UK Government Injectable Opiates Prescribing Guidelines

Link here to the NTA (national treatment agency) UK injectable opiate prescribing guidelines

I've quoted below the most important parts... There is a lot of interesting information in the PDF so I would suggest reading through if you have an interest in the subject

This is taken from the PDF. The main message from the NTA is that the following eight principles should be adhered to when considering prescribing injectable opiates:

This link is the guidelines issued to my local NHS specialist addiction unit, it's specific to east London but the guidelines are probably applicable to most drug services nationwide.

        Principles guiding injectable maintenance prescribing

This guidance recommends that injectable maintenance prescribing should only be undertaken in line
with eight principles.

1. Drug treatment comprises a range of treatment modalities which should be woven together to
form integrated packages of care for individual patients.

2. Substitute prescribing alone does not constitute drug treatment. Substitute prescribing requires
assessment and planned care, usually with other interventions such as psycho-social
interventions. It should be seen as one element or pathway within wider packages of planned
and integrated drug treatment.

3. Within the substitute prescribing modality, a range of prescribing options are required for
heroin misusers requiring opioid maintenance. Some options may carry more inherent risks
than others (e.g. injectable versus oral options). Patients who do not respond to oral
maintenance drug treatment should be offered other options in a series of steps. This would
normally include:
• oral methadone and buprenorphine maintenance, specifically optimised higher dose
oral methadone or buprenorphine maintenance treatment, then
• injectable methadone or injectable heroin maintenance treatment (perhaps in
combination with oral preparations).

4. Injectable maintenance options should be offered in a local area that can offer optimised oral
methadone maintenance treatment including adequate doses, supervised consumption and
psycho-social interventions. This is essential to ensure oral drug treatment options have been
fully explored prior to a trial of injectable maintenance treatment and to ensure smooth
transition back to oral treatment if required.

5. Injectable and oral substitute prescribing must be supported by locally commissioned and
provided mechanisms for supervised consumption. Injectable drugs may present more risk
of overdose than oral preparations and have a greater value on illicit markets and hence may
require greater levels of supervision.

6. Injectable maintenance treatment is likely to be long-term treatment with long-term resource
implications. Clinicians should consider the move from oral to a trial of injectable preparations
carefully, including long-term implications for the patient and drug treatment systems and
involvement of services.

7. Specialist levels of clinical competence are required to prescribe injectable substitute drugs.
Heroin prescribing also requires a Home Office licence.
8. The skills of the clinician should be matched with good local systems of clinical governance,
supervised consumption and access to a range of other drug treatment modalities.



         Clinical eligibility

The expert group reached some consensus on eligibility criteria, precautions and outcome measures.
However, guidance on issues such as dose or the prescribing of combinations of oral and injectable
preparations will require further work.
The agreed criteria are set out in full and relate to factors such as:
• age and drug usage
• willingness to comply with conditions such as supervision and monitoring, engagement
in a range of care options, avoidance of some risky behaviours and of diverting prescriptions
into illicit markets
• persistence of poor outcomes within an optimised oral programme.


         Recommendations

The key recommendations are that:
• optimised oral methadone maintenance should be the maintenance treatment for
the majority of heroin users
• injectable heroin and methadone treatments should be considered only for the minority of
patients who are genuinely unresponsive to an optimised oral maintenance treatment approach
• injectable heroin and injectable methadone treatments based on this guidance should
be seen as a new drug treatment modality requiring the development of new integrated
care pathways.


         Key messages

The document has four key messages:
1. The prescribing of injectable substitute opioid drugs may be beneficial for a minority of heroin
misusers. The document makes preliminary recommendations on eligibility criteria.
2. Future maintenance prescribing of injectable heroin or methadone should only be undertaken
if it is in line with eight principles identified by the expert groups. This is essentially a new
standard of injectable drug treatment to that previously provided in England. Applying these
principles in practice, sets a high standard for delivery of this treatment intervention, in
recognition of the risks involved.
3. Services should be improving for patients already in receipt of injectable maintenance
prescriptions for heroin or methadone. Where patients are stable, maintaining this stability
is paramount.
4. Priority should be given to improving the effectiveness of oral maintenance treatment (on
methadone or buprenorphine) for the majority of patients in all drug action team areas in England.


