Significance of Unofficial Ibogaine Treatment Scenes

The existence of these scenes indicates demand for alternatives to existing treatment options. Averse events including fatalities indicate the need for appropriate prospective medical evaluation of patients, monitoring within the treatment, and reliable formulations of ibogaine. Anecdotal or case report evidence suggests a possible neurobiological drug action. All of the above strongly support the need for appropriate clinical trials to evaluate safety and efficacy in order to gain official approval

US and European Ibogaine Scenes Through the Year 2000

Scene, yr. beganUS, New York City, 1962-63 N 20 Indication Psychological insight, selfexperimentati on Addiction, mainly opioids and coca ine Addiction, mainly opioids and coca ine Psychological insight Dose 6-19 mg/kg Comments Initial cohort on whom H. Lotsofs o servation of putative b effect on opioid withdrawal was made1,2,3 Treatments arrange d by H. Lotsof and Dutch and U.S. addict self-help groups1,2,3,4 Medical model including MD supervised pretreatment evaluation and monitoring1,5 Highly secretive scene involving significant involvement of credentialed hea lth professionals1,6 Majority of treatments for indication of psychological insight, conducted in Caribbean in informal setting1

Netherlands, 1989-93 St. Kitts, West Indies 1996U.S. West Coast 1950s-?

~40-45

15-29 mg/kg

~150 as of 2000 ?

600-1200 mg

150-300 mg

Eric Taub 1992-

~310 as of 2000

Psychological insight, addiction

Netherlands 1999-

22 addicts, 4 nonaddicts

Slovenia 1995-

~150 as of 2000

Addiction (heroin, cocaine alcohol), psychological insight Addiction, psychological insight Addiction, psychological insight Addiction, psychological insight psychological insight, addiction (heroin)

(mg/kg) Insight: 9-12; Addiction: cocaine, 1218, heroin, 20-24 3 to 6 g extract (unk. % iboga ine), sometimes with 3-500 mg ibogaine ?

Individual providing treatments in setting of her own home1

U.K. 1998-

Italy 1994-

~1/week as of 2000 35-40

Czech Republic 2000-2001

~60 nonaddicts, 18 addicts

(mg/kg) Insight, 13-18; Addiction, 2022

Loosely organized; the Iboga Foundation in Ljubljana provides information and assists in arranging treatments1,7 Very loosely organized, ibogaine available via internet or certain small retail shops1 Small scene involving a s ingle individual working with his own extract from iboga root bark1 Treatment provider discontinued activity after approximately one year due to perception of limited benefit w/o systematic afterca re1

1. Alper, K.R., Beal D., and Kaplan C.D. (2001). A Contemporary History of Ibogaine in the United States and Europe. In Ibogaine: Proceedings of the First International Conference (The Alkaloids Volume 56), pp. 249-281. Academic Press, San Diego, California. 2. Lotsof, H.S., and Alexander N.E. (2001). Case studies of ibogaine treatment: implications for patient management strategies. In Ibogaine: Proceedings of the First International Conference (The Alkaloids Volume 56), pp. 293-313. Academic Press, San Diego, California. 3. Alper, KR, Lotsof, HS, Frenken, GMN, Luciano, DJ, and Bastiaans, J. Treatment of Acute Opioid Withdrawal with Ibogaine. American Journal on Addictions 8: 234-242, 1999. 4. Frenken G. (2001). From the roots up: ibogaine and addict self-help. In Ibogaine: Proceedings of the First International Conference (The Alkaloids Volume 56), pp. 283-292, Academic Press, San Diego, California. 5. Mash, D.C., Kovera A. , Pablo J., Tyndale R., Ervin F.R., Kamlet J.D., and Hearn W.L. (2001). Ibogaine in the Treatment of Heroin Withdrawal Ibogaine: Proceedings of the First International Conference (The Alkaloids Volume 56), (K. Alper and S.D. Glick Eds.), pp. 155-171. Academic Press, San Diego, California. 6. Stolarof MJ. The Secret Chief. (1997) Multidisciplinary Association for Psychedelic Studies, Charlotte NC, 144 pages. 7. Kastelic , A. Self-Help Use of ibogaine in Slovenia Presented at the First International Conference on Ibogaine. New York, NY, Nov. 5 1999.

