Thomas Brown | University of California, San Diego (original) (raw)

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Papers by Thomas Brown

Background: Ibogaine is a monoterpene indole alkaloid used in medical and nonmedical settings for... more Background: Ibogaine is a monoterpene indole alkaloid used in medical and nonmedical settings for the treatment of opioid use disorder. Its mechanism of action is apparently novel. There are no published prospective studies of drug use outcomes with ibogaine. Objectives: To study outcomes following opioid detoxification with ibogaine. Methods: In this observational study, 30 subjects with DSM-IV Opioid Dependence (25 males, 5 females) received a mean total dose of 1,540 ± 920 mg ibogaine HCl. Subjects used oxycodone (n = 21; 70%) and/or heroin (n = 18; 60%) in respective amounts of 250 ± 180 mg/day and 1.3 ± 0.94 g/day, and averaged 3.1 ± 2.6 previous episodes of treatment for opioid dependence. Detoxification and follow-up outcomes at 1, 3, 6, 9, and 12 months were evaluated utilizing the Subjective Opioid Withdrawal Scale (SOWS) and Addiction Severity Index Composite (ASIC) scores, respectively. Results: SOWS scores decreased from 31.0 ± 11.6 pretreatment to 14.0 ± 9.8 at 76.5 ± 30 hours posttreatment (t = 7.07, df = 26, p < 0.001). At 1-month posttreatment follow-up, 15 subjects (50%) reported no opioid use during the previous 30 days. ASIC Drug Use and Legal and Family/Social Status scores were improved relative to pretreatment baseline at all post-treatment time points (p < .001). Improvement in Drug Use scores was maximal at 1 month, and subsequently sustained from 3 to 12 months at levels that did not reach equivalence to the effect at 1 month. Conclusion: Ibogaine was associated with substantive effects on opioid withdrawal symptoms and drug use in subjects for whom other treatments had been unsuccessful, and may provide a useful prototype for discovery and development of innovative pharmacotherapy of addiction.

Ibogaine is a psychoactive alkaloid derived from Tabernanthe iboga, a plant used in initiatory ri... more Ibogaine is a psychoactive alkaloid derived from Tabernanthe iboga, a plant used in initiatory rituals in West Central Africa. Largely because of ibogaine's status as a Schedule I substance in the U.S., the development of ibogaine's use in the treatment of drug addiction took place outside conventional clinical and medical settings. This article reviews the history of ibogaine's use in the treatment of drug addiction, and discusses progress made towards, and obstacles blocking, the establishment of controlled clinical trials of ibogaine's efficacy. Preclinical research has generally supported anecdotal claims that ibogaine attenuates withdrawal symptoms and reduces drug cravings. Concerns about ibogaine's safety, as well as a dearth of solid data from human studies, have hampered progress in its development as an approved medication. This article outlines major findings from preclinical studies, discusses concerns about ibogaine's safety, and details previous and ongoing research on ibogaine's use as an anti-addictive treatment for humans.

Conference Presentations by Thomas Brown

Ibogaine is a psychoactive alkaloid, one of roughly a dozen known alkaloid compounds present in t... more Ibogaine is a psychoactive alkaloid, one of roughly a dozen known alkaloid compounds present in the root bark of the iboga shrub, Tabernanthe iboga. For at least a few centuries, iboga has traditionally been used in West Central Africa, where the plant is indigenous, for healing and for initiatory rituals conferring membership in the Bwiti religion. Ibogaine, on the other hand, in recent decades has primarily been used for the treatment of drug addiction, usually outside of Africa. This paper will outline the development of a global ibogaine medical subculture that has seen treatment clinics established in many countries in the decades following the 1962 discovery of ibogaine’s ability to greatly diminish the withdrawal symptoms and drug cravings associated with opiate addiction. It will then provide an overview of current ibogaine treatment, including the availability of treatment in countries such as Mexico and Canada, where ibogaine is unregulated; in New Zealand, where ibogaine has been approved as a prescription medication; and in the USA, where ibogaine is illegal and yet underground treatment persists. In so doing this work will incorporate some discussion of the impacts of the widely varying legal landscape upon the development and geography of the ibogaine medical subculture, and will consider the mismatch between the availability of iboga (and access to treatment) around the globe versus the ubiquitous need for effective treatment of drug addiction. The paper will also discuss concerns over potential overuse and scarcity of iboga, declared a national treasure by the Republic of Gabon, for both indigenous use and for medical purposes around the world, and will assess the importance of an alternate source of ibogaine by way of a semi-synthesis from voacangine, a compound found in the bark of the comparatively plentiful and widespread plant, Voacanga africana. The paper will also discuss research showing the efficacy of ibogaine for opiate and other drug dependence, highlighting a recently completed study, led by the paper’s author, of long-term outcomes for opiate-dependent patients treated at ibogaine clinics in Baja California, Mexico. The study is the first to systematically observe and investigate long-term outcomes for patients treated with ibogaine for the interruption of substance dependence. In conclusion, this paper will argue for the important role of continuing research on the efficacy of iboga- and ibogaine-assisted treatment for drug addiction as a means for challenging the existing legal restrictions on the medical use of iboga.