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IBOGAINE, TRAUMA, AND ABREACTION: THE TREATMENT OF CHEMICAL DEPENDENCE

H.S. Lotsof1, C.A. Smith F.2, J. Bastiaans3

1Dora Weiner Foundation, 46 Oxford Place, Staten Island, NY 10301 USA, 2Chairman, Rep. of Panama chapter, American Society of Addiction Medicine (ASAM), 3Oegstgeest, The Netherlands (deceased) © Lotsof 1996 correspondence


TABLE OF CONTENTS

Abstract

Introduction

Case Report One

Case Report Two

Case Report Three

Selected Ibogaine Bibliography

Abstract

Ibogaine, an alkaloid of the West Central African plant Tabernanthe iboga has been used in traditional religion and medicine for centuries. Recent clinical research has demonstrated Ibogaine's utility in the interruption of dependence to narcotics, stimulants, alcohol, nicotine and poly-drug use. Ibogaine manifests itself pharmacologically and psychologically. In the latter, repressed memories are accessed objectively by the patient, for the most part in a non-emotional, non-threatening manner. Ibogaine initiates a pharmacologically induced process whereby patients gain insight into the trauma underlying their chemical dependence. Ibogaine is particularly important as it eliminates narcotic withdrawal and drug craving, while concurrently allowing the patient and the treatment group to come to an understanding of the patient's underlying psychopathology. These effects, including abreaction, are generally accomplished within four days of a single Ibogaine administration. Ibogaine therapy, as other treatment modalities for substance-related disorders, may require a psychosocial support structure to assist the patient in overcoming chemical use disorders. return to table of contents

Introduction

Over the last eight years numerous papers have been written on the pharmacology, behavioral pharmacology and mechanisms of action of Ibogaine. Dzoljic et al. (1988), Glick et al. (1992) and Lotsof et al. (1996) clearly demonstrated Ibogaine's ability to diminish narcotic withdrawal. Glick (1991), Cappendijk (1993) and Rezvani (1995) published respectively on the attenuation by Ibogaine of morphine, cocaine and alcohol self-administration. Ibogaine’s actions effect substance dependencies as diverse as opiates, stimulants, alcohol and nicotine according to Lotsof (1985, 1991, 1992, 1995), Kaplan et al. (1993), Sisko (1994) and Sheppard (1994). The mechanisms of action of Ibogaine have been shown to be dopaminergic by Maisonneuve et al. (1992) and Harsing et al. (1994); to effect the 5-HT system by Broderick et al. (1994), Sershen et al. (1994a) and Mash et al. (1995a); to involve opiate receptors by Deecher et al. (1992), Sershen et al. (1994b), Mach et al. (1995) and Pearl et al. (1995) while Popik et al. (1994), Mash et al. (1995b) and Sershen et al. (1996b) found Ibogaine to act on the NMDA receptor complex, a system that may be central to the actions of drugs having abuse potential and capable of inducing chemical dependence. Molinari et al. (1996) determined that Ibogaine was not neurotoxic at therapeutic doses. Review articles of Ibogaine have been published by Goutarel (1993a,b), Popik (1995) and Popik and Glick (1996). Naranjo (1969, 1973) published on the use of Ibogaine as an adjunct to psychotherapy while Fernandez (1982) describes the ethnographic history of use in Africa of Ibogaine containing plants in Fang Bwiti religion and medicine. Gollnhofer and Sillans (in Goutarel) told of the Mitsogho Bwiti, a more orthodox sect of this religion of Gabon. Two areas that are lacking in investigation that may be principal to Ibogaine's ability to interrupt drug seeking and craving behavior concern trauma as reviewed by Bastiaans (1982) and abreaction. These are areas of study that are difficult to quantify by the standards of data analysis and therefore a case report method used by Bastiaans (1978) and others has been chosen to review these matters.

Three distinct examples of abreaction that have been seen in opiate or poly-drug dependent patients treated with Ibogaine will be discussed. These are an acute effect to a single treatment, an acute effect after multiple treatments and a delayed effect after multiple treatments.

In our work we have recognized that chemical dependence is distinct from underlying medical problems that may have been masked by years of drug use. We are aware that treatment with Ibogaine will not supply an education that was not previously obtained or an occupation that was not previously known to the patient.

