Valerie Mojeiko: World Psychedelik Forum - Ibogaine to Treat Heroin Addiction

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A close friend gifted the following speech to me when he learned of my fetish for all-things-Ibogaine/Noribogaine. He has a massive collection of a variety of speeches given at the psychedelics conference in Basel, Switzerland, in 2008. Since I’ve been writing a handful of papers on the pharmacology/potential uses of Ibogaine & Noribogaine in the central nervous system, I decided it would likely work to my advantage to have this speech in a transcript as a reference. Over the past few months, numerous members have voiced their commonly intense interest in Ibogaine; this speech is a nice overview of the history, experience, and therapeutic application of Ibogaine - and is comprised of input from three different individuals involved in two Ibogaine clinics (Mexico & Canada). Here is the speech (finally people are really talking about it!):

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Valerie Mojeiko (with John Harrison & Sandra Carpedes): World Psychedelik Forum, Basel, 21 – 24, March 2008
Mit Psychedelika aus der Abhangigkeit: Ibogain in der Behandlung von Heroinsucht (in english)
(Ibogaine in the Treatment of Heroin Addiction)

(Valerie M.)
Welcome to the ibogaine panel. I’m Valerie, and this is Sandra and John. I know the program said it was just me, but we changed it a little – but after the fact. But I’m really glad they’re here because we have more information among the three of us. So john is going to speak first; John Harrison is from the San Francisco area, he just is working on his [doctorate in psychology] at the California Institute for Integral Studies, and he is our principal investigator for a study of Ibogaine-assisted therapy in the treatment of opiate addiction. The study is just starting now, but john is going to talk to us a little about Ibogaine, and give some background and a little bit about where he’s from and the study he’s working on.

(John H.)
Hi, thanks Valerie. I want to say, first of all, that it’s truly an honor to be here in Basal with such inspirational and astonishingly bright individuals. It’s really a pleasure. I want to thank Rick Doblin and Maps for really tireless support for what we believe to be very important and groundbreaking research in this area. Valerie mentioned that I’m going to be the principle investigator for a study in Mexico, which is going to be started any day now - literally. We have a lot to cover, and I’m going to do a little bit of reading – but I’m going to try not to, because there’s just so much to cover. As Valerie stated we will be starting this study. It will be a long-term observational case-series study between 20-and 30, primarily opiate-addicted, individuals at the ibogaine association in Tijuana, Mexico. Using a battery of outcome measures, we will attempt to gauge Ibogaine’s efficacy in the treatment of opiate addiction. In the very limited time I have today, we’ll talk a little bit about Ibogaine and it’s history, and some risks associated with use and it’s promising potential.

