History

Ibogaine comes from the roots of an African shrub, Tabernanthe iboga, and has been used by Shamanic tribes for centuries in rituals that connect humans with the spirit world.  The use of Ibogaine in the treatment of drug addiction was discovered by accident in the 1960′s, and the use of it for treatment has been argued about ever since.

Addiction Interrupter

Ibogaine at low doses is a mild stimulant.  At higher doses it causes hallucinations and an experience that interrupts a patient’s addiction to a variety of substances.  Ibogaine is known by scientists to have anti-addictive properties, and actually seems to alleviate withdrawal symptoms of substances such as heroin, cocaine, nicotine, and alcohol.  The problem is that the experience that comes with taking Ibogaine is severe and scary and dangerous to the patient.

Effects of Ibogaine

Someone that has taken a high dose of Ibogaine will experience two phases.  The first phase is the visual phase and it consists of hallucinations of objects moving around the room, colors flying, memory impairment, and dreamlike sequences.  This phase can last up to four hours before the second phase begins.  The introspective phase consists of a feeling of euphoria and thought clarity.  The patient will often reflect on their lives and the background behind their drug addiction.  This phase can last one hour, or it can last a few days, depending on the patient.

Risks

It is the experience that comes with taking Ibogaine that has many people concerned.  The patient is not in control of their body, and often is paralyzed by their altered mental state.  There have been a number of deaths from Ibogaine, possibly caused by interaction with other drugs, or pre-existing medical conditions.  But because of all these things, the U.S. government put Ibogaine on Schedule 1 in 1967, making it illegal in this country.  Other countries have banned Ibogaine as well, while there are as many as 12 countries that do allow its use.  Canada and Mexico both are among those that do allow the use of Ibogaine in clinics.

Future of Ibogaine

Boston’s Northeastern University recently held the Boston Ibogaine Forum, where those interested in the future of Ibogaine met for a conference filled with information about the drug.  Supporters want more research to be done on the drug in the hopes that it will soon be legal to use.  Perhaps, though, it is actually the study of the drug that both sides are waiting for, to determine whether or not it is as effective and safe to use as some say.

Sources

Greene, Doug Feature: The Boston Ibogaine Forum — from Shamanism to Cutting Edge Science 3/1/09

Sanchez, Carolina Banishing addiction forever? March 17, 2009

Why Choose Ibogaine for Drug Detox?

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Unfortunately, there is not enough evidence to conclude that either way is better.  Numbers do show that the use of methadone is successful in getting patients to give up heroin, but then the patient does not really end up being drug-free because they are addicted to the methadone.

History of Heroin
Heroin has been around for a long time, and is currently grown around the world, with large supplies in the Middle East, Asia, and Latin America.  The drug had been a problem in the United States for decades, but the Nixon administration actively tried to diminish supplies of heroin when he declared a war on drugs in the 1970′s.  It was during this time that methadone maintenance treatments came to light, and experiments were done to measure its effectiveness.  However, incomplete data recording, complex situations of treatment, and inconclusive evidence have all aided in the differing of opinions that we have today.

Heroin Withdrawal
What we do know is that heroin is a hard drug to beat.  The addict’s body quickly becomes so dependent on the substance that to go without it would mean a severe withdrawal.  Nausea, vomiting, pain, sweating, fatigue, depression and insomnia are what an addict goes through when trying to quit.  But, if a patient is put on methadone when stopping the heroin, the symptoms are not nearly as bad.  The patient will need to work to withdraw from the methadone, but that can often happen over weeks or months.

Another thing we know is that addicts that are required to quit heroin without the use of medication are less likely to stay in treatment than those that are assisted by drugs such as methadone.  Perhaps it gets to be too big of a task before them to be rid of drugs completely, but whatever the reason, more heroin users will stay in treatment if it involves using methadone or another medication.

Methadone Treatment Facilities
Many drug treatment facilities have built their programs around these pieces of information.  By using medications such as methadone, physicians are able to ease the withdrawal symptoms and to keep the addict in treatment.  Facilities may not be able to come up with statistics that say their patients have completed their program and are clean and drug-free, but that they are heroin-free.  According to many, this is a better alternative.  Many facilities work to help their patients become responsible members of society, by keeping a job or taking care of their family, something heroin addicts find almost impossible.  For those patients that require the use of methadone to achieve those goals, the benefit of living a normal life is worth it.

