Experiences of opioid detoxification using ibogaine in various treatment settings:Exploring ibogaine users’ motivations, understanding of risks, and effects of ibogaine

Masters Thesis, Otago University

Jamie Walker, ARA Institute Canterbury

“There will be some open minded people that will go; yeah this ibogaine treatment suits my personality, my situation, my frame of mind, my ability to deal with it. I can rationalisehallucinations for what they are, I’m not going to flip out. Yes, it is a big spider in a web made out of mechano or origami, that’s dropping out of the ceiling looking at me,.. I can deal with that.”(respondent 002).

Background to the research….Working as an OST case manager (RN) in Christchurch.Three clients utilised ibogaine treatment independently. One was reported as successful and this client was not seen again at this service nor other addiction services – anecdotal reports said no use and ‘completely detoxed’. One client had a negative experience (used ibogaine alone in bedroom and experienced extreme anxiety with hallucinations), they continued to utilise methadone. The third client requested to use an ibogaine clinic (over seas) and the client was withdrawn from OST for ‘dangerous other drug use’ and lost established case manager support.

Sex Ethnicity Area living NZ Currently employed / studying

Age now

Years since ibogaine treatment

001 Female NZ / Euro Christchurch Y 26 2002 Male NZ / Euro Dunedin Y 42 7003 Male NZ / Euro Bulls Y 40 2004 Male NZ / Euro West Coast Y 53 3005 Male NZ / Euro Dunedin Y 28 7006 Female NZ / Euro Dunedin Y 42 4007 Female NZ / Euro Dunedin Y 45 8008 Female NZ / Euro Dunedin Y 42 8009 Female NZ / Euro Dunedin Y 42 4010 Male NZ / Euro Dunedin Y 42 7

Main opioid used

Illicit or PDM

Aprox years dependent

Aprox years in OST

Other detox attempted

Age when used Ibogaine

Years abstinent of opioids

001 Methadone

Illicit 1 7 1-2 24 0.25(r)

002 Morphine / methadone

Illicit 8 5 10+ 35 7 +

003 Codeine Illicit 10 Nil OST 10+ 38 0.25(r)004 Methadon

ePDM 15 Nil (PDM) 1-2 49 3+

005 Morphine / methadone

Illicit 2 2 1-2 21 7+

006 Morphine Illicit 12 10 1 -2 38 4+007 Morphine Illicit 7 2 10+ 38 8+008 Morphine Illicit 5 5 10+ 35 8+009 Heroin Illicit 5 7 10+ 38 4+010 Morphine Illicit 5 13 10+ 35 0.5(r)

Recruitment via advertising, “snowballing” and establishing connections with ‘Iboga Aotearoa’ (Dunedin based ibogaine treatment provider)

Special acknowledgement to Tanea Patterson, Iboga Aotearoa for her on-going support and work in the field.

Categories Themes1. Desperation to be opioid free

1) Not sitting comfortably on opioids(Nine respondents)

1. Multiple attempts at quitting1. Societal and self-stigma of addiction

1. Physical and Mental aversion to substitution opioids

1. Withdrawals and associated mood not tolerated

1. Keep my methadone dose low1. Anti-establishment and critical of standard treatments

1. Restricted achiever 1. Anxiety of being dependent1. Hope and reports of treatment success

1) Motivations for using ibogaine(Ten respondents)1. How ibogaine therapy was discovered

1. Quickness of treatment1. Previous hallucinogenic use1. Use unaffected by legality1. Safety conscious and seeking medical input

1) Safety conscious and support seeking

(Ten respondents)

1. Need for preparation and guidance before treatment

1. Need for 24/7 care during treatment1. Need for guidance after treatment1. Family/Friend/General Practitioner support

1. AA / NA treatment dichotomy1. Anxiety of ibogaine treatment1. Negative experience of ibogaine treatment

1) The best practise(Six respondents)