How many people have heard of Ibogaine? So you know a little bit about it. Well I came to work with ibogaine through a rather circuitous, and yet synchronistic way; I completed my pre-doctoral internship at the 14th Street Clinic in Oakland California. This was a methadone maintenance outpatient clinic. For those who are not familiar, Oakland is a low-income, high-crime area - and by any definition, this was a tough gig for an intern in training. Real belly of the beast stuff. But it was also a good opportunity to become familiar and intimate with so many amazing and wonderful people. I learned so much from my patients there and it really moved me to continue with this work. At the clinic I did witness, unfortunately, the inherent cynicism that permeates the methadone-maintenance subculture. As you know, methadone, like heroin, is a highly addictive substance. And we were in effect, dealers, at the clinic. What was worse for me, really, was the low self-esteem with which the patients were held and perceived, and the life-negating ways in which they were treated. The assumption is that these people will always be addicted, allowing for no possibility of change or personal transformation. That was a real downer, and that’s an intended pun. So when I heard about Ibogaine, I was, of course, skeptical. Folks were claiming what a miracle it was, and I was curious. I began looking into Ibogaine’s history, and I’m going to give you a very brief timeline because we have a very brief amount of time, because theirs so much to talk about. Ibogaine comes from Africa, primarily from the country of Gabon. Before we in the west stumbled upon this medicine, the ritual eating of Iboga had been a psychopharmacological sacrament in the Buiti religion for several centuries. This was mostly in Gabon and elsewhere, in the area, and the ritual aim of eating Iboga had been conceptualized as binding – and this was the binding across time through ancestral contact, or binding participants socially, or on the basis of a common shared experience of a distinctive consciousness or system of belief. Iboga has not been commonly used in the Buiti tradition to treat addiction – this is something we’ve come across more recently. It has been used to treat a number of somatic conditions, particularly infertility. Now, in the west, we came across ibogaine; the first time we really knew about it was 1864 and it was in the first description of Tabernanthe iboga, was published and a specimen was brought to France from Gabon. Following in 1901, Ibogaine was isolated and crystallized from root back, and then jumping ahead to 1957, the description of the definitive chemical structure of Ibogaine was published and the total synthesis of Ibogaine was reported in 1965. Then something very special happened; a fellow by the name of Howard Lotsoff – whom we now call the grandfather of Ibogaine – was addicted to heroin in New York City, and a lot of his pals got together and they found out that they had a new drug. “So lets try it” – and they didn’t know what was in store. As I like to describe, Ibogaine is a ride – it’s not necessarily a recreational substance, and they found out the same. What was also a wonderful development was 5 days after they ingested the ibogaine, 6 out of 9 were no longer addicted and weren’t craving or withdrawing – were not showing symptomology of withdrawal. This is remarkable, by any definition. So, that was 1962; Howard Lotsoff, whom I honor very much, has been trying ever since that day to make this medicine available to as many people as possible, and he’s run into road-block after road-block – I wont go into all of the politics of it right now, but in any case he’s still working on it and so are we. Jumping ahead to 1989, this is kind of a semi-humorous note, Ibogaine was added to the list of substances banned by the international Olympic committee, and I’ll tell you what – I’ve done Ibogaine, and it will not help you in the poll-vault. It’s the truth. You know, it’s revealing. In the meantime, since several countries have made Ibogaine illegal – I will give you the full list right now. They are: US, Belgium, Denmark, France, Sweeden, Australia, and Switzerland – have made it illegal. In the process, one of the developments of this illegality or criminalization has been that there has been a lot of underground providers - folks that know this is useful and powerful medicine, and they want to get it into the hands of people who can use it. Subsequently, there have been a couple of clinics that have sprung up; one in Canada, as Valerie mentioned, and one in Mexico, as well as several others around the world. We’re trying to legitimize, well, that’s not the right word – to make Ibogaine more safely accessible to as many people as possible. These alternative or underground treatment centers and providers that I’ve mentioned have been characterized as a vast, uncontrolled experiment. And I want to say that I think that these underground providers, and I’ve met several, are really to be applauded for their courage and compassion. I can vouch personally, that I have had the honor and privilage of meeting and getting to know literally dozens of individuals who have ended their addiction facilitated by the ingestion of Ibogaine. But as Rick Doblin said earlier today at the opening session, it is imperative that we asses the risks as well as the benefits of any psychedelic treatment model. To our knowledge, up until this point, there has been 11 individuals that are reported to have died within 72 hours of ingesting ibogaine. This dates back to the first such known fatality in 1990. Collectively, these cases suggest that cardiac rhythm may be a particularly significant domain of medical risk with this treatment model. Yet, out of the several thousand people who have ingested Ibogaine, this is a very very small number – less than a quarter of 1%. An of course people die every day in methadone clinics and so-called rehab centers. But the politically-sensitive nature of psychedelics requires us to, I feel, take special care with safety measures. At the Ibogaine clinic in mexico, we have a rigorous pre-screening process that includes a full-blood panel, anEKG, and extensive pre-interviews with special attention to co-occurring addictions and other concurrent medications. We have 5 full-time physicians on staff, pre-screening and monitoring during the Ibogaine journey. The journey usually lasts between 24-36 hours, and is followed with body-work sessions, nutritional therapy, acupuncture, and reintegrative psychotherapy. Soon, we will be initiating a comprehensive after-care program for a minimum of 10 weeks. These clients will be primarily treated through phone sessions, since the majority of our clients live hundreds, if not thousands of miles away. There is a strong consensus, and I strongly support the notion, that follow-up psychotherapy and aftercare during the window after an Ibogaine session, is the necessary component of any successful long-term treatment. Ibogaine is a catalyst, not a cure. The real journey to being addiction-free only begins with this remarkable medicine. Then it is the engaged client who must discover his or her own power to obtain and maintain optimal health. We at MAPS are looking forward to presenting our findings at the next world psychedelic forum, and I want to thank you.