Schneider, Eric The War on Drugs Redux 1-12-09

Mooney, Bette From Yale to Jail

Mattick, RP Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence

http://wwwdasis.samhsa.gov/teds05/TEDSD2k5Hi.htm

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First of all, it might be necessary to call a hotline to get immediate help for an addiction. This would be used when a person doesn’t know where else to go for help, or possibly someone is in immediate danger. If this is the case, the individual on the other end of the phone can give you valuable information about immediate treatment options.

Types of Facilities and Programs

If the decision is something that is thought about for a while and discussed, there are many different types of programs that might be useful. The first questions might be whether the facility offers residential, in-patient, or out-patient treatment, or a recovery house or long-term care. Some facilities are gender or age-specific, which might be particularly helpful to adolescents or females who might feel more comfortable in a setting with their peers.

It may be necessary for the treatment facility to have a detoxification program for the individual to rid their body of harmful substances while being monitored by a staff of medical professionals. After the physical dependency of the substance is addressed, the patient can begin counseling and treatment to manage the psychological dependency. Many treatment facilities have different activities to aid in this part of the recovery process. Things such as group therapy and family involvement have proven successful in treatment, as well as the 12-Steps for recovery. Some specialized facilities also provide programs such as equine therapy, recreational activities, cooking opportunities, and other things geared toward giving the mind and body something positive to focus on.

Recovery is an Ongoing Process

It is important for patients to be directed to long-term care to assist them in staying sober in the future. By learning about the risks of relapse and the skills needed to cope with stress and addiction triggers, an individual will be more likely to stay substance-free. A facility should provide follow-up services to give the recovering patient a support base when they move back into their lives. Recovery is an ongoing process. The groundwork is laid when an individual goes through treatment, but recovery continues on as the person is put back into their lives and families and has to effectively put what they learned into practice.

Entering into a treatment facility is a scary thing for most people. The unknown is hard to face. But the right facility can ease discomfort with their caring staff and positive programs. It still won’t be easy, but the goal is for the treatment to be successful. By working with counselors and staff to learn about oneself and taking accountability for the addiction, an individual can actually aid in the recovery process. So while you can expect treatment to be a challenge, it will hopefully be the best thing you’ve ever done.

Sources

T., Buddy Components of Effective Treatment Programs What Makes Alcohol Treatment Programs Work? January 22, 2008

http://en.wikipedia.org/wiki/Drug_rehabilitation

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This may be the exact reason some doctors are able to successfully support a drug habit without getting caught. They have easy access to the drugs, being around the drugs every day may lead to cravings for the drug, they see the positive results patients experience with the drugs, and they know the symptoms of drug abuse and how to hide them without getting caught.

Anesthesiologists and drug abuse

A recent study examined the risk of anesthesiologists being exposed to low levels of drugs through patients exhaling them or through the skin. While more studies are being done on this subject, it could be said that just the constant presence of the substances near a person could easily drive them to try it. Many anesthesiologists who are addicts started using drugs when they were under the stress of their residency training period and were not experienced enough with their profession to say “no” to the temptation to try a drug. It’s easy to become addicted to such powerful drugs, and it often doesn’t work to “just try it once”.

Even though the statistics are low- as few as 2% of anesthesiologist residents abuse substances- the drugs that they do use are usually some of the most powerful intravenous drugs around. This often leads to death because of the strong substances and addictive nature of them. A few additional problems result from anesthesiologists using drugs: being so educated about controlled substances, anesthesiologists may be more able to cheat on drug tests to keep from getting caught. The chances of an anesthesiologist making it through treatment and going back to their work are not very good; 1 out of 9 will end up dying from relapse and subsequent addiction. And the public safety issue is very concerning – how do we ensure that those responsible for our lives are sober when treating us?

Solutions for hospitals

Some hospitals have measures in place to catch drug abuse among staff, including urine drug tests and strict monitoring of controlled substances being taken out of stock. While these may be useful tools to help keep people honest, some would argue that the thing hospitals need to focus on is prevention of the problem. Education and training should include drug addiction awareness, and stress reduction practices should be taught. Perhaps if we focus on the well-being of individuals before they feel the need to turn to substances we can prevent the abuse in the first place.

