Exploratory Outcome Study of Ibogaine Therapy in 20 Subjects with Opiate Addiction Valerie Mojeiko...
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Transcript of Exploratory Outcome Study of Ibogaine Therapy in 20 Subjects with Opiate Addiction Valerie Mojeiko...
Exploratory Outcome Study of Ibogaine Therapy in 20
Subjects with Opiate Addiction
Exploratory Outcome Study of Ibogaine Therapy in 20
Subjects with Opiate Addiction
Valerie MojeikoMultidisciplinary Association for
Psychedelic Studies (MAPS) www.maps.org
Valerie MojeikoMultidisciplinary Association for
Psychedelic Studies (MAPS) www.maps.org
AgendaAgenda
What is ibogaine and where is it from? What does it do? What is this study about? What kind of results have we collected so
far?
What is ibogaine and where is it from? What does it do? What is this study about? What kind of results have we collected so
far?
Tabernanthe Iboga
Bwiti people
Howard Lotsof
Subjective EffectsSubjective Effects
Psychedelic that produces a dreamlike state Review of memories Experience lasts several days Many find it unpleasant, not a recreational drug Some experience psychological material related to addiction Greatly reduces physical and psychological withdrawal
symptoms from heroin, methadone, other drugs
Psychedelic that produces a dreamlike state Review of memories Experience lasts several days Many find it unpleasant, not a recreational drug Some experience psychological material related to addiction Greatly reduces physical and psychological withdrawal
symptoms from heroin, methadone, other drugs
Neurotransmitter ActivitiesNeurotransmitter Activities
Novel mechanism of action Complex interactions between multiple neurotransmitter
systems Mu-opiod agonist; NMDA antagonist; kappa opioid agonist;
serotonin 5ht2a agonist; serotonin uptake inhibitor; 5ht3 agonist; dopamine uptake inhibitor; sigma opioid receptor agonist
Novel mechanism of action Complex interactions between multiple neurotransmitter
systems Mu-opiod agonist; NMDA antagonist; kappa opioid agonist;
serotonin 5ht2a agonist; serotonin uptake inhibitor; 5ht3 agonist; dopamine uptake inhibitor; sigma opioid receptor agonist
RisksRisks Potentiates effects of other drugs in the body Several deaths have been reported probably
related to ibogaine Myocardial infarction (heart attack), deep vein
thrombosis (blood clots), unknown causes Around 1% (+/- 1) death rate suggested
Appears to be much more dangerous than any other psychedelic
Potentiates effects of other drugs in the body Several deaths have been reported probably
related to ibogaine Myocardial infarction (heart attack), deep vein
thrombosis (blood clots), unknown causes Around 1% (+/- 1) death rate suggested
Appears to be much more dangerous than any other psychedelic
Existing treatment facilities providing detoxification--not collecting information…
Existing treatment facilities providing detoxification--not collecting information…
How well does it work? How safe is it? What percentage of people benefit and
to what degree? How can these treatments be
improved? Should formal studies be conducted?
How well does it work? How safe is it? What percentage of people benefit and
to what degree? How can these treatments be
improved? Should formal studies be conducted?
MAPS’ Role: Evaluating program, providing feedback, and collecting data for research
Preliminary Data: June 2004: Iboga Therapy House: 2wks-1yr after tx
(avg. 6 months)
Preliminary Data: June 2004: Iboga Therapy House: 2wks-1yr after tx
(avg. 6 months) 20 subjects 6 of 7 treated for
Cocaine/Crack abstinent (86%)
3 of 8 treated for opiates abstinent (38%)
4/5 treated for other substances abstinent (80%)
20 subjects 6 of 7 treated for
Cocaine/Crack abstinent (86%)
3 of 8 treated for opiates abstinent (38%)
4/5 treated for other substances abstinent (80%)
0
1
2
3
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6
COC Alcohol Meth
AbstinentUsing
0
1
2
3
4
5
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COC Alcohol Meth
AbstinentUsing
How?How? This is an exploratory study to get preliminary
basic data--NOT a controlled study, but it is representative since we’re including 20 Subjects treated consecutively at a treatment center
One-year series of questionnaires and interviews from 20 subjects verified by interview with significant others
Harm reduction model: looking at abstinence as well as non-abstinence outcomes, trying to differentiate between abuse and controlled use
This is an exploratory study to get preliminary basic data--NOT a controlled study, but it is representative since we’re including 20 Subjects treated consecutively at a treatment center
One-year series of questionnaires and interviews from 20 subjects verified by interview with significant others
Harm reduction model: looking at abstinence as well as non-abstinence outcomes, trying to differentiate between abuse and controlled use
MeasuresMeasures
Addiction Severity Index (primary variable) Beck Depression and Anxiety Inventories Subjective and Objective Opiate Withdrawal
Scales (SOWS/OOWS) Visual Analogue Scale Pain Measure Peak Experience Profile Supplemental Surveys
Addiction Severity Index (primary variable) Beck Depression and Anxiety Inventories Subjective and Objective Opiate Withdrawal
Scales (SOWS/OOWS) Visual Analogue Scale Pain Measure Peak Experience Profile Supplemental Surveys
i P W2
1 2 3 4 5 6 7 8 9 10
11
