20/10/2020
Detoxification from methadone using low, repeated, and increasing doses of ibogaine:
The main objective of the treatment was to completely detoxify the patient safely and with as much comfort as possible from methadone.
The patient was a 47-year-old woman (58 kg), who was on MMT for 17 years to treat her previous he**in dependence. Three years before starting the ibogaine treatment, she tried to abruptly end her methadone intake with non-pharmacological support but was unsuccessful. After3 months, she returned to the methadone program, as the abstinence syndrome (AS) was intolerable for her. She reinitiated the methadone treatment at a lower dose than before (from 70 to 37 mg). Upon initiating the ibogaine treatment, she was stabilized at 37 mg. Regarding her use of
other drugs, the patient occasionally used **in (2–3 times per month, intranasally) and (2–3 times per month, intranasally), and a limited use of ethanol (1/2standard units per week). She was a daily user(1–2 joints per day).
During the ibogaine treatment, the patient had a stable work and partner, owned her own house, and was without socio-familiar and legal conflicts assessed by the ASI(McLellan et al., 1992). As a consequence of her former intravenous use of he**in, the patient acquired the C virus (HCV). Before initiating this treatment, the viral count for the HCV was 2,140,000 Ul/ml (logarithm HCV =6.33; interval of quantification =15–69,000,000 Ul/ml).
An analytic exam was performed before the treatment, including complete blood count and biochemistry, hormones, urine biochemistry, coagulation, serology, and molecular biochemistry. From over 70 parameters measured in the analytical tests, only the following were out of the interval of reference (IR),but only slightly, and without clinical significance: leuko-cytes =10.34 ×109/L (IR =4–10); LKS-basophils =0.1%(IR =0.2–2); lymphocytes =3.09 ×109/L (IR =1–3);basophils =0.01 ×109/L (IR =0.02–0.1); alanine amino-transferase; b =0.72 μkat/L (IR =0.00–0.55); 43.20 U/L(IR =0.0–33.0); and transferrin saturation =46.18% (IR =20–45). An electrocardiogram (EKG) was also performed before the treatment, and no abnormalities were found. HerQTc values were 425 ms, blood pressure (BP) =120/70mm Hg, and heart rate (HR) =85 bpm. The psychiatric examination performed using the M.I.N.I.(Mini-International Neuropsychiatric Interview, Version5.0.0; Sheehan et al., 1998) did not result in any psychiatric diagnosis. Objectives of the treatment, procedures, and assessment materials
