A review of the available literature and treatment experiences by Jonathan Freedlander, MA Cand Towson University Ibogaine and methamphetamine

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 , METH related visits to hospital emergency departments (EDs) rose from 12,496 to 21,644

Pharmacology dopaminergic agonist attenuate dopamine transporter (DAT) clearance efficiency, thereby increasing synaptic dopamine (DA) levels activates classical reward circuitry

Methods of administration METH can be insufflated (snorted), injected, smoked (“ice”), taken orally (uncommon)

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

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

After 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

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

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

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

Ibogaine and methamphetamine Three treatment providers’ experiences

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

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

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 months

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

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

Sara Glatt Limited experience treating METH problems About 50% success rate Sees quicker recovery in those who eat nutriously –phenylalanine –melatonin –soya proteins

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

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

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

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

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