2.+Brief+Description+of+Heroin+and+The+Fundamental+Usage+of+Ibogaine+Treatment

**Brief description of Heroin**
Heroin is a highly effective painkiller that surfaced in 1874, as an opioid it is related to morphine and codeine that are opiates derived from the opium poppy. As an illicit drug it is illegally imported into North America from production countries of Asia and Latin America (CAMH, 2013). Categorized as a semi-synthetic opioid that is made from morphine and when it reaches the brain it is converted back to morphine (CAMH, 2013). The joining of two acetyl groups are attached to morphine which make diacetylmorphine, aka heroin. This composition is three times more potent than morphine. The two acetyl groups in a heroin molecule increase the possibility of fat solubility, which in turn allows the molecule to rapidly enter the brain. It is seen that the effective properties found in heroin and morphine are the same but heroin has a faster onset and is more potent (Hart et al., 2012). The Bayer Laboratory company branded it as heroin in 1898 and originally marketed it as non-addictive formulation that would differ from its codeine counterpart. Upon its introduction to the public, studies supported its pharmacological use. Manufactured originally as a substitute for codeine, that did not display significant tolerance and dependency problems. A few years later it was observed that this was not the case and heroin proved to have high dependence especially when injected into the blood system in higher doses (Hart et al., 2012). Heroin, much like other drugs affect people differently based on a variety of factors, such as age, pre-existing medical or psychiatric conditions among many other persisting factors (CAMH, 2013). Heroin as a variety of routes of administration, the most common ways are injection. Heroin dependence is associated with mostly with intravenous use but heroin dependence can occur any route of administration and produce behavioural and physiological effects (Hart et al., 2012). Injection is the most used method due to its cost effective nature, it is the most rapid method and the least amount of heroin needed. The effects of heroin are described to provide a feeling of euphoria and rushing feelings of warmth. The desired effect that heroin users seek is a psychological detachment from one’s emotional pain and is replaced by an overall feeling of well being (CAMH, 2013). When injected, heroin provides the user with an almost immediate rush or feeling warmth. Those addicted may inject on average from 2 to 4 times a day (CAMH, 2013). First time users have been observed to experience side effects of nausea and vomiting. Other effects of heroin use include a depression of breath, itchiness, sweating, and small pupils (CAMH, 2013). Regular users of heroin can yield a dependency estimated within 2-3 weeks. There are a variety of factors that influence ones probability of developing heroin dependence, not everyone who experiments with heroin will become addicted. The most important factor is dependent on the regularity of use; individuals may use on only some occasions and will not increase their dosage. Regular users develop a tolerance where a greater amount of heroin is required in order for one to experience its desired effects. The withdrawal experienced from heroin is not life threatening but it can be tremendously uncomfortable and unsettling. Because heroin lasts about 3 to 6 hours depending on the dose, users must use consistently to fend off withdrawal. The symptoms of withdrawal initially are intense discomforts that include, a runny nose, diarrhea, restlessness, vomiting, and also an incessant craving to use heroin. After 5 to 10 days withdrawal symptoms have usually peaked and faded but some symptoms that are longer lasting include, insomnia, feelings of anxiety and craving (CAMH, 2013).

Ibogaine and Its Fundamental Usage
Brackenridge (2010) supports that ibogaine and psychoanalytic psychotherapy is somewhat of a departure from mainstream treatments but still is observed to be and effective alternative. Although it has been scientifically contested of what ibogaine provides, one possibility lies within dopamine activity. When administered, ibogaine interferes with other agents that block dopamine receptors and reduce sensitized levels of drug cravings (Blackbrun & Szumlinski, 1997). Despite inconsistent findings on dopamine, Brackenridge (2010) would argue that it is effective because the fast acting effects of ibogaine are similar to the immediate rush of heroin, which poses as a familiarity to the individual. Ibogaine treatments gain it strengths in its juxtaposition with psychoanalytic psychotherapy, which is slower and more calculated. It offers a different relationship of the therapeutic process that aims to help the individual become more present in the life process and maintain it. Ibogaine therapy enlists the use of the administration of the ibogaine root in accompaniment with psychoanalytic psychotherapy. Brackenridge (2010) suggests that ibogaine treatment is attractive to those struggling with opiate dependencies because of its fast acting effects that help control the undesired effects of withdrawal, and most importantly the altered state of consciousness creating an insightful experience. There are three stages in ibogaine therapy. As a supervised and guided type therapy the first period begins with an initial assessment that is followed by roughly six ‘pre-ibogaine’ psychotherapeutic sessions. This first stage mainly focuses on getting to know the client and seeing if this form of treatment is an appropriate for the client and providing information pertaining to the risks. It is an important stage for the role of the psychotherapist in that they are making an assessment to if the individual will be able to endure the altered state of consciousness and ‘awakening’ that ibogaine has been observed to offer. In this stage the development of the relationship between the therapist and the client is paramount, because this relationship will serve as a supportive, guiding basis that will allow for the patient to proceed through the treatment safely, comfortably, and efficiently. The second stage in the treatment is the actual administering of ibogaine therapy. Brackenridge (2010) approximates this period to be about 30 hours in length where ibogaine is taken orally. The client is instructed to lie in bed for a minimum of 24 hour as the ibogaine takes it effect and they will experience a psychic exploration. As the individual experiences a dreamlike state similar to lucid dreaming, the psychotherapist is constantly monitoring the vitals of the individual throughout the process. While in this state for about 4 to 8 hours the patient experiences illusionary visions followed by a contemplative state that has very little visual components that will last for an average of 16 hours. Approaching the end of this stage the client may they are slowly returning to a state of reality and feel stable enough to not have to lie down anymore.



The third stage is the post-ibogaine experience here the psychotherapist monitors the individual on an outpatient basis for the first several weeks following the administering of ibogaine. This stage is long-term and may last a minimum of 2 years. Brackenridge (2010) holds the importance of ibogaine in its ability to help the addict re-establish a connection with their inner self and life as a general process. The psychoactive properties of ibogaine allow for the individual to make a symbolic reassessment of their cognitive understanding of their addiction, and how their dependency has altered the view. In this particular study, it was observed that 15 out of the 45 participants were able to abstain from their opiate addiction for more than two years (Brackenridge, 2010). Brackenridge (2010) supports that this alternative form of opiate dependency treatment allows the individual to transgress through and correct their inner maladaptive cognitions and behaviours.

Based on this information, do you think that every opiate dependent individual could benefit from ibogaine treatment? Why? Do you think ibogaine treatment therapy is a good alternative? Why or why not?
 * Discussion questions:**

Blackburn, J. R, & Szumlinski, K. K. (1997). Ibogaine effects on sweet preference and amphetamine induced locomotion: implications for drug addiction. //Behavioural Brain Research, 89,// 99-106. Brackenridge, P. (2010). Ibogaine theray in the treatment of opiate dependency. //Drugs and Alcohol Today//, 10, 1-25. CAMH: Heroin. Retrieved November 10, 2013, from http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/heroin/Pages/default.aspx Hart, C. L., Ksir, C., Hebb, A. L., Gilbert, R. W., & Black, S. (Ed.). (2012). //Drugs, behaviour, and society: Canadian Edition// (1st ed.). Toronto: McGraw-Hill Ryerson.
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