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Exploratory Outcome Study of Ibogaine-Assisted Therapy in 20 Chemically-Dependent Persons Valerie Mojeiko Multidisciplinary Association for Psychedelic Studies (MAPS) www.maps.org Tabernanthe Iboga Ibogaine Outcome Study, V. Mojeiko 1 Ibogaine Outcome Study, V. Mojeiko 2 Ibogaine Outcome Study, V. Mojeiko 3 Howard Lotsof Ibogaine Outcome Study, V. Mojeiko 4 Subjective 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 Ibogaine Outcome Study, V. Mojeiko 5 Neurotransmitter 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… Ibogaine Outcome Study, V. Mojeiko 6 Where do addicts take ibogaine? Ibogaine Outcome Study, V. Mojeiko 7 Hotel Rooms Ibogaine Outcome Study, V. Mojeiko 8 At Home Ibogaine Outcome Study, V. Mojeiko 9 Iboga Therapy House, Canada Ibogaine Outcome Study, V. Mojeiko 10 Ibogaine Treatment Options Tribal Bwiti Underground Hotel Rooms Medical/Therapeutic At Home Bwiti-Inspired Clinics Iboga Therapy House Govt is supportive Harm Reduction Model Others No regulations on ibogaine in Canada Applied for grant Ibogaine Outcome Study, V. Mojeiko 11 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? MAPS’ Role: Evaluating program, providing feedback, and collecting data for research Ibogaine Outcome Study, V. Mojeiko 12 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%) 6 5 4 3 Abstinent Using 2 1 0 COC Opiate Alcohol Pot Meth Comb. Ibogaine Outcome Study, V. Mojeiko 13 Exploratory Outcome Study • Seeking to obtain basic preliminary data • Not a controlled study, but is representative since including 20 Subjects treated consecutively • 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 Ibogaine Outcome Study, V. Mojeiko 14 ASI-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 Ibogaine Outcome Study, V. Mojeiko 15 Peak Experience Profile (PEP) • Measures the psychedelic experience • 180 items; one composite score; 16 subscores • Scores for peaks (highs) and nadirs (lows) Ibogaine Outcome Study, V. Mojeiko 16 Measures • Addiction Severity Index (primary variable) • Peak Experience Profile • Beck Depression and Anxiety Inventories • Subjective and Objective Opiate Withdrawal Scales (SOWS/OOWS) • Pain and Craving Scales Ibogaine Outcome Study, V. Mojeiko 17 Process • All interviews are conducted by evaluation coordinator • Baseline in person; follow-up by phone • Each interview takes about an hour or two • Valerie organizes and analyzes data Ibogaine Outcome Study, V. Mojeiko 18 Schedule for Outcome Measures ASI BDI/BAI PEP O/SOWS Pain/Cra SO check i P W1 2 X X X X X X X X X X X X X X X X X 2 3 4 5 6 7 8 9 1 0 X X X X X X X X X X X X X X X X X X 1 1 X X 1 2 X X X X X X X X X X X X X X X X X X X X X X X X i=Intake; P=Post-treatment; W2=Week 2; 1-12=Months 1-12 Ibogaine Outcome Study, V. Mojeiko 19 Challenges • No drug testing • Difficulty of remaining in contact during follow-up • Check-in with significant other addresses these concerns Ibogaine Outcome Study, V. Mojeiko 20 Progress • End of protocol design and training phase • Began study at Ibogaine Association; ended prematurely • Assisting Iboga Therapy House in obtaining grant from Health Canada • Partial funding obtained from private donors for study, Iboga Therapy House seeking additional funding for operating costs Ibogaine Outcome Study, V. Mojeiko 21 Goals • Obtain basic information about outcomes in underground clinics • Provide feedback to improve services; help win funding from Canadian government; increase safety • Ideally lead to placebo-controlled double-blind studies • Ibogaine available to drug addicts in a safe, supportive, and humane setting Ibogaine Outcome Study, V. Mojeiko 22