         Clinical evidence

The following statements were agreed as consensus on ‘clinical evidence’ by the expert group based
upon many years’ experience of prescribing heroin and other injectable drugs.
Statements from the expert advisory group

1. We consider that the prescribing of injectable substitute opioid drugs, including heroin and
methadone ampoules, may be of benefit for a minority of heroin misusers. In principle this
should be part of a range of potentially available drug treatment options, provided it is set
in the context of a comprehensive drug treatment package.

2. We consider the prescribing of heroin and other injectable opiate maintenance treatment is
not a first-line treatment for dependent heroin users. Injectable opioid maintenance treatment
(including injectable heroin maintenance) is an exceptional treatment that should only be
considered for patients who have not responded to optimised conventional oral
maintenance treatment.

3. We consider that there may be greater inherent risks with injectable opioid treatment, when
compared with the better-studied oral methadone maintenance (and other treatments, such
as sublingual buprenorphine maintenance that has less risk of overdose). These include
greater risks of overdose, continued injecting harms and greater risks of diversion and abuse
of medication. Formal consideration of the risks and benefits of injectable opioid treatment
should be undertaken with all potential patients, particularly those who may be at highest risk.

4. We consider that these risks and dangers (to the individual patient and to society at large)
can be greatly reduced by adherence to practices and procedures which increase
compliance with treatment, and which reduce prescribing to inappropriate patients, erratic
use and diversion to the illicit market.

5. We consider the assessment of potentially suitable patients, and the subsequent initiation of
injectable opioid maintenance treatment, to be a task that requires considerable experience
and expertise in the addictions field, and which should consequently be undertaken by a
competent specialist doctor* working in an appropriately supported treatment setting.

6. We consider that the wider safe provision of injectable opioid maintenance treatment
requires substantial identifiable resources and facilities (as recently established in Switzerland
and the Netherlands). These are required in order to make possible the wider provision of
injectable maintenance treatment options and thereby achieve these greater potential benefits
to the patient and society whilst minimising adverse consequences.


           Cost and cost-effectiveness of injectable substitute prescribing

Injectable substitute drug treatment is a relatively expensive drug treatment option. Calculating cost
and cost-effectiveness of different types of drug treatment is complex and attempts to do so are
compounded by a lack of agreement on appropriate methodology. The NTA is engaged in further
work to provide more accurate and consistent unit costings of drug treatment modalities and options.
Strang et al (2003) estimated that injectable methadone represented 20 per cent of the methadone
prescription drug costs in 2001 for four per cent of treatments. Indeed injectable methadone and heroin
treatment has been estimated to cost between 5 to 15 times as much as oral methadone treatment,
depending on the content of treatment packages and arrangements to supervise consumption.
Surveys of clinicians indicate that the cost of injectable heroin in particular is a prohibitive factor. In
addition, it is recognised that the substitute prescribing of injectable heroin and methadone in the UK
appears to be a long-term treatment which may limit long-term cost-effectiveness.
The NTA will explore issues of cost in greater depth. However, cost factors indicate that commissioners
need to be able to ensure that the provision of injectable maintenance drug treatment does not
undermine the overall quality of care for all patients. Where adequate access to optimised oral drug
treatment options are not available to the majority of patients, it may be particularly difficult to
demonstrate this.
The potentially “high cost and low volume” nature of injectable maintenance drug treatment indicates
that it should be targeted at patients with high levels of need. These patients are, in any case, likely
to incur high levels of costs to health and social care systems.


          Inclusion criteria for injectable opioid maintenance

Clients should meet all of the following inclusion criteria in order to be eligible for injectable
opioid maintenance:
• The client should have a protracted history (> 3 years) of heroin dependence and regular
daily injecting.
• The client should be aged 18 or over.
• The client should be able to provide informed consent. This includes no active medical
or psychiatric condition impairing the patient’s capacity to provide informed consent
• The client should be willing to comply with the conditions of injectable opiate
treatment2, including:
• a treatment plan
• regular supervision and monitoring
• avoidance of persistent injecting in high risk areas (e.g. neck or groin veins)
• continuation of injectable treatment being conditional upon positive healthy response
to treatment (which includes other treatment elements in a package of planned,
co-ordinated care)
• diversion of the prescribed injectable drugs and “double scripting” being grounds
for discontinuation of injectable treatment.
• The client should first have received optimised oral maintenance treatment - an adequate
period (normally at least six months and for some this could be significantly longer) of
optimised conventional substitution maintenance treatment and associated package of care.
• There should be a persistence of poor treatment outcomes despite a current optimised oral
maintenance treatment episode. Indicators of poor outcomes may include:
• continued frequent (daily or almost daily) injecting of illicit heroin or other opioids
• patients at continuing high risk of the transmission of HIV, HBV or HCV to
themselves or others
• continuing injecting-related health problems (e.g. abscesses, cellulitis,
systemic infections), poor general health, poor psychosocial functioning and
drug-related criminality.
If the inclusion criteria are met injectable opioid maintenance treatment may then legitimately
be considered by the clinician, in consultation with the patient, key carers and the relevant
multidisciplinary team.
22

