Ibogaine – an anti addiction medication originating from activists’ efforts

Boaz Wachtel & Howard Lotsof
     

Indigenous use in Africa Historical outline Activist’s tactics Current uses Science Some thoughts on UN drug conventions and prohibition

Map of indigenous use of Iboga in Africa

Ibogaine Root cutting & temple

T. Iboga is Valued for its roots

Tabernanthe iboga fruit

Root-bark images: Freshly cut roots

Iboga alkaloids are concentrated in the bark of the root

Usable forms include scraped or ground root bark

Bwiti Initiates Bwiti Missoko-gonde initiation

Photo – Dan Liberman

In all the visions collected, five different reasons given for eating eboga. In order of frequency the reasons given were:  because of the urging of a dead relative in a dream  because of attacks by witches, causing impotence, sterility, pain, and sleeplessness;  because of discontent with the missionary religions;  because of a desire to know Zame (last of the creator gods);  because of a general malaise and sickliness

Howard Lotsof – Credited for finding the Ibogaine application to treat drug addiction

Chasing the dragon” to no-“ ...where

.Photo: B.W

Heroin overdose of a young women, New York City 1992

.Photo: B.W

Americans' Views of the Seriousness of Health Problems ((Top Ten of Thirty-Six Problems Source: Harvard School of Public Health et al., 20004

Sources: Rice, 19991; ONDCP, 20012; Harwood, 20003

Substance Abuse Costs Our Nation More than $484 Billion per Year

Brief Historical Time Line
 

1864-A first description of T. Iboga is published 1885- A published description of the ceremonial use of the T. Iboga in Gabon appears. 1901- I. Is isolated and crystallized from T. Iboga root bark 1939-1970 I. is sold in France as Lambarene ,”a neuromuscular stimulant” for fatigue, depression and recovery from infectious disease

Brief Historical Time Line

•1962-1963 In the USA Howard Lotsof administered Ibogaine to 19 individuals at dosages of 6 to 19 mg/kg including 7 with Opioid dependency who noted an apparent effect on acute withdrawal symptoms •1969-Claudio Naranjo ,a psychiatrist, received a French patent for the psychotherapeutic use of Ibogaine at a dosage of 4 to 5 mg/kg •1967-1970 The WHA classifies Ibogaine With hallucinogens and stimulants .The FDA: assigns Ibogaine Schedule I classification

Brief Historical Time Line
 

    

1985- Howard Lotsof received a US patent for use of Ibogaine to treat Opioid withdrawal (additional patents for indications of dependency on cocaine, alcohol, nicotine and poly-substance abuse) 1988-1994-US and Dutch researchers published initial findings in animals: diminished Opioid self administration and withdrawal + diminished cocaine self administration 1991-NIDA :Ibogaine Project. (pre-clinical toxicological evaluation and development of a human protocol) 1993-Dr Deborah Mash got approval for human trials. The dosage:1,2,5 mg/kg. Activity is eventually abandoned NIDA ends its Ibogaine project: opinions of the industry mostly critical 1997 begins the Ibogaine Mailing List 1990-2001 I. Becomes increasingly available in alternative settings in view of the lack of approval in the USA and Europe. (Panama- St. Kitts) 2001 – present: Ibogaine use spreads around the world – 30 to 40 clinics or non medical operations administer Ibogaine for addition treatment and psychological transformation

Ibogaine Data Generation Evolution
Lotsof antiaddiction discovery Early60’s Underground treatments -1988-present

.1 African use & knowledge Hundreds ofyears Data from Clinical trials– yet to arrive Semi clinical settings (with doctors( -1993 present

Scientific pre-clinical addiction related (animals( -1980’s present

Purified Chemical
Proposed as an approved regulated drug

Total Alkaloid extract

Courtesy Sara Glatt

Ibogaine Activist Organizations

International Coalition for Addict Self-Help (ICASH( Dutch Addict Self-Help (DASH( Cures-Not Wars (ibogaine and other
issues(

 

Ibogaine Underground

Example of Activists’ tactics to draw government and media attention to promote Ibogaine research

Treatment provider’s sleeping quarters at an apartment in Rotterdam where many treatments took place

Always seek local support - like here from the squatters community NL.

“typical” hang out in Amsterdam

The Ibogaine medicalization movement is part of the progressive harm reduction and addict’s human rights movement (New York, ( 1992 demonstrating against mandatory minimum sentences

Typical closed circuit monitors used during Ibogaine treatments

The late professor of Psychiatry Yan Baastians – the first doctor to observe and conduct Ibogaine treatments with Howard Lotsof ((Lieden, Holland 1991

The Journal of the American Medical Association Vol. 288 No. 24, pp. 30963101, December 25, 2002 © 2002 American Medical Association. All rights reserved

