Background and aimsVery few studies have reported the effectiveness of ibogaine as a treatment for chronic opioid use. Therefore, this study evaluated the acute subjective effects of ibogaine, outcomes on problematic opioid consumption, and the long-term associations with psychological functioning.MethodsUsing online data collection, 88 patients who received ibogaine treatment in Mexico between 2012 and 2015 completed our survey.ResultsMost participants (72%) had used opioids for at least 4 years and 69% reported daily use. Most (80%) indicated that ibogaine eliminated or drastically reduced withdrawal symptoms. Fifty percent reported that ibogaine reduced opioid craving, some (25%) reporting a reduction in craving lasting at least 3 months. Thirty percent of participants reported never using opioids again following ibogaine treatment. And over one half (54%) of these abstainers had been abstinent for at least 1 year, with 31% abstinent for at least 2 years. At the time of survey, 41% of all participants reported sustained abstinence (>6 months). Although 70% of the total sample reported a relapse following treatment, 48% reported decreased use from pretreatment levels and an additional 11% eventually achieved abstinence. Treatment responders had the lowest rates of depressive and anxious symptoms, the highest levels of subjective well-being and rated their ibogaine treatment as more spiritually meaningful compared with treatment non-responders.ConclusionThe results suggest that ibogaine is associated with reductions in opioid use, including complete abstinence, and has long-term positive psychological outcomes. Future research should investigate the efficacy of ibogaine treatment using rigorous longitudinal and controlled designs.

We examined persisting effects, self-perceived challenges, and potential benefits associated with positive outcomes following ibogaine detoxification using data collected as part of a larger online retrospective study of 73 patients who received treatment for chronic opioid use in Mexico between 2012 and 2015. A mixed-methods design was used comparing treatment responders versus non-responders, as well as content coding of themes from open-ended questions. Most participants reported positive persisting effects of ibogaine detoxification (e.g., enhanced personal sense of gratitude and authenticity, and meaning and appreciation for life). Compared to non-responders, treatment responders endorsed greater persisting changes in their ability to tolerate difficult/painful feelings, capacity for coping with stress, and reduced unhealthy anger. Treatment responders reported greater change in subjective levels of inner peace, joy, feelings of love/openheartedness, and experiences of sacredness in life. Qualitative analyses revealed that treatment responders reported a heightened sense of spiritual awareness and greater connection to their intra-/interpersonal relationships after ibogaine detoxification. Notable challenges of ibogaine detoxification included psychological and health-related difficulties during treatment and challenges with post-treatment integration. Findings highlight the persisting effects associated with positive response to ibogaine detoxification and possible post-treatment needs (i.e., more integration/aftercare resources). Future research using rigorous experimental designs is needed.

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Purpose: The purpose of this study was to compare the efficacy and safety of conventional transarterial chemoembolization (cTACE) with drug-eluting beads (DEB)-TACE in patients with hepatocellular carcinoma (HCC) without portal venous thrombosis (PVT). Materials: This retrospective analysis included a total of 370 patients with HCC, who were treated with either cTACE (N ¼ 248) or DEB-TACE (N ¼ 122) between 2000 and 2014. Clinical and biochemical toxicities of Grade 3 (CTAEv4) were recorded for all patients. Survival analysis was conducted using uni-and multivariate Cox proportional hazards models and Kaplan-Meier analysis using log-rank test and propensity score weighting via a generalized boosted model. In addition, sub-group analysis was performed to compare survival after cTACE and DEB-TACE stratified according to tumor size (>3 cm or >5 cm) and tumor morphology (infiltrative vs. nodular) on baseline imaging. Results: There was no significant difference in the prevalence of adverse events except for abdominal pain/discomfort which occurred more frequently after DEB-TACE (87.1%) than after cTACE (75.1%, p ¼ .02). The median overall survival (MOS) of the entire cohort was 28.1 mo. There was no significant difference in MOS between cTACE (19.5 mo) and DEB-TACE (22.2 mo) patients after propensity score weighing (p ¼ .405). However, in patients with infiltrative disease, cTACE achieved significantly longer MOS (12.1 mo) compared to DEB-TACE (8.6 mo; p ¼ .033). Conversely, in patients with nodular disease, DEB-TACE patients (25.4 mo) demonstrated significantly greater survival compared to cTACE patients (23.5 mo; p ¼ .023). Stratification according to tumor size did not achieve a significant separation of survival curves.Conclusions: This study did not demonstrate a significant difference in efficacy and toxicity between cTACE and DEB-TACE for the treatment of HCC without PVT. However, subgroup analysis of the cohort revealed that cTACE showed superior efficacy in patients with infiltrative disease whereas DEB-TACE was more effective in nodular tumors. Thus, tumor morphology and distribution on baseline imaging should be used as a parameter to inform decisions on the selection of embolic materials for TACE.

Purpose: To compare the analgesic and antiemetic requirements after transarterial chemoembolization with doxorubicin eluting microspheres (DEB-TACE) versus conventional chemoembolization (cTACE) in patients with hepatocellular carcinoma (HCC). Materials: Between 2014-2016, 283 patients (mean age 66 y, 72% male) underwent 395 super-selective TACE procedures (189 cTACE, 206 DEB-TACE) for HCC within UCSF criteria. cTACE was performed using 5 mg/mL doxorubicin emulsified with ethiiodized oil for a maximum dose of 50 mg and DEB-TACE was performed with100-300 m spheres impregnated with 150 mg of doxorubicin (LC beads, BTG, UK). Patients were retrospectively reviewed for tumor characteristics, procedural technique, prior therapies and chronic pain. Postoperative (within 6 h post-TACE) and overnight use of intravenous and oral analgesics and antiemetic agents was assessed. Results: Baseline demographics, Child-Pugh scores, prior therapies and chronic pain history were similar between both groups. Median tumor diameter for cTACE was 2.2 cm (mean 2.5 cm, SD 1.2 cm) and was 2.4 cm for DEB-TACE (mean 2.9 cm, SD 1.4 cm). Delivered doxorubicin dose was higher with DEB-TACE than with cTACE (55.2 mg vs 29.6 mg, p<0.0001). While the need for intravenous analgesia and antiemetic agents was similar for both groups in the postoperative period (p ¼ 0.3), a higher percentage of patients treated with DEB-TACE required overnight intravenous analgesia and antiemetics (23% vs. 11% cTACE, p ¼ 0.002), increasing the overall utilization of intravenous drugs in the DEB-TACE group (p ¼ 0.04). Requirements for oral narcotic analgesia were also higher following DEB-TACE compared to cTACE (56% vs. 43%, p ¼ 0.01). Delivered doxorubicin dose and nausea were correlated (p ¼ 0.016) and thus resulted in increased requirements for antiemetic agents following DEB-TACE (25% vs 16% for cTACE, p ¼ 0.04). Conclusions: Patients undergoing DEB-TACE require more post procedural analgesia and antiemetic agents compared to cTACE. Postprocedural care should be planned accordingly to ensure patient comfort especially when considering same-day discharge.