The Night Before!!

Wow, so many mixed emotions, mainly positive I have to say!

Ive planned and planned, read and read, researched and read forum after forum about iboga,
I think I have a pretty good understandingmofmthe risks and benefits now.

It's an informed decision, I NEED to do this!

I should be taking my last dose of 100mg MST in a couple of hours, after a dinner of Dahl, rice and pakora I'll be taking a long bath, having some auricular acupuncture, meditating and having a chilled  evening until an early night.

Davidmis nearly here, I'll bring him up to speed with all the medical stuff, doses etc with a view to taking the test dose early morning, my first 'low wave' dose (200mg-400mg HCL) an hour later, the longer I can wait between last morphine dose and flood the better, overnight is my best chance, I'll be able to get a minimum of 12 hours, hopefully more like 15-20 but will see how it goes.

Knowing the first dose will attenuate withdrawals is great,
I'm really looking forward to it all actually!

Will keep you all updated!

Wish me luck!

Sids

Ibogaine Treatment Centres & Sources

I'm writing this post in response to the enquires I get about seeking treatment and ibogaine.
I'll probably turn this into a page as opposed to a post to a blog post too

So, ibogaine treatment,

As ibogaine is illegal in countries such as the United States, most treatments are either carried out 'underground', there is a network of UG providers thougout the U.S, they usually operate by carrying out the treatment in hotels or their own homes.
This option is a bit hit and miss, there are some great, empathic, caring providers out there but there are also some horror stories about providers preying on desperate addicts, taking deposits and not following through with treatment, under dosing, over charging and a even few cases of sexual assault!

Legal treatments are carried out in Mexico and Canada, these are generally more expensive but if you can afford to then this is definitely the preferred option. As official clinics they usually follow guidelines, meaning medical staff on site, more staff, better organisation and accountability if things go wrong.

If you're serious about doing ibogaine then my biggest piece of advice is, research research research!

There is a huge amount of information online, reviews on clinics, support forums and medical papers. Go join Mindvox mailing list, join a Facebook ibogaine group and ask questions!

Any provider worth their salt will help out your mind at ease and answer any questions you have.

Elsewhere in the world, most countries have providers, I can help point you I the right direction if you want to message me or leave a comment.

From my experiences with it, if I could afford it, id pay for a proper treatment, DIY is difficult, dangerous and usually unsuccessful long term.
An experienced provider will help you from the first email through to long term abstinence strategies.

Some good forums worth joining:

Mindvox - The original ibogaine mailing list
Eboka forum - www.eboka.info

Ibogaine sources

IbogaWorld - trusted, reasonably priced, quality ibogaine HCL,TA and Root bark - www.ibogaworld.com

Simon Loxton - Simon is a provider and supplier based in Cape Town, South Africa, contact for more details
ibogaine.treatment@iboga.co.za

Cerebus Extract - Online ethnogen supplier, Ibogaine HCL along with ayahuasca, DMT etc...
http://cerberusextract.com/

There are other places to get Ibogaine from but I only have experience with these three

Ibogaine Providers:
UK Ibogaine info
Providers in Europe
Ed Conn, the guy who treated David in 'detox or die' doesn't work or live in the UK anymore.

I'll be updating this page with new providers and vendors as soon as I can verify their honesty and integrity.
The sources I list will always be respected, trusted sources/people.
The world of Ibogaine can me a bit of a minefield so I'll try to take the work out of it all for you!

