1 / 22

Ibogaine and methamphetamine

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

ivi
Télécharger la présentation

Ibogaine and methamphetamine

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

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

  2. Methamphetamineepidemiology • 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. Neurocognitive issues • After chronic drug abuse and during withdrawal, brain dopamine function is markedly decreased • can result in pre-Parkinsonian 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

  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. 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 Psychological issuesLong-term users may experience:

  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 • soya 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: jfreed1@umbc.edu

More Related