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

Abstract

Background and aims
Ibogaine is a natural alkaloid that has been used in the last decades as an adjuvant for the treatment of opiate withdrawal. Despite the beneficial results suggested by animal studies and case series, there is a lack of clinical trials to assess the safety and efficacy of ibogaine. Moreover, the majority of reports described cases of heroin-dependent individuals, with and without concomitant use of methadone, using high doses of ibogaine. Therefore, it is not clear if ibogaine at low doses could be used therapeutically in people on methadone maintenance treatments (MMT).

Methods
Case report of a female on MMT for 17 years who performed a self-treatment with several low and cumulative doses of ibogaine over a 6-week period.

Results
The patient successfully eliminated her withdrawals from methadone with ibogaine. Each administration of ibogaine attenuated the withdrawal symptoms for several hours, and reduced the tolerance to methadone until all signs of withdrawal symptoms disappeared at the end of the treatment. No serious adverse effects were observed, and at no point did the QTc measures reach clinically significant scores. Twelve months after the treatment, she was no longer on MMT.

Conclusions
To our knowledge, this is the first case report describing an ibogaine treatment using low and cumulative doses in a person on MMT. Although preliminary, this case suggests that low and cumulative doses of ibogaine may reduce withdrawal symptoms in patients undergoing MMT.

Full text

Detoxification from methadone using low, repeated, and increasing doses
of ibogaine: A case report
CLARE WILKINS
1
, RAFAEL G. DOS SANTOS
2,3,4
, JORDI SOLÁ
2
, MARC AIXALÁ
2
, PEP CURA
2
, ESTEFANÍA MORENO
2
,
MIGUEL ÁNGEL ALCÁZAR-CÓRCOLES
5
, JAIME E. C. HALLAK
3,4
and JOSÉ CARLOS BOUSO
2
*
1
Pangea Biomedics, Nayarit, Mexico
2
International Center for Ethnobotanical Education, Research & Services, Barcelona, Spain
3
Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
4
National Institute of Science and Technology –Translational Medicine, Ribeirão Preto, Brazil
5
Departamento de Psicología Biol´ogica y de la Salud, Facultad de Psicología, Universidad Aut´onoma de Madrid, Madrid, Spain
(Received: September 26, 2016; accepted: March 23, 2017)
Background and aims: Ibogaine is a natural alkaloid that has been used in the last decades as an adjuvant for the
treatment of opiate withdrawal. Despite the beneficial results suggested by animal studies and case series, there is a
lack of clinical trials to assess the safety and efficacy of ibogaine. Moreover, the majority of reports described cases of
heroin-dependent individuals, with and without concomitant use of methadone, using high doses of ibogaine.
Therefore, it is not clear if ibogaine at low doses could be used therapeutically in people on methadone maintenance
treatments (MMT). Methods: Case report of a female on MMT for 17 years who performed a self-treatment with
several low and cumulative doses of ibogaine over a 6-week period. Results: The patient successfully eliminated her
withdrawals from methadone with ibogaine. Each administration of ibogaine attenuated the withdrawal symptoms for
several hours, and reduced the tolerance to methadone until all signs of withdrawal symptoms disappeared at the end
of the treatment. No serious adverse effects were observed, and at no point did the QTc measures reach clinically
significant scores. Twelve months after the treatment, she was no longer on MMT. Conclusions: To our knowledge,
this is the first case report describing an ibogaine treatment using low and cumulative doses in a person on MMT.
Although preliminary, this case suggests that low and cumulative doses of ibogaine may reduce withdrawal
symptoms in patients undergoing MMT.
Keywords: ibogaine, methadone, opioid substitution treatments (OST), methadone maintenance treatments (MMT),
methadone detoxification, drug addiction
INTRODUCTION
Opioid misuse is increasing alarmingly in both the EU and
North America. According to the US Centers for Disease
Control and Prevention, “since 1999, the number of over-
dose deaths involving opioids (including prescription opioid
pain relievers and heroin) nearly quadrupled. From 2000 to
2014 nearly half a million people died from drug overdoses.
78 Americans die every day from an opioid overdose”
(Centers for Disease Control and Prevention, 2016). Since
the problem has repeatedly been described as an “epide-
mic,”a drug abuse and treatment bill has recently been
signed into US law after passing through the House and
Senate (Spangler, 2016). Simultaneously, in the EU, and
according to the 2016 European Drug Report, “Europe’s
opioids problem remains a central issue in the 2016 analysis,
reflecting the significant impact these drugs still have on
mortality and morbidity. We see now an increasingly com-
plex relationship between use of heroin and synthetic
opioids, accompanied by a worrying increase in overall
estimates of opioid-related deaths”(European Monitoring
Centre for Drugs and Drug Addiction [EMCDDA], 2016).
The new epidemic of opioid overdoses is not only related
to heroin misuse, as it has been in the past, but also to a high
prevalence of the misuse of prescription opioids, including
methadone (Substance Abuse and Mental Health Services
Administration [SAMHSA], 2016). The Guidelines for the
Psychosocially Assisted Pharmacological Treatment of
Opioid Dependence of the World Health Organization
(WHO) state that there are two strategies to treat opioid
use disorders: (a) to progressively reduce the dose and
(b) to begin an opioid substitution treatment (OST), gen-
erally using methadone or buprenorphine (WHO, 2009).
According to those guidelines, opioid withdrawal (rather
than maintenance treatment) results in poor outcomes
over the long term (WHO, 2009). Although an OST is a
successful approach to reduce opioid misuse and crime, it
tends to become a perpetual treatment, and it has been
shown that those stabilized on high doses in methadone
maintenance treatments (MMT) have more medical, cog-
nitive, and emotional problems and a decreased quality of
life than people who terminated MMT (Pedrero-Pérez &
MethaQoL, 2016). It is clear that novel pharmacological
treatments that are effective in ceasing opioid misuse are
necessary.
* Corresponding author: José Carlos Bouso; International Center
for Ethnobotanical Education, Research & Services, c/Cendra 8,
bajos, 08012 Barcelona, Spain; Phone/Fax: +34 931 882 099;
E-mail: jcbouso@iceers.org
© 2017 The Author(s)
CASE REPORT Journal of Psychedelic Studies 1(1), pp. 29–34 (2017)
DOI: 10.1556/2054.01.2017.005