(Valerie M.)
Thanks John. The next person that is going to talk is Sandra Carpedes. She runs the Iboga therapy house in Vancuver, and she’s going to talk a little bit about one of the actual treatment programs – what it’s like, and she does this every day. So, she knows a lot about what the whole Ibogaine clinic is like. When she’s done, I’m going to talk about the research and show some preliminary results from people that were treated at her center. Here’s Sandra:

(Sandra C.)
Greetings and hallucinations - I’ve been wanting to say that at a conference for a very long time now, and this is the very event that I feel safe doing that, so thank you and welcome. My name is Sandra Carpedes – I am the director of the Iboga therapy house. We are a Canadian non-profit organization dedicated to exploring the therapeutic uses of Ibogaine in therapy for chemical dependence and also for personal psychotherapy. We are a non-profit society in BC, we aren’t a charity but we’re working on that. We’re located on the sunshine coast of BC, surrounded by temperate rainforests – some of the last temperate rainforest in the world – an extremely beautiful place. There’s a wonderful community there, and hence there is a lot of support for our program where we are. Also, our location is not too far from where the famous Hollywood Hospital, where the LSD was used in therapy legally between 1957 and 1975. So in some ways, we have some pride around that that we’re continuing in that vein of work. We have two programs, one for detoxification from opiates, stimulants, alcohol – occasionally we get someone who wants to come in for nicotine or other substances. It’s quite a task doing the intake for detoxification, as you would probably understand; we’re working with quite a high-risk population, and so we must be very careful with the people we bring into our program, and the people we decide to administer Ibogaine to. It’s a 5 day residential program, essentially we treat one person at a time – so it’s highly individualized and highly personalized. We also offer a setting for personal psychotherapeutic sessions and that can be a 3-5 day program, depending on what it is that the person wants to work through and how long they want their stay to be. Our team is amazing, I wish they were all here. On our team, for our intake, we have an MD who acts as a consultant and helps us with the medical screening we require such as EKG, liver panel, and full-blood tests as well as any other tests we deem necessary based on the application filled out and some issues that might have come up in their lives in terms of what they face on a physical level. Our doctor doesn’t administer the Ibogaine in our clinic, because in this point at time, the college of physicians and surgeons in Canada, through which doctors are regulated in Canada, wont insure her for working with us. So if there were to be a problem, we haven’t had any deaths or any complications yet. We’re working on legitimizing Ibogaine in Canada; so eventually hopefully, this will be something that will be accepted by the medical establishment. We have a wonderful intake coordinator – she’s the front line person. Her name is Karen Mckenzie, and her job is quite a big one, and she does a very good job at it. We also have a registered nurse, who’s also a midwife, she’s amazing. We have an emergency medical technician, we actually have a couple of them that rotate shifts. A relapse prevention councilor, which is also Karen. A naturopathic doctor who does a one-hour consultation with people who are coming in for detox. A follow-up councilor who essentially meets with people before their therapy, during, and then afterwords he does follow-up phone calls for a period of a year. Follow-up is difficult; we often lose track of people or they lose track of us. However, we continue to be dedicated to trying to get more information through follow-up and what we have learned has been amazing. We have facilitators on our team, and later I’d like to give a definition of facilitation. A massage therapist also volunteers. Our guiding principles for our program, and particularly with regards to detoxification therapy, is coming from a holistic approach. We’re essentially coming from a place that is non-judgmental, and our model is based on harm reduction therapy and health promotion models. We actively research and employ as much as possible the best practices in treatment, and these are best treatments in both Canada and the United States; we draw upon what is already known about what works. Ethical and informed consent is of utmost importance, so is confidentiality. Our ethos comes from a place of trans-personal approach, to go beyond the self can be highly therapeutic, and catalyzing. Our model for psychedelic therapy; there is no real model for Ibogaine therapy in that sense. There is a manual for Ibogaine therapy that’s published on the internet that gives a very basic list of things to incorporate into a program – what to look for, what to be careful, and what not – but there isn’t a necessarily a model specific to Ibogaine. So essentially our model is consiliance of various psychedelic and entheogen models; we draw upon what we feel might be useful, what we learn, and try to incorporate what seems to be beautiful, supportive, and productive. Back to the topic of facilitation. I’d like to give a definition of facilitation because I feel that it’s really important to make the distinction between a facilitator and a guide or sitter. Often when people talk about psychedelic therapy they talk about having a guide or having a sitter. I personally don’t really like those terms so much with regards to psychedelic therapy because to guide is to direct the experience, to facilitate is to assist the process of an individual. We have a lot of support, both nationally and internationally. We’re listed with the Canadian center for Substance Abuse, it’s a national database of treatment programs. Vancouver coastal health both gives and accepts referrals from us and to us. We’re working with the hospital on emergency protocol, and there is a lot of support. I put this slide up there because Vancouver drug policy is quite unique. This here is a document that’s a policy document that’s entitled a public health approach to drug control in Canada. You’ll see here, in the spectrum of use they’ve included beneficial. Under beneficial they’ve included sacramental use of Peyote or Ayahuasca. This was written by policy-makers in Vancouver, one day we’ll get Ibogaine on that list as well. Our goals are to legitimize ibogaine, and these are just a couple pictures of the house. And this is our temple, our ceremony begins there. It’s very much catered to the individual; we work with people who come from all sorts of classes, cultures, perspectives, so it’s important for us to really honor where those people are coming from – but at the same time we want to try to draw upon what is known from indigenous cultures and other cultures other than our own. I’ll stop there because I’m out of time, thanks very much.

