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Cosm

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