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CNS Drugs
Published in: CNS Drugs 12/2011

01-12-2011 | Leading Article

Herbal Medicines for the Management of Opioid Addiction

Safe and Effective Alternatives to Conventional Pharmacotherapy?

Authors: Dr Jeanine Ward, Christopher Rosenbaum, Christina Hernon, Christopher R. McCurdy, Edward W. Boyer

Published in: CNS Drugs | Issue 12/2011

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Abstract

Striking increases in the abuse of opioids have expanded the need for pharmacotherapeutic interventions. The obstacles that confront effective treatment of opioid addiction — shortage of treatment professionals, stigma associated with treatment and the ability to maintain abstinence — have led to increased interest in alternative treatment strategies among both treatment providers and patients alike. Herbal products for opioid addiction and withdrawal, such as kratom and specific Chinese herbal medications such as WeiniCom, can complement existing treatments. Unfortunately, herbal treatments, while offering some advantages over existing evidence-based pharmacotherapies, have poorly described pharmacokinetics, a lack of supportive data derived from well controlled clinical trials, and severe toxicity, the cause for which remains poorly defined. Herbal products, therefore, require greater additional testing in rigorous clinical trials before they can expect widespread acceptance in the management of opioid addiction.
Literature
1.
2.
Mokri A. Brief overview of the status of drug abuse in Iran. Arch Iran Med 2002; 5: 184–90
3.
Liu L, Fang Y, Wang X. Drug abuse in China: past, present and future. Cell Mol Neurobiol 2008; 28: 479–90CrossRef
4.
5.
Boyer E, Wines J. Impact of Internet pharmacy regulation on opioid analgesic availability. J Stud Alcohol Drugs 2008; 69: 703–8PubMed
6.
Boyer EW, Babu KM, Adkins JE, et al. Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth). Addiction 2008 Jun; 103(6): 1048–50PubMedCrossRef
7.
Babu KM, McCurdy CR, Boyer EW. Opioid receptors and legal highs: Salvia divinorum and kratom. Clin Toxicol (Phila) 2008 Feb; 46(2): 146–52CrossRef
8.
Adkins JE, Boyer EW, McCurdy CR. Mitragyna speciosa, a psychoactive tree from southeast Asia with opioid activity. Curr Topics Medicinal Chem 2011; 11: 1–11CrossRef
9.
Sunwalert S. A study of kratom eaters in Thailand. Bull Narc 1975; 27: 21–7
10.
Grewal KS. Observations on the pharmacology of mitragynine. J Pharmacol Exp Ther 1932 Nov; 46: 251–71
11.
Takayama H. Chemistry and pharmacology of analgesic indole alkaloids from the rubiaceous plant, Mitragyna speciosa. Chem Pharm Bull 2004; 52(8): 916–28PubMedCrossRef
12.
Matsumoto K, Mizowaki M, Suchitra T, et al. Antinociceptive action of mitragynine in mice: evidence for the involvement of supraspinal opioid receptors. Life Sci 1996; 59(14): 1149–55PubMedCrossRef
13.
Matsumoto K, Horie S, Takayama H, et al. Antinociception, tolerance and withdrawal symptoms induced by 7-hydroxymitragynine, an alkaloid from the Thai medicinal herb Mitragyna speciosa. Life Sci 2005 Nov 19; 78(1): 2–7PubMedCrossRef
14.
Takayama H, Ishikawa H, Kurihara M, et al. Studies on the synthesis and opioid agonistic activities of mitragynine-related indole alkaloids: discovery of opioid agonists structurally different from other opioid ligands. J Med Chem 2002 Apr 25; 45(9): 1949–56PubMedCrossRef
15.
Beckett AH, Casy A. Synthetic analgesics: stereochemical considerations. J Pharm Pharmacol 1954; 6: 986–1001PubMedCrossRef
16.
McCurdy CR, Prisinzano T. Narcotic analgesics. In: Abraham D, editor. Burger’s medicinal chemistry, drug discovery and development. Vol. 7. 6th ed. Hoboken (NJ): John Wiley & Sons, 2010: 569–73
17.
Jansen K, Prast C. Ethnopharmacology of kratom and the Mitragyna alkaloids. J Ethnopharmacol 1988; 23: 115–9PubMedCrossRef
18.
Jansen K, Prast C. Psychoactive properties of mitragynine (kratom). J Psychoactive Drugs 1988; 20: 455–7PubMedCrossRef