Cox, Lauren Urine Drug Tests for Doctors? Nov. 12, 2008

O’Brien, Keith Something, anything to stop the pain 11/9/08

Vogler, Mark Former Lawrence General Hospital nurse gets 41 years in federal prison Nov. 20, 2008

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Opiate Detoxification Medications

Buprenorphine is a medication that significantly reduces the cravings of opioids. When combined with naloxone, an opioid antagonist, the results seem to be even better. Naloxone reduces or prevents the effects of drugs such as heroin or prescription painkillers, making them much less desirable to the addict. Naloxone also prevents the patient from misusing the buprenorphine combination because those that would try to inject the drug for a high (instead of taking it orally as prescribed) would suffer severe withdrawal symptoms.

While these medications have been used for adults in many instances, there has been little research on the effectiveness among young people addicted to opioids. The overall number of adolescents that abuse drugs has decreased since 2002, and while this is a very positive trend, the number of painkillers and opioids abused among teens has increased.

Study on Treating Adolescents

Dr. David A. Fiellin of the Yale University School of Medicine reports that as many as 10 percent of ninth graders have used opioids, and that 200,000 to 400,000 adolescents have abused some of these drugs. It seems that drugs are even more readily available to teens today than alcohol, as teens are able to order drugs online or steal them from their parents’ medicine cabinets. Often drug addiction starts as a fun thing that teens try, and ends up as a lifetime of dependence on the substance.

The study done by Dr. George Woody of the University of Pennsylvania’s Department of Psychiatry is one of the first of its kind. As was reported this week, researchers found that those teens that were put on a buprenorphine/naloxone combination (Suboxone) for an extended period of time (12 weeks or longer) were more likely to stay opioid free than those only given the medication for a short period of time. When taken off the medication, the drug use went up. Even with detoxification and counseling, the individuals that were taken off the Suboxone were back to using drugs in a short period of time.
While more research needs to be done on this topic, it seems that Dr. Woody and his team of researchers have shown that Suboxone is an effective treatment in the addiction of opioids when used for an extended period of time. There are those that disagree with the use of drugs to treat drug addiction, but if it means these adolescents have a chance to continue their life free of opioid addiction, many think these more drastic measures are worth taking.

Sources

Reinberg, Steven Extended Therapy Helps Drug-Addicted Teens November 4, 2008

Carver, Alice Extended Therapy for Young Opioid Addicts Better than Short Term Detox, Study November 5, 2008

Opiate Detox

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Congress approves Mental Health Parity Act

Congress approved legislation last week that would change the way insurance providers handle claims for mental illness and substance abuse. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 provides “equity in the coverage of mental health and substance use disorders by ensuring that group health care plans do not charge higher co-payments, coinsurance, deductibles, and impose maximum out-of-pocket limits and lower day and visit limits.” Supporters of this measure include many in the House and Senate, businesses, insurance companies, and physicians. However, a few questions remained and until last week, it was uncertain whether or not the bill would pass before Congress went into recess this year. By attaching it to the Wall Street bailout bill, however, Congress was able to pass it quickly.

Help is needed

Help can’t come soon enough for many Americans struggling with drug or alcohol addiction. According to the National Alliance on Mental Illness and the National Council for Community Behavioral Healthcare, mental illness is the leading cause, and substance use is the second leading cause, of disability among adults. Many of these adults are not getting the help they need to recover from their mental illness, and often it is because of the high cost of treatment. Another reason is fear of discrimination from their employer if they do seek treatment.

Equal Coverage for an epidemic

With legislation such as the Mental Health Parity Act, those with a substance abuse disorder can be reassured that their insurers will not be able to set a cap on healthcare coverage for mental illness or substance abuse that isn’t set for other illnesses.

In order to deal with the epidemic of substance abuse, we need more good addiction treatment facilities, more affordable health care to addicts, and more support behind families dealing with substance abuse. Through the passage of this bill, those with addiction should be encouraged to move forward and seek treatment, so that we can work toward decreasing the incidence of drug and alcohol abuse.

Sources

Congresswoman Shea-Porter Hails Passage of Mental Health Parity Act September 24, 2008

Many State Reform Initiatives Are Neglecting Mental Illness, Says Study July 08, 2008

Layton, Lyndsey Congress Approves Mental Health Bill Private Insurers Would Provide More Benefits Sept. 24, 2008

Ault, Alicia Equal Coverage For Mental Health?
Many States Require Parity, and Congress May Order It Nationwide November 6, 2007

Curley, Bob Congress, Bush Approve Addiction and Mental Health Parity Legislation October 3, 2008

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With all the anti-drug campaigns in communities today, it seems that teens may be getting the point about the dangers of some of these “street drugs” and are actually turning away from them in some cases.

