Posts Tagged ‘ibogaine’

Bad Science on “Homeland”

Bad Science on "Homeland"

Bad Science on “Homeland”

I’d like to announce my willingness to serve as a media consultant on topics relating to opioid addiction. I’m prompted to do this after another bit of bad science on TV.

There I was, catching up on recorded episodes of “Homeland,” one of my favorites. One of the main characters, Brody, was on the run since he was suspected of planting the bomb that blew up the CIA. He survived an abdominal gunshot wound, and then was imprisoned in a weird high rise for the homeless in Venezuela by a mysterious group of people who may or may not have his best interests at heart. To treat both his physical and mental pain, he was encouraged to shoot up opioids, and he became addicted.

Saul, acting head of the CIA, flies to Venezuela to fetch Brody back to the U.S. for a top secret mission. He found Brody, strung out of opioids, living in squalor, and in terrible shape. He’s so appalled by the smell in Brody’s cell that he does the male equivalent of a pearl clutch…he puts a handkerchief to his nose. Brody is transported back to the states, where he goes into terrible opioid withdrawal. He’s screaming, groaning, and stewing in secretions.

Saul needs him to be well in order to take part in a clandestine mission in Iran. Saul asks his staff if there’s any way to get Brody back into shape and out of withdrawal faster. One of the team mentions methadone, and Saul says something like no, we need for him to be functional.

No one mentions buprenorphine.

Shifty CIA operative Dar Adal pipes up that ibogaine will cure Brody but will have bad side effects like hallucinations. A sidekick adds, “Yes, violent, mind-bending hallucinations.” Adal then mysterious says (everything he says is mysterious) “Take my word for it.”

So they give poor Brody ibogaine, and he has violent, mind-bending hallucinations. He screams. He cries. He has terrifying hallucinations of his old war buddy, now dead. At one point presses his face to the window of his cell, screaming, “What did you give me??”

I guess such histrionics make better TV than seeing Brody look normal after several days of methadone or buprenorphine.

After the agony of the ibogaine, Brody is well enough to start running and getting back into shape.

Now for the truth: Ibogaine is a hallucinogenic psychoactive substance found in some species of plants that grow in Africa. It’s been used in religious ceremonies, chewed to give a mild stimulant effect. With increased doses, this substance has hallucinogenic effects. Ibogaine has effects on at least three types of brain receptors. Ibogaine’s metabolite, noribogaine, has serotonin reuptake inhibition properties, like found in many antidepressants. It also has a weak opioid effect on the mu opioid receptors and a stronger effect at the kappa opioid receptors, causing less dopamine to be released. It also has effects on at least two other receptor types.

Limited studies show that since the drug does block the release of dopamine, it may have some benefit in the treatment of addiction. Both animal studies and case reports suggest ibogaine may reduce withdrawal symptoms of opioid addiction and craving for cocaine. But so far there have been no good scientific trials of the drug. This drug has been outlawed in the U.S. and in most European countries due to concerns about the drug’s side effects and case reports of death. (See my blog post of June 1, 2013) Ibogaine’s supporters claim this drug can cure addiction to alcohol, cocaine, opioids, and nicotine.

In other words, there are case reports of possible benefits of ibogaine, but it is not at present an evidence-based treatment for opioid addiction.

I’m really getting annoyed with Homeland. It was my favorite show in the past, but started to drag this season. (Don’t get me started on the booooring Dana storyline.) Now it has me snorting in disgust at bad science.

Thin ice, Homeland…you are on thin ice with me. If you need a medical consultant, I’m available.

Case Report of Death from Ibogaine Ingestion

IBOGAINE

IBOGAINE

In the latest issue of the American Journal on Addictions (Volume 22 (3) May/June 2013, p. 302) was a one-page case report of a death due to ibogaine, ingested for the purpose of curing heroin addiction.

Ibogaine is a hallucinogenic psychoactive substance found in some species of plants that grow in Africa. It’s been used in religious ceremonies, chewed to give a mild stimulant effect. With increased doses, this substance has hallucinogenic effects. Ibogaine is a sloppy drug, affecting at least three types of brain receptors. Ibogaine’s metabolite, noribogaine, has serotonin reuptake inhibition properties, like found in many antidepressants. It also has a weak opioid effect on the mu opioid receptors and a stronger effect at the kappa opioid receptors, causing less dopamine to be released. It also has effects on at least two other receptor types.

Limited studies show that since the drug does block the release of dopamine, it may have some benefit in the treatment of addiction to these drugs. Both animal studies and case reports suggest ibogaine may reduce withdrawal symptoms of opioid addiction and craving for cocaine. But so far there have been no good scientific trials of the drug. This drug has been outlawed in the U.S. and in most European countries due to concerns about the drug’s side effects and case reports of death. Ibogaine’s supporters claim this drug can cure addiction to alcohol, cocaine, opioids, and nicotine.