1. Sleep disruption and management1. Morphine versus methadone1. High versus low ibogaine dose, use of boosters

1. Control the vomit1. Positive effects on mood post treatment

1) Ibogaine treatment effects on depression and anxiety

(Seven respondents)

1. Anxiety management affecting abstinence

1. How to cope without a crutch1. Powerful effect of hallucinogen1. Mental /cognitive work after treatment

1. Acceptance of fears, vulnerability and pain

1. Heightened senses post treatment1. Absence of opioid withdrawals

1) Ibogaine treatment effects on dependence

(Seven respondents)

1. Effects on opioid usage1. 3 month point after treatment1. Effects on other drug use1. Effects of treatment on pain and the physical body

1. Long term effect of hallucinogen1) The spiritual effect

(Four respondents)1. Sense of epiphany during treatment1. The little brown man1. Search of the spiritual

1. Desperation to be opioid free1. Multiple attempts at quitting1. Societal and self-stigma of addiction1. Physical and Mental aversion to substitution

opioids

1. Withdrawals and associated mood not tolerated

1. Keep my methadone dose low1. Anti-establishment and critical of standard

treatments

1. Restricted achiever 1. Anxiety of being dependent

Not sitting comfortably on opioids(Nine respondents)

1. Hope and reports of treatment success

1. How ibogaine therapy was discovered

1. Quickness of treatment

1. Previous hallucinogenic use

1. Use unaffected by legality

Motivations for using ibogaine(Ten respondents)

1. Safety conscious and seeking medical input1. Need for preparation and guidance before treatment

1. Need for 24/7 care during treatment1. Need for guidance after treatment1. Family/Friend/General Practitioner support1. AA / NA treatment dichotomy1. Anxiety of ibogaine treatment

Safety conscious and support seeking(Ten respondents)

1. Negative experience of ibogaine treatment

1. Sleep disruption and management

1. Morphine versus methadone

1. High versus low ibogaine dose, use of boosters

1. Control the vomit

The best practise(Six respondents)

1. Positive effects on mood post treatment

1. Anxiety management affecting abstinence

1. How to cope without a crutch

1. Powerful effect of hallucinogen

1. Mental /cognitive work after treatment

1. Acceptance of fears, vulnerability and pain

1. Heightened senses post treatment

Ibogaine treatment effects on depression and anxiety(Seven respondents)

1. Absence of opioid withdrawals

1. Effects on opioid usage

1. 3 month point after treatment

1. Effects on other drug use

1. Effects of treatment on pain and the physical body

Ibogaine treatment effects on dependence(Seven respondents)

1. Long term effect of hallucinogen

1. Sense of epiphany during treatment

1. The little brown man

1. Search of the spiritual

The spiritual effect(Four respondents)

More effective management of opioid withdrawal symptoms and treatment of associated low moods could potentiate an individual's success of opioid detoxification. Greater emphasis on opioid withdrawal management during gradual opioid reduction and current methods of exiting OST services, could help individuals achieve and maintain their abstinence goals. This case study described low tolerance for opioid withdrawal symptoms as a barrier to successful detoxification, and highlighted how better mood and less anxiety assisted individuals in remaining abstinent from opioids.

1) Support people getting off OST

An experienced ibogaine clinic provided individuals with safe and superior ibogaine treatment outcomes. Respondents who obtained pre-treatment medical screening without the guidance of an experienced ibogaine provider, received inadequate physical/medical assessments. Respondents who obtained pre-treatment medical screening through their GP said their doctor did not know about the risks associated with ibogaine or what to ‘test’ for. Where available, all GPs in this study followed ibogaine treatment provider’s recommendations. Respondents sought and stated they required support before, during and long after ibogaine treatment. This was obtained through ibogaine treatment providers, families and GPs, or in their absence, internet chat forums and ibogaine internet support sites. This education and support role will be an important one for any future ibogaine service providers in New Zealand, as this study clearly showed that greater support before, and long-term support after treatment, resulted in better and safer treatment outcomes.

