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: 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

Ibogaine molecule

Tabernanthe iboga shrub

Roots contain ibogaine

Pharmaceutical ibogaine

experimental medication

Discovery of antiaddctiveeffects

MethadoneNYC1964

Doctors administer to drugs users

IbogaineNYC1962

Drug users administer to

drug users

Methadone

•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 team.

• 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 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.

Two important issues in methadone today

• Stigma

• Discrimination

Focuses attention on the victim

Stigma

Focuses attention on

those who produce rejection and exclusion

Discrimination:

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 providers.

Attention patients, counselors or methadone providers

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

program.

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