Iatrogenic Addiction Nonopioids See Prescription Drug Abuse

IBOGAINE The roots of the shrub Tabernanthe iboga first aroused pharmacological interest in 1864 when a French naval surgeon brought some back from Gabon, West Africa. The root was eaten by various Gabonese tribes as part of initiation ceremonies of puberty and was said to produce intoxication, visions, and a reduced need for sleep.

An active alkaloid, ibogaine (C20 H26 N2 O), was isolated in 1901 from the roots, bark, and leaves of Tabernanthe iboga. In the early 1900s, some medical researchers in France recommended ibogaine for use in treating neurasthenia and asthenia (syndromes that would probably be diagnosed in the 1990s as depression or fatigue syndrome). Although the drug was part of a proprietary medication marketed in Europe in the late 1930s and throughout the 1940s, ibogaine attracted little medical or scientific attention until the emergence of interest in indole alkaloids that accompanied the use of reserpine in the 1950s. During the 1960s, when there was considerable research on the use of

Lysergic Acid Diethylamide (LSD) and other psychedelic agents (HALLUCINOGENS) in psychotherapy, ibogaine was also studied, since it appeared to produce mental effects similar in some ways to other hallucinogens. At about the time of these studies, 1967-1968, the World Health Organization and the U.S. Food and Drug Administra tion (FDA) classified ibogaine as a hallucinogen, along with LSD, MESCALINE, and PSILOCYBIN.

In 1962, Howard Lotsof, who was at the time addicted to heroin, ingested ibogaine in search of a different drug experience. Lotsof came out of a long psychedelic experience, during which he had not taken any heroin, and found that he had no withdrawal symptoms and did not crave drugs. At the time, he noticed that ibogaine had a similar effect on several other heroin addicts. He subsequently remained drug free, completed law school, eventually obtained a patent on the use of ibogaine for the treatment of addiction (brand name ENDABUSE), and became active in seeking funding to further develop the drug and to obtain FDA approval for its medical use in treatment of addiction.

As a Schedule I drug under the CONTROLLED SUBSTANCES Act, ibogaine is considered to be highly subject to abuse and without any approved medical use. To be approved by the FDA, an agent must be shown to be safe and effective. Throughout the early 1990s the only reports of the efficacy of ibogaine have been anecdotal ones from individuals in Europe who were addicted to heroin, COCAINE, and TOBACCO. Those who take ibogaine are generally highly motivated since the drug is expensive, costing up to several thousand dollars. While many reported a decrease in drug CRAVING after taking ibogaine, relapse to drug use within a few months was also observed.

As a result of pressure from activists, the U.S. government funded animal studies of ibogaine's actions on opioid and cocaine withdrawal, opioid and cocaine self-administration, and neurotoxicity. Studies in animals have not been entirely consistent. High doses of ibogaine reduced some manifestations of opioid withdrawal in monkeys. Studies in opioid-dependent rodents have shown that ibogaine decreases withdrawal, but other studies have not. Some rodent studies have shown a decrease in drug self-administration. Studies of ibogaine toxicity have also produced mixed results. Some studies in monkeys produced no obvious nervous system toxicity, but a study in rats produced damage to neurons in the cerebellum, the part of the brain known best for its role in control and coordination of movement. Other research studies indicate that ibogaine is not similar to opioids such as MORPHINE and heroin nor to hallucinogens such as LSD in terms of actions at drug RECEPTORS.

Despite these inconclusive research findings, in the early 1990s an FDA advisory committee recommended approval of limited trials in humans aimed at establishing safety and efficacy in treating drug dependence. At least one death has been attributed to the use of ibogaine in the treatment of heroin addiction.

(SEE ALSO: Ayahuasca; Hallucinogenic Plants; Hallucinogens; Pharmacotherapy; Treatment)

BIBLIOGRAPHY

Blakeslee, S. (1993). A bizarre drug tested in the hope of helping drug addicts. New York Times, October 27, p. C11.

Deecher, D. C., ET AL. (1992). Mechanisms of action of ibogaine and harmaline congeners based on radioligand binding studies. Brain Research, 571, 242247.

Goutarel, R., Gollnhofer, R., & Sillans, R. (1993). Pharmacodynamics and therapeutic applications of iboga and ibogaine. Translated by William Gladstone. Psychedelic Monographs and Essays, 6, 71-111. Jetter, A. (1994). The psychedelic cure. New York

Times Magazine, April 10. KAREL, R. (1993). FDA approves trials of hallucinogen for treating cocaine, heroin addiction. Psychiatric News, September 17, p. 7. Rumsey, S. (1992). Addiction and obsession. New York

Newsday, Thursday, November 19, p.1. SCHULTES, R. E. (1967). The place of ethnobotany in the ethnopharmacologic search for pychotomimetic drugs. In D. H. Efron, B. Holmstedt, & N. S. Kline, (Eds.), Ethnopharmacologic search for psychoactive drugs. Public Health Service Publication no. 1645. Washington, DC: U.S. Government Printing Office.

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