Side event: Heroin- and Ibogaine Assisted- Treatments in the Era of the Covid Crisis

Organised by the European Coalition for Just and Effective Drug Policy (ENCOD) with the support of the Nonviolent Radical Party, Transnational and Transparty

Massimo Barra, Foundation Villa Maraini, International Federation of Red Cross and Red Crescent: Dear colleagues and friends. It’s a great pleasure to be here on behalf of the International Federation of Red Cross and Red Crescent, the largest relief organisation in the world. Present in 192 countries. Well known for its protection and assistance activities in times of armed conflict, as a neutral actor between the parties, and for its emergency intervention in peacetime, in support of the victims of natural and human made disasters. Our Red Cross and Red Crescent is less known for its action on drugs, despite the fact that the first resolution on substance abuse, dates back on 1922, during the Bangkok conference for ASEAN countries, struggling with the harmful consequences of the abuse of opium. It is true that psychoactive substances can be consumed in the world to enjoy the positive or apparently positive effects for it, but it is equally true that millions of people get sick from the consumption of substances when they come to take them; not because they want to take them, but because they need to take them. Otherwise, the suffering of people with drag disorders is still neglected and denied, and political authorities in many parts of the world underestimate this globally impactful suffering. In fact, only one out of eight people who need treatment for their disease can get it. This is a scandal, a true own-goal for humanity; not treating or pressing obstacle in delivery in the treatment of a person with drug disorders is one of the political attitudes (Technical difficulties) that contribute the most to worsen human suffering. The Red Cross is against all kinds of suffering. It is therefore against any prohibition of treatment that based on scientific evidence can improve the quality of life or a person with drug addiction, their family, and more generally, of the entire humanity. Omitting or prohibiting treatment is a crime against humanity, for which the guilty will sooner or later be called to respond. Punishment is not part of the treatment. On the contrary it hinders it; punishment and treatment are two different chapters that must not interfere,  just as violence has no right of citizenship when it comes to treatment; violence, always brings more violence. And this world needs everything except more violence. Bringing the treatment, everywhere, and facilitate the access to recovery is a feasible and desirable strategy that would have immediate effects on the millions of people affected. And in decreasing the violence and dangers, that is destroying entire communities, and which is the main issue linked to drug use and abuse phenomenon, everywhere. As the Red Cross and Red Crescent, we officially express our opinions and concerns on these issues to the member states with plenary statements, and with a global humanitarian manifesto launched last year to the CND, already shared and signed by hundreds of organisation working all over the world, to reduce the harm caused by drug abuse. The document called Rome Consensus 2.0 for a humanitarian drug policy is available on the web that all participants in this meeting can read share sign and spread it all over the world. Thank you for your attention.

Dr Carla Rossi, former Professor of Medical Statistics at the University of Tor Vergata: Heroin-assisted treatment involves supply of pure pharmaceutical diacetylmorphine to those who are dependent of the drug, but have not benefitted from the standard substitution therapies, utilising mainly methadone or buprenorphine. It is currently considered a second line treatment that assists people to escape the criminalisation of the obtainment of street heroin and other risks associated with illicit drug use, such as the sharing of needles, and other injection paraphernalia that leads to the risk of infection with HIV, hepatitis C, and other viral illnesses. Doses are administered under direct supervision of medical staff. Switzerland was the country that provided the initiative, underlying the form of heroin assisted therapy treatment. The initial Swiss project for medical prescription of narcotic began in January, 1994, and was supplemented by follow up and partner study, including to recruit heroin users who were not reached by the treatments. In order to attract these clients who were associated with actually infection, crime and disorder, the new treatment needed to be both readily accessible, and to have the intoxicant of choice, which was heroin. Although the country study was subject to criticism as they were observational study, they had more effect on people involved in heroin use than traditional oral methadone therapy. The benefits of HAT consists of removing people from the street heroin culture, and the criminality,  improving their health, increasing social engagement, and reducing the impact of heroin use on neighbourhoods, the evidence base is very powerful, and should lead, governments to realise HAT in the management of intractable heroin users for whom other forms of treatment, failed to work. As HAT has proven to be more effective in retaining people in treatment. HAT proven to be more effective in reducing illicit heroin use. HAT is proven to be more effective in reducing criminal activity. HAT has proven to be more effective in improving social functioning. Indeed, in the last 20 years many clinical trials were also conducted on HAT to compare with some specific people using HAT or methadone and showing that such kind of people can be more safe using HAT. In particular also many studies have been summarised in reports by RAND. And so if you, if you want more in-depth information you can find those reports from website of RAND. We can also say that HAT saves money, because the relatively high costs is more than matched by savings across health, the criminal justice and other services that cannot be achieved with other treatments. It has been estimated that the (…)percent of heaviest users of heroin, fall into the target group, consuming around 50% of all illicit heroin imported. As a result, the reduction in consumption of illicit heroin by those entering a programme could substantively reduce the scale of the illicit market, the crime, organised criminals’ resources. This is very important, because it’s also a goal that in the 2020 report of the Global Commission on Drug Policy, entitled Enforcement of Drug Laws, refocusing on crime gains can be considered, and also can be verified on the basis of (…) providing that the OECD is 26.4. So this means that between 2011 and 2016, the number of overdose deaths for heroin and opioids increased of 26.54. So now, is very important to use HAT as heroin assisted treatment is fully a part of the National Health System is Switzerland and locally, it is applied also in Germany, the Netherlands, Canada and Denmark. For the clinical trials on efficacies have been conducted in the United Kingdom Norway with an interest in using the therapy to those, those countries. The presence of pandemic makes the lives of heroin and opioid dependent users even more serious. So it’s very useful to extend in other countries, application of HAT to to make the lives of the subject better and most healthy by applying the therapy. And this is also to reduce the contagion. By therapy.