Ibogaine is the principal alkaloid in Tabernanthe iboga,
an African plant used in ethnomedicine in traditional
communities (Alper, 2001). In 1956, a Ciba Pharmaceu-
ticals patent was acquired for its properties to reduce
tolerance to morphine (United States Patent Office,
1957). In the 1960s, Howard Lotsof serendipitously dis-
covered the anti-withdrawal properties of ibogaine (Alper,
2001). Ibogaine has demonstrated efficacy in attenuating
opioid withdrawal in animal models (Belgers et al., 2016),
but the evidence in humans is scarce (Brown, 2013).
Globally, approximately 70–100 private clinics and practi-
tioners offer treatments with ibogaine, and in New Zealand
and South Africa, ibogaine is listed as a prescription
medication (Ibogaine Legal Status, 2016). The typical
doses used for treating substance use disorders are between
15 and 20 mg/kg (Brown, 2013) in a single administration.
High doses of ibogaine may induce bradycardia and pro-
long the QTc interval (Litjens & Brunt, 2016;Meisner,
Wilcox, & Richards, 2016), which can be life-threatening.
Indeed, ibogaine administration has been associated with
several fatalities (>25 cases), which appear to involve
increases in cardiac arrhythmias, previous cardiovascular
diseases, and use of opiates/opioids or other drugs during
the acute effects of ibogaine (Litjens & Brunt, 2016;
Meisner et al., 2016).
In a recent clinical trial with noribogaine (Glue, Cape,
Tunnicliff, Lockhart, Lam, Hung, et al., 2016), the main
metabolite of ibogaine and a possible candidate for explain-
ing its anti-addictive properties (Mash et al., 1998), this
compound was administered to people on MMT who were
switched to morphine. No significant reduction in with-
drawal symptoms was observed after the administration of
60, 120, and 180 mg [the 180 mg dose of noribogaine is
equivalent in noribogaine plasma concentration to a 286 mg
dose of ibogaine (Glue, Cape, Tunnicliff, Lockhart, Lam,
Gray, et al., 2016)] but was observed a concentration-
dependent increase in QTc. The authors of that study
speculated that the dose of noribogaine administered prob-
ably was too low, and repeated dosing would be necessary
to achieve a reduction in withdrawal symptoms. A recent
report establishes the safe dose to be administered in an
ibogaine treatment in 0.87 mg/kg that is far from the 15–20
mg/kg doses (Schep, Slaughter, Galea, & Newcombe,
2016).
We present here the case of a successful detoxifica-
tion from long-term methadone dependence using low,
repeated, and increasing doses of ibogaine.
CASE PRESENTATION
The patient was a 47-year-old woman (58 kg), who was on
MMT for 17 years to treat her previous heroin dependence.
Three years before starting the ibogaine treatment, she
tried to abruptly end her methadone intake with non-
pharmacological support but was unsuccessful. After
3 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 heroin (2–3 times
per month, intranasally) and amphetamine (2–3 times per
month, intranasally), and a limited use of ethanol (1/2
standard units per week). She was a daily cannabis 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
heroin, the patient acquired the hepatitis 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 biochem-
istry, 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 ×10
9
/L (IR =4–10); LKS-basophils =0.1%
