Pubdate: Sun, 02 Jan 2000
Source: Daily Southtown (IL)
Copyright: 2000 Daily Southtown
Contact:  6901 W. 159th St., Tinley Park, IL 60477
Fax: (708) 633-5999
Website: http://www.dailysouthtown.com/
Author: Malcolm Ritter, The Associated Press

BREAKING ADDICTION

CAN EXTRACT OF AFRICAN SHRUB 'CURE' DRUG ADDICTION?

What if addiction, whether to cocaine, heroin or alcohol, could be broken 
by taking a single pill?

That's the audacious claim behind ibogaine, an extract of an African shrub. 
But don't look for it at your local treatment center anytime soon.

Ibogaine is stuck in limbo.

Yes, anecdotal reports of addiction-breaking power go back some 30 years. 
There have been some intriguing animal studies and initial studies on 
humans. And the federal government has spent more than $2 million on 
preliminary ibogaine research.

More than 150 papers about ibogaine have appeared in scientific journals, 
said Dr. Kenneth Alper, who directed a recent conference on the drug at the 
New York University School of Medicine.

"This is a drug development project in which a lot of work has already been 
done," he said.

But ibogaine is stuck short of the final step. Nobody has done the big, 
more elaborate studies that could convince mainstream addiction specialists 
that the stuff really works — or doesn't. And neither the government nor 
the pharmaceutical industry is jumping in to take that on.

Ibogaine is illegal in the United States, but it's available through an 
international black market. It also is used in clinics in Panama City and 
the Caribbean. And, for $1,500 and up, you can get it from a nurse or 
psychiatrist on a boat cruising international waters off South America.

"It's not a matter of debate whether ibogaine should be made available," 
said Geerte Frenken, who helped organize a group called International 
Addict Self-Help in the Netherlands to offer treatments. "It already is 
available."

Ibogaine advocates say it suppresses the painful withdrawal symptoms that 
can make it difficult to give up physically addictive drugs.

Furthermore, they say, ibogaine halts or reduces drug cravings for weeks to 
months. That can be long enough for a person to get psychological help and 
learn to live clean and sober.

"It's a honeymoon period, a very precious time," said Eric Taub, a 
Gainesville, Fla., man who arranges ibogaine treatments outside the 
country. While ibogaine doesn't work for everyone, he said, it's still "the 
most humane way of interrupting addiction on the planet."

What makes the ibogaine story even more curious is the experience of taking it.

First come visions: four to eight hours of fantasies such as floating in 
space or fast-forward reviews of one's life. For another eight hours or so, 
addicts mull the meaning of those visions, a step some advocates say 
provides insights that promote staying clean.

Ibogaine comes from the roots of a four-foot-tall, flowering African shrub 
called Tabernanthe iboga. Its root bark is chewed in rituals in Gabon. Chew 
enough, it is said, and you see your dead ancestors. Just a little prevents 
fatigue.

Ibogaine was purified from the root bark around the turn of the century, 
and low doses were sold in France from 1939 to 1970 as a tonic for fatigue 
and depression.

The notion of using it to break addiction goes back to 1962.

Howard Lotsof, a 19-year-old New Jersey history major, had been using 
heroin for a few months. One day, just to see what would happen, he tried 
some new stuff called ibogaine after a chemist friend had mentioned it.

"Thirty-three hours later, I was no longer a heroin addict," said Lotsof. 
Five of the seven addicts in his crowd who tried a single dose stopped 
using heroin for about six months without withdrawal symptoms, he said.

He didn't jump on the discovery right away, he said, because, "What does a 
19-year-old kid know about anything?" But in the 1980s, he patented 
ibogaine treatments for a variety of addictions and set out to interest 
pharmaceutical companies, the government and scientists.

"The first time Mr. Lotsof called me up and told me about this, I thought 
he was a lunatic," said Dr. Stanley Glick, chairman of the pharmacology and 
neuroscience department at Albany Medical College. "My colleagues hear 
about this, that's their first reaction."

Yet, as Glick and others looked at ibogaine's performance in lab animals, 
they found evidence that it did act against addiction to cocaine, alcohol 
and opioids, the class that includes heroin. Their results began showing up 
in scientific journals about a decade ago.

