Methadone

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  • This presentation was made during the During Workshop D1, “Medicated Assisted Treatment in Different Practice Settings: Patients’ Perspectives” as part of the National Alliance of Methadone Advocates’ (NAMA) conference participation on April 15, 2003, at the American Association for the Treatment of Opioid Dependence Conference (AATOD) held in Washington, DC. April 13 - 16, 2003.
  • The principal source of ibogaine is in the bark of the root of Tabernanthe iboga.
  • Based on the writing of Link BG & Phelen JC, “On Stigma and Public Health Implications. Columbia University, 2001. <http://www.stigmaconference.nih.gov/papers.html>
  • A brief discussion to the responses of these questions will be reviewed during the workshop to provide insight as to how and where stigma and discrimination are attached or directed towards patients and providers alike with methadone itself in this venue remaining neutral.
  • Workshop participants will be asked if they have a copy of the manual. If everyone has a copy, fine. If not, those who do not want the manual will be asked to give their copy to someone who wants a copy. This resulted in some participants requesting second copies of the Manual for associates not in attendance at the workshop.
  • Methadone

    1. 1. Methadone and Ibogaine A Historical Comparison of Patient Status and Advocacy Issues Howard S. Lotsof
    2. 2. Background: Drug Control <ul><li>• 1906 Pure Food and Drug Act </li></ul><ul><li>• 1914 Harrison Narcotic Act </li></ul><ul><li>• 1970 Controlled Substances Act </li></ul>
    3. 3. Background: Methadone <ul><li>• 1937 synthesized by Max Bockmühl and Gustav Ehrhart, I.G. Farbenindustries. Patent issued 1941 </li></ul><ul><li>• 1950 use in treatment of opioid abstinence syndrome established in US </li></ul><ul><li>• 1964 use in opioid maintenance therapy </li></ul>
    4. 4. Methadone molecule
    5. 5. Methadone powder
    6. 6. Methadone diskets
    7. 7. Methadone liquid
    8. 8. Background: Ibogaine An experimental medication <ul><li>• Botanical source Tabernanthe iboga. Used for 100s of years in African medicine and religion </li></ul><ul><li>• 1901 ibogaine isolated by Dybowski and Landrin </li></ul><ul><li>• 1958 molecular structure determined Bartlett et al. </li></ul><ul><li>• 1962 Lotsof discovers Antiaddictive effects </li></ul>
    9. 9. Ibogaine molecule
    10. 10. Tabernanthe iboga shrub
    11. 11. Roots contain ibogaine
    12. 12. Pharmaceutical ibogaine experimental medication
    13. 13. Discovery of antiaddctive effects <ul><li>Methadone </li></ul><ul><li>NYC </li></ul><ul><li>1964 </li></ul><ul><li>Doctors administer to drugs users </li></ul><ul><li>Ibogaine </li></ul><ul><li>NYC </li></ul><ul><li>1962 </li></ul><ul><li>Drug users administer to drug users </li></ul>
    14. 14. Methadone <ul><li>The golden age of Dole and Nyswander </li></ul><ul><li>1966 - 1973 </li></ul>
    15. 15. Drs. Dole and Nyswander ca 1976
    16. 16. Early generation methadone patients <ul><li>The program was administered or controlled by doctors in a medical research environment even at the clinic level. </li></ul><ul><li>Nurses, counselors and patients believed in opioid maintenance therapy and collaborated to make it work. Patients and staff were a team. </li></ul><ul><li>There was no “us” and “them”. Patients were treated like any other medical patients. </li></ul>
    17. 17. Early generation ibogaine patients <ul><li>A full collaboration between academic researchers, pharmaceutical developers and user self-help groups with mutual respect. </li></ul><ul><li>Equal status between the parties. Users, doctors and drug developers worked together to define the ideal administration paradigm. </li></ul><ul><li>There was no “us” and “them”. Patients were treated just like any other medical patients, except when they were treated like doctors. </li></ul>
    18. 18. Later generation ibogaine patients <ul><li>Drug users are no longer involved as equal participants in ibogaine development. </li></ul><ul><li>Drug users and self-help groups, no longer affiliated with medical academics or drug developers, lost a level of authority and control. </li></ul><ul><li>Ibogaine patients are not dependent on clinic administered drugs. Ibogaine providers generally leave the field rather than control or abuse patients. This could change in the future. </li></ul>
    19. 19. What’s wrong with methadone today? <ul><li>Nothing is wrong with methadone. </li></ul><ul><li>Almost something is wrong with many clinics that administer and provide it to patients. </li></ul><ul><li>Medical decisions are often not made by medical doctors. </li></ul><ul><li>Many clinics practice control of patients rather than providing them with ethical medical care. </li></ul>
    20. 20. Two important issues in methadone today <ul><li>Stigma </li></ul><ul><li>Discrimination </li></ul>
    21. 21. Stigma Focuses attention on the victim
    22. 22. Discrimination: Focuses attention on those who produce rejection and exclusion
    23. 23. Attention patients, counselors or methadone providers If you are a methadone counselor or provider, please think for a moment and write on a piece of paper the words that come to mind when you think of methadone patients. If you are a methadone patient, please think for a moment and write on a piece of paper the words that come to mind when you think of methadone counselors, administrators or providers.
    24. 24. Methadone 1.3 Internet program. Runs only on PCs will not run on a mac.
    25. 25. Whether you are a patient, counselor or methadone provider, now write the words that come to mind when you view the methadone internet program.
    26. 26. Workshop Manual <ul><li>Lotsof/Dole letters </li></ul><ul><li>Early Dole methadone paper </li></ul><ul><li>History of Methadone </li></ul><ul><li>Methadone patient reports </li></ul><ul><li>Methadone physician reports </li></ul><ul><li>Methadone research bibliography </li></ul><ul><li>Review of Stigma and Discrimination </li></ul><ul><li>Ibogaine patient experience </li></ul><ul><li>History of ibogaine </li></ul><ul><li>Ibogaine pharmacology </li></ul>

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