Cosm

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Cosm

  1. 1. A review of the available literature and treatment experiences by Jonathan Freedlander, MA Cand Towson University Ibogaine and methamphetamine
  2. 2. Methamphetamine epidemiology <ul><ul><ul><li>According to the 2002 National Survey on Drug Use and Health, 12.4 million Americans age 12 and older had tried methamphetamine (METH) at least once in their lifetimes (5.3 % of the population) </li></ul></ul></ul><ul><ul><ul><li>Up from 3.8 million (1.8 %) in 1994 </li></ul></ul></ul><ul><ul><ul><li>Majority of past-year users between 18 and 34 years of age </li></ul></ul></ul><ul><ul><ul><li>In 2003, 6.2 % of high school seniors had reported lifetime use </li></ul></ul></ul><ul><ul><ul><li>From 1999-2002, METH related visits to hospital emergency departments (EDs) rose from 12,496 to 21,644 </li></ul></ul></ul>
  3. 3. Pharmacology <ul><ul><ul><li>dopaminergic agonist </li></ul></ul></ul><ul><ul><ul><li>attenuate dopamine transporter (DAT) clearance efficiency, thereby increasing synaptic dopamine (DA) levels </li></ul></ul></ul><ul><ul><ul><li>activates classical reward circuitry </li></ul></ul></ul>
  4. 4. Methods of administration <ul><li>METH can be insufflated (snorted), injected, smoked (“ice”), taken orally (uncommon) </li></ul>
  5. 5. Acute effects <ul><ul><ul><li>euphoria </li></ul></ul></ul><ul><ul><ul><li>increased activity and alertness </li></ul></ul></ul><ul><ul><ul><li>decreased need for sleep </li></ul></ul></ul><ul><ul><ul><li>appetite reduction </li></ul></ul></ul><ul><ul><ul><li>reduced behavioral dishinibition </li></ul></ul></ul><ul><ul><ul><li>increased heart rate and blood pressure </li></ul></ul></ul><ul><ul><ul><li>anxiety/paranoia </li></ul></ul></ul><ul><ul><ul><li>increased aggression </li></ul></ul></ul><ul><ul><ul><li>grandiose thinking </li></ul></ul></ul><ul><ul><ul><li>hyperthermia and convulsions, can result in death </li></ul></ul></ul>
  6. 6. Long term effects <ul><li>damage to blood vessels </li></ul><ul><li>stroke </li></ul><ul><li>irregular heartbeat </li></ul><ul><li>respiratory problems </li></ul><ul><li>anorexia </li></ul><ul><li>cardiovascular collapse </li></ul><ul><li>withdrawal syndrome following abrupt cessation in chronic users </li></ul><ul><ul><li>anxiety </li></ul></ul><ul><ul><li>craving </li></ul></ul><ul><ul><li>sleep disturbances </li></ul></ul>
  7. 7. <ul><li>A fter chronic drug abuse and during withdrawal, brain dopamine function is markedly decreased </li></ul><ul><ul><li>can result in pre-P arkinsonian symptoms </li></ul></ul><ul><li>dysfunction of prefrontal regions </li></ul><ul><ul><li>problems with attention </li></ul></ul><ul><ul><li>deficits in episodic verbal memory </li></ul></ul><ul><li>decreased serotonergic function </li></ul><ul><li>altered EEGs correlated with neurocognitive deficits </li></ul><ul><li>neurocognitive impairment may be especially pronounced in HIV+ individuals </li></ul><ul><li>neuropathology may reverse somewhat following prolonged abstinence </li></ul>Neurocognitive issues
  8. 8. Brain images for (11C)d threo-methylphenidate, which show the concentration of dopamine transporters in a control and in a methamphetamine abuser tested 80 days after detoxification
  9. 9. Psychological issues Long-term users may experience: <ul><ul><li>mood disturbances </li></ul></ul><ul><ul><ul><li>depression and sucicidality </li></ul></ul></ul><ul><ul><ul><li>anxiety and panic attacks </li></ul></ul></ul><ul><ul><li>sleep disturbances </li></ul></ul><ul><ul><ul><li>insomnia/hypersomnia </li></ul></ul></ul><ul><ul><ul><li>reduced slow wave sleep </li></ul></ul></ul><ul><ul><ul><li>poor sleep continuity </li></ul></ul></ul><ul><ul><li>paranoia </li></ul></ul><ul><ul><li>problems controlling anger and violent behavior </li></ul></ul><ul><ul><li>hallucinations and psychosis </li></ul></ul>
  10. 10. Iboga alkaloids and METH – scientific research <ul><li>Iboga agents augment both the locomotor and stereotypic effects of METH in a manner consistent with previous reports for cocaine </li></ul><ul><li>Reverse the behavioral disinhibiting and corticosterone effects of acute meth in rats </li></ul><ul><li>Reduces IV METH self-administratration in rats, but least effective compared to other drugs tested </li></ul>
  11. 11. Ibogaine and methamphetamine Three treatment providers’ experiences
  12. 12. Jeffrey Kamlet, MD <ul><li>Has treated many people for methamphetamine dependency and abuse </li></ul><ul><li>Estimates about 50% are able to achieve long-term abstinence with effective aftercare </li></ul><ul><li>Long-term abstinence unlikely without aftercare </li></ul><ul><li>More receptive to treatment/therapy following ibogaine </li></ul>