While these issues may seem obvious to professionals in the field of chemical dependence treatment, there seems to be a great deal of confusion on the part of the general public who anticipate the interruption of chemical dependence will by some magical act provide medical health, education and occupational skills. I am afraid that I will have to disappoint those persons. The responsibility to provide for the health, the education and the training of the general population if we are to remain a well society is a matter distinct from the treatment of chemical dependence. However, the failure to provide such care or training to persons recovering from chemical dependence will hinder their ability to recover from substance-related disorders. Chemical dependence must be replaced by activities providing greater benefit to the patient than that of drug use if the patient is to heal.

It is evident to those of us who have worked with Ibogaine that every patient we have treated has suffered trauma due to physical /emotional consequences. The issues are inseparable. return to table of contents

Case Report One

The first example of abreaction to trauma during treatment with Ibogaine is that of a 39 year old female patient dependent on 80 mgs per day of Methadone that she supplemented with between $120 USD and $250.00 USD of heroin at night or on the weekend by IV administration. She had a 20 year history of heroin use.

The patient was HIV positive and had an adolescent daughter. Her reason for seeking treatment for narcotic dependence was so that she might provide her daughter with quality time together before she passed.

Her treatment period was not remarkable in any way. She suffered little discomfort .

On the third day after Ibogaine treatment, being significantly recovered from the physical effects of Ibogaine she met with the presiding psychiatrist and complained that she was suffering emotionally the loss of her husband who had died of a heroin overdose while the patient was in prison on a charge of heroin smuggling. The patient had repressed emotions related to the loss of her husband while in prison and complained to her psychiatrist that the feelings of loss were now present and cried. She was angry that she had to feel these emotions. The psychiatrist suggested that she wait another day and visit again to see how she felt.

On the following day the matters relating to the loss of her husband appeared to be resolved and patient was content with her treatment. She had no desire to use opiates and showed no signs of opiate withdrawal. return to table of contents

Case Report Two

The second example is of a 33 year old woman with a twenty year history of heroin, Methadone and cocaine use. This patient received a series of four treatments with Ibogaine. Three were at therapeutic doses and one was part of an experimental protocol not anticipated to be therapeutically effective.

This patient came to our attention seeking treatment with Ibogaine for Methadone detoxification. The patient was in a Methadone program and was receiving 80 mgs/day of Methadone.

Upon arrival for her first treatment the patient revealed deep ulcerations on both arms due to IV cocaine use of approximately $100.00 USD per day. Infection was so significant that treatment was delayed for some days while the infection was treated. The patient stated she did not disclose cocaine use as her employer who had paid for her treatment and felt her employment would have been terminated if the employer had knowledge of her cocaine use.

The patient was administered Ibogaine. Twenty-four hours after Ibogaine treatment the patient was very uncomfortable due to inability to sleep and was sedated with benzodiazepines. Forty-eight hours post treatment the patient was recovered, claimed to feel well, appeared exuberant and asked to be released to stay with a friend in a nearby city.

Three months after her treatment the patient requested a second treatment for heroin use. The patient’s response was similar to her first experience and within two days she had recovered and left the treatment environment.

Approximately one year later the patient requested treatment again and was among the first patients to be treated in the experimental program authorized by the Ministry of Health of the Republic of Panama. These were the first treatments in fully controlled hospital environments.

Detailed discussions were held with the patient concerning her previous experiences. The patient disclosed that on both previous occasions she experienced withdrawal four to six days after treatment. Maintaining the patient in-hospital would allow us to observe the patient and determine what withdrawal signs might be seen.

The patient was part of the research program conducted in collaboration with the University of Miami. That phase of the research incorporated pharmacokinetic studies at 10 mgs/kg of Ibogaine. This dose, based on prior experience, was not anticipated to eliminate narcotic withdrawal and the patient was maintained as required on morphine or Meperidine. The patient was very anxious.

Two days later, apparently recovered from the 10 mgs/kg of Ibogaine, the patient was administered a therapeutic dose of 20 mg/kg of Ibogaine. The patient did not display any objective signs of narcotic withdrawal though she did exhibit increasing degrees of anxiety. She signed a hospital release designating that she was leaving against medical advice, but then overslept, missed her plane and was persuaded to stay in the hospital to allow observations of the withdrawal signs she anticipated.

