Detoxification from methadone using low, repeated, and increasing doses of ibogaine: A case report

Introduction

Opioid misuse, including misuse of prescription opioids such as methadone, has risen sharply in recent years and contributes substantially to overdose mortality and morbidity in Europe and North America. Conventional strategies endorsed by the World Health Organization are gradual dose reduction or opioid substitution treatment (OST) with methadone or buprenorphine; OST reduces harms but often becomes long-term and is associated with persistent medical, cognitive, and quality-of-life problems for some patients. Ibogaine, an alkaloid from Tabernanthe iboga, has shown anti-withdrawal effects in animal models and long-standing anecdotal and case-series evidence in humans, but safety concerns (notably bradycardia and QTc prolongation) and a lack of controlled clinical trials limit its acceptance. Typical therapeutic regimens have used single high doses (around 15–20 mg/kg), and fatalities related to cardiac arrhythmia and comorbid factors have been reported. A recent noribogaine trial in people switched from methadone to morphine showed no reduction in withdrawal at the doses tested and raised the possibility that repeated dosing or different dosing regimens might be required. This report describes a single-case attempt to detoxify a long-term methadone patient using a protocol of low, repeated, and progressively increasing oral doses of ibogaine administered intermittently while methadone doses were reduced. The authors present clinical procedures, monitoring, adverse effects, and follow-up up to 12 months, with the aim of exploring whether a lower-dose, cumulative ibogaine strategy might reduce withdrawal symptoms and methadone dependence while improving safety compared with single high-dose approaches.