Date: Wed, 14 Jan 1998 13:42:07 EST
From: Chris Jenks <infinity@sj.bigger.net>
To: Multiple recipients of list <ibogaine@ibogaine.org>
Subject: Full Sheppard Article (1/2)
Journal of Substance Abuse Treatment, Vol. 11, No. 4, pp. 379-385, 1994
Copyright (C) 1994 Elsevier Science Ltd
Printed in the USA. All rights reserved
0740-5472/94 $6.00 + .00
INTERNATIONAL PERSPECTIVE
A Preliminary Investigation of Ibogaine:
Case Reports and Recommendations for Further Study
Simon G. Sheppard, BSc
Hirez, Amsterdam, The Netherlands
Abstract - A naturally occurring substance, ibogaine, was taken by seven
individuals who were addicted to opiates. Ibogaine, an alkaloid with
psychotropic effects at doses of 200-300 mg and above, was taken in single
doses of 700-1800 mg by the subjects in the study. At the end of the
24-38-hr psychoactive period induced by the drug at these doses, none of
the subjects displayed significant opiate withdrawal symptoms. At the
lowest dose of 700 mg, one subject recontinued his drug abuse after 2 days;
of the remaining six individuals who took 1,000 mg or above, two relapsed
after a number of weeks, one reverted to intermittent heroin use, and three
appear to have remained drug-free 14 weeks or more after undergoing this
experimental treatment. Ibogaine may be of value in the present and could
serve as a model for the development of improved agents for the treatment
of substance abuse in the future.
Keywords - addiction; detoxification; heroin dependence; opiate withdrawal;
substance abuse; substance withdrawal syndrome.
INTRODUCTION
The regular taking of heroin is an evident problem in many cities with an
array of associated problems including homelessness, crime, and damage to
health. Individuals who have been heroin-dependent for long periods often
desperately wish to end their addiction but cannot, and prolonged substance
dependence can lead to death.
Following reports that a nonaddictive plant extract was capable of
rapidly arresting opiate dependence, an informal study by an autonomous
group of researchers, a "Skunk Works" originating from the Amsterdam
squatter community, was undertaken.
Hirez is a loosely knit organization founded by the author that has
undertaken valuable research work, which may be of especial interest
because of its unconventional nature, in the fields of virology and
substance abuse.
Background to Ibogaine
The indole alkaloid ibogaine naturally occurs in the root bark of the
plant Tabernanthe Iboga, which is native to equatorial Africa. The plant is
a rich source of a dozen or more alkaloids, and the root bark is consumed
in huge quantities in raw, ground form during ceremonies of the Bwiti and
Mbiri cults of Gabon and Kameroon. The quantity consumed can be up to 60
times the threshold dose of ibogaine (Fernandez, 1982), and a number of
fatalities have occurred, reportedly chiefly among initiates of low body
weight. The ritual has been termed "cracking the skull." The root of Iboga
is also regularly used in smaller quantities to enable hunters and warriors
to remain awake while standing motionless for long periods.
Ciba-Geigy performed some detailed pharmacological and toxicological
studies on ibogaine and the ability of the substance to potentiate morphine
analgesia was documented in an early study (Schneider & McArthur, 1956). An
extensive French-language review of the chemistry and pharmacology of the
alkaloids of Tabernanthe Iboga is available (Gaignault & Delourme-Houde,
1977), and this includes 121 references to the literature relating to
ibogaine published between 1864 and 1975. In the review, several
therapeutic applications of ibogaine are detailed at doses of 10-30 mg
together with a summary of previous investigations of ibogaine's mechanisms
of action on the central nervous system. Similarities are drawn, at least
as far as the ability to modulate serotonin and the catecholamines are
concerned, between ibogaine and 2-bromo LSD.
In the 1960s Lotsof became aware of the apparent ability of ibogaine to
interrupt dependence on heroin and cocaine. It is a controlled substance in
Belgium and the United States, and for this reason several U. S. citizens
have been brought to Holland to undergo treatment with the substance. The
method of treatment with the drug to arrest addiction to opiates,
amphetamine, alcohol, and nicotine is the subject of a number of U. S.
patents held by Howard S. Lotsof.
