Global Ibogaine Therapist Alliance 2014Tanea Paterson (Dip. App. Addiction Counselling)

Prescription Ibogaine Therapy in Aotearoa/NZ – Timeline, Considerations and Moving Forward.

Ko Tinana toku wakaKo Hereweka toku mauka

Ko Mata-Au toku awaKo Tanea Paterson toku ikoa

No Otepoti ahauNo reira

Tena koutou, tena koutou, tena koutou katoa

Tanea Paterson• Born in Otepoti/Dunedin• Spanish, Scottish and English • Two Sons, Josef 14 and Salem 10

Journey towards Ibogaine – • Chronic pain/fibromyalgia post MVA, subsequent IV Opioid dependence

• Methadone program 2000-2006Since 2006• Ibogaine consultant/provider• Qualified Addiction Practitioner

• Clinical Supervisor/Mentor • Providing Applied Training

Mihi ki te whare tupuna – acknowledgement of the ancestral house Mihi ki a Papatūānuku - acknowledgement of Mother EarthMihi ki te hunga mate - acknowledgement of those who live in the spirit realmMihi ki te hunga ora - acknowledgement of the living : giving thanks for our continued existence.Te take o te hui - purpose of the meeting"E nga mana, e nga reo, e nga waka, e tau nei.”To all the chiefs, all the dialects, all the waka that have gathered here. “In Central West Africa grows a plant called Tabernanthe iboga the root bark of which has played a major role in rites of passage and healing ceremonies. The plant is used in Cameroon, Equatorial Guinea, Congo and, most notably, in Gabon by the Pygmees, Fang and Mitsogo tribes in a culture called Bwiti.” sourced from ICEERS

Pathway to Prescription Ibogaine – A Timeline2006-2011

•2006 August - Australia “’hanging out’ with my Bro’ Jasen”•2007 June - first sit Winter Solstice, client obtained their own ibogaine, pre status change•2009 Early - Dana Beal contact re forum•2009 Sept – Dec NZ Ibogaine Fora with international guests Otepoti/Dunedin, Wellington, Palmerston North and Auckland•Marie Cotter encouraged people to contact Medsafe to enquire about the status of Ibogaine •2009 Nov - Medsafe discuss ibogaine with key psychiatrists

10.1 Ibogaine and its metabolite noribogaineMedsafe received several enquiries about the status of ibogaine • provided with a table of data regarding ibogaine related fatalities in the public domain. Alper

• figures suggested deaths due to methadone (controlled) were a little higher that those associated with ibogaine (un-controlled)

• ibogaine reported to alleviate the symptoms of opiate withdrawal, may be useful in treating dependence to other substances such as alcohol, methamphetamine and nicotine

Medsafe believed that there was a case for classifying ibogaine and its metabolite nor-ibogaine as prescription medicines.

At the November 2009 meeting the Committee agreed with the recommendation to classify ibogaine as a non-approved prescription medicine…..

Rationale:• Concerns that use in an ad

hoc fashion as a self-medication

• potential for therapeutic use

• relatively low profile for ‘abuse’

• mortality rate in treatment lower than for methadone

• 40 methadone-related deaths in NZ in 2009-2010

Implications:•opens way for prescription by a licensed physician•leads to research possibilities (current – MAPS)i.e. data collection for efficacy / treatment outcomes, leverage for potential future funding

Importation and supply

Product Accepted for Use•Phytostan Enterprises, Inc - REMOGEN™ Brand GMP Quality Ibogaine Hcl

•Wilkinson and Son Pharmacy, Dunedin – Pharmacist Warren Leonard encapsulates 200mg capsules

Prescription Status of Ibogaine in Aotearoa - Positive Implications

• Legitimizing ibogaine as a therapeutic intervention • Existing health professionals gain awareness and understanding

• Integration with existing services for individual needs allowing ‘wrap-around’ care

• Medical inclusion creates a lower risk profile• Legitimacy and availability of ibogaine therapy grows with awareness and commonality of care, familiarity

• Common language and synchronized assessment and therapy plans within sector

Common Language AcquisitionApplied Addiction Diploma - Moana House, Te Taketake Broadened •Knowledge and Exposure of the potential of Ibogaine Therapy

•Trust and Respect from existing health providers Enabled Development of ibogaine therapy plans with key considerations;Co-existing problemsPsychopharmacological InterventionsRisk Management and Emergency Plans Whanau Inclusive Practice

