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Experiences of Opioid Detoxification

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Experiences of Opioid Detoxification Experiences of opioid detoxification using ibogaine in various treatment settings: Exploring ibogaine users’ motivations, understanding of risks, and effects of ibogaine treatment A thesis submitted for the degree of Masters of Health Sciences University of Otago, Christchurch New Zealand Jamie Walker December 2016 ABSTRACT Introduction Opioid dependence is a significant health concern in New Zealand. It has been estimated that there are 10,000 people who are daily or almost daily intravenous users of opioid drugs, half of whom are receiving opioid substitution treatment (OST) Similar to overseas countries. It is also estimated that there is a growing number of people in New Zealand who are dependent on prescribed opioids. However how many is currently unknown (Adamson et al., 2012). One alternative intervention for opioid dependence is ibogaine treatment. Ibogaine is a hallucinogenic drug that alleviates opioid withdrawal symptoms for up to three months. (Alper, Lotsof, Frenken, Luciano, & Bastiaans, 1999). However, ibogaine's metabolites interfere with cardiac centres in the brain, in some cases causing heart arrhythmia and death (Maas & Strubelt, 2006). Ibogaine providers promote pre-treatment tests (bloods and electrocardiogram (ECG)) reducing this risk (Alper, Lotsof, & Kaplan, 2008). Anecdotal reports suggest ibogaine treatments can occur with support from ibogaine treatment providers, ranging to; ‘peer to peer’ use with unknown medical advice. The aim of this study was to explore the experiences of people who had used ibogaine in New Zealand; and to discover what, or if, any medical tests had been sought and/or accessed. Method A qualitative, collective case-study research design was used. Ten people who used ibogaine for their opioid detoxification were recruited. Face-to- face interviews were conducted with each of the participants, in participants' homes or public cafes. The interviews were recorded and ~ ii ~ transcribed. Common experiences were coded then grouped into themes and analysed. Findings Seven identified themes and their described interactions collectively related an ibogaine user’s experience. It began with 'not sitting comfortably on opioids', due to associated low moods, physical side effects, stigma and despair. Hope of a successful and quick opioid detoxification treatment, with no opioid withdrawal experience was the main motivator for people choosing ibogaine. All participants sought medical testing before ibogaine treatment but those who had the support of an ibogaine treatment provider (ITP) received the most appropriate medical screening and recommended test. People had more positive treatment experiences when medical supports such as nausea control, sleep management, use of ibogaine booster doses and psychological support after treatment were available. Ibogaine treatment had major positive effects on mood and anxiety reduction for the participants, and was the main contributing factor for seven respondents who remained opioid-abstinent. Respondents described seeking and obtaining a spiritual or deep psychological change regarding their drug use and attributed this to ibogaine treatment. Conclusions The collective experience of the ten participants provided implications for possible future practise of ibogaine treatment. Use of an ibogaine treatment provider (ITP) afforded safer, more positive treatment outcomes. The continued legality of ibogaine is supported by this study, where respondents, supported by an ITP, had better access and greater medical support when ibogaine was legal. The use of additional doses of ibogaine and medical management of nausea and sleep appeared to affect better treatment results. This case study participants sought the hallucinogenic ~ iii ~ effect of ibogaine as part of the treatment and had better treatment results when psychedelic experiences were achieved. Best treatment results were described as, no opioid withdrawals, positive effects on mood and anxiety and ultimately, opioid abstinence. ~ iv ~ ACKNOWLEDGEMENTS To the only one who knows the cost, and to the only one who can forgive, my gracious, forever patient wife, Katie. To my academic supervisors Dr Daryle Deering and Dr Dave Caryle, and the Otago University, School of Psychological Medicine and the National Addiction Centre, supporting and teaching always, but also making this ‘science’ happen. To my newfound heroes, the respondents of this case study, who are true pioneers in this field and have taught me never to give up. Special acknowledgement to Tanea Patterson whose work helped forge this study and has helped many other ‘heroes’. Thank you, ARA Institute of Canterbury who helped finance the research and more importantly, have been really supportive through the duration of the study. ~ v ~ TABLE OF CONTENTS ABSTRACT ........................................................................................................... II INTRODUCTION ................................................................................................. II METHOD ........................................................................................................... II FINDINGS ......................................................................................................... III CONCLUSIONS .................................................................................................. III ACKNOWLEDGEMENTS .................................................................................. V TABLE OF CONTENTS ..................................................................................... VI LIST OF TABLES ................................................................................................. X LIST OF FIGURES ............................................................................................. XI GLOSSARY AND TERMINOLOGY .............................................................. XII CHAPTER ONE: INTRODUCTION .................................................................. 1 OVERVIEW OF CHAPTER .................................................................................... 1 BACKGROUND .................................................................................................. 1 Opioid dependence in New Zealand ...................................................... 1 Alternative treatments ............................................................................ 2 Ibogaine ................................................................................................. 3 RESEARCH PROBLEM ........................................................................................ 5 AIM/RESEARCH OBJECTIVES ............................................................................ 5 RESEARCH QUESTION ....................................................................................... 6 DESCRIPTION OF RESEARCHER ......................................................................... 6 THESIS OUTLINE ............................................................................................... 6 CONCLUSION .................................................................................................... 8 CHAPTER TWO: LITERATURE REVIEW ..................................................... 9 OVERVIEW OF CHAPTER .................................................................................... 9 LITERATURE REVIEW METHODOLOGY ............................................................ 10 STATEMENT 1: OPIOID DEPENDENCE IS A SIGNIFICANT HEALTH CONCERN FOR NEW ZEALAND ............................................................................................... 11 Introduction ........................................................................................... 11 New Zealand opioid use trends ............................................................. 11 Prescription Drug Misuse (PDM) ........................................................ 13 Sub-groups and subculture ................................................................... 14 Associated harm with opioid use ......................................................... 14 Opioid dependence treatment............................................................... 16 Statement 1: Conclusion ...................................................................... 17 STATEMENT 2: IBOGAINE HAS BENEFICIAL EFFECTS ON OPIOID DRUG WITHDRAWAL SYMPTOMS AND CRAVINGS DURING OPIOID DETOXIFICATION. 18 Introduction .......................................................................................... 18 Historical context ................................................................................. 19 Animal studies ...................................................................................... 20 ~ vi ~ Ibogaine trials ...................................................................................... 21 Wider ibogaine trials ............................................................................ 23 Hallucinogens used with psychotherapy for addiction ........................ 26 Spirituality and addiction treatment .................................................... 27 Statement 2: Conclusion ...................................................................... 28 STATEMENT 3: IBOGAINE USE HAS CARDIAC CONCERNS, WHICH ARE ATTRIBUTED TO CASES OF DEATH. .................................................................. 29 Introduction .......................................................................................... 29 Adverse effects.....................................................................................
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