Although ibogaine is the principal alkaloid of the Iboga plant, it is
also obtainable from parts of the Voacanga plant. Investigations undertaken
for this study show that ibogaine would be present in Voacanga seeds, Iboga
whole root, and Iboga root bark at less than 0.007%, 0.02% and 0.1% w/w,
respectively, neglecting any stable derivatives of ibogaine which may be
present. The total synthesis of ibogaine has been accomplished (Buchi,
Coffen, Kocsis, Sonnet, & Ziegler, 1966; Duc & Fetizon, 1969), although in
practical terms isolation and purification from Iboga plant material is the
most obvious source of ibogaine (Dickel, Holden, Maxfield, Paszek, &
Taylor, 1958). Much of the previous information was unknown to us during
the early part of the study, and neither did we fully appreciate at the
time that what we were doing was not so short of a Phase 2 trial of a new
and experimental treatment.
MATERIAL AND METHODS
Some accounts have tended to dwell on the primary effects of ibogaine: the
lucid visions and emergence of repressed memories that are experienced by
individuals taking the substance at high doses. Notwithstanding the
enormous difficulties of maintaining contact and monitoring the drug use of
individuals for extended periods after taking ibogaine, it was our primary
objective to document the secondary, long-term effects of ibogaine on
opiate consumption in the weeks and months subsequent to taking the drug.
The author and two other primary workers undertook this study with a number
of other trusted individuals assisting at various stages. By these means we
observed and documented the immediate and longer-term effects at high doses
of ibogaine on the subjects in this study.
It would have been impractical for us in the circumstances of this study
to have attempted a routine objective assessment of the subjects' hard drug
use after taking ibogaine, for example, by obliging the subjects to undergo
regular urine analysis, but nevertheless we believe that the reports and
observations of the subjects' drug use subsequent to taking ibogaine are an
accurate reflection of the true situation. By this time the subjects had
become well known to us, and we cite the frank admissions by some of the
subjects of a small sporadic amount of drug abuse after taking ibogaine,
which we attribute to residual habit, as evidence of the authenticity of
the remainder of the reports and observations. It is admitted, however,
that the present study is flawed in this respect. In any event, because it
was directly and repeatedly observed by the primary workers in this study,
we believe that there can be no doubt about the essential loss of opiate
craving and absence of withdrawal (commonly referred to as "cold turkey")
experienced by the subjects in the immediate period after taking a single
high dose of ibogaine.
Documented in this study are six heroin-addicted individuals and one
subject who was addicted to codeine. The subjects took ibogaine at doses
ranging from 700 to 1,800 mg (Table 1). With the exception of one Swiss and
one British subject, all of the subjects were Dutch. All had expressed a
desire to end their drug abuse, and the ibogaine was orally
self-administered in each case. The first six subjects took organically
derived ibogaine hydrochloride, which was independently confirmed as being
of greater than 98% purity. The remaining subject, NL7, was treated from a
second batch of ibogaine of identical origin. The dosages were normally in
the form of previously prepared 100-mg or 200-mg capsules. In each case the
subject was counseled and took a dose of ibogaine, either 100 mg or 200 mg,
followed 1-2 hr later by the remainder of the dose.
TABLE 1
Subject Data and Treatment Dosages
Subject Age Sex Weight Addiction Ibogaine dosage
NL1 32 M 65 kg Heroin (250 mg/d) 1,600 mg
Methadone (65 mg/d)
Alcohol
NL2 25 F 48 kg Heroin (250 mg/d) 1,200 mg
CH1 21 M 60 kg Heroin 700 mg
NL3 33 M 72 kg Heroin 1,800 mg
Methadone (30 mg/d)
NL4 25 F 49 kg Heroin (1,000 mg/d) 1,000 mg
Methadone
UK1 39 M 68 kg Codeine (100-250 mg/d) 1,000 mg
NL7 30 M 70 kg Heroin 1,100 mg
Alcohol
/d = Subjects' claimed daily drug intake. There was little or no attempt to
verify the subjects' precise intake prior to taking ibogaine. Where no
amount appears, the data were not obtained.
RESULTS
Four individuals with whom contact was lost do not appear in this study,
one of these (NL5), a male who was addicted to heroin, was reported to have
been drug-free for 5 days after taking a 1,000-mg dose of ibogaine. Further
contact could not be maintained. Besides NL5, three other individuals are
known to have taken ibogaine under some sort of supervision, but no further
data were available to us. Loss of contact with these individuals was due
in each case to existing subjects in the study attempting to enlist others
into it.
The general pattern of effects following ingestion were as follows. About
1 hr after administration of the total dose, the subject would experience
decreased muscular coordination, increased sensitivity to light, and might
see visions. Around half of the subjects experienced nausea and vomiting
during the early stages of ingestion. The elevated, hallucinogenic state
would continue for 4-8 hr, after which they would enter a contemplative
phase interspersed with light sleep, which would last for 12-24 hr. It was
during this period that lucid dreaming and emergence of repressed memories
occurred. Finally the primary effects of ibogaine terminated with a deep
sleep of about 4 hr. None of the subjects experienced significant opiate
withdrawal symptoms on waking.