Dr. Elena Khudolei, MedicoMente Clinic for Addictology Ukraine: Hello, my name is Juliana Khudolei. I’m a doctor narcologist just in medical centre of modern addictology, MedicoMente. I want to tell you about Ibogaine, and it uses in the complex treatment of heroin addiction. Today’s situation with (…) injection of narcotic substances or psychotropic substances is more huge in the world. According to various sources, Ukraine takes the fourth place in the (…), distribution, and to use in narcotic substances. It’s useful to know to (…) of narcotic substances from (…) through your brain is very huge. As application of synthetic medical opiates, like methadone and buprenorphine is legalised, like in European countries have substitutional therapy, it helps to lead a person from street drugs,  reduces the risk of infection, decreases the level of criminalization and (…). But of half million officially registered drugs users the state finances, only 8000 places of substitutional therapy. And what is the result? There a lot of recipes clinic, where anyone for $10 or $20 can get a receipt for narcotic and  other substances; buy drugs legally. If you professionally approach the consideration of this issue, we can find some private drug clinics on the territory of Ukraine where patient can solve the problem of dependence and don’t replace from one drug to another; but really heal a person. You can go with addiction to a former drug addiction. To describe the experience of using Ibogaine in the medical practice, it has expectable psychedelic effects on the human consciousness and subconsciousness. On its use in the treatment of people dependent on psychoactive substances and alcohol, on the treatment of people with severe depression. The recognition of the mistake of yours, and the desire to know the truth, change yourself. The uniqueness of the plant’s alkaloids causes unique psychedelic effects. Analogs haven’t been replicated. It does not form addiction. Extremely effective treatment to treat any opiate addiction. I have heard about deaths caused due to the use of iboga, which is why it’s important to have education on adequate selection criteria and exclusion, a detailed medical history, assessment of the general condition, a physical examination and consideration for the mental state. This is to be applied in a ‘clean’ body – complete abstinence for the past 7-10 days before the session. Ibogaine must be used after complete stabilisation of the body function. Ibogaine must be in powder form. Ukraine can be considered a unique state, with Canada Brazil and the Netherlands, as medical use of ibogaine is advancing rapidly. Ibogaine is not included in the list of substances prohibited. We use a comprehensive approach in treating patients with chemical and non-chemical addictions. We use ibogaine intensely. And we have a unit for emergency care. We employ an anaesthesiologist, psychiatry, psychotherapist, psychologist.