Micro dosing and Using Different Types Of Ibogaine

Ibogaine is the root of Tabernathe Iboga, a shrub that grows mainly on the African continent.
Iboga is processed from the roots of mature plants, usually at least eight years old.
The Bwiti use pure root bark but some clever westerners worked out a way to process the root into Ibogaine HCL, this is around nine to ten times stronger so is better suited to medical use as less needs to be ingested.
Ibogaine HCL is sometimes synthesised from vocangine another shrub, vocangine, pure HCL is mainly Ibogaine, this is just one of the active alkaloids.

The other preparation used for detoxifying is 'TA' or Total Alkaloids, this is a purified form of root bark but includes all the active alkaloids, not just Ibogaine. TA, sometimes referred to as Indra, is usually around 8% Ibogaine the rest being many active alkaloids.
TA is preferred by many and used sometimes for opiate detoxification.
Some believe because it is the whole extract it gives more of a psychospiritual experience, it is often combined with HCL.

Ibogaine root bark is around ten times less powerful then Ibogaine HCL, it is rarely used for detoxification purely because so much would be needed its inpracticle.
The main use for root bark is for boosters post detox, root bark can be used in small doses as often as neccasary to help control cravings and Post Acute Withdrawal Symptoms like restless leg syndrome, goosebumps, chills, anxiety etc
A booster dose would usually be around 250-1000mg daily.

It's usually advised to take a decent booster seven days after flooding too

Micro-dosing For Reducing Opiate Tolerance & Potentiating

Microdosing with iboga is a bit of a grey area with little research and only anecdotal evidence.
It can be used in small doses alongside opiates to reduce tolerance although this can be risky.
Iboga potentates opiates so must be used carefully and sparingly.
Iboga's Potentiating effect is something most providers don't want to become common knowledge for this very reason!

That said, I have micro dosed with root bark quite successfully to reduce my tolerance.
Taking 500mg of root bark an hour before an opiate dose... it's worth experimenting but I found I could take 3/4 my usual dose and wasn't withdrawing.

It's also possible to use smaller amounts of HCL or TA for acute withdrawal.
I used doses of between 250mg and 500mg over five days to get through a heroin detox.
This could be an option for anyone scared of flooding or unable to flood for medical reasons.

Please understand that the above is not really a tried and tested method and you need to do your own research!

New Study On Iboga Deaths

Hi everyone, sorry for not updating for such a long time!

The life of an addict is a hectic one so finding the time to write original and intersting material can be difficult!

Anyway, the long awaited study relating to deaths with Ibogaine has finally been released and here's the abstract!

ABSTRACT: Ibogaine is a naturally occurring psychoactive plant alkaloid that is used globally in medical and nonmedical settings for opioid
detoxification and other substance use indications. All available autopsy, toxicological, and investigative reports were systematically reviewed for the
consecutive series of all known fatalities outside of West Central Africa temporally related to the use of ibogaine from 1990 through 2008. Nineteen
individuals (15 men, four women between 24 and 54 years old) are known to have died within 1.5–76 h of taking ibogaine. The clinical and postmortem
evidence did not suggest a characteristic syndrome of neurotoxicity. Advanced preexisting medical comorbidities, which were mainly cardiovascular,
and ⁄ or one or more commonly abused substances explained or contributed to the death in 12 of the 14 cases for which adequate
postmortem data were available. Other apparent risk factors include seizures associated with withdrawal from alcohol and benzodiazepines and the
uninformed use of ethnopharmacological forms of ibogaine.

I'm not sure what the situation is with copyright, and the file is too big to copy and paste so if anyone wants a copy please email me and ill forward you the full document.... londonpunk@live.co.uk

Using Ibogaine With Different Opiates

 

Using Ibogaine for detox from differing opiates

• I'm writing this piece in response to questions around the suitability of Ibogaine detox from short acting opiates like heroin vs long acting like methadone and subutex.

• I would like to make it clear that in no way am I a professional in the field, I'm writing only from my personal experience and what seems to be the general consensus from various forums and mailing lists composed of Ibogaine users and treatment providers.

My blog was recently used in a thread on the suboxone forum as evidence that Ibogaine doesn't work for long acting opiates like Suboxone or Methadone.

The person quoting me (without my permission) and also by the way had no personal experience of Ibogaine was arguing that Ibogaine has no effect on PAWS and cravings and that it only postpones the inevitable withdrawals.