Emergence of the subject from the primary effects of ibogaine, lasting
24-38 hr, was characteristic; all subjects emerged full of vitality, and
withdrawal symptoms were limited to slight nose flood, sweating, and
sensations of cold in some cases. In no instance did severe withdrawal take
place as might have been expected from the extended abstinence of the
subject from his or her drug of addiction during the long treatment period.
Increased energy, appetite, and a reduced requirement for sleep was evident
for several weeks after taking ibogaine, with these effects diminishing
slowly. Some of the subjects, notably NL3 and NL4, were reported to have
spent the money that had formerly been required to maintain their addiction
on clothes and mountain bicycles in the period immediately after undergoing
the ibogaine treatment. Many of the subjects commented that the treatment
environment was important to a successful outcome, and a comfortable
darkened room was considered to be ideal. It was obvious that ibogaine did
not suppress the desire to consume cannabis during the treatment period.
Three subjects, NL2, NL3, and NL4, when interviewed several months after
treatment, stated that it had taken them some months to come to terms with
the psychological effects of taking ibogaine. The drug probably exerts a
strong social influence in its areas of widespread use, possibly a cohesive
effect reinforcing the tribal and religious sects of the indigenous people
of Equatorial Africa. Several of our subjects had evidently been very
impressed by their experience, particularly the extended period of
emergence of repressed memories. None of the primary workers in this study
took ibogaine themselves, and so it remains purely a matter of speculation,
but it may be that the repeated, recreational use of ibogaine at moderate
doses could result in an enhanced ego and sensations of godliness. At the
higher doses typical of those used in the present study, however, it seems
that a proportion of individuals will thereafter have no desire to take
ibogaine again.
Physical side effects reported during the ibogaine treatment procedures
documented here include weight loss (NL3 4 kg, NL4 3 kg, NL7 3 kg), extreme
sensitivity to (red) color and sound (NL2), ataxia (NL2, NL3), diarrhea
(NL1, NL2, NL3, NL4, NL7), backache (NL7), and nausea and vomiting (CH1,
NL3, NL5). A strong aphrodisiac effect was reported by NL3 among others,
but in at least one subject (UK1, who was homosexual) this effect was
completely absent. Side effects that receded completely in the weeks after
treatment were concentration difficulties (NL2, NL4), sudden spells of
tiredness up to 2 weeks after treatment (NL4), sudden loss of coordination
and "going cross-eyed" up to 3 weeks after treatment (NL3), and insomnia
(NL3, NL4, NL7).
Case Reports
NL1 was probably the most severely addicted subject in the study and had
been abusing heroin for 12 years, except for 1 year during a residential
detoxification program. As well as daily injecting heroin and a regular
intake of methadone, he took alcohol to intoxication in 15 out of 30 days
prior to taking ibogaine and was inebriated with heroin and methadone at
the time of treatment. He took methadone shortly afterward "to see what it
was like" and, being dissatisfied with the effect, remained drug-free until
a trip to India. It was during this trip that his heroin abuse recontinued.
Three months later he expressed his desire to repeat the ibogaine treatment
but was unable to do so. This subject has been independently documented
(ICASH, 1990a).
NL2 was a partner of NL1 and had been abusing heroin for 4 years prior to
treatment, although a 15-month remission in her drug taking had occurred
that had ended 6 months previously. For 3 months prior to taking ibogaine,
she had been smoking heroin daily. The subject panicked, fearing
withdrawal, and took heroin during the treatment period, but it had little
effect. This subject has also been independently documented (ICASH, 1990a),
and a personal account of her experiences is in circulation (ICASH, 1990b).
Following an extended period after taking ibogaine during which she
remained drug-free, this subject reverted to intermittent use of heroin to
combat period pains, a level of consumption that she gave every indication
of being capable of sustaining.
CH1 had been sniffing heroin daily for over 12 months prior to treatment
and was being cared for and discouraged from heroin abuse by a nonaddicted
male friend in what appears in retrospect to have been a classic
addict/co-addict syndrome. CH1 had been injured in two industrial accidents
to which a contributing factor was his background of drug abuse and
intoxication at work. This subject took the lowest dose of all the subjects
but despite the treatment initially appearing to have an encouraging
outcome, drug abuse recontinued after only 2 days. He was observed for
several days 3 months after treatment and was entirely free of heroin use
during that time but the treatment was otherwise completely unsuccessful.