No withdrawal signs were noticed, however, by day four anxiety levels were significant and the patient began to recount a history of terrible physical abuse by her mother and later a heroin dealer she worked for when she was 14 years of age. The patient recounted scar by scar the story: A scar on her head where her mother hit her with a shoe, a scar on her leg, a burn received from a coal stove. The patient reported that though the wound from the stove was bleeding uncontrollably, her mother sent her to the butcher to buy some meat. The butcher bandaged her leg before sending her home.

The most disturbing account was that of an incident that occurred at the age of 14 when she was dealing heroin for a pimp. One of the women who worked as a prostitute told the patient of a babysitting job that she could have. When she went to the apartment in response to the job offer, the pimp and the women were there. She was beaten and sexually asaulted. There followed a period of beathings, threats of beatings and death in order to maintain her as a prostitute. It was not clear how long this lasted, but was believed to be about two years until she was rescued by friends.

The patient's anxiety became acute after leaving the hospital five days post Ibogaine treatment. When the car taking her to the hotel slowed for a light the patient opened the door and fled the car with staff in pursuit calling her name to which she was not immediately responsive. After a few minutes she responded to her name and informed the treatment group that she had not recognized them and thought she was being chased by her mother. Members of the treatment group stayed with her in a hotel until anxiety levels became reasonable. The patient continuously recounted how she had been physically abused by her mother.

When the patient returned to New York she confronted her mother who admitted the abuse. The patient who had been living with her mother obtained her own apartment, remained drug free and determined to seek training in substance-abuse counseling. return to table of contents

Case Report Three

Patient three is the most public of our patients and has provided himself on video tape and cooperated in a manner that is difficult under the effects of Ibogaine: To answer questions and hold discussions. The patient's response represents a multiple treatment delayed effect of Ibogaine.

Patient was 32 years of age when first treated with Ibogaine and had been waiting 3 years for treatment. We were eventually able to offer him a subsidized treatment as he had no funds. At that time he was on a Methadone program and using 80 mgs/day of Methadone. He was also using heroin and smoking crack. He was about to be discharged from his Methadone program for continuous positive urines and was making no progress in his life. He had been using various drugs since the age of 14.

He was treated with Ibogaine and remained drug free for approximately 3 months. During his treatment he claimed to have reviewed early life experiences relating to abuse by his step father for which he held his mother responsible. He also felt alienated as, in his words, Being a Jewish kid in a tough Italian neighborhood in New York, he was getting continuously beat up."

He recovered more slowly from the effects of Ibogaine then any other patient we treated. I think he would have remained in bed for more then five days if we did not have to give up the room.

His treatment appeared to follow a normal course including elimination of withdrawal and interruption of drug seeking behavior. During this "window of opportunity" period, he arranged for a scholarship to a University and was accepted as a student. Three months later he requested retreatment, claiming he was experiencing craving for heroin. Retreatment was given with similar results in that a temporary interruption of his drug using behavior was accomplished and he continued with his studies. Some months later he informed us that he had resumed drug use.

We were not able to offer the patient another treatment for over a year. During that time he had escalated his Methadone to 100 mgs/day, supplementing it with up to $40.00 USD of heroin and was beginning to smoke crack. But, he was in school, getting B+ grades and we were determined not to loose him.

Following this treatment his pattern of ibogaine therapy and drug use continued unabated. He had about three months of non drug use followed by craving. He returned to Methadone, dose escalating up and eventually returning to his pattern of supplementing the Methadone with heroin.

It was difficult to understand why he was following this pattern. He was making progress at the University and beginning to establish a lifestyle that would allow him to be self supporting. In discussions with the patient he was asked, "Can't you see the tremendous progress that you have made since the time of your first Ibogaine treatment?" He said, "No, he could not see any progress."

Three months later he called again and told of an experience that occurred during the work/study program within which he participated at the University. He had been assigned to take a group of Freshman and walk them through the campus. He said, "Suddenly, he recognized that two years ago he was one of those Freshman." He recognized his accomplishment and the progress he had made. He ceased heroin use immediately and began a slow methodical reduction in his 80 mgs/day of Methadone. Prior to leaving for a study program in Italy, he had reduced his Methadone to 10 mgs/day and was intent on stopping Methadone use completely.

The patient throughout this period, continued intermittent but, regular contact with a psychotherapist from the time of his first Ibogaine treatment. He views Ibogaine in conjunction with psychotherapy as allowing him to bring order and a sense of accomplishment to his life.