Timeline 20112011 - Sept - presentation at Cutting Edge (NZ Addiction Practitioners’ Association), awarded “Best Contribution to Clinical Practice”2012 - April – graduated from Te Taketake Applied Addictions Practitioner Diploma through Moana House 2012 June – Dec - use of a housing unit within a supported housing facility, PACT Group 2012 Nov - joined GITA, Vancouver2012 June - MAPS Observational Study begins

‘Pre-Set, Mind-Set, Setting, Sitting, Set Off’

Pre-SetPreparation Assessment and Tx Planning (assessment, motivational interviewing, whanau inclusive practise, aftercare, risk management), Stages of Change (Mind-Set)

Reduction of medications Improve health outcomes (medical, nutritional, physical) Increase support (whanau, social, community, therapeutic accessibility)

Consult with present health providers; methadone clinician, gp and/or other

Mind-Set, SettingMind-Set - Psychological Interventions • Motivational Interviewing and other Models of Change • Reduction in Pre Tx Anxiety – Coping Skills (Pre-Set)• Assertiveness practice• Relapse Prevention Planning• Informed consent (feeling safe)

Setting• Where (accommodation) • When (dates)• Who (sitters, Sitting)• How (travel, getting there)

Sitting Set-OffSitters - carers, providers• Pre-formed Therapeutic Alliance (Mind-Set)• Skills and knowledge• Medical intervention training (first aid qualifications)

• Mind Set of the Sitters - who, how they are, what they bring in with them (psycho-osmosis)

Set-Off• Re-integration (implementing Pre-Set plans)• Six weeks post tx support service (room for extension)

Honouring Origins by Assessment“initiatory process in therapy”

•Spend time with people prior to ibogaine builds trust and truth, allows greater respect for iboga/ibogaine

•Assessment and therapy planning viewed as an initiatory process

•Time spent prior to ibogaine can increase long term efficacy, can reduce the amount of ibogaine used – sustainability of tabernanthe iboga

The Limits or Restrictions

•Lack of funding restricts access (non-subsided to date)

•No official safety guidelines or best practise protocol meaning any gp can prescribe for a client without ibogaine knowledge/considerations

•Caution needed around prescribing intervention medication during the process (standard detox protocol)

•Times without a gp prescriber restricts access to legal Ibogaine Hcl

•Suppliers willing to supply to NZ regardless of status

Future Potentials

•formalize ‘good practise’ protocols integrated with medical models of addiction, psychology and wellbeing in therapeutic process

•publish protocols to reduce harm and increase potential of tx

•create a ‘training program’ or adding it to the already existing substance use education

•look to the MAPS Observational Study to provide data substantiating best practise (see Dr Geoff Noller presentation Friday)

•outcomes will implement a wider understanding of areas needing growth

Good Practice Guideline Development• Psychological and Medical/Physical Testing• Therapeutic Intervention – Client Centred, Strengths Based, Motivational Interviewing, Whanau Inclusive Practice, Education, Informed Consent

• Assessment, Intake Forms and Tx Contract• Pharmacotherapy Awareness • Clinical Supervision for providers (personal & professional growth)

• Combined input is strength – the status of ibogaine in NZ further allows this synergy

He aha te mea nui o te ao? He tangata! He tangata! He tangata!

What is the most important thing in the world?It is people! It is people! It is people!

Further Investigations• Global Ibogaine Therapist Alliance http://ibogainealliance.org/about-us

• Dr Geoff Noller, Substance Use and Policy Analysis http://geoffnoller.com/

• Dr Ken Alper, Fatalities Temporally Associated with the Ingestion of Ibogaine http://iceers.org/docs/science/iboga/Alper%20et%20al_2012_Fatalities_Temporaly_Associated_Ingestion_Ibogaine.pdf

• GMP Ibogaine: REMOGEN ™ [Ibogaine HCl] http://phytostan.ca/products/

• Medsafe Minutes Nov 2009 – re Ibogaine: Minutes of the 42nd meeting of the Medicines Classification Committee - 3 November 2009 http://www.medsafe.govt.nz/profs/class/mccMin03Nov2009.htm

• Multi-disciplinary Association for Psychedelic Studies: Ibogaine Research http://www.maps.org/research/ibogaine/