In this case report, the decedent was a 25-year old male with heroin addiction and a history of supraventricular tachycardia, meaning he had an underlying heart problem that caused episodes of rapid heart rate. This man took ibogaine 2.5 grams over 3 hours, and then had hallucinations, difficulty with balance, fever, and muscle spasms. He improved over the first day, but by the next day he developed problems breathing and had a respiratory arrest. Despite cardiopulmonary resuscitation, he remained in a deep coma and died after two days of multi-organ failure.

This death was of course a tragedy, but I’m not sure this case and other similar cases mean ibogaine won’t ever have a place in the treatment of opioid addiction. It surely gives us information that patients with underlying heart disorders are at increased risk of death from ibogaine.

I still think there’s a need for further (careful) research on ibogaine. This can’t be done at present in the U.S. or Europe, but perhaps other counties can do necessary trials.

Yes, this is a medication that can kill, but then, addiction kills, too. And many medications routinely used in the medical treatment of various illnesses can be deadly at the wrong doses or in the wrong patients. For all medical treatments, the risks have to be weighed against the benefits. Right now, we don’t have a full idea of the benefits or the risks of ibogaine.

Like many treatments for addiction, there are also people who make unsubstantiated claims in favor of ibogaine, and sell it via the internet or in countries where it isn’t outlawed, as a miracle cure for opioid addiction. The evidence for this claim is lacking, to put it mildly. This case report reminds us that ibogaine can be deadly. Until/unless we have more knowledge about the risks/benefits of ibogaine, evidence-based treatment of opioid addiction with methadone and buprenorphine are much better options and should be recommended.

For further information of the state of ibogaine research, here’s a great reference:

http://www.ibogaine-research.org/Ibogaine-Research-Project/Areas/Media/JAMA.htm

Ibogaine: Cure or Con?

So there I was, happily watching a “Law and Order” mini-marathon. In one episode, the psychiatrist who works with the SVU staff goes on a diatribe about how ibogaine, a hallucinogenic root, cures opioid addiction. He’s trying to help a heroin-addicted youth detoxify from opioids, to enable him to testify against a rapist. Dr. Huang, the TV doctor, says ibogaine works great, but the big nasty drug companies won’t market it because it won’t make money, and U.S. doctors are (paraphrasing) too cowardly to do what’s right, and use something that really works.

 Sadly, some addicts are more likely to believe the words of a fictional character on a fictional TV program than their doctor.

 The truth is that ibogaine hasn’t been proven a safe and effective treatment for any kind of addiction.

 On the other hand, we don’t know for sure that it doesn’t work, either. NIH, the National Institute of Health, did laboratory studies with ibogaine in the mid-1990’s, but stopped work on the drug due to concerns about potentially fatal heart arrhythmias and neurotoxicity.

 However, the NIH tends to be a rather conservative bunch, and other scientists have taken up further research on the drug. At least two reputable doctors have independent, ongoing research projects on the drug. (1)

 So what is ibogaine? It’s a naturally occurring root found in Africa, and used in religious ceremonies there. In these ceremonies, rootbark from the plant Tabernanthe iboga is chewed to give a mild stimulant effect. With increased doses, this bark has hallucinogenic effects. Ibogaine is a sloppy drug, affecting at least three types of brain receptors. Ibogaine’s metabolite, noribogaine, has serotonin reuptake inhibition properties, like found in many antidepressants. It also has a weak opioid effect on the mu opioid receptors, and a stronger effect at the kappa opioid receptors, causing less dopamine to be released. It also has effects on at least two other receptor types.

 Ibogaine’s supporters claim this drug can cure addiction to alcohol, cocaine, opioids, and nicotine. Limited studies show that since the drug does block the release of dopamine, it may have some benefit in the treatment of addiction to these drugs, but we just don’t have enough information now.

 The drug’s reputation as a favorite of the drug culture may contribute to our government’s hesitation to approve studies of ibogaine in this country, but other countries are more permissive (or careless, depending on how you look at things).

 It’s also been difficult to get pharmaceutical companies interested in ibogaine. That’s not just due to the drug’s reputation as a recreational drug. Pharmaceutical companies tend to view all anti-addiction drugs as having low profitability (addicts tend to lack both money and insurance) and of course there’s still – sadly – the stigma of addiction and its treatment. (OK, so maybe Dr. Huang was partially right!) 

The limited data available so far suggest that at best, ibogaine may eventually prove to be another useful tool to use against addiction, but it’s unlikely to be the cure-all magic bullet that the fictional Dr. Huang claims. 

I hope we can see some well-done clinical trials before we decide what, if any, benefit this potential medication may have in the treatment of addiction.

 1.  http://www.ibogaine-research.org/Ibogaine-Research-Project/Areas/Media/JAMA.htm