It is generally accepted that Ibogaine is much more effective for treating SAO's like heroin, it's also true that most treatment centres (any that genuinely care anyway) advise people switch to a SAO for at least a month before treatment.

This doesn't mean Ibogaine does not work for LAO's like subs/methadone, because with a suitable dosage regime and some willpower from the client it can!

Dosing for detox from heroin vs methadone/subs are very different, LAO's hang around for a long time, especially if they have been used for many years.

As with any opiate detox there is no quick fix, this does not mean Ibogaine doesn't work! and it annoys me when people say otherwise.

To complicate matters, there has been many 'clinic's' popping up in Canada and Mexico offering 'instant, painless detox'. Inevitably people are going to be let down, high expectations play a big part in peoples negative views to Ibogaine. 

A lot of these 'clinic's' are run by unscrupulous providers that are looking to make a quick buck.

I've heard many horror stories about people being left under dosed, in pain and thrown out if they kick up a fuss. These providers are exploiting desperate addict's, looking for a way out.

Another problem with Ibogaine is as it is still experimental and schedule I in the U.S there isn't much research going on, and a lack of scientific evidence about it's efficacy.

No one is even sure still exactly how it works. We know it affects pretty much every system in the human body, it seems to fill opiate receptors although it is not an opiate, and it seems to empty the receptors of any existing opiates thereby having the perceived effect of 're-setting' tolerance.

I can vouch for the tolerance re-set personally, and I can also say 100% that it stops acute withdrawals by around 95% for around three days (after a full flood dose)

This, by the way is true for any opiate, methadone or heroin (I've used it for both)

The issue of PAWS is a big one, and will exist whether Ibogaine has been used or not, and this I think is the crux of this argument.

People say Ibogaine doesn't work because some people struggle with PAWS and cravings post detox.

Well of course some people will! Ibogaine or not!

There are a small majority of people that have successfully detoxed with a single flood dose and did not suffer PAWS, cravings and are still clean today.

But for most people, especially people with years of use behind them and those using LAO's boosters will be needed, and sometimes even a second flood dose.

For methadone/Subutex, after the initial 100mg 'test' dose, a flood of around 19mg/kg is given, boosters of around 400mg(TA) or 200mg(HCL) are then given as required for as long as the next two weeks!

Please do not write off Ibogaine as a treatment option simply because some people struggle afterwards... I have tried pretty much every method of detox over the years and Ibogaine is the easiest I have ever done.

Next to a traditional quick methadone reduction and cold turkey, Ibogaine is a walk in the park.

And don't take my experiences as evidence it will not work for you! 

Every one reacts differently to Ibogaine, and everybody's body is different, the speed the Ibogaine is converted, the amount's of body fat that hold LAO's longer, age (research has shown those over 30 have a higher chance of attaining abstinence) and willpower have so much to do with your chance of a successful detox that it's not sensible as simple as taking one persons word for the outcome of your treatment.

Do your homework, read the existing research papers, get medically checked before contemplating treatment and make an informed decision.

Interview With An Ibogaine Treatment Provider

The following is taken from an interview conducted by email of an ibogaine treatment provider in the U.S

Due to ibogaine being a schedule one drug in America I have kept the identity of the interviewee

anonymous. 

  Hi S, could we start by you telling us a little bit about you?

Sure. I’m a middle aged mom of three, an ex-nurse and an ex-alcoholic, here on the west coast, USA. I went through my own iboga journey in 2009. It was a home session, which I would not repeat. I’ll have a person experienced with iboga around for my next time. But it did allow me to walk away from alcohol, and opened me up to myself. I’ve come further since iboga than I had in the 40+ years preceding, and I’ve long been interested in self exploration and personal evolution. Iboga is a huge jump start for self transformation.

 What got you interested in carrying out Ibogaine treatments?

I knew before I took it myself that I would be working with it. I had a very strong gut feeling about that. My own journey confirmed this feeling. There is no denying the tremendous healing potential of iboga, and not just for addictions. I came out of my journey wanting everyone in the world to take it, lol. I’ve since mellowed, but do know that there is nothing like this in the world. How could I not make this available? It has been a striking series of ‘coincidences’ that I have been able to keep working with this good root in all its forms. I will continue as long as I can, as long as it is what is in front of me to do.