Jonathan Dickinson, Ibogaine advocate and Director of Ceiba Recovery (Canada-Mexico): I am very happy to be invited today and honoured to be able to share with you, I’ll be speaking from my experience working around, Ibogaine therapies since late 2009. I currently work as a recovery coach and a consultant on different projects, mainly supporting individuals through follow up care, through virtual outpatient services, once people have been through, Ibogaine treatment. I’ve also worked as a community organiser and a researcher and serve as the executive director of the Global Ibogaine Therapy Alliance. One of the projects that I developed with them was a clinical guideline for Ibogaine assisted detoxification, sort of consolidated knowledge, from researchers, from physicians, from underground care providers, from various sources in order to try to address some of the cardiac issues and other preparations, screening, and monitoring issues that would help to mitigate risks of doing Ibogaine, especially with the vulnerable patient populations that we see seeking Ibogaine treatment. So I think that this document still remains a very useful resource for people in the field. I think that we have gradually, through this work and through the broader discussions, seen drastic improvement in the level of care, and monitoring that people do receive. And I think that while there’s still adverse events, they’ve changed in terms of where they appear and why they appear. So some of the more recent concerns are around treating people who are habituated to using fentanyl or other synthetic fentanyl analogues, or other tranquillisers and things that are now found in street level opiates that are available to people. So one of the big questions that people always have when they’re looking at Ibogaine is: does it work or how well does it work. So there’s one observational study that was put out by Thomas Kingsley Brown, and others through the Multidisciplinary Association for Psychedelic Studies that compared itself to a number of different studies looking at long-acting opiates; so one in particular what that buprenorphine taper protocols, which is a detox protocol. That had a 8.6% success rate is defined as people using opiates (…). There’s also a bit of a comparison with opioid maintenance (…). What’s the research, shows us that Ibogaine is an effective detox. It significantly helps reduce opioid withdrawal, and significantly helps to reduce cravings for other drugs but to do that universally (…) people needs to be sort of prepared for some level of comfort, different needs afterwards, in terms of what they need to do in order to change. If they’re really trying to anchor into abstinence as the goal. And so it’s really important to understand that although we’re comparing Ibogaine as a detox to treatment outcomes, we’ve seen that people that go to access treatment services or several living environments or other related resources to have an easier time making long term changes. So to sort of further frame those results. It’s not exactly a fair comparison to look at people doing buprenorphine or methadone programmes against people that are coming to do Ibogaine. For one, people that are taking Ibogaine are often a highly-willing patient population, paying out of pocket, travelling out of country, that either means a certain amount of financial solvency or family support. It also means that they’re not being legally coerced to do it. In many cases it’s a violation of parole for individuals that are on parole, to be able to travel that way so. So there’s a lot less extrinsic motivation. Although it’s not absent completely. So, we do see that many people who come arrive with a genuine desire to make a difficult life change. Most of them have found that or many people have found that they haven’t been presented with options to taper off of long-acting opioid maintenance programmes like Suboxone or methadone and so they’re seeking alternatives like Ibogaine. Also in general they’re not being presented with sufficient detox options, other than going into recovery programmes which are typically oriented around spiritual counselling and peer support, and don’t provide the same level of physiological relief that people are looking for, which doesn’t involve long-acting opiate maintenance, in a lot of places. So, again, motivations do still include those kinds of extrinsic motivators like health-related legal problems that are related with, with prohibition of drugs in the first place. In terms of improving services in general, and where Ibogaine sort of fits into this, I think that the biggest change that we can see which will not only sort of improve the health and legal status of people who use drugs in general, but also improve the safety of Ibogaine treatments for people who do want to have that option would be to decriminalise drugs, and to provide access to short-acting opioid maintenance. There’s plenty of places in Europe and there’s some availability of it in Canada, but obviously in the United States that’s lacking and in many other places it’s not available. We’d also like to see access to better detoxification options including those that are outside of industry and profit models like vitamin C, which is cheap and readily available and extremely helpful, especially in IV therapy for people who are detoxing, as well as other education and resources to assist physicians in managing tapers from different things; I listed here benzodiazepines in particular because I feel like that’s lacking. And then there’s all kinds of research that I would like to see personally in terms of Ibogaine, including what is actually happening for people outside of just looking at abstinence outcome;  but what kinds of changes are we seeing in order to be able to target those services to the most appropriate people, rather than seeing, like, coercion into sort of a standardised treatment model for Ibogaine; I don’t think that’s the way to go. I also think that there’s a massive benefit in improving models of pure involvement in treatments rather than placing it strictly into a medical framework. And looking at other things like inclusion of arts, which is something that (…) talks about frequently. I think it’s important to consider.

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