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Addiction: The dangerous drug withdrawal with ibogaine

And there are other gaps in knowledge: Maarten Belgers from Radboud University Medical Center in the Netherlands, together with his colleagues, scrutinized all studies that have looked at ibogaine and similar substances in animal experiments. The researchers discovered that the effects of ibogaine had so far only been studied in relation to opioid, cocaine and alcohol addiction. Scientists also tested 18-MC and noribogain on rodents who could not stop using amphetamines or nicotine, but it is unclear whether the agent really works for all types of substance dependencies. Belgers also complains that the methodological standards in numerous studies are inadequate. Often researchers did not even randomly assign their test animals to the treatment or control group - a basic requirement for serious experimental design.

Many of the studies in which scientists tested ibogaine on humans are similarly problematic. Control groups are usually completely absent here, and none of the studies has so far been able to show a statistically relevant number of test persons. And one key question still remains unanswered: Is there even a dose of ibogaine that works and is safe at the same time?

Additional research is required to answer that. Senior physician Gabriele Koller sees it similarly. She treats people with addiction disorders at the University of Munich Clinic. "Before we can say whether ibogaine has a future in addiction therapy, we need more data and experience," she says. The doctor advocates further research into new, promising substances. However, she does not find ibogaine necessary, because withdrawal is also so easily feasible. Rüdiger Holzbach, chief physician for addiction medicine at the Arnsberg Clinic, has a similar view: "A drop-out rate of 40 to 50 percent in heroin withdrawal is not a free ticket for experimental therapies, some of which are fatal."

Too simple an addiction model

In the eyes of the two medical professionals, addictions are too complex to be cured with a single tablet. "The dream of the pill against addiction is based on an addiction model that is too simple," says Holzbach. Ultimately, the way out of addiction could look very different. The more the substance determines the patient's life, the more psychotherapy is needed, in which those affected learn to change their thinking and acting. "This includes a certain biographical work, but also very specific changes in everyday life."

So is ibogaine not a miracle cure after all? »Substance only gives you space to change«, is Álvaro de Ferranti's conclusion. The native Briton, who now lives in Portugal, was addicted to crack and cocaine for years. At the same time he ran several companies and a life as a family man. After trying various addiction therapies unsuccessfully, Ibogaine first frees him from his cravings for drugs. He relapsed six months later. He then takes the substance again and relapses again. Then it finally “clicks!”: “I realized that I had to change something in my life,” says de Ferranti. Psychotherapy helps with this process. He takes one last drug treatment and begins to work on himself. He's been clean for many years now. Keller is also thinking about therapy, but has not yet been able to bring himself to do it. "I'm just so happy and positive at the moment."

De Ferranti would like to pass on his experience with ibogaine to others. He has opened his own treatment center in Portugal. Together with a doctor, nurses and "providers" who are experienced in handling the drug, he wants to offer patients not just a pill for their addiction, but a complete rehabilitation program. Addicts should take a break from their familiar surroundings and be professionally instructed to combat their addiction. He doesn't want to wait until ibogaine is approved as a medicinal product.

Meanwhile, the neuroscientist Mash and the addiction medicine specialist Belgers are working on this. The 66-year-old Mash is fully concentrating on the commercialization of noribogain with the pharmaceutical company DemeRx she founded. "I will devote the rest of my life to fighting this terrible opioid epidemic," explains the researcher. She is about to publish the largest study to date on 200 patients. In the meantime, Belgers is evaluating the data from a clinical study in which he and his colleagues want to investigate whether the substance can be safely used in opioid-dependent patients.

Addiction medicine specialist Holzbach is less optimistic. "From my point of view, ibogaine will not change addiction treatment." It is unclear, however, whether a ban like the one in the USA would be the better option. Brunt from the Dutch Trimbos Institute hopes researchers will not give up the substance yet. “I don't think ibogaine deserves its bad reputation. The first experiments with the active ingredient in the 1980s were not particularly professional. Now scientists have to prove that they can do a better job. "

& ast; Name changed by the editor.