 Do you think the risks of providing the service you do in a country where ibogaine is schedule one are worthwhile?

I do. I don’t say this lightly, either. I have two of my children still at home with me. I have to be careful, I take certain precautions. At the same time, I feel like iboga isn’t really ‘on the radar’ in any significant way. Nobody is getting rich, nobody is dying. It would also be a sticky mess for those who don’t want to deal with iboga at all were it to make it into court.

What are your views on the legal status of ibogaine, do you think re-scheduling is a good idea and given the definition of a schedule one drug (no medicinal value and high potential for abuse) how do you think the government can justify this?

I don’t have strong views on the legal status. Iboga itself is quite beyond laws, and I’ve never been drawn to overt activism. If iboga were less restrictively scheduled, and in the hands of the medical establishment, there would still be a huge need for underground services. For price, for atmosphere and for the loving support necessary to allow a session to be all that it can.

How can the government justify keeping it on schedule one? The government doesn’t need to justify, lol. Look at the wars we wage, look at the state of the school system, look at poverty, oh hell, no honest justification necessary. The government is a convoluted labyrinth of power and money games.

 What kind of service do you offer?

Addiction interruption and psycho spiritual iboga sessions. I use root bark, total alkaloid extract, precipitated/purified total alkaloid extract and ibogaine hydrochloride. Which product(s) I use depends on the individual and the reasons for seeking iboga. I work with a partner as often as possible, and we provide a safe, conducive environment for the experience. I incorporate both western medical techniques, and as much ritual as the individual is comfortable with. I have not been initiated in Bwiti, which is the African religion using iboga as a sacrament, but I have worked along side Bwitists as they have held sessions. I found that there are many similarities in the type of Bwiti I saw to other traditional transformative rituals, and many good practices there that support psychologically as well as spiritually an individual’s readiness for a session. As you know, iboga is far more than ‘just a detox’.

Just how risky is it performing treatments in the U.S? What specific challenges do you face?

A true quantitative risk assessment I have not performed.

When I am speaking with someone interested in a session, there are many, many questions asked. I need to see an EKG/ECG, and for many, liver panel results. On top of that, I have an application for folk to fill out that covers medical conditions and history, as well as diet, psychological health, goals and more. I use that information, and I trust my gut. I have had quite a few instances where I could not work with someone based on either test results or a strong gut reaction. I am grateful to the clinics who will handle the riskier medical cases. Based on this screening process, the risks are greatly reduced.

Challenges specific to the underground, I guess primary would be the difficulty ensuring the integrity of a person’s reported drug use. When someone goes to a clinic, at least those I am readily familiar with, they do not begin  their session that night. They are stabilised and observed. In underground work, that unfortunately is not usually an option. I have to trust that the person is using what they tell me they are using, that they have taken the recommended supplements, that their diet has been modified, all of it. When I meet with someone, I have my own assessment skills, but rely on their report. I have had people misrepresent facts to me before. Basically, iboga is quite safe. It is safer when the person considering it is completely honest.

 Tell us some of your success stories..!

My only success story is the one I’m living. All the rest are not my story to tell. I have seen many people walk away from their drugs of choice and not return. This has taken effort, diligence and courage on their part. It is the person eating iboga, and iboga itself who are doing the hard work, who can claim ‘success’. Me, I just try to stay open to being able to facilitate, to making the environment as safe and conducive as possible. It’s always an honor to do this work and I take credit only for my desire to stay present and be open.

What are your views on,  ibogaine versus methadone or suboxone when it comes to opiate withdrawal and long term abstinence?

Oh, my goodness, heavens. Very simply, ibogaine affords many the opportunity to examine their thoughts, emotions and behaviors and take responsibility for their lives. Ibogaine provides many with emotional healing, and a window of a few weeks to a few months without intolerable cravings and compulsions. Neither methadone nor suboxone can facilitate the aforementioned. You are talking about using these long acting opiates as replacers or as detox? If used as replacers, the person isn’t abstinent. Harm reduction, probably, if going from street drugs to these prescriptions, but it’s not abstinence. If used for detox, how long do you want to draw out your withdrawal? Iboga is the most humane detox on the planet. In many instances, three days, no withdrawal symptoms, and you’re done. You’re clean. If there is some breakthrough withdrawal, a little more iboga can knock that right out. If someone gets lingering waves, there are simple over the counter supplements which help. Again, iboga asks a person to take responsibility. Once the drug is gone, there is still the same life to walk back into. What will you change? Your friends? Your routines? Your level of self care? The willingness to change these things can do a lot for the predicting of ‘success’ if it is defined as long term abstinence.

