Date: Wed, 14 Jan 1998 13:42:22 EST
From: Chris Jenks <infinity@sj.bigger.net>
To: Multiple recipients of list <ibogaine@ibogaine.org>
Subject: Full Sheppard Article (2/2)
NL3 had a long history of hard drug abuse, being addicted to heroin for
12 years and both heroin and methadone for 4 years prior to treatment with
ibogaine. He also had a hepatitis condition. Heroin was being injected
intravenously up to and including the eve of treatment with ibogaine. This
subject took the highest dose of all the subjects and experienced the most
marked side effects, including temporary paralysis of the leg 3 days
posttreatment. The duration of ibogaine psychoactivity was also
particularly long. The subject smoked heroin three times against insomnia
shortly after treatment but otherwise completely abandoned his addiction to
both heroin and tobacco, also reporting a reduced alcohol consumption in
the months after taking ibogaine.
NL4 was a partner of NL3 and had been addicted to heroin for 6 years,
smoking heroin daily at the time of treatment. Ibogaine psychoactivity
lasted 38 hr with no nausea. She suffered concentration difficulties for
over a month after taking ibogaine, saying that she was "very
introspective" during this period. The subject also gave up tobacco and
said that she feels relieved and happy to be free from her heroin
addiction. Her gain in weight and general healthy appearance several weeks
after taking ibogaine was the topic of some comment.
UK1 was a worker in a medical environment, giving him ready access to the
codeine tablets to which he had become addicted. He was an experienced drug
user and had been addicted to heroin several years previously. He was the
only subject to have taken ibogaine while not under immediate supervision.
The substance was taken according to written instructions, and he spent
most of the treatment period alone and in a contemplative mood. A
liveliness characteristic of the immediate aftereffects of ibogaine was
evident when the subject was seen a few days later, at which time he
reported that he had been able to cease his codeine consumption
immediately. His alcohol consumption also fell. He likened his sense of
rejuvenation after taking ibogaine to that felt after a 2-week holiday abroad.
NL7 had been addicted to heroin for 10 years. He was smoking heroin
several times a day immediately before taking ibogaine. He was
sympathetically cared for by NL3 and NL4 and stayed with them for several
days after the treatment. He took heroin once during this period of care,
subsequently flushing a remaining quantity of heroin down the toilet. His
alcohol consumption also fell. Some weeks later NL7 cheerfully reported
that the "highs" he now experienced from heroin were clearer and more
enjoyable: "It was like starting again from the beginning." Later he
expressed a desire to repeat the ibogaine procedure, but by this time our
supplies of the drug were exhausted. Seventeen weeks after taking ibogaine,
his addiction to heroin was approximately as severe as it had been
immediately prior to treatment.
DISCUSSION
Treatment with ibogaine visibly alleviates morbidity and appears to remove
an addicted individual's desire to seek and use narcotics. Several subjects
took heroin again shortly after treatment but found the effect to be
unsatisfying; ibogaine may possess some subtle, short-term antagonistic
effect on subsequent opiate use. Many of the subjects also stopped smoking
or excessive alcohol consumption after the treatment. Some of the subjects
found the idea of undertaking the treatment an attractive proposition to
which a contributory factor was the natural origin of ibogaine. Others were
surprisingly cautious about taking another drug, considering their existing
regular drug intake, and suspicions that we were attempting to get them
hooked on another drug were occasionally voiced.
The side effects of ibogaine both during and after treatment are almost
certainly dose-related, and differing opinions emerged during the latter
part of the study as to the dosage and treatment strategy that should be
recommended to individuals who wish to take ibogaine in an attempt to
arrest their drug dependence. It became the view of the author of this
report that the dosages recommended by the U. S. proponents of ibogaine
were excessive. It is with regret that sufficient supplies of the substance
were not available to us to try an alternative approach, such as short-term
maintenance therapy with dosage levels just sufficient to allay opiate
withdrawal symptoms. However, in the strategy utilized in this study, it
must be admitted that high doses did appear to have a significant influence
on whether the subject achieved a successful interruption in drug abuse.
Taking just one example from our data, the Swiss subject CH1 received the
lowest dose of all the subjects, and his treatment gave the least
satisfactory outcome. Such a trend might already be observable in the small
number of subjects documented here (Table 2), but the number of subjects in
this study is considered to be inadequate for any serious statistical
analysis.
Some individuals may be hypersensitive to ibogaine, and for this reason a
trial dose of 100 mg or 200 mg was invariably given to our subjects prior
to ingestion of the remaining, larger part of the dose. We have received
reports of two fatalities that have occurred while taking ibogaine: in the
United States a person taking an unknown dose committed suicide, and in
France a young woman experienced breathing difficulties approximately 4 hr
after ingestion of 400 mg. In this instance the drug was being used as an
adjunct to group psychotherapy and the possibility that multiple drugs were
involved has been raised. From early investigations by Ciba using doses of
50-300 mg, ibogaine is known to provoke variable responses between
different individuals and in the same individual when administered on
different occasions. It was suggested that this may be due to slow and
irregular absorption of the drug when taken by the oral route and that this
complication can be obviated by parenteral administration. In comparison
with the 25 mg/kg elevated doses taken by some of the subjects in this
study however, such considerations may seem subtle.