Addiction Treatment Strives for Legitimacy by Brian Vastag
New York -- Some drugs are made in laboratories. Others, like penicillin, are discovered by accident. And then there's ibogaine, a sacramental substance from West Africa that some say interrupts heroin, cocaine, and other addictions. Over the past 40 years, the tale of ibogaine's flirtation with legitimacy boasts more twists than the roots of Tabernanthe iboga, . the shrublike source of ibogaine After riding the backpacks of Westerners to the radical 1960s New York City underground, ibogaine rose from a counterculture star to a serious project funded by the National Institutes of Health (NIH(. In 1995, after spending several million dollars on laboratory and animal studies, the NIH decided not to pursue ibogaine development. Since then, patent disputes have divided the drug's champions; a growing network of informal clinics has sprung up; and pharmacologists have discovered that ibogaine works on the brain in a manner unlike that of any other known drug

282 papers (pre-clinical, clinical, anecdotal etc.) published to-date on Ibogaine, it’s analogs and other Alkaloids in the plant, as found at the US National Library of Medicine (Pubmed)

Ibogaine Treatment Providers (Medical, non medical and psychological (sessions
   

   

5 in UK 4 in France, 2 in Germany 5 in Africa (2 in South Africa) 7 more in Europe – 2 in Holland (one with extract), Slovenia, 2 in Canada, 3 – Mexico, 1 – Bahamas, 1 Brazil, 1 Ecuador, 1 Pakistan, 2 Thailand 2 Australia, 1 New Zealand Few underground treatments in the USA and in many more countries

Conclusions: Opioid withdrawal is the most common reason for which individuals took ibogaine. The focus on opioid withdrawal in the ibogaine subculture distinguishes ibogaine from other agents commonly termed “psychedelics”, and is consistent with experimental research and case series evidence indicating a significant pharmacologically mediated effect .of ibogaine in opioid withdrawal

Feedback | Bookshop | Treatment | Links | Literature | Opinion | Science | Search | new

The purpose of this document is to provide information. Treatment providers and patients are solely responsible for their actions.

Manual for Ibogaine Therapy Screening, Safety, Monitoring & Aftercare
Second Revision

by Howard S. Lotsof & Boaz Wachtel Contributing Authors Marc Emery, Geerte Frenken, Sara Glatt Brian Mariano, Karl Naeher Martin Polanko, Marko Resinovic Nick Sandberg, Eric Taub Samuel Waizmann, Hattie Wells © 2003

Intake Procedure

 

 

 

many individuals have been doing detox work not according to the standard of modern medicine and security measures. Interview – Personal and Medical history, GP report. Find out level of self motivation (not family’s or partner’s motivation), drug use and past treatments. A minimum of ECG under stress, A clinical chemistry panel (chem 25) a complete blood count with differential platelets (CBC), HIV blood screen, liver count

Necessary equipment for medical & non clinical settings
       

Defibrillator EKG monitor Resuscitator Stretcher First Aid Kit Doctor’s case # 1& 2 (if doc present) Telephones Car with room for laying down

Subjective Effects

Acute :

The onset of this phase is within 1 to 3 hours of ingestion with a duration of 4 to 8 hours The predominant reported experiences appear to be a panoramic readout of longterm memory (“visit to the ancestors, archetype”) “Oneiric experience”

Subjective Effects
:Evaluative or visualization

 

Onset after 4 to 8 hours after ingestion with a duration of 8 to 20 hours The volume of material recalled slows Attention is still focused on inner subjective experience rather than external environment. Patients are easily distracted and annoyed and prefer little environmental stimulation

Subjective Effects

Residual stimulation

   

The onset of this phase is approximately 12 to 24 hours after ingestion with a duration in the range of 24 to 72 hours. Allocation of attention to the external environment Less subjective psychoactive experience Mild residual subjective arousal or vigilance Some patients report reduced need for sleep for several days to weeks

Frequent but temporary side effects of Ibogaine

  

    

Coordination disturbances (unstable gait and tendency to fall) Hallucinations-like experiences Sleep disturbances Concentration and speech troubles Heart rate and blood pressure changes Nausea and vomiting Dizziness Light sensitivity Tiredness Muscles soreness

Pharmaco-dynamics and Therapeutic Applications of Iboga and Ibogaine
By  Robert Goutarel, Honorary Research Director;  Otto Gollnhofer and Roger Sillans, Ethnologists, C.N.R.S.  (French National Scientific Research Center) (Translated from French by William J. Gladstone) Psychedelic Monographs and Essays, Volume 6:70-111, 1993

“The women take iboga in smaller quantities than the ones taken in the Bwiti initiation. In their case, the visions do not go beyond the third (Freudian) stage during which genies, good or evil, communicate to the women that they are in possession of the causes of the affliction or illness for which they were consulted”

Drug Self-Administration

 

 

Reduction in morphine, heroine, cocaine, alcohol and nicotine self-administration. The effects are apparently persistent (five days in rats) but water intake stopped just for a day. The results improved with repeated treatments. Noribogaine has also been reported to reduce |Morphine, Cocaine and Heroine self administration. Some of the Iboga alkaloids tested produce tremors. 18-MC reduces drugs intake but not water intake.