Prescription Drugs

Today, however there are many more drugs available to teens, and different drugs of choice are making their way into schools and homes. Prescription painkillers like oxycodone and Vicodin® have been used more and more by adolescents in recent years. Many teens today believe there is nothing wrong with prescription drugs when taken once and while for fun, yet statistics show that oxycodone and Vicodin® are the most common drugs involved in fatal overdoses by young people.

The risk with these drugs is that young people do not believe they are dangerous or illegal because they are prescribed by a doctor. Another danger with these prescription drugs is that teens are able to get them for a very low cost or even free from friends or relatives. The easy accessibility of these drugs leads to a higher number of teens getting their hands on them, simply stealing the pills from their parents’ medicine cabinet.

Drugs such as oxycodone and Vicodin®, when used under the supervision of a physician, can be very beneficial to patients. On the other hand, the abuse of these drugs can cause strokes, seizures, comas, addiction, and even death. These prescription drugs can be just as addictive as street drugs, and the effects can be serious on the bodies and minds of young, developing teens.

Prevention

Even though the problem seems staggering, there are ways for parents to help prevent the misuse of drugs in their homes. Parents need to keep track of their prescription drugs, and be aware that their children may be able to get drugs from family members or friends very easily. Parents should talk with their children about the use of medication, and alert them to the severity of abusing prescription drugs.

While it seems that many anti-drug campaigns have been beneficial in the past, funding is becoming an issue when it comes to teen drug prevention. Every year, Congress gives money to states for drug treatment prevention, allowing the states to divide up the money among some of the programs they wish. A recent trend shows many states often spend very little of the money on adolescent drug prevention. With the new problem of prescription drug abuse in teens, it seems it is important that organizations that educate teens on prevention and treat teen addicts would receive funding to continue to fight this national problem.

Sources

More Kids Dying, New York Times July 18, 2008

Heroin’s Hold on the Young, New York Times Jan. 13, 2008

OxyContin, Vicodin Grow Popular as Teen Drug Use of Choice, Think and Ask nonprofit news February 2007

Teens Turn Away from Street Drugs, Move to Prescription Drugs, New Report Reveals ONDCP Press Release February 14, 2007

Rx—A New Intentional High for Teens National Youth Anti Drug Media Campaign, Greater Dallas Council on Alcohol and Drug Abuse 2006

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The Methadone Controversy

Russia is one of several countries where methadone is controversial. Recently, members of a Kremlin youth group launched a protest outside a methadone conference, where a group of physicians and specialists were gathered to discuss methadone treatment for drug addictions. In Russia and other countries struggling over this debate, critics of methadone argue that it traps patients in their addictions for life, leaving them addicted to yet another drug.

Methadone is used as a gradual therapy for recovering heroin users, allowing physicians to relieve their patient’s craving for heroin and block the effects of opiates. With methadone, the gradual and mild onset of the “high” prevents users from gaining the pleasurable effects associated with heroin.

However, opponents argue that methadone treatment substitutes one opioid for another, and fear of methadone being sold on the black market is a big concern. Often patients are left struggling with their addiction to methadone, causing their treatment to be lengthy or fail altogether.

In the United States, methadone treatment has become more regulated and widespread in recent years. An individual’s methadone treatment is often viewed as treatment for a disease rather than a poor moral choice. Therefore, treatment may continue throughout the patient’s life, allowing their bodies to be maintained with methadone and avoiding the symptoms of withdrawal altogether. While not a complete solution for a drug free life, methadone treatment has been found to decrease heroin related deaths and crime, and help individuals achieve greater control of their lives.

Buprenorphine and Suboxone

Today a new opioid medication is making its way into treatment facilities, doctor’s offices, and even homes. Buprenorphine is a partial opioid agonist, which causes it to be less addictive than either heroin or methadone. The “high” produced by buprenorphine is less intense, and the side effects are less dangerous. In general, buprenorphine is safer than methadone, and it is easier for a patient to discontinue buprenorphine than to detox from methadone. The NIDA views buprenorphine as a safer, more acceptable maintenance drug than methadone for the treatment of heroin addiction.

A form of buprenorphine, Suboxone, has been rapidly gaining approval for the treatment of opiates. Suboxone contains buprenorphine and naloxone, an opioid antagonist which is to be taken orally. As long as it is taken by mouth as prescribed, the naloxone causes no side effects. If a user would dissolve the Suboxone and inject it in order to get high, the injected naloxone would cause sever withdrawal symptoms. This special formulation of buprenorphine and naloxone is considered safer than just buprenorphine because it so strongly discourages misuse.