19.
Boyer E, Babu K, McCurdy S, et al. Self-treatment of opioid withdrawal with kratom. Addiction 2008; 103: 1048–50PubMedCrossRef
20.
Macko E, Weisbach J, Douglas B. Some observations on the pharmacology of mitragynine. Arch Int Pharmcodynamics 1972; 198: 145–61
21.
Nelson J, Lapoint J, Hodgman M, et al. Seizure and coma following kratom (Mitragynina speciosa Korth) exposure. J Med Toxicol 2010; 6: 424–6CrossRef
22.
Boyer E, Babu K, Macalino G. Self-treatment of opioid withdrawal with a dietary supplement, Kratom. Am J Addictions 2007; 16: 352–6CrossRef
23.
24.
25.
Mash D. Ibogaine therapy for substance abuse disorders: clinical addiction psychiatry. Cambridge: Cambridge University Press, 2010: 50–60
26.
Lotsof H. Ibogaine in the treatment of chemical dependence disorders: clinical perspectives. Newsletter of the Multidisciplinary Association for Psychedelic Studies 1995; 5: 16–27
27.
A chronology of selected abstracts for ibogaine: rapid method for the interruption of the narcotic addiction syndrome, presented as a courtesy to the American Association for the Treatment of Opioid Dependence. Bear (DE): Addiction Research Institute, 2004
28.
29.
30.
Kontrimaviciute V, Olivier M, Mathieu-Daude J. Distribution of ibogaine and noribogaine in a man following poisoning involving root bark of the Tabernanthe iboga shrub. J Analyt Toxicol 2006; 30: 434–40
31.
Hough L, Bagal A, Glick S. Pharmacokinetic characterization of the indole alkaloid ibogaine in rats. Methods Findings Exp Clin Pharmacol 2000; 22: 77–81CrossRef
32.
Helsley S, Rabin R, Winter J. Further investigations of the serotonergic properties of the ibogaine-induced discriminative stimulus. Prog Neuropsychophamacol Biol Psychiatry 1999; 23: 317–26CrossRef
33.
Deecher D, Teitler M, Soderland D, et al. Mechanisms of action of ibogaine and harmaline congeners based on radioligand binding studies. Brain Res 1992; 571: 242–7PubMedCrossRef
34.
Sweetnam P, Lancaster J, Snowman A, et al. Receptor binding profile suggests multiple mechanisms of action are responsible for ibogaine’s putative anti-addictive activity. Psychopharmacology 1995; 118: 369–76PubMedCrossRef
35.
Codd E. High affinity ibogaine binding to a mu opioid agonist site. Addiction Biol 1995; 57: 315–20
36.
Itzak Y, Ali S. Effects of ibogaine on the various sites of the NMDA receptor comles and sigma binding sites in the brain. Ann NY Acad Sci 1998; 844: 245–51CrossRef
37.
Leal M, Michelin K, Sousa D, et al. Ibogaine attenuation of morphine withdrawal in mice: role of glutamate N-methy-D-aspartate receptors. Prog Neuropsychophamacol Biol Psychiatry 2003; 27: 781–5CrossRef
38.
Arias H, Rosenberg A, Targowska-Duda K, et al. Interaction of ibogaine with human a3b4-nicotinic acetylcholine receptors in different conformational states. Int J Biochem Cell Biol 2010; 42: 1525–35PubMedCrossRef
39.
Glick S, Maisonneuve I, Kitchen B, et al. Antagonism of a3b4 nicotinic receptors as a strategy to reduce opioid and stimulant self-administration. Eur J Pharmacol 2002; 438: 99–105PubMedCrossRef
40.
Onaivi E, Ali S, Chirwa S, et al. Ibogaine signals addiction genes and methamphetamine alteration of long-term potentiation. Ann NY Acad Sci 2002; 965: 28–46PubMedCrossRef
41.
He D, Ron D. Autoregulation of glial cell line-derived neurotrophic factor expression: implications for the long-lasting actions for the anti-addiction drug ibogaine. FASEB J 2002; 20: E1820–7
42.
Sheppard S. A preliminary investigation of ibogaine: case reports and recommendations for further study. J Subst Abuse Treat 1994; 11: 379–85PubMedCrossRef
43.
Alper K, Lotsof H, Frenken G, et al. Treatment of acute opioid withdrawal with ibogaine. Am J Addictions 1999; 8: 234–42CrossRef
44.
45.
Mash D, Kovera C, Pablo J, et al. Ibogaine: complex pharmacokinetics, concerns for safety, and preliminary efficacy measures. Ann NY Acad Sci 2000; 914: 394–401PubMedCrossRef
46.
Witter S. Ibogaine. The Times (London) magazine. London: TIME, 1998 Jun
