Patient Medication Acceptability and Treatment Options:

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Patient Medication Acceptability and Treatment
Options

• Ibogaine
• Methadone
• Buprenorphine

Howard S. Lotsof DORA WEINER FOUNDATION
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Background Drug Control

• 1906 Pure Food and Drug Act
• 1914 Harrison Narcotic Act
• 1970 Controlled Substances Act

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Background Methadone

• 1937 synthesized by Max Bockmühl and Gustav
  Ehrhart, I.G. Farbenindustries. Patent issued
  1941
• 1950 use in treatment of opioid abstinence
  syndrome established in US
• 1964 use in opioid maintenance therapy

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Methadone molecule
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Methadone powder
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Methadone diskets
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Methadone liquid
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Background Buprenorphine

• 1965 synthesized by KW Bentley at Rickitt
  sons, UK.
• 1975 - 1978 DR Jazinski et al. Indicate utility
  in treating opiate addiction
• 1977 - 2003 John Lewis champions analgesic and
  antiaddictive development
• 2000 Drug Addiction Treatment Act authorizes
  use in opioid maintenance therapy
• 2002 FDA approves that use to Reckitt Benckiser

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Buprenorphine molecule
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Buprenorphine productsmanufacturer, Reckitt
Benckiser will not make current product
photographs available
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Background IbogaineAn experimental medication

• Botanical source Tabernanthe iboga. Used for
  100s of years in African medicine and religion
• 1901 ibogaine isolated by Dybowski and Landrin
• 1958 molecular structure determined Bartlett et
  al.
• 1962 Lotsof discovers Antiaddictive effects
• 1993 - 2003 Mash Glick develop second
  generation ibogaine-like drugs

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Ibogaine molecule
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NoribogaineLiver transforms ibogaine into
noribogaine
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18-methoxycoronaridine molecule18-MCSynthetic
molecule
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Tabernanthe iboga shrub
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Roots bark contain ibogaine
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Pharmaceutical ibogaineexperimental medication
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Discovery of antiaddctiveeffects

• Ibogaine
• NYC
• 1962
• Drug users administer to drug users

• Methadone
• NYC
• 1964
• Doctors administer to drugs users

Buprenorphine Lexington, KY 1975 Pharmaceutical
industry/gov. Development
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Methadone

• The golden age of Dole and Nyswander
• 1966 - 1973

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Drs. Dole and Nyswander ca 1976
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Early generation methadone patients

• The program was administered or controlled by
  doctors in a medical research environment even at
  the clinic level.
• Nurses, counselors and patients believed in
  opioid maintenance therapy and collaborated to
  make it work. Patients and staff were a team.
• There was no us and them. Patients were
  treated like any other medical patients.

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Early generation ibogaine patients

• A full collaboration between academic
  researchers, pharmaceutical developers and user
  self-help groups with mutual respect.
• Equal status between the parties. Users, doctors
  and drug developers worked together to define
  the ideal administration paradigm.
• There was no us and them. Patients were
  treated just like any other medical patients,
  except when they were treated like doctors.

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Later generation ibogaine patients

• Drug users are no longer involved as equal
  participants in ibogaine development.
• Drug users and self-help groups, no longer
  affiliated with medical academics or drug
  developers, lost a level of authority and
  control.
• Ibogaine patients are not dependent on clinic
  administered drugs. Ibogaine providers generally
  leave the field rather than control or abuse
  patients. This could change in the future.

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Later Generation Methadone PatientsWhats wrong
with methadone today?

• Nothing is wrong with methadone.
• Almost something is wrong with many clinics that
  administer and provide it to patients.
• Medical decisions are often not made by medical
  doctors.
• Many clinics practice control of patients rather
  than providing them with ethical medical care.

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Buprenorphine patients

• Buprenorphine patients never shared an important
  role in the development of the drug.
• The manufacturer and the US government appear to
  desire that stigma associated with chemical
  dependence not be attached to buprenorphine.
• Whether this early generation or later
  generations of buphrenorphine patients are well
  treated by the medical community and society will
  have to be seen.

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Two important issues in chemical dependence
treatment

• Stigma
• Discrimination

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Stigma
Focuses attention on the victim
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Discrimination
Focuses attention on those who produce
rejection and exclusion
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The ibogaine advantage
Ibogaine removes the stigmatized condition.
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Why ibogaine is not available?

• Industry deems ibogaine not to be profitable.
• Government, industry and academia chose to place
  their interest in the development of opiate drugs
  with which they are familiar.
• 3. Ibogaine represents a new scientific paradigm
  to the understanding of addiction.

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Ibogaine availability proximate to United States

1. St Kitts West Indies
2. Vancouver, BC, Canada
3. Rosarito, Baja, Mexico

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Ibogaine availability
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Ibogaine resources

• The Ibogaine Dossier
• An internet library
• http//www.ibogaine.org
• http//www.ibogaine.desk.nl

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Manual for Ibogaine TherapySecond Revision

• Release date
• Friday, May 9, 2003
• http//www.ibogaine.org/manual.html