12
ASI X X X X X X X X X X X X X
BDI/BAI X X X X X X X X X X X X X X
PEP X
O/SOWS X X X
Pain X X X X X X X X X X X X X X X
Surveys X X X X X X X X X X X X X X
SO check
X X X X X X X X X X X X X X X
Schedule for Outcome Measures
i=Intake; P=Post-treatment; W2=Week 2; 1-12=Months 1-12
ASI-Addiction Severity IndexASI-Addiction Severity Index
Semi-structured 1 hour interview Scores on 7 subscales: medical status,
employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status
Been used extensively on a wide variety of outcome studies
Semi-structured 1 hour interview Scores on 7 subscales: medical status,
employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status
Been used extensively on a wide variety of outcome studies
Peak Experience Profile (PEP)Peak Experience Profile (PEP)
180 items; one composite score; 16 subscores Developed in the 60s for Walter Pahnke’s Good
Friday experiment Used in LSD/Psilocybin studies with alcoholics,
heroin addicts, and cancer patients with anxiety Expanded later by Francesco Di Leo to include nadirs as well as peaks for a study on LSD and cancer
Di Leo hypothesized that people who had high scores on both peak and nadir would have greater benefit (unfinished)
180 items; one composite score; 16 subscores Developed in the 60s for Walter Pahnke’s Good
Friday experiment Used in LSD/Psilocybin studies with alcoholics,
heroin addicts, and cancer patients with anxiety Expanded later by Francesco Di Leo to include nadirs as well as peaks for a study on LSD and cancer
Di Leo hypothesized that people who had high scores on both peak and nadir would have greater benefit (unfinished)
ChallengesChallenges
No drug testing Difficulty of remaining in contact during
follow-up Check-in with significant other
addresses these concerns
No drug testing Difficulty of remaining in contact during
follow-up Check-in with significant other
addresses these concerns
So Far…So Far…
Five Subjects have enrolled in study 1 has maintained abstinence from opiates 4 have gone back to opiate use 2 dropped out of study early
Five Subjects have enrolled in study 1 has maintained abstinence from opiates 4 have gone back to opiate use 2 dropped out of study early
Subject 1001Subject 1001
36 year old male Problem substance: Methadone 38/mg/day 2 weeks after tx, client decided to resume
methadone maintenance at 19 mg/daily Proceeded to taper down By M8/V12 was abstinent again
36 year old male Problem substance: Methadone 38/mg/day 2 weeks after tx, client decided to resume
methadone maintenance at 19 mg/daily Proceeded to taper down By M8/V12 was abstinent again
Baseline= 1.8879Avg post-treatment=1.1462
Decrease=.7417
Baseline= 1.8879Avg post-treatment=1.1462
Decrease=.7417
Subject 1001Subject 1001
Subject 1002Subject 1002
54 yr old male Problem substance: Heroin 2.5/g/day Has achieved complete abstinence,
currently at V15
54 yr old male Problem substance: Heroin 2.5/g/day Has achieved complete abstinence,
currently at V15
Baseline Score=1.1631Avg score post-treatment=.423525
Decrease=.739575
Baseline Score=1.1631Avg score post-treatment=.423525
Decrease=.739575
Subject 1003Subject 1003
25 yr old female Problem substance: binge heroin use,
prescribed methadone 20mg/day, self prescribed hydrocodone 20-300 mg/day, oxycodone 240 mg/day
M1/V6 reported relapse at 40mg oxy/day Increased opiate use, began methadone
again
25 yr old female Problem substance: binge heroin use,
prescribed methadone 20mg/day, self prescribed hydrocodone 20-300 mg/day, oxycodone 240 mg/day
M1/V6 reported relapse at 40mg oxy/day Increased opiate use, began methadone
again
Baseline score=1.3353Average score post-treatment=1.3540
Increase=.0187Remove outlier, decrease=.17268
Baseline score=1.3353Average score post-treatment=1.3540
Increase=.0187Remove outlier, decrease=.17268
Subject 1004Subject 1004
51 yr old male Problem substance oxycodone 160-200
mg/day Car accident on way home from airport,
restarted oxycodone (20mg/day) to aid pain related to accident
Chose not to complete study
51 yr old male Problem substance oxycodone 160-200
mg/day Car accident on way home from airport,
restarted oxycodone (20mg/day) to aid pain related to accident
Chose not to complete study
Subject 1005Subject 1005
25 yr old male Problem substance: heroin 1g/day Reported relapse 1-2 weeks after treatment Chose not to complete study
25 yr old male Problem substance: heroin 1g/day Reported relapse 1-2 weeks after treatment Chose not to complete study
GoalsGoals
Obtain basic information about outcomes in underground clinics
How well does it work and under what conditions does it work best?
Does it work best in some subset of subjects more so than in others?
Ideally lead to placebo-controlled double-blind studies, or not
Obtain basic information about outcomes in underground clinics
How well does it work and under what conditions does it work best?
Does it work best in some subset of subjects more so than in others?
Ideally lead to placebo-controlled double-blind studies, or not
ConclusionConclusion
Ibogaine is an unusual psychedelic For addiction: works for some people,
doesn’t work for others Don’t have a large enough sample yet
to know what is different about people for whom it works
Ibogaine is an unusual psychedelic For addiction: works for some people,
doesn’t work for others Don’t have a large enough sample yet
to know what is different about people for whom it works