[Revisiting this paper ten years after the original writing we can further ccomment on patient #3. He returned to heroin use, was arrested a served a few years in prison. Upon release he obtained work as a counselor in a therapeutic cocmmunity. Currentely he attends NA meetings and has not used drugs for four years.]

In closing Ibogaine appears to offer a unique tool to both the patient and the clinician to allow the elimination of physical withdrawal characteristics and the accessing of repressed memories in a non threatening manner by which the majority of patients can gain an understanding of the trauma underlying their chemical dependence and to achieve accomplishments necessary to give them a sense of self worth without which it would be more difficult to break the cycle of substance use disorders. Most important, for many of the patients, Ibogaine allowed them to understand the benefit and role required of a psychosocial support structure including medical professionals, counselors, self-help organizations and the ability to tap into their own inner strength to allow normalization into and survival in a prohibitionist society. return to table of contents

Selected Ibogaine Bibliography

Bastiaans J, The Use of Hallucinogenic Drugs in Psychosomatic Therapy, Proceedings of the European Conference on Psychosomatic Research, Norway, 1978.

Bastiaans J, On Freedom and Induction, Psychotherapy and Psychosomatics, 38:24-31, 1982.

Broderick PA, Phelan FT, Eng F, Wechsler RT, Ibogaine Modulates Cocaine Responses Which Are Altered Due to Environmental Habituation: In Vivo Microvoltammetric and Behavioral Studies, Pharmacology Biochemistry and Behavior, 49(3):711-728, 1994.

Cappendijk SLT, Dzoljic MR, Inhibitory effects of ibogaine on cocaine self-administration in rats, European Journal of Pharmacology, 241:261-265, 1993.

Deecher DC, Teitler M, Soderland DM, Bornmann WG, Kuehne MR, Glick SD, Mechanisms of action of ibogaine and harmaline congeners based on radioligand binding studies, Brain Research, 571:242-247, 1992.

Dzoljic ED, Kaplan CD, Dzoljic MR, Effects of Ibogaine on Naloxone-Precipitated Withdrawal Syndrome in Chronic Morphine-Dependent Rats, Archive of International Pharmacodynamics, 294:64-70, 1988.

Fernandez JW, Bwiti: An Ethnography of the Religious Imagination In Africa, Princeton University Press, 1982.

Glick SD, Rossman K, Steindorf S, Maisonneuve IM, Carlson JN, Effects and aftereffects of ibogaine on morphine self-administration in rats, European Journal of Pharmacology, 195:341-345, 1991.

Glick SD, Rossman K, Rao NC, Maisonneuve IM, Carlson JN, Effects of Ibogaine on Acute Signs of Morphine Withdrawal in Rats: Independence from Tremor, Neuropharmacology, 31(5):497-500, 1992.

Goutarel R, Gollnhofer O, Sillans R, Pharmacodynamics and Therapeutic Applications of boga and Ibogaine, Psychedelic Monographs and Essays, vol. 6, 1993a.

Goutarel R, Gollnhofer O, Sillans R, L'IBOGA CONTRE LA DEPENDENCE AUX STUPEFIANTS. PHARMACODYNAMIE ET APPLICATIONS PSYCHOTHERAPEAUTIQUES, Psychotropes, 3(3):63-86, 1993b.

Harsing LG, Sershen H, Lajtha A, Evidence that ibogaine releases dopamine from the cytoplasmic pool in isolated mouse striatum, Journal of Neural Transmission, 96:215-225, 1994.Harsing LG, Sershen H, Lajtha A, Evidence that ibogaine releases dopamine from the cytoplasmic pool in isolated mouse striatum, Journal of Neural Transmission, 96:215-225, 1994.

Kaplan CD, Ketzer E, de Jong J, de Vries M, Reaching a State of Wellness: Multistage Explorations in Social Neuroscience, Social Neuroscience Bulletin, 6(1):6-7, 1993. http://ibogaine.org/wellness.html

Lotsof HS, U.S. patent 4,499,096; Rapid Method for Interrupting the Narcotic Addiction Syndrome, 1985. http://www.ibogiane.desk.nl/4499096.html

Lotsof HS, U.S. Patent 5,026,697, Rapid Method for Interrupting or Attenuating The Nicotine/Tobacco Dependency Syndrome., 1991.

Lotsof HS, U.S. patent 5,152,994; Rapid Method for Interrupting or Attenuating Poly-drug Dependency Syndromes, 1992. http://ibogaine.org/5152994.html

Lotsof HS, Ibogaine in the Treatment of Chemical Dependence Disorders: Clinical Perspectives (A Preliminary Review), Bull. MAPS, 5(3), 1995.