Reports of Ibogaine Treatment in Humans

Case studies presented to NIDA in March 1995; 41 individuals receiving a total of 52 treatments Published case reports (high degree of overlap with the above) describing a total of 56 treatments Open label prospective study N=32 (Mash et al.)

Published Ibogaine Case Studies

One paper describing 33 treatments for opioid dependence; complete resolution of withdrawal signs and absence of drug-seeking behavior in 25 (76%)1. Total of 13 treatments, mainly for opioid dependence, in four additional papers2,3,4,5.
1. Alper, KR, Lotsof, HS, Frenken, GMN, Luciano, DJ, and Bastiaans, J (1999). Treatment of Acute Opioid Withdrawal with Ibogaine. American Journal on Addictions 8: 234-242. 2. Cantor, M. (1990). ``Interviews: ibogaine treated addicts''. The Truth Seeker 117(5), 23-26. 3. Luciano, DJ. (1998). Observations on treatment with Ibogaine. American Journal on Addictions 7, 89-90. 4. Sheppard, S.G. (1994). A preliminary investigation of ibogaine: case reports and recommendations for further study. J.Subst.Abuse Treat. 11, 379-385. 5. Sisko, B. (1993). Interrupting drug dependency with ibogaine: a summary four case histories. Multidisciplinary Association For Psychedelic Studies (MAPS) Newsletter 4: 15-24.

Drug Abstinence Following Ibogaine Treatment (unpublished, presented to NIDA March 1995)
Reported Time Interval of Posttreatment Drug Abstinence
<2 months N (%) 15 (29%)

2 to <6 months 6 months to <1 year 1 year Not determined

15 (29%) 7 (13%) 10 (19%) 5 (10%)

Alper, K.R. (2001). Ibogaine: A Review. In Ibogaine: Proceedings of the First International Conference (The Alkaloids Volume 56), (K. R. Alper and S.D. Glick, Eds.), pp. 1-38. Academic Press, San Diego, California.

Retrospective Case Series From Early1960s U.S. and Late 1980s-Early 1990s Dutch Informal Scenes: Subjects

Table 1 from: Alper, KR, Lotsof, HS, Frenken, GMN, Luciano, DJ, and Bastiaans, J. Treatment of Acute Opioid Withdrawal with Ibogaine. American Journal on Addictions 8: 234-242, 1999.

Retrospective Case Series From Early1960s U.S. and Late 1980s-Early 1990s Dutch Informal Scenes: Outcomes

Table 2 from: Alper, KR, Lotsof, HS, Frenken, GMN, Luciano, DJ, and Bastiaans, J. Treatment of Acute Opioid Withdrawal with Ibogaine. American Journal on Addictions 8: 234-242, 1999.

Prospective Open Label Study (Mash et al. 2001) 1

32 patients treated for opioid (heroin or methadone) withdrawal. Withdrawal Symptoms measured using the Objective Opiate Withdrawal Scale (OOWS) Fixed dose of 800 mg ibogaine HCl given approximately 12 hours after the last opiate dose OOWS significantly reduced at 12 and 24 hours post ibogaine administration; the level of discomfort at these acute relative to post-treatment time points was as low as the level seen 1 week later. Objective signs of opiate withdrawal rarely seen and none increased at later time points. Decreased craving at <72 hours post-treatment; these reductions were maintained at 6 to 9 days post-treatment Depression scores reduced relative to pre-treatment at 6 to 9 days and 1 month posttreatment
1. Mash, D.C., Kovera A. , Pablo J., Tyndale R., Ervin F.R., Kamlet J.D., and Hearn W.L. (2001). Ibogaine in the Treatment of Heroin Withdrawal in Ibogaine: Proceedings of the First International Conference (The Alkaloids Volume 56), (K. Alper and S.D. Glick Eds.), pp. 155-171. Academic Press, San Diego, California.

Disease-Specific Advocacy

Examples of Disease Specific Advocacy

HIV: Aids Coalition to Unleash Power (ACT UP); Treatment Action Group (TAG) Opiate Dependence: Dutch Junkiebond, Danish Drug Users Union Psychiatric Disorders: National Alliance for the Mentally Ill (NAMI)

Nico Adriaans
organizer

Dutch Addict Self-Help

Political Advocacy Graphics