 Do you think a patients age and length of habit has a bearing on the success of the treatment?

Length of habit I have not seen play a big part. I think there is a personality style that seeks external sources of emotional relief, whether it’s heroin, shoplifting, fits of rage, overeating, methamphetamine, etc. A person may have only been addicted for a couple years, but their personality has sought escape much longer. As for age, I have seen the most profound changes in folk over 30. This has just been my experience, and I have no data or even theories to explain it. That’s not true, I always have a theory...

 Do you worry about complications when treating people? How do you avoid such situations?

Yes, I worry! But I try to do it before we meet for the session. At the session I’m just alert. It is far easier not to worry when working with a partner, as well. The screening process does much to ensure there will be no emergencies.

 I’ve heard stories about ibogaine clinics in Mexico facing threats of violence from the Mexican drug cartels, is this true?

I haven’t heard that. I know there is a difference between the border towns and deeper into Mexico, but I don’t know much. I’ve yet to go very far south into Mexico. But I do have a soft spot for Tijuana. It’s as safe as any big city. 

      Finally, what advice would you give someone seeking treatment with ibogaine?

Someone who feels iboga may help them should do as much research as they can before they talk to any providers. Ask the providers many questions, and be as honest as you possibly can when they in turn ask questions of you.

Even if you intend to do this on your own, it can be helpful and instructive to talk to those who work with iboga. This may be one of the single most important events of your life. Prepare for it, take it seriously.

      Thank-you so much!




Notes:

For anyone interested in treatment for addiction, there are some links on my links page to treatment providers, there's also a wealth of information out there on the internet.
Ibogaine is a spiritual journey and as such all I can recommend is that you find your own path, do your research and don't let anyone talk you into/out of it!

UK Heroin Drought Drags On!

And the drought continues!

I've never known it this bad in fifteen odd years!

A Europe-wide heroin drought is affecting thousands of junkies everywhere!

I, along with the rest of the UK have struggled to find anything for the past month or so.

Is this a good thing? Well no if you have a habit! I've read stories of people giving opiate negative urine tests!
People are in effect withdrawing and cleaning up without knowing it!

Although it's shit, this may actually be the kick up the ass some people need to clean up!
Obviously having the choice taken away isn't nice, but it means addicts up and down the country are finding themselves without tolerance/habits!

The drug services and GP surgeries must be over-run with people trying to get scripted..
Unfortunately there's no standard way of doing things here (in the UK), last time I got a methadone script from a DDU, I had to jump through so many bloody hoops I almost gave up!....

See this counsellor, see your GP with the counsellors letter, your only allowed 30mls and will titrate over a few weeks if your sick (which obviously you are)

I mean im not complaining, if we think we have it hard, try being a junkie in America! Not only do you have to provide clean samples and see counsellors you have to pay for it, AND everything's recorded, so once youv'e recieved any kind of narcotic your forever marked as an addict!

Back in the 80s here all addicts were 'home office registered', and although they now say your personal details aren't used for anything here they obviously are!

On another note, in my experience,  addicts are some of the most sensitive, screwed up, self deprecating individuals you would ever meet, I know I internalise all my shit, and always have, I was sexually abused at a young age and never really dealt with it.. I ended up falling into drugs and by seventeen was determined to get myself a habit.. I mean, wow.. what an amazing feeling heroin gives you, I wasn't depressed for the first time in my life!

How could I not use this drug to hide from the crap in my head!?

Why can the government not give me the dignity of a regular supply of clean, safe, opiates?

I've seen it from both sides, when I cleaned up the first time properly, at 26, I took a degree in counselling and psychotherapy, I had to give it up though as I relapsed and couldn't justify working as a drug counsellor while using! (although many in serious denial do)

Anyway, signing off for the night, some useful/interesting links below



http://gledwood2.blogspot.com/2010/11/heroin-drought-uk-2010-life-goes-on.html

http://www.bluelight.ru/vb/showthread.php?t=538306

http://www.guardian.co.uk/society/2010/nov/21/heroin-shortage-uk-overdose-users

Why Rehabs dont work for everyone

In my 30 years on this planet, Iv'e been to rehab nine times...