(Valerie M.)
I wish we had more time, because we could each take up 40 minutes. We’ll just have to come back another time. Listen to us again. So, just to clarify, we’re talking about 2 different clinics. Sandra is from a clinic in Vancouver called the Iboga Therapy House, and John is soon to be from the Ibogaine association in Mexico; both clinics are sites of this study that we’re doing with MAPS of the people who were already treated at the clinics. I’m Valerie, and I work at maps, and I coordinate studies. So we’re looking to find out how well does Ibogaine work, how safe is it, what percentage of people benefit and to what degree, how can the treatment be improved, should formal studies be conducted? This is a different slide show from last year’s psychedelic forum, I promise, it just looks the same. So I wanted to just briefly explain to you why we decided to do this study in the first place; this is some preliminary data from the Iboga Therapy House in Vancouver. This was just collected informally, and it was collected in 2004 or sometime around then; 20 of their subjects, who had been treated between 2 weeks and a year before they were surveyed for this survey – 6 our of 7 who were treated for cocaine or crack were abstinent. 3 out of 8 treated for opiates were abstinent – that’s the worst one. And 4 our of 5 for other substances (alcohol, pot, methamphetamine, or combination) were, at the time, abstinent. So we decided, ‘yeah – lets go ahead with this study’. We’re seeking to obtain some basic preliminary data on people who were treated – we decided to just go with opiate, even though it wasn’t the best result, because it’s the most straightforward in terms of addiction. It was starting to get really fuzzy because people come in for psychospiritual reasons, and just to have some clarity, we said we want them to report that opiates are their primary reason for coming in. It’s not a control study, so there’s no placebo, but it is representative since the people are just consecutively treated, we just sample this block of people. There’s a 1-year series of questionnaires and interviews from 20 people, and verified by interviews with a significant other like a parent, spouse, or friend. We don’t do drug testing, but we’ve found that this is working pretty well to simply have another person to ask, and in one case, even though the subject was reporting abstinence, the mother was not – and we noted that and reported her not abstinent. We’re using a harm-reduction model, so we’re not just looking at abstinence, but also a bunch of other life factors using the addiction severity index – which is a measure for looking at different outcomes. I’ll show some scores from that. The peak experience profile measures the actual highs and lows of the Ibogaine experience, and we’re going to be looking at whether that’s correlated with better outcomes – like is a bigger peak experience is a better outcome? I don’t know, we’ll find out. Back to depression, anxiety, and subjective and objective opiate scales just to make sure it worked in the long term. This is the schedule: it’s monthly, it’s every week for the first month after treatment, they do. They do baseline, every week, and then once a month phone-calls. The addiction severity index is a harm-reduction measure. It studies medical status, employment and support, drug use, legal circumstances, family and social status, and psychiatric status. I’m going to show you some scores in a minute, but it asked a bunch of questions – it’s not just whether you were using or not. This is the good part; this is the new part. 5 people have enrolled in the study so far. It’s been pretty slow on enrollment, they’ve not had a lot of people treated for opiates for a lot of reasons. So far, out of 5, only 1 has maintained abstinence; 4 have gone back to using, and 2 dropped out of the study early. So when you look at this it’s not really that great of results, but