Lotsof HS, Della Sera EA and Kaplan CD, Ibogaine in the Treatment of Narcotic Withdrawal, Proceedings of the International Council on Alcohol and Addiction's 37th International Congress on Alcohol and Drug Dependence, La Jolla, CA, http://ibogaine.org/ibonarco.htm

Mach RH, Smith CR, Childers SR, Ibogaine possesses a selective affinity for sigma2 receptors, Life Sci., 57:57-62, 1995.

Maisonneuve IM, Rossman KL, Keller Jr. RW, Glick SD, Acute and prolonged effects of ibogaine on brain dopamine metabolism and morphine-induced locomotor activity in rats, Brain Research, 574:69-73, 1992.

Mash DC, Staley JK, Baumann MH, Rothman RB and Hearn WL, Identification of a Primary Metabolite of Ibogaine that Targets Serotonin Transporters and Elevates Serotonin, Life Sciences 57(3):PL 45-50, 1995.

Mash DC, Staley JK, Pablo JP, Holohean AM, Hackman JC and Davidoff RA, Properties of Ibogaine and its Principal Metabolite (12-hydroxyibogamine) at the MK-801 Binding Site of the NMDA Receptor Complex, Neuroscience Letters, 192:53-56, 1995.

Molinari HH, Maisonneuve IM, Glick SD, Ibogaine neurotoxicity: a re-evaluation, Brain Research, 737:255-262, 1996.

Naranjo C, Psychotherapeutic Possibilities New Fantasy Enhancing Drugs, Clinical Toxicology, 2(2):209-224, 1969.

Naranjo C, The Healing Journey, Pantheon Books, Div. Random House, NY, 174-228, 1973.Naranjo C, The Healing Journey, Pantheon Books, Div. Random House, NY, 174-228, 1973.

Pearl SM, Herrick-Davis K, Teitler M, Glick SD, Radioligand-Binding Study of Noribogaine, a Likely Metabolite of Ibogaine, Brain Research, 675, 342-344, 1995.

Popik P, Layer RT, Skolnick P, The Putative anti-addictive drug ibogaine is a competitive inhibitor of [3H]MK-801 binding to the NMDA receptor complex, Psychopharmacology, 114:672-674, 1994.

Popik P, Layer, RT, Skolnick P, 100 Years of Ibogaine: Neurochemical and Pharmacological Actions of a Putative Anti-addictive Drug, Pharmacological Reviews, 47(2):235-250, 1995.

Popik P and Glick SD, Ibogaine, A Putively Anti-Addictive Alkaloid, Drugs of the Future, 21(11):1109-1115, S.A. Prous, 1996. >/p>

Rezvani AH, Overstreet DH, Yue-Wei Lee, Attenuation of Alcohol Intake by Ibogaine in Three Strains of Alcohol-Preferring Rats, Pharmacology, Biochemistry and Behavior, 52(2), 1995.

Sershen H, Hashim A, Lajtha A, Effects of Ibogaine on Serotonergic and Dopaminergic Interactions in Striatum of Mice and Rats, Neurochemical Research, 19(11):1463- 1465, 1994a.

Sershen H, Hashim A, Lajtha A, The Effects of Ibogaine on Kappa-Opioid and 5-HT3-Induced Changes in Stimulation-Evoked Dopamine Release in Vitro from Striatum of C57BL/By Mice, Brain Research, 36(6):587-591, 1994b.

Sershen H, Hashim A and Lajtha A, Effect of Ibogaine on Cocaine-Induced Efflux of [3H] Dopamine and [3H] Serotonin From Mouse Striatum, Pharmacology Biochemistry and Behavior, 53(4):863-869, 1996a.

Sershen H, Hashim A, Lajtha A, The Effects of Ibogaine on Sigma- and NMDA-Receptor-Mediated Release of [3H]Dopamine, Brain Research Bulletin 40(1):63-67, 1996b.

Sheppard SG, A Preliminary Investigation of Ibogaine: Case Reports and Recommendations for Further Study, Journal of Substance Abuse Treatment, 11(4):379-385, 1994.

Sisko B, Interrupting Drug Dependency with Ibogaine: A Summary of Four Case Histories, MAPS 4(2):15-23, 1994.

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