Ive done just about every possible detox from opiates over the years, NA twelve step programmes, cold turkey, drug assisted detox (methadone/subutex reduction, benzodiazepine,clonodine)

To complete a detox programme you need to be 'ready', it's the most horrendous experience you will ever go through, and to get through it you need to be so determined to succed it will override the physical and psychological torment of opiate withdrawls..

The problem with acute opiate withdrawl is that not only it's physically uncomfortable (to the extent you want to kill yourself) but it throws up a lot of physological stuff from your past.

The first time I went into a residential rehab I had no clue really what I was doing, I was on 100mls of methadone daily, a large dose by anyones standards, I was also taking prozac and valium,
I was reduced from the methadone over five days and the prozac was stopped along with valium.

It hit me like a ton of bricks!

Not only was I in the most physical pain I've ever experienced, I was suddenly having to deal with issues from my past which I had succesfully blocked out with drugs since I was seventeen..

I started having mini seizures and had to be givven rectal diazepam on a few occasions

I think, looking back now, I had a mini nervous breakdown, I was self harming quite badly, cutting and stubbing cigarettes out on myself.
I became suicidal, and just couldn't deal with it.
I ended up discharging myself and coming straight back to London and scoring some Heroin.

This understandably put me off rehabs for years, when I eventually cleaned up I was 26, and was by this point at my rock bottom, it's cliche but true, it takes getting to a point where you are so low, so sick of the lifestyle to have the determination to get clean.
I actually threw the last bit of heroin I had down the toilet and decided to go for it.
I did it on my own, It took me three years to taper down my 80mls methadone daily down, at around 1ml a week to 6mls, at this point I switched onto 8mg of Subutex (Temgesic/Buprenorphine) - A partial opiate agonist/antagonist with a much shorter half-life than methadone, I reduced my Subutex dose down to 0.2mg and then stopped.... I waited for the withdrawls but they didn't come!  was actually clean, opiate free for the first time in ten years!

The only real symptoms I suffered were insomnia (for around six months) and I fell into quite a bad depression, I was actually suicidal for around 12 months after.
I researched appropriate anti-depressants that work for people that have had a long term opiate addiction (opiates really mess with dopamine and seratonin re-uptake, and it can take around six months for the brain to repair itself to a point where the seratonin and dopamine are absorbed normally again.

I started taking Venlaflaxine, it helped slightly, it took the edge of the depression anyway, I wasn't suicidal at least.

Anyway, my opinions of rehabs,...

 they tend to use a 'one size fits all' treatment modality.

You are generally thrown in with a bunch of people you wouldn't normally associate with, at clouds house for example, we had people ranging from a fifty-six year old woman who had become addicted to tramadol after a hysterectomy to a twenty something man who had been sent to rehab on a court order, he would be sent to prison if he did not complete, he didn't want to be there and he made sure he made the process as difficult for everyone else he possibly could, (sabotaging your own and others' detox is a common behaviour observed at residential rehabs).

My main issue with most of the rehabs i've been in however is my sexuality, as a gay man I suffered homophobic abuse at nearly every one I went to.

When people are detoxing they tend to be very defensive and can revert back to adolescent behaviours from childhood.

It's almost like a school!

Being continually bullied is obviously not conducive to recovery when you are feeling low and struggling anyway and it was one of the reasons I didn't ever complete my treatment.

I really think to aid an individuals recovery a holistic view needs to be taken.
It's not just about physically detoxing someone.
I believe treatment needs to be individually tailored for each persons needs, post-detox treatments are as if not more important than the actual detox itself.

Even with ibogaine, probably the most powerful 'addiction interruptor' we have, post-detox therapy has been shown to be useful if not essential and the majority of people that have maintained abstinence have used therapies such as counselling, physical therapies like acupuncture, exercise, yoga, or thai chi.

I honestly believe that if a treatment is going to be succesful, it doesn't matter where the person is, if one is determined to clean up they will do it whether they are at a £30,000 private holisitc rehab or on their friends sofa doing a DIY Ibogaine treatment.

I think in the future we will see patients having more input to their detoxification process and a focus on aftercare.