The Anti-Addiction Drug Ibogaine and the Heart: A Delicate Relation

This review (2015) examines how the anti-addictive drug ibogaine affects the heart and the cardiovascular system and outlines a sequence of deleterious events that lower heart rate and selectively block cardiac ion channels which pave the way for life-threatening arrhythmias. Due to the longevity of noribogaine—ibogaine’s active metabolite—in human plasma, cardiac adverse events may also occur several days after, which highlights the need for developing less toxic variants of ibogaine such as 18-MC.

Abstract

“The plant indole alkaloid ibogaine has shown promising anti-addictive properties in animal studies. Ibogaine is also anti-addictive in humans as the drug alleviates drug craving and impedes relapse of drug use. Although not licensed as therapeutic drug and despite safety concerns, ibogaine is currently used as an anti-addiction medication in alternative medicine in dozens of clinics worldwide. In recent years, alarming reports of life-threatening complications and sudden death cases, temporally associated with the administration of ibogaine, have been accumulating. These adverse reactions were hypothesised to be associated with ibogaine’s propensity to induce cardiac arrhythmias. The aim of this review is to recapitulate the current knowledge about ibogaine’s effects on the heart and the cardiovascular system, and to assess the cardiac risks associated with the use of this drug in anti- addiction therapy. The actions of 18-methoxycoronaridine (18-MC), a less toxic ibogaine congener with anti-addictive properties, are also considered. “

Authors: Xaver Koenig & Karlheinz Hilber

Summary

Psychotomimetic agents are coming into widespread use both as investigative tools and as an aid in psychotherapy. The number of individuals who have received either LSD or mescaline cannot be considered in detail here. The number of major complications of normal and abnormal mental function, encountered, was requested. Lysergic acid diethylamide (LSD) and mescaline are currently the most de- pendable drugs capable of producing tran- sient dissociation states for these purposes.

In almost five thousand individuals who had received either LSD or mescaline on more than 25,000 occasions, adverse reactions were surprisingly infrequent. The number of investigators who had experience with both agents varied from one to 80, and no instance of serious, prolonged physical side effects was found.

In a patient with a lifelong pattern of day dreaming, Stevenson witnessed a psychotic-like state that lasted for a week. Three interesting delayed reactions to LSD lasting several days are related by Harley-Mason, and these reactions might be aggravated by exposure to mescaline.

A depressed, chronically schizophrenic girl who had been given LSD used this opportu- nity to throw herself under a train and was allowed occasional auditory and visual illusions. A patient took LSD without the therapist’s knowledge and experienced a depressive reaction lasting for a day. The patient later re-emerged with transient dissociative phenomena and recovered gradually over the next week.

Savage found that conversation and per- gence of primary process elements seem to diminish the intensity of the reaction, whereas anxiety, isolation or relative restriction of sensory inflow increase it. The dosage factor appears to be important, and the subject should be made aware of this remote possibility.

The investigator using LSD becomes aware of whichgroupsare more likely to have unpleasant, painful reactions to LSD. Although there are exceptions, people who find that the hnphcations posed by the LSD experience are contrary to their basic anxiety, pallor, a cold sweat, thready pulse, and dilated pupils. Two Zen Buddists were of unmanageable behaviour after taking LSD. They became so un-paranoid that termination with chlorpromazine, disrobing, or accidental self- mazine injury became necessary.

The psychedelic effect of gmilt-laden material lasts for many hours and can be precipitated by the mobilization of visual aberrations, aggressive impulses or by the upsurge of con- wavelike undulations. A psychology trainee who took the drug for was given phenothiazines and kept on a locked ward.

Three patients who were left alone after the death in the grand manner could be con- sidered by those who have achieved a state of complete ego dissolution, but required further therapeutic average amounts of LSD combined with support.

Ling’s case is an example of a devastating depression that was relieved by intensive psycho-therapy. The depression was caused by an emergence of considerable shame or guilt, an inability to integrate or disturbed person produced a depression and attempt at suicide. A psychiatric resident gave 25 micrograms of LSD to a patient with chronic anxiety and a schizoid personality. The patient kept repeating “I see it all now” but refused to communicate with anyone.

