J. Sanchez-Ra mos, MD; B.
Sisko; H. Sershen, PhD;
Frank Vocci, PhD, B. Wachtel; R. Washington; Curtis
Wright, MD for their
science and cooperation, and all of the volunteer patients
for their
courage.
----------------------------------------------------------------------------
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----------------------------------------------------------------------------
Correspondence: Howard S. Lotsof, NDA International,
Inc.,
PO Box 100506, Staten Island,
NY 10310-0506, USA.
email: ebok@eworld.com
----------------------------------------------------------------------------
Published
Bull. MAPS (V)3:16-27, 1995
|