  13. 13. <ul><li>Recommend individualized therapy following treatment </li></ul><ul><ul><li>Different patients respond better to different kinds of treatment/therapy based on their particular needs </li></ul></ul><ul><li>Be aware of physical health – METH addicts frequently in poor shape </li></ul><ul><ul><li>cardiac problems </li></ul></ul><ul><ul><li>pre-Parkinsonian symptoms </li></ul></ul><ul><li>Some METH users may not be able to take full advantage of “spiritual experience” because of poor health </li></ul>
  14. 14. <ul><li>Since METH withdrawal symptoms are less tangible than opiates, more difficult to say how ibogaine affects them post treatment </li></ul><ul><li>Suggests a week of stabilization prior to treatment, at least 5 days </li></ul><ul><ul><li>off METH </li></ul></ul><ul><ul><li>good nutrition and hydration </li></ul></ul><ul><ul><li>cardiac work-up </li></ul></ul><ul><li>Proper nutrition very important to restore physical and psychological health </li></ul><ul><li>Patients should be informed they are likely to feel “unwell” for 3 - 6 months </li></ul>
  15. 15. Eric Taub <ul><li>Has treated several stimulant users, 2 or 3 for METH specificially (most have been for cocaine) </li></ul><ul><li>Stimulant users usually younger (under 35) </li></ul><ul><ul><li>have lost less compared to older addicts </li></ul></ul><ul><ul><li>less responsibility </li></ul></ul><ul><ul><li>feeling of invincibility - “I don’t need therapy” </li></ul></ul><ul><li>Ibogaine increases treatment readiness </li></ul><ul><li>Less of “the equation” than with opiates </li></ul><ul><li>Ibogaine seems to help with withdrawal related anxiety, but not hypersomnia </li></ul>
  16. 16. <ul><li>70 – 80 % success with effective aftercare </li></ul><ul><li>New environment very important post-ibogaine </li></ul><ul><ul><li>90% relapse rate if they return home to same environment </li></ul></ul><ul><ul><li>Visual and behavioral cues more salient than with opiates </li></ul></ul><ul><li>Must engage in therapy of some kind post-ibogaine </li></ul><ul><ul><li>address issues that led to dependence </li></ul></ul><ul><ul><ul><li>abandonment (real or emotional) by same-sex parent </li></ul></ul></ul><ul><ul><li>must admire and respect therapy provider </li></ul></ul><ul><ul><li>explore emotions that have been repressed </li></ul></ul>
  17. 17. Sara Glatt <ul><li>Limited experience treating METH problems </li></ul><ul><li>About 50% success rate </li></ul><ul><li>Sees quicker recovery in those who eat nutriously </li></ul><ul><ul><li>phenylalanine </li></ul></ul><ul><ul><li>melatonin </li></ul></ul><ul><ul><li>s oya proteins </li></ul></ul>
  18. 18. <ul><li>People with external motivations (job, drug test) faired better in short term </li></ul><ul><ul><li>addictions research shows external motivation unlikely to produce long-term success without internal motivation </li></ul></ul><ul><li>People who’s family paid for treatment didn’t do as well </li></ul><ul><ul><li>lack of internal motivation? </li></ul></ul><ul><li>Long term outcomes unknown </li></ul>
  19. 19. Discussion <ul><li>Ibogaine seems to be an effective tool in the treatment of METH dependence, though not as effective as for opiates </li></ul><ul><ul><li>The suppression of opiate withdrawal symptoms may give opiate users more of a feeling of a “clean break” from their habits </li></ul></ul><ul><li>Aftercare is important in all ibogaine treatment, but this seems especially true for METH </li></ul><ul><ul><li>Behavioral cues or triggers seem more of a challenge </li></ul></ul><ul><ul><ul><li>Makes sense as stimulants act primarily on pleasure-reward system involved in classical and instrumental conditioning </li></ul></ul></ul>
  20. 20. <ul><li>METH users tend to have different demographic characteristics </li></ul><ul><ul><li>younger </li></ul></ul><ul><ul><li>typically newer dependent </li></ul></ul><ul><ul><li>may be more treatment resistant, ibogaine seems to help with this </li></ul></ul><ul><li>Nutrition especially important </li></ul><ul><ul><li>reverse effects of anorexia-related malnutrition </li></ul></ul><ul><ul><li>stimulants more physiologically damaging than opiates </li></ul></ul>
  21. 21. Future research <ul><li>Effect of ibogaine on salience of visual and behavioural cues </li></ul><ul><ul><li>Classical conditioning: </li></ul></ul><ul><ul><ul><li>suppresion ratio following ibogaine </li></ul></ul></ul><ul><ul><li>Instrumental conditioning: </li></ul></ul><ul><ul><ul><li>response rate following ibogaine </li></ul></ul></ul><ul><li>Effect of ibogaine on withdrawal symptoms </li></ul><ul><ul><li>polysomnograph to measure sleep disturbances </li></ul></ul><ul><ul><li>measures of craving and anxiety </li></ul></ul>
  22. 22. For references, questions, or general harrassment, email: [email_address]

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