Clare Wilkins’ presentation at the Psychedelic Science conference 2017 titled “A novel approach to detoxification from methadone using low, repeated and cumulative administering of ibogaine”
Clare is the director of Pangea Biomedics where they work with ibogaine alongside many supporting therapies.
In this talk Clare talks about how ibogaine treatments have changed in her clinic over time and most importantly a case study of detoxing a woman from methadone with ibogaine. Detoxing people from long acting opiates like methadone, suboxone, subutex, using ibogaine has always a been a subject of debate in ibogaine circles with many people saying you should be 3 or more weeks off all long acting opiates beforehand.
For most methadone users the only choice for getting hold of short acting opiates is to buy them from the street. So they return to their old haunts, often a part of the lifestyle that these people had left many years before and full of risks.
Clare has an interesting case study for us below of a woman addicted to methadone who was successfully detoxed with low dose intermittent ibogaine treatment
Problems with treatments in the early days.
“In the early days conventional treatment was risky as it was done in a short space of time with little trust built up between clients and providers”
She went on to elaborate stressing the following risk factors of working with ibogaine this way.
• There was a lack of preparation, fortification, stabilization and agency
• Traumatic Flood doses (large doses of ibogaine)
• Metabolic Stress. Physical dependency and ibogaine both cause metabolic stress
There is a lot of fear about ibogaine because:
• Ibogaine effects the heart. It is pro-arrhythmic, bradycardia inducing, QT prolonging, potassium channel blocking, cardio stimulant
• There is a need for medical interventions or to pause ibogaine administration due to bradycardia, prolonged QT interval, panic attacks and hypertension issues.
• Ibogaine stimulates the heart a lot even though it usually lowers blood pressure and heart rate.
For the majority of healthy people the above would not be an issue. But its when people have pre-existing health conditions or take medications and drugs (especially those that effect the heart) that people are at a higher risk of having problems. Drug users are often in this high risk group due to their lifestyles. There is a screening process to see whether a candidate is suitable for this type of work. Low dose regimes have often been used for candidates where their have been concerns, and Clare is big proponent of low dose ibogaine regimes.
Ibogaine’s Medical Contraindications and Complex Cases
There are many medicines and medical conditions that are not a good mix with ibogaine and could even be deadly. Clare specifically sited the below contraindications and complexities of treating drug addiction with ibogaine.
• Obesity, blood clots, arrhythmias, Crohn’s disease, gastro-intestinal issues, liver disease, high blood pressure, etc
• Poly-substance dependencies and benzos
• This is the demographic! These people are 4 times more likely to have an adverse reaction than a non-drug-dependent person.
A more extensive list can be found on the “Ibogaine Medical Contraindications” page
Clare started using ibogaine as an adaptogen (something that results in homeostasis).
• Smaller amounts of ibogaine create a sense of balance. At these doses it acts as an adaptogen.
• Used alongside Orthomolecular medicine and adjunct therapies
• Including other adaptogens and amino acids such as Gaba, Mucuna Dopa, 5-HTP, valerian and L-tryptophan.
Traditional Low Dose Use
Clare also sited the following traditional uses of low dose iboga
• Ombiwiri – they use low doses in diagnosis and healing
• Bwiti Womens Initiations build up slowly in the system over 1 month
Low Dose Ibogaine Treatment for Methadone Addiction
Clare talked through a case study that was conducted alongside ICEERS in Spain.
• The candidate was a 47-year-old woman that had been on methadone for 17 years. She had Hepatitis C but was in overall good health.
• The objective was to detox without using short acting opiates (such as morphine, oxys, heroin) as normally clients on methadone, Subutex, suboxone etc are asked to swap to a short acting opiate for the weeks or months prior to ibogaine administration and this causes other problems if they are already stable on methadone.
• 5 small doses of ibogaine were administered progressively getting larger at the same time as the dose of methadone got progressively smaller over a 6-week period.
• The dosage sizes of the ibogaine HCL were 150mg, 300mg, 400mg, 500mg, 600mg
• After each dose of ibogaine her methadone was cut in half. She started at 36mg, this was reduced as follows after each ibogaine administration: 18mg, 9mg, 4.5mg, 2.25mg
• Ibogaine was only administered when the withdrawals become physiologically evident.
• 3-7 days between each dose of ibogaine.
• After the final dose of 600mg her withdrawal symptoms did not return.
• At time of filming this woman is 20months free of methadone and feeling marvellous.
• Her liver enzymes went down (related to improved liver function / Hepatitis C)
• Supplemental small micro-doses used after for post-acute withdrawals
• Note: a micro-dose is so small you can’t really feel it, so you can go to work etc
Notes on treatment protocols
• Vitals measured every 30mins for first 4 hours, then every hour until stable
• ECG monitoring of the QTc every 60 mins during first 8 hours, then at 10 hours, 12hours, 16 hours, 20 hours, 24 hours
• Client was glad to have a rest between doses due to sleep deprivation
• QTc did not raise above the safe clinical scores (the highest it got to was a QTc of 444)
The Need for Change in how we Administer Ibogaine
Clare then went on to outline the changes she says we need to make in how ibogaine is administered for the following reasons:
• Incomplete Treatments
• Persistent withdrawals and cravings
• Asking clients to return to short acting opiates is controversial as they often have to return to illegal outlets to obtain them
• Continuing health risks
• Expectations anticipated of profound perspective shift may not be achieved and the client feels let down
Clare Wilkins: A Novel Approach to Detoxification from Methadone Using Ibogaine
You can see Clare’s presentation at the Psychedelic Science conference 2017 here:
Clare Wilkins is the director of Pangea Biomedics – an ibogaine clinic in Mexico specialising in low dose treatments and supporting treatments.
Thoughts on this Article
It should be remembered that this is just one case study and does not constitute clinical trials or evidence.
Long acting opiates like Methadone, subutex, suboxone, buprenorphine are notoriously difficult to detox from with ibogaine. 3 weeks on short acting opiates is considered the minimum, with many providers reommending 3-6months free of long acting opiates.
What worked on this woman, might not work on another person and it should be remembered that she had space between each dosage for the “half lives” to “catch up”. And that she was on a relatively low dose (36mg) of methadone.
Other providers have said that a slower reduction of 25-30% after each dose of ibogaine, with a longer time period between each dose is more feasible. And works better for those on higher doses of methadone.
Some providers would dismiss this article and insist on short acting opiates for several weeks beforehand.
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