By David Dardashti
First, do no harm
Would I offer my patients to change from mainstream medicine or Evidence Based Medicine (EBM) to alternative therapies? The only reasonable answer to me was no. For a very simple reason: If I have no proof that a therapy really helps a patient of mine, I am not going to put him/her thru it.
Solid evidence (as in well interpreted statistics) Is the only reason that makes me put a patient thru any treatment.
For example: Do I use antibiotics to treat a common cold? Well, if 99% of all cases are proven to be viral, then the answer is no. What does “proven” mean in EBM? Well some questions have to be answered, like: How old is the information that I have? How many people were studied to make such a statement? Where did the study took place? This and many other factors are taken into account before deciding (together with the patient) the best course of action.
My personal favorite motto in medicine: “Primum non nocere” which means “first, do no harm” because is such an easy thing to forget: Any treatment means harm to the patient. Starting with the endless lists of side effects on even the most basic over the counter medication, and adding the costs and potential lack of effectiveness of such medication, the list of cons goes on.
To me EBM (with all its flaws) was the best scale to weigh the pros and cons of any given therapy, because numbers are so straight forward, as they say: they do not lie.
Until Ibogaine came along.
Thru chance I found myself doing physical exams on patients that wanted to undergo a treatment with an obscure hallucinogenic drug, mainly with the purpose of getting rid of their opiate addiction.
So, I started doing research. What is Ibogaine? How does it work? And DOES it work?
The evidence is of poor quality: observational studies, case reports, anecdotal articles and testimonials. Nowhere near what I needed to justify a treatment.
But then I saw the treatment for myself. Patients addicted to pain killers (opiates), methadone, heroin, alcohol.
All of them went out of treatment free of withdrawal symptoms, free of cravings.
The first time a patient, a seven-yearlong heroin addict complained of anxiety (a common side effect of Ibogaine) we were on the street, he had been drug free for 48 hours and was just walking back from having lunch at a local restaurant.
48 hours! Talking, walking, eating lunch. It took a moment until it sunk in. No vomiting, no diarrhea, no dilated pupils no general sickness, nothing.
It was amazing.
So, were these amazing benefits reason enough to give a patient Ibogaine? Especially when there have been reports of casualties during the treatment with it?
On death and numbers
So how do we measure the burden of a disease? How do we know how “bad” it is? Mainly we take two things into account: How bad is your everyday life because of the disease, and how many years of life it takes away from you.
If you or someone you know is affected by opiate addiction, I do not need to explain how bad it affects everyday life way worse than, let’s say, diabetes or Heart disease.
As for the years of life it takes away from an individual the best tool to measure it is the years of potential life lost (YPLL) because it gives more weight to deaths that occur among younger people.
Everyone is going to die eventually. If we use the raw numbers (mortality rate) to look at death we may lose sight of what is most important, because big numbers impress the most. Take a look at the following:
Nearly 574,743 people died on 2010 of cancer
Nearly 15,000 people die every year of overdoses involving prescription painkillers (by the way, more than heroin and cocaine combined)
The first thing that comes to mind: If we concentrate our efforts on curing cancer we will save half a million lives a year! On the other hand a cure for opiate addiction would only save 15,000 people a year.
That is true, but addicts die younger.
While most cancer patients are older people (The median age at death of cancer patients between 2001 and 2005 was 73 years) the death rates related to opiate overdose were highest among persons aged 35-54 years.
So how many years do these diseases take away from a person’s life?
Cancer: 15.5 years
Opiate addiction: 18.3 years
It is not the same to lose your father when he is 65 than when he is 35. It is not the same to lose your grandmother than to lose your daughter. The social impact has to be taken into account. And while the misuse of Ibogaine might kill 1 in 300 people, nearly half of all heroin addicts will die of drug related problems.
Minimizing the risks
The estimate number on the death rate with the use of Ibogaine can be diminished by doing mainly three things right.
First: The use of pure (or pharmaceutical grade) Ibogaine, which means that the procedure and specific technology used to produce the substance are U.S. FDA compliant.
Second: The implementation of a thorough health assessment before the treatment.
Third: The careful calculation and adjustment of the individualized dose for every patient, taking into account the patients response to the treatment.
All of that makes the use of Ibogaine very safe. How safe? Take the following into consideration: At least 16,500 NSAID-related deaths occur each year among arthritis patients alone.What are NSAID’s? Aspirin, Advil, Toradol, Voltaren, etc. Almost all of them are over the counter medication.
Putting everything together
So why did I decided to oversee the Ibogaine therapies if it’s not an approved medication? How can I justify the use of Ibogaine if the evidence supporting it it’s not very solid? Why do I think that the benefits overweigh the risks even if that judjment it’s just experience based?
Very simple, because Ibogaine saves lives. And that is why I became a Doctor, to get into the business of saving lives.
Ibogaine, an anti-addictive drug: pharmacology and time to go further in development. A narrative review.
Maciulaitis R, Kontrimaviciute V, Bressolle FM, Briedis V. Department of Basic and Clinical Pharmacology, Kaunas University of Medicine, Lithuania.
3,414 documented cases of ibogaine-assisted treatment through 2006 (K. Alper, H. Lotsof, and C. Laughlin (2008) J. Ethnopharmacol. 115 (1): 9-24)
 Animal studies show that it greatly reduces craving, withdrawal (e.g. S.D. Glick, M.E. Kuehne, J. Raucci (1994) Brain Res. 657: 14-22)
 Treatments by Lotsof, addict self-help groups in the Netherlands and in New York City, and providers such as Eric Taub (K. Alper, D. Beal, and C. Kaplan (2001) A Contemporary History of Ibogaine in the United States and Europe. The Alkaloids 56: 249-282)
 Epidemiology. 1990 Jul;1(4):322-9. Years of potential life lost (YPLL)–what does it measure? Gardner JW, Sanborn JS. Department of Preventive Medicine and Biometrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799.