2) Ibogaine treatment providers allow people to have superior outcomes with ibogaine treatment

3. Alongside the need for an ibogaine support service was a clear indication that safer ibogaine treatment practises were achieved when ibogaine was legal in New Zealand. Respondents said they had greater support and could be more open with their GP when ibogaine was a legal, prescribed medicine. This supported current New Zealand legislation and policy, with ibogaine being an off-label registered (able to be prescribed prescribed) medicine for the treatment of opioid detoxification. When ibogaine was legal and able to be openly discussed, respondents received the correct medical screening, more supportive medical care, and screening for alcohol and other drug use. This last, as co-morbid use of stimulant drugs increases the risk of cardiac arrhythmia with ibogaine treatment (Alper et al., 2012). Respondents felt they could be more honest about ibogaine treatment with their AOD treatment services when it was a legal treatment, and some utilised these services for support after ibogaine treatment

3) Keep it legal, its safer

The hallucinogenic experience was embraced. Respondents sought and stated they felt it was beneficial for their desired treatment goals, to have psychedelic experiences during ibogaine treatment; to feel the drug's mental and cognitive effects. The hallucinogenic properties appeared to have positive effects on respondents' reported moods and management of anxiety, which is consistent with the literature on hallucinogenic treatments for other psychiatric disorders such as depression (Strassman, 1995). It is a significant consideration for future ibogaine treatment providers.

4) The Hallucinogenic experienced was sort after and utilised for greater treatment outcomes

The benefits of multiple ibogaine doses. The use of ibogaine booster doses, 24 hours to three months after initial ibogaine treatment, had beneficial treatment effects on all respondents that utilised them. They further reduced opioid withdrawal symptoms and helped with pain management issues. The boosters were all described as ‘sub-therapeutic’ doses, amounts around 200-400mg, and did not produce further psychedelic effects. Prescribers currently have little guidance or literature to support the prescribing and use of booster doses, so this was a significant implication in terms of continued practise, and the prescribing of ibogaine as a medicine for opioid detoxification.

5) Multiple doses of ibogaine are beneficial

“Do you know I think that’s probably one of the major side effects I felt on methadone was the anxiety. And why I say that, on the actual ibogaine night, one of the biggest outcomes for me was that in the treatment I was, sort of, shown this fear and anxiety and afterwards it was gone.”

(Respondent 004)

…and then this wee dude came and sat on my bed and he said... you’re really anxious as a person and we need to do something about that otherwise it’s not going to be good and he said to me ‘breathe like this’ and it was really like (deep breaths) and he said ‘blow your breath out as much as you can and blow your breath out as hard as you can and you will feel less anxious’ and so I did that. And K.… I could hear K. saying; ‘are you alright in there K?’ and I said I’m just exorcising some demons because this is what this man is telling me, he was sitting there, just sitting there talking to me. He was black… this wee African dude. (Respondent 006)

What the researcher gained?

As an methadone (OST) case manager I would often dissuade clients to reduce their doses or ‘de-stabilise’ themselves.

This journey and peoples very personal shared experiences allowed insight into the motivations and ‘heart’ some people have to come off opioid’s all together . This will always be supported in future practise

oh that’s right. So what was happening I was getting into bed every night and what’s a way of putting it, praying, asking some higher power, like can you save me

J: Get me out of this circus

F: get me off this crazy round about. This crazy fucking round about. Then out of the blue, at night time, at this stage my wife would always watch Shortland street on TV and I’d go off and do something else play on the computer whatever. And this particular night she didn’t. And it went onto Mark Sainsbury programme which used to come after the news

J: That’s right

D: and Mark Sainsbury was interviewing Tanea

J: Right I’d seen the same one

D: And it was like oh my God. So by the time the interview had finished, I went onto the net, found the site and got in contact with Tanea and she made it happen pretty quick