Methadone and Ibogaine A Histori by xumiaomaio


									Methadone and Ibogaine

 A Historical Comparison of
     Patient Status and
      Advocacy Issues

       Howard S. Lotsof
Background: Drug Control

• 1906 Pure Food and Drug Act

• 1914 Harrison Narcotic Act

• 1970 Controlled Substances Act
   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
Methadone molecule
Methadone powder
Methadone diskets
Methadone liquid
    Background: Ibogaine
      An experimental medication

• Botanical source Tabernanthe iboga. Used for
  100s of years in African medicine and religion

• 1901 ibogaine isolated by Dybowski and

• 1958 molecular structure determined Bartlett
  et al.

• 1962 Lotsof discovers Antiaddictive effects
Ibogaine molecule
Tabernanthe iboga shrub
Roots contain ibogaine
Pharmaceutical ibogaine
    experimental medication
Discovery of antiaddctive
Methadone       Ibogaine
    NYC            NYC
   1964            1962
  Doctors       Drug users
administer to   administer to
 drugs users     drug users

•The golden age of Dole
    and Nyswander

     •1966 - 1973
Drs. Dole and Nyswander ca 1976
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

• There was no “us” and “them”. Patients were
  treated like any other medical patients.
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.
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.
   What’s wrong with methadone
• 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

• Many clinics practice control of patients rather
than providing them with ethical medical care.
Two important issues in
  methadone today

       • Stigma

    • Discrimination

Focuses attention on the

Focuses attention on
those who produce
rejection and exclusion
Attention patients, counselors
   or methadone providers

 If you are a methadone counselor or provider,
    please think for a moment and write on a
    piece of paper the words that come to mind
    when you think of methadone patients.

 If you are a methadone patient, please think for
    a moment and write on a piece of paper the
    words that come to mind when you think of
    methadone counselors, administrators or
  Methadone 1.3 Internet
program. Runs only on PCs
   will not run on a mac.
Whether you are a patient, counselor
 or methadone provider, now write
 the words that come to mind when
  you view the methadone internet
     Workshop Manual
•   Lotsof/Dole letters
•   Early Dole methadone paper
•   History of Methadone
•   Methadone patient reports
•   Methadone physician reports
•   Methadone research bibliography
•   Review of Stigma and Discrimination
•   Ibogaine patient experience
•   History of ibogaine
•   Ibogaine pharmacology

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