TABLE 2
Ibogaine Dosage/Weight Ratio and Treatment Outcomes
Subject DWR Outcome
NL1 24.6 Took methadone 2 days p/t
To 10 weeks p/t confirmed d-f
Relapse to regular heroin use 11-12 weeks p/t
12 months p/t total relapse, worsening
NL2 25.0 Took heroin once during treatment
Confirmed d-f to 3 months p/t
4 months p/t intermittent heroin use
8 months p/t intermittent heroin use
10 months p/t intermittent heroin use
12 months p/t apparently healthy
CH1 11.7 2 days p/t relapse to regular heroin use
3 months p/t 5 days observed d-f
8 months p/t injecting heroin
NL3 25.0 Took heroin 3 times in 2 weeks p/t
Otherwise, to 18 weeks p/t confirmed d-f
NL4 20.4 To 17 weeks p/t confirmed d-f
UK1 14.7 To 1 month p/t confirmed d-f
To 14 weeks p/t confirmed d-f
NL7 15.7 Took heroin 4-5 times in 3 weeks p/t
6 weeks p/t "needs retreatment"
10 weeks p/t almost daily heroin use
17 weeks p/t taking methadone
DWR = Dosage/Weight Ratio: dosage of ibogaine divided by the subjects' body
weight, in mg/kg. p/t = posttreatment. d-f = drug-free, no hard drug
consumption up to and including the observation date except in the
instances stated. The treatments took place between October 1989 and August
1990.
If a second study involving ibogaine were to be undertaken, one
potentially promising strategy may be to offer the subjects incremental
doses of ibogaine until their opiate cravings were successfully displaced;
this approach might minimize the side effects and risk of psychological
trauma associated with high doses and still be effective. We would also
attempt to devise a controlled study using the Himmelsbach Scale to measure
the degree of withdrawal experienced by the subjects. A more obvious but
very probably unsatisfactory approach would be to use another psychotropic
substance, for example, the psilocybin that ibogaine possibly most
resembles in some of its effects, as the control substance. This latter
strategy would be likely to be fraught with difficulties, not least the
possibility of physical danger to a member of the control group undergoing
acute opiate withdrawal. The design of a truly controlled and ethical trial
of a substance like ibogaine, which is strongly psychoactive at its
therapeutic dose, could be regarded as a challenging academic exercise.
Besides contention about the dose, conflict also arose within the study
group during the final stages of the study due to the strong view of one of
the primary workers that approval from the subjects should be sought before
circulation or publication of any documentation. This was considered by the
author to be irrelevant at the time of compilation of the first draft of
this report and in some respects inadvisable. It was also proposed that the
nationalities of the subjects and the personal relationships between them
should be withheld from the report. The recriminations and bad feeling
resulting from these disagreements account to a large extent for the delay
in submitting this information in a form suitable for publication. In
actuality the commitment of the author to documenting ibogaine's activity
was originally instigated at the direct and concerted request of NL2, NL3,
and NL4.
There are considered to be a number of possible modes of action of
ibogaine, some or all of which may contribute to its ability to interrupt
opiate (and other) addictive syndromes:
1. suggestive, the placebo effect
2. metaphysical, in that the subject is carried away on a "trip" and
returns to a new beginning
3. physical/psychological, in that the vomiting and physical emptying give
a sense of cleanliness and renewal
4. physically psychological, an "endorphic reset" such that the receptors
responsible for addiction are reset to their normal, nonaddicted state.
It is not the objective of the present study to investigate the complex
actions and interrelations of various neural receptors and here a
simplistic mechanism of central endorphin stimulation is assumed. If it is
the case that ibogaine possesses an ability to rapidly restore endorphin
production to a level sufficient to allay opiate withdrawal, this property
may be linked in some way to its strong aphrodisiac properties. This effect
of ibogaine has been known for many years and was independently (because it
was not included in our counseling) remarked upon by some of the subjects.
Opiate-addicted individuals show a marked disinterest in sex; their normal
sexual/pleasure-seeking drives have apparently been efficiently satisfied
by the synthetic endorphin analogue upon which they have become dependent.
A similar correspondence in neural mechanisms might be inferred from the
fact that naltrexone, an opiate antagonist, has been successfully used to
give long-term therapeutic benefit in the treatment of the self-injurious
behavior (SIB) that is frequently to be found in womens' prisons,
childrens' homes and institutions for the mentally ill or disadvantaged
(Barrett, Feinstein, & Hole, 1989). This association between self-injury
and hard drug abuse might point to a physical psychological origin of the
destructive drive displayed by individuals who allow themselves to become
caught up in addictive syndromes.
CONCLUSION
Some reports have suggested that ibogaine may possess a superior efficacy
in the treatment of cocaine addiction, but no attempt was made in the
present study to test this claim. After observing ibogaine's effect on
addicted individuals, some of whom were in an advanced and severe state, we
believe that the risks of taking ibogaine can be outweighed by the
advantages. Claims by Lotsof (1986, 1991) that hard drug use is interrupted
for 6 months cannot be substantiated by this preliminary data, but a
remission in hard drug use could perhaps be reliably achievable.
From a pragmatic point of view, the withdrawal-attenuation effect alone
should warrant further investigation of the therapeutic action of ibogaine
in treating opiate dependence. If, as we believe, a temporary interruption
in drug abuse can reproducibly be obtained with the drug, this would
provide a valuable opportunity for reflection and self-appraisal for
individuals who have lost control of their addiction. At this stage also,
serious physical disorders are sometimes found that had hitherto been
completely masked by narcosis. At the very least ibogaine treatment could
provide an occasion for a review of personal health for individuals who
would otherwise be in a state of acute and intractable opiate dependence.
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R. Heeck and C. Swart BSc would have been attributed with secondary
authorship of the study had it been possible to obtain their final approval
of this report. Acknowledgments are also due to Dr. C. J. Olliff and L.
Martz, who, among a number of others, greatly assisted at various stages of
the study.
Requests for reprints should be addressed to Simon G. Sheppard, BSc,
Hirez, Postbus 3707, 1001 AM Amsterdam, The Netherlands.
Received June 10, 1993; Revised November 10, 1993; Accepted March 8, 1994.