we only have 5 people so far. It might not end up being that great, and that’s good to know. 20 people isn’t a lot of people to do a study on, but 5 is really not enough at all. But if this was representative, this would probably be about similar to any other treatment method because 20% is standard across the board for how well treatments work. We’re wondering maybe if it was opiates, or if we were studying people form other substances, maybe we’d be getting better outcomes? Because the people treated for crack, alcohol, or pot did way better – so maybe the opiate addiction is a really bad one, and is really hard to break. We don’t know, we’re just this much into the study – so we’ll find out. The first subject that I want to show you the scores from, he was on methadone 38 mg a day. 2 weeks after the treatment, he decided to resume the maintenance, and then he started to taper down again, and by month 8 he was abstinent again – so lets look at that. This is a composite score; he started using again, but then he stopped again – the scores kind of went down, which kind of looks good (laughs). I think this [slide] is more interesting though, because it breaks it down to all of the different levels. Can you read what it says on the right there? Okay. Visit 12 is when he started being abstinent again; something happened here. It looks like there was some kind of employment problem. There was some kind of alcohol problem right after the employment problem. A bunch of stuff, it looks like a bunch of stuff happened right here, and it looks like he stopped using again – or stopped using methadone – so, you could speculate on that one. But it seems that he went down kind of, and what it makes me think of is that there are so many different variables in these people’s lives, and we have so little data yet – but it’s interesting to see what’s happening with them. So this is subject 2 (next subject); he was on 2.5 grams of heroin a day, he has achieved complete abstinence – he’s never used again after – and he’s at visit 15. This one you can see a more dramatic down-slope. When the scores go down, that means the life factors get better. It asks you questions, like for employment it asks you how many days were you employed, how much money did you make. For drugs it might ask, how many days did you do heroin – and then it comes up with a score from those kinds of questions. Subject 3 was using a whole lot of different things. And started again at visit 6, that’s like the first month. Her’s is not that great, it looks like she’s back about the same point at the end as she was in the beginning. It looked like she was probably hospitalized or something right here, but everything remained pretty much the same. Subject 4, these are the last two people, decided not to complete the study, so I don’t have any charts for him. This was really unfortunate, but he had a car-accident on the way home from the airport – it was right after he came home from…interrupted by crows…this relation between pain, and emotions – and if you get hurt, you need to take opiates sometimes, and then you’re back where you started. Subject 5, who also chose not to do anymore outcome measures, also reported relapse 1-2 weeks after treatment. Those are the information I have so far; it’s not super promising, but we’re going to keep going foreword and see what happens. I think whatever we find out is really good to know, and it’s good for people who are seeking this out to know. For some people, it works so well, and we’ve all heard these really amazing stories of people that it worked really well for. The statistics can be kind of discouraging, but what about the 1 in 5 people that are like ‘this changed my life’. That happens. But then there’s also the 4-5 people that are expecting that ‘this is going to change my life’, and it didn’t. We don’t know, but we’re just kind of trying to find out. I think we’re over time a little bit.