The future of drug addiction treatment with Suboxone looks promising. With the support of the NIDA and the SAMHSA, and with further testing, there is hope that in the future this will be a widespread, successful treatment for drug addiction in the United States and other countries.

1. Schwirtz, Michael, Russia Scorns Methadone for Heroin Addiction The New York Times July 22, 2008
2. Blaine, Jack D., Buprenorphine: An Alternative Treatment for Opioid Dependence NIDA Research Monograph, Number 121, 1992
3. National Institute on Drug Abuse, 1999. Principles of Drug Abuse Treatment: A Research-Based Guide. NIH Publication No. 99-4180.
4. Marion, Ira J., Methadone Treatment at 40 Science and Practice Perspectives December 2005
5. Wunsch, Martha Buprenorphine: Balancing Access with Quality of Care (NIH) February 2008
6. Condon, Timothy P., and Clark, Wesley Buprenorphine in the Treatment of Opioid Addiction: Balancing Medication Access with Quality Care (NIH) February 2008

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According to the CASA report a total of 365 web sites were found which advertise or offer for sale controlled prescription drugs. Granted of the 365 206 were only advertising the sales of controlled substance but 159 actually offered these drugs for sale. Only two of these 159 websites were certified by the National Association of Boards of Pharmacy as legitimate on-line pharmacies. (you’ve Got Drugs V, Pg.1)

This puts dangerous drugs into the hands of anyone surfing the internet. It is no wonder that prescription drug abuse and addiction rates have been steadily on the rise since 2001, even as rates of other illicit drug use have dropped. It is troubling also to note the trends of who uses the internet when discussing how easily controlled substances are available in these on-line pharmacies. The CASA report states that while only 68% of adults in the U.S. have access to the internet nearly 100% of college students and 78% of children aged 12-17 years old have online access regularly (you’ve Got Drugs V, Pg. 2).

These internet pharmacies are also not verifying the age of customers either. Users 13 and under were allowed to purchase drugs even while admitting their true age (you’ve Got Drugs V, Pg. 9). This dangerous combination of ready availability and access by young people to the internet has led to an increase of prescription drug use especially by teenagers and young adults.

No longer is it necessary to venture to “the wrong side of tracks” to find drugs. There is no need to associate with drug dealers or have to seek them out any longer. Today drugs are so readily available on the internet that anyone can use them and purchase them at will. The disturbing statistics released in the CASA report reveal that we all need to be vigilant in watching our children and their friends for signs that they may be an addict, and offering the appropriate help when necessary.

Download the Full CASA report for free here
Sources:
You’ve Got Drugs V CASA whitepaper
Prescriptions drugs Abuse and Addiction, a research Report by the NIDA

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When most people hear the words detox, they automatically think of managing drug withdrawal. While this certainly is the most important aspect of any drug detox, a service equally important is the ability to evaluate every individual as to their need for ongoing treatment. For this reason all centers need to employ clinicians trained in addiction and mental health problems, in conjunction with medical personnel, to evaluate each patient’s individual needs.

Credentials

There are many factors to consider when choosing a drug detox such as; ensuring that you are choosing a reputable and effective program. One way to achieve this goal would be to review the licensure of the program and the credentials of the staff.

Licensure

A program should always be licensed by the state in which they provide services. In Florida for example, it would be the Department or Children and Family Services. Secondly, and most important, is a program should be accredited by the Joint Commission on Accreditation of Hospital Organizations (JCAHO). This accreditation insures the drug detox maintains certain standards of care as determined the Joint Commission.

Drug Detox Staff Credentials

The physicians providing the drug detox services should be board certified in their particular discipline and secondly credentialed by A.S.A.M., the American Society of Addiction Medicine. This insures the physician has a thorough understanding regarding the disease of addiction and drug detoxification protocol. The nursing staff should consist of Registered Nurses (R.N.) and Licensed Practical Nurses (L.P.N.) both trained in the treatment of drug addiction, alcoholism and the dynamics that accompany the person in drug detox. The clinical staff should as a minimum be master’s degreed or be a Certified Addiction Professional (C.A.P.). They should have experience in the treatment of drug addiction, alcoholism and psychiatric disorders and have spent some time working in a drug detox.

This article was provided by Dan Clark with Recovery Connection Addiction Treatment Helpline at www.recoveryconnection.org

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