Around that same time, two addict self-help groups began offering ibogaine 
treatments to a few heroin addicts in the Netherlands, with positive 
results. Frenken's group found that seven of the eight addicts it treated 
stayed clean for an average of six months. The eighth addict said he just 
liked the lifestyle of heroin use.

But not all the history of ibogaine is so positive. Rat studies suggested 
it may kill certain brain cells, a concern Glick now calls overblown. And 
the field has been haunted by the deaths of two women who took it.

One, a 24-year-old heroin user, died about 19 hours after ibogaine 
treatment in 1993. The cause of death wasn't established, but she might 
have taken heroin after the ibogaine, and some evidence suggests ibogaine 
increases toxic effects of heroin.

Previously, a Swiss woman who'd taken ibogaine during psychotherapy in 
Europe died a few hours after. She had a history of heart disease.

Those deaths were one reason that advisers to the National Institute on 
Drug Abuse recommended in 1995 that the instittute not launch an extensive 
program of ibogaine research in humans. The brain damage in rats was 
another, and some dog studies suggested a risk of seizures and cardiac 
arrest. Some advisers also were unimpressed with the human evidence that 
ibogaine actually works.

Overall, the consultants "just felt it was essentially going to be an 
expensive, time-consuming, ultimate failure," said Frank Vocci, NIDA's 
point man on ibogaine.

Vocci stressed that NIDA has not declared ibogaine shouldn't be tested in 
people, just that NIDA won't pursue that research. The institute remains 
open to paying for such studies by others if the proposals get favorable 
review from outside scientists, he said.

Scientists disagree on whether such applications have much chance of a 
favorable review. Glick suspects not, saying ibogaine's reputation has been 
too tarnished.

What's more, he notes, ibogaine emerged not from a research lab but from 
the experiences of addicts, not exactly the royal road to scientific 
acceptance.

Lotsof hasn't been able to sell drug companies on ibogaine either. He says 
company officials have given him a variety of reasons for not touching it, 
such as legal liabilities in treating a population more prone to dying than 
usual, the stigma attached to drug abuse and lack of profit in a medicine 
taken only once or a few times.

There's no sign that ibogaine itself is addicting, Lotsof said. The 
dream-like "visions" don't cause any LSD-like euphoria that would tempt 
people to repeat them.

"I would say 90 percent of the people who are provided with ibogaine do not 
want to take it a second time," Lotsof said. "It's exhausting. You're up 
for 36 hours."

The latest news on ibogaine comes from a clinic on the Caribbean island of 
St. Kitts, where the drug is being used with addicts who weren't helped by 
conventional treatment.

They were "self-destructing, at the end of the road … . This thing really 
spins them around," said Deborah C. Mash of the University of Miami School 
of Medicine. She has studied more than 80 addicts treated with ibogaine at 
the clinic.

While her work is preliminary, she's finding it "extremely effective" in 
blocking withdrawal from opiates like heroin and morphine, as well as the 
"crash" from stimulants like cocaine and amphetamine.

"It's a very gentle detox," she said.

What's more, she said, her studies suggest a single dose of ibogaine can 
block craving for opiates and cocaine for at least 30 days afterward. And 
it lifts depression and anxiety, making addicts more amenable to 
counseling, she said.

Ibogaine also shows effectiveness against withdrawal and craving with 
alcohol dependence, with less evidence for help in kicking crack cocaine 
and no sign of an effect on smoking, she said. But Mash emphasized she has 
studied too few patients to make definite statements.

So what now? Lotsof figures ibogaine will break out of its limbo someday, 
but he says he doesn't know how.

For scientists, ibogaine still presents some basic puzzles. How does it 
produce its apparent effect on addiction? How can the effect persist long 
after the stuff is gone from the body? Are the dream-like visions important 
or just a side effect?

And is ibogaine just a stepping stone to something better?

Glick and Mash think the future lies not with ibogaine but with related 
substances. Glick is studying a synthetic derivative called 18-MC in rats. 
And Mash thinks that noribogaine, which the liver makes from ibogaine, is 
the real source of the anti-addiction effects.

In any case, Mash hopes scientific data from her work on St. Kitts will 
provide the rationale for somebody to pay big money -- finally -- to 
develop noribogaine or some other ibogaine-related substance.

"I would hope we can get enough of a tailwind going here that we can launch 
this boat," she said. 
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MAP posted-by: Richard Lake