47.
Alper K, Glick S. Ibogaine: proceedings of the First International Conference. San Diego (CA): Academic Press, 2001
48.
49.
Luciano D. Observations on treatment with ibogaine. Am J Addictions 1998; 7: 89–90CrossRef
50.
Hoelen D, Spiering W, Valk G. Long-QT syndrome induced by the antiaddiction drug ibogaine. N Engl J Med 2009; 360: 308–9PubMedCrossRef
51.
52.
Maas U, Strubelt S. Fatalities after taking ibogaine in addiction treatment could be related to sudden cardiac death caused by autonomic dysfunction. Medical Hypoth 2006; 67: 960–4CrossRef
53.
54.
Espinoza EO, Mann M-J, Bleasdell B. Arsenic and mercury in traditional Chinese herbal balls. N Engl J Med 1995; 333: 803–4PubMedCrossRef
55.
Chen M, Jin G. Role of d-tetrahydropamatine in the inhibition of dopamine and serotonin or synaptosomes in the rat brain. Chin J Physiol Sci 1996; 12: 25–30
56.
Liu Y, Liang J, Yan L, et al. Effects of l-tetrahydropalmatine on locomotor sensitization to oxycodone in mice. Acta Pharmacol Sinica 2005; 26: 533–8CrossRef
57.
Ge X, Zhang H, Xu Z, et al. Experimental study of tetrahydroprotoberberines inhibiting morphine withdrawal syndromes. Chin J Drug Depend 1999; 8: 178–84
58.
Yang Z, Shao Y, Li S, et al. Medication of l-tetrahydropalmatine significantly ameliorates opiate craving and increases the abstinence rate in heroin users: a pilot study. Acta Pharmacol Sinica 2008; 29: 781–8CrossRef
59.
Gillis C. Panax ginseng pharmacology: a nitric oxide link. Biochem Pharmcol 1997; 54: 1–8CrossRef
60.
Attele A, Wu J, Yuan C. Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmcol 1999; 58: 1685–93CrossRef
61.
Takahashi M, Tokuyama S. Pharmacological and physiological effects of ginseng on actions induced by opioids and psychostimulants. Methods Find Exp Clin Pharmacol 1998; 20: 77–84PubMedCrossRef
62.
Shi J, Xu G, Liu T, et al. A comparative clinical study of the effects of the traditional Chinese medicine Jinnui capsules and lofexidine on acute heroin withdrawal symptoms. Am J Drug Alcohol Abuse 2008; 34: 792–800PubMedCrossRef
63.
Harris I. Regulatory and ethical issues with dietary supplements. Pharmacotherapy 2000; 20(11): 1295–302PubMedCrossRef
64.
Li Z, Wu C, Pei G, et al. Antagonistic effect of psuedoginsenoside-F11 on the behavioral actions of morphine in mice. Pharmacol Biochem Behav 2000; 66: 595–601PubMedCrossRef
65.
Li Z, Xu N, Wu C, et al. Pseudoginsenoside-F11 attenuates morphine-induced signalling in Chinese hamster ovary-mu cells. Neuroreport 2001; 12: 1453–6PubMedCrossRef
66.
Seo J, Lee J, Lee W, et al. Inhibitory effects of ginseng total saponin on up-regulation of cAMP pathway induced by repeated administration of morphine. Arch Pharm Res 2008; 31: 167–70PubMedCrossRef
67.
68.
Hao W, Zhao M. A comparative clinical study of the effect of WeiniCom, a Chinese herbal compound, on alleviation of withdrawal symptoms and craving for heroin in detoxification treatment. J Psychoactive Drugs 2000; 32: 277–84PubMedCrossRef
69.
Kang L, Li B, Gao L, et al. Tai-Kang-Ning, a Chinese herbal medicine formula, alleviates acute heroin withdrawal. Am J Drug Alcohol Abuse 2009; 34: 269–76CrossRef
70.
Wang X, Li J, Huang M, et al. A study of Fu-Yuan Pellet, a traditional Chinese medicine formula for detoxification of heroin addicts. Am J Drug Alcohol Abuse 2009; 35: 408–11PubMedCrossRef
71.
72.
Cohen H, Law-Yone B, Lu S. Poppy to fugu: a historical perspective of the treatment of opiate addiction in China. J Chinese Med 2002; 68: 15–20
73.
Metadata
Title
Herbal Medicines for the Management of Opioid Addiction
Safe and Effective Alternatives to Conventional Pharmacotherapy?
Authors
Dr Jeanine Ward
Christopher Rosenbaum
Christina Hernon
Christopher R. McCurdy
Edward W. Boyer
Publication date
01-12-2011
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 12/2011
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.2165/11596830-000000000-00000

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