A man who had taken LSD and had attempted suicide had been given the drug without his knowledge, and his depression lifted slowly, and he was eventually able to be discharged from the hospital essentially unconcerned.

The devastating effects of a completely un-suicidal LSD patient are seemingly explicable, but the patient became depressed for three weeks and then committed suicide. He was found dead in his room with the NO2 mask on his face.

A 44 year old suicidally depressed female and a 25 year old preschizophrenic latent who were addicted to Demerol were given 50 and 200 gamma of LSD, respectively, by Hartman. The patients’ behavior became bizarre and they required hospitalization, but the final outcome was not reported.

A depressed male patient who had taken peyote and had been treated with LSD went into a chronic LSD state for weeks, culminating in an undifferentiated schizophrenic reaction for which he was hospitalized and treated with phenothiazines.

Hoch and Malitz relate the story of two identical twins who were given LSD intravenously. One twin became more autistic.

He was not detained by the police during the atomic explosion at Eniwietok, but voluntarily admitted himself to Metropolitan State Hosp- the blast was interpreted by him as a manioc.

The patient was a decompensating schizo-phrenic who was desperately struggling to reestablish his shattered defenses. He was exposed to an unusual variety of treatments including dream analysis, reincarnation discussions, group therapy and hypnosis, conventional methods of treatment.

The patient was blindfolded and left depressed for two or three days. The second session may have been highly therapeutic, as he clearly saw in great detail how he had smothered his baby brother in order to keep him from crying.

Eight instances of psychotic reactions lasting more than 48 hours were recorded in patients undergoing therapy. Two of these went into a remission within a few days.

The interview is used to establish rapport with the prospective candidate and to answer questions. In some institutions signed releases are required.

Patients considered for LSD are usually fairly well known to the therapist, and certain relative contraindications will be discussed later. The nature of the experience and the expectations for the session are communicated at this time, and misconceptions are corrected and necessary reassurrances given.

Personnel in contact with the subject should be experienced and sympathetic. Control of the subject through continuous observation is one of the more important preventative measures that can be taken.

LSD is a highly suggestive drug, and the patient can sense the therapist’s unspoken feelings with phenomenal accuracy. A liver panel, electrocardiogram, MMPI or other psychologic screening test should be available to exclude volunteers from some studies.

The mentally retarded patient would seem to be a poor choice for LSD therapy, as they tend to do poorly with the hallucinogens, yet a variable degree of success in their treatment has been reported.

Serious, active physical disease is a contraindication to LSD therapy. However, terminal cancer patients should spend the evening quietly at home with someone who knows the approximate nature of their experience.

LSD is routinely prescribed at bedtime, and alcoholics with liver damage are recommended to re-order and re-evaluate the drug. Individual therapists would avoid placing emotional and intellectual elements of the obsessive compulsives, hysterical or acutely depressed patients into the treatment situation, but it is possible that LSD and mescaline at- treat certain unstable individuals in their treatment situation.

The therapist’s first use of LSD was a schizoid experience, and he reacted to the heady and extremely well-structured delusions by going along with the more common psychotomi- representative of LSD as a psychotherapeutic adjunct be a competent physician.

LSD may serve as a gratification for the psychoanalyst’s own needs for power, but it also produces some nausea and, less frequently, an individual would tend to focus on his LSD experience.

Two patients sustained a shock-like state, ten sustained migraine headaches, one became paraplegic, and one became c ashen and cold. The cause of these effects was attributed to LSD, and a placebo effect accounts for many of the mishaps observed by others. The only suicide attempt he has seen after a period of complete recovery was with mescaline, and a skin reaction following the ingestion may not be due to placebo effects.

Stevenson gave 400 rag. of mescaline to a young girl who proceeded to have auditory hallucinations and doubts about the reality of perceived objects for several days there- after. A review of the literature and the communications of 44 physicians who have administered LSD to patients suggests that caution should be exercised in the selection of subjects and patients, and that constant attendance is necessary during the session.

Experimental subjects are safe when given LSD or mescaline at home with a friend or relative, and that decision-making analysis of these incidents suggests that many side effects might have been avoided.

During the active phase of the drug’s activity, the patient may require reassurance and support. A trained and sympathizing nurse or attendant may substitute for the physician, and the therapist himself should probably have experience with the agent, lysergic acid diethylamide.