(Sandra C.)
This study reported on abstinence rates. If someone starts using again, are they using the same amounts? Are they using in a way that’s problematic? We’ve had people go from injecting cocaine to snorting it, and that actually is an improvement in quality of life because it’s reduced potential harm. Looking at improvements in emotional content – what’s going on in the individual there, communication with their family, with their friends, we see in terms of our follow up on the phone, people have reported amazing improvements – but these measures just aren’t designed to really look at those kinds of things. And in some ways, how can you quantify, you know, how much someone loves themselves? Right? These are really really important things to know. Would it also be possible to look at what kind of changes happened aside from just the fact that they relapsed.

(Valerie M.):
Yeah. It’s hard; we try to choose these measures. A lot of people use the addiction-severity index, but does the index really change your score if you go from injecting to snorting that much? Probably not – you know, who wrote these things; probably not people that were once injecting, and are now snorting, cocaine. It was probably someone who was never doing either one of them.

(John H.):
I think what this speaks to, though, that’s interesting is when we have clarified this – and it’s pretty strongly established – that it definitely stops the craving and withdrawal. There is a window post-administration called the noribogaine-window, and there is a sense of wellbeing, almost a glow – we call it the Ibo-glow – and that’s a really rich and fertile time for process work and psychotherapy because almost everyone that comes to heroine, initially it might have been for fun, ultimately it’s a pain reliever. It is the ultimate pain reliever. Unless that source of that pain is addressed, and worked through, it will continue to percolate up. So this is a window, like a said earlier, and Sandra confirmed – it’s a catalyst, not a cure. I think it’s important to have that understanding, so we don’t set the bar too high because then we’ll be disappointed. So I think we work with this tool; it’s a tool, like any other tool.

(Valerie M.)
Definitely, and I hope, if anyone here is thinking of doing Ibogaine, that they just really think that ‘I have to do some work on this too, I’m not just going to go in and it’s going to, like, cure me.’ Probably the person that it worked for probably put some more effort into it than some of the other people.

(John H.)
Grunts his concurrence. There are so many variables that are part of that; your family structure, psychosocial history – all of these things come in like a big soup.

(Sandra C.)
I’d also like to make one last, quick note. At the Therapy house, because we do accept people for psycho-spiritual and psychotherapeutic reasons – often those people have really done their research, and they’re coming in, not because they’re desperate to get off with a substance, but they’re coming in for personal growth and personal exploratory reasons. That whole level of the potential of Ibogaine therapy has not really been talked about or discussed here, but the potential is immense – it’s great – and I think a lot more research on that side of it, a lot more people communicating and publishing their experiences I think is really important. What I’ve seen certainly has inspired me to dedicate a lifetime to working with this substance.

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The first picture is the World Psychedelic Forum insignia. The second is a picture of Valerie Mojeiko, while the third is a picture of John Harrison (right) with Howard Lotsoff (left). Unfortunately, I was unable to locate nay pictures of Sandra Carpedes.