Ibogaine in the treatment of heroin withdrawal
Mash DC, Kovera CA, Pablo J, Tyndale R, Ervin FR, Kamlet .JD, Hearn WL
Departments of Neurology and Pharmacology, University of Miami School • Medicine, Miami, FL 33124, that Ibogaine provided a safe and of The results suggest USA

effective treatment for withdrawal from heroin and methadone. •These preliminary results demonstrate that single doses of Ibogaine were well tolerated in drug-dependent subjects. •Our observations of the safety of Ibogaine have not been limited to opiate-dependent subjects. •To date, we have evaluated ibogaine’s safety in more than 150 drug-dependent subjects that were assigned to one of three fixed-dose treatments under open label conditions; 8, 10, 12, mg/kg Ibogaine. •To date, no significant adverse events were seen under

Objective Opiate Withdrawal Signs and Ibogaine Signs: Human Observations
Signs Diarrhea Yes Yawning Yes Rinorrhea Yes Piloerection Yes Lacrimation Yes Mydriasis Yes Shivering Yes Restlessness Chronic Vomiting Yes Muscle Twitches Yes Abdominal Cramps Yes Sweating Yes Anxiety Yes Sleeplessness Yes Yes No 3% No *16% - 25% No No No No Acutre/motion related Acutre/motion related Post 20 Hrs ibogaine Post 20 Hrs ibogaine No No No 5% (moderate) No No No No No No Rare Rare Opiate Withdrawal Yes Ibogaine No Ibogaine + Opiates days post 6, 12% - 3% *

It appears that the most effective :treatment involves
1. Visionary doses of Ibogaine (that produce an interruption of opiate cravings and appetite), 2. Intensive counseling + therapy during the interruption period. 3. maintainig a healthy life style and occupation Few patients require a second or third session over the course of the next 12 to 18 months to completely rid themselves of opiate addiction. A minority of patients relapse back into opiate addiction.

Howard Lotsof and Norma Alexander Lotsof near the FDA Building in Maryland, 1992

First scientific publication of ibogaine antiaddictive effects

Ibogaine effects on cocaine

A key paper relating to ibogaine effects on opioid .narcotics

Ibogaine effects on alcohol

Why ibogaine is not available
1. 2. Industry deems ibogaine not to be profitable (single administration modality) The molecule is found in nature and cannot be owned

3. Stigmatized patient population with liability higher than general population. 4. Government, industry and academia chose to place their interest to treat narcotic dependence in the development of opiate drugs with which they are familiar. Ibogaine represents a new scientific paradigm to the understanding of addiction. Lack of prioritization of pharmacotherapies. Intellectual conformity.

5. 6. 7.

signed Reduction, Rational Addiction andand Harm to reduce the private the Optimal Prescribing of Illegal Drugs, Journal article by Richard social Stevenson; Contemporary Economic Policy, Vol. 12, 1994 cost of illegal drug use within the frame­ work of existing law. It is distinct from decriminalization or legalization, which would require de jure or de facto changes in national and international law. HR pol­ icy also differs from coercive demand and supply-side policies, which indirectly aim

HR policy tackles public health issues directly by seeking to improve the welfare of individual users. Many strategies have been proposed, but the principal ingredients of most programs are educational and advisory services, syringe exchanges, treatment and maintenance services. Some programs also employ outreach workers to contact drug users most at risk from HIV infection and other health hazards

Something to think about for UN People Even by itself, a millennium of sacramental indigenous
use of Ibogaine in Africa is a sound enough foundation to approve the use of Ibogaine in the west. It certainly strengthens the safety and efficacy claims made by its proponents and users of Ibogaine in the west. That is true for other sacraments as well. The evidence of the therapeutic effects of Ibogaine for socio/medical improvements across few cultures is therefore well established by now and supported with data obtained from thousands of addiction treatments + unbiased scientific work across the globe. Ibogaine related research stands out in entheogens' history because its efficacy, especially for the anti addiction indications, has been scientifically measured both in animals and humans.

•Historically

speaking, all the might and "services" offered by Colonialist missionaries in western Africa were not sufficient to conquer the place at heart that Ibogaine won, throughout centuries, among the Bwiti Iboga worshipers of a holy 'tree of life', a key for harmony with nature, one self, and for communicating with their ancestors. Therefore: Outlawing the sacramental use of foreign entheogens for adults by any society is an act of cultural ignorance and racial supremacy of the highest order. The FDA is a barrier that popular sacramental medicines, including Ibo and medical cannabis, can not cross due to issues of patents, legal status and money. • Denying people legal access to entheogens can be explained, maybe, with the desire of governments to monopolize the consciousness of people so behavior of the masses can be predicted under conditions of control.

Freeing the mind and spirit from government/media dictated consciousness and fighting human rights abuse in the name of “war on drugs” and FDA rules is the task at hand. Monotheistic, abstinence base religions, suppress competition with holy plant based religions. The strength of abstinence based opposition to plant based faiths negatively influence the will of western governments and UN drug conventions to support use of sacred plants and associated science. Entheogens, or plant teachers, promote independent thinking, communal awakening as well as the preservation of personal health and that of nature. These traits directly conflict with economic forces benefiting from western government's love affair with the abstinence based belief systems, taxes from legal drugs, endless industrial growth models and the horrendous feeding of the monster called the prison/industrial complex. Thank you