(IR =0.2–2); lymphocytes =3.09 ×10
9
/L (IR =1–3);
basophils =0.01 ×10
9
/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. Her
QTc values were 425 ms, blood pressure (BP) =120/70
mm Hg, and heart rate (HR) =85 bpm.
The psychiatric examination performed using the M.I.N.I.
(Mini-International Neuropsychiatric Interview, Version
5.0.0; Sheehan et al., 1998) did not result in any psychiatric
diagnosis.
Objectives of the treatment, procedures, and assessment
materials
The main objective of the treatment was to completely
detoxify the patient safely and with as much comfort as
possible from methadone. The Opiate Withdrawal Scale
(OWS; Bradley, Gossop, Phillips, & Legarda, 1987) and the
Short OWS (SOWS; Gossop, 1990) were used to assess
withdrawal symptoms, the Brief Psychiatric Rating Scale
(BPRS; Overall & Gorham, 1962) was used as a measure of
psychiatric safety, and the Udvalg for Kliniske Underso-
gelser Side Effects Rating Scale (UKU-SERS; Lingjaerde,
Ahlfors, Bech, Denckes, & Elgen, 1987) was used to assess
the side effects of ibogaine. The OWS was administered
once a day throughout the treatment. The SOWS was
administered before each ibogaine session and every hour
for the first 6 hr, and at 8- and 12-hr post-ibogaine. The
BPRS was administered before each ibogaine session and
every hour for the first 6 hr, at 8- and 12-hr post-ibogaine,
and also every morning during the treatment process. The
UKU was administered for 24 hr after each ibogaine session.
During each ibogaine administration, BP and HR were
monitored every 30 min for the first 4 hr, then every hour
for the next 12 hr, and at 18- and 24-hr post-ibogaine. EKG
monitoring and measurement of the QTc were performed
during each ibogaine session every 60 min for the first 8 hr
and then at 10-, 12-, 16-, 20-, and 24-hr post-administration.
30 |Journal of Psychedelic Studies 1(1), pp. 29–34 (2017)
Wilkins et al.

The patient had psychological support throughout the treat-
ment. She continued with psychotherapy for 3-month post-
treatment to reorient her life.
Treatment
The patient contacted the ICEERS Support Service
(http://iceers.org/support-service.php) for advice, as she was
planning to undergo a self-treatment with ibogaine. She felt
that her methadone dependence was iatrogenic and wished
to cease the treatment utilizing ibogaine, after considerable
research. Since ICEERS is a non-profit research organiza-
tion that does not provide ibogaine treatments but has
contact with several treatment centers/providers, and after
assessing that the patient had the irreversible plan of taking
ibogaine for self-treating her methadone dependence, the
Support Service put her in contact with Pangea Biomedics, a
clinic in Mexico with 10 years of experience in treating
substance dependencies, such as MMT with ibogaine (note:
ibogaine is not scheduled in Mexico). Financial constraints
denied her from traveling to Mexico, thus she and the
clinicians at Pangea Biomedics decided to undergo the
detoxification while she was being supervised live through
Skype video in Spain, along with the ICEERS Support
Service team who offered psychological support and col-
lected the measures. The treatment consisted of low and
increasing doses of ibogaine administered in between pro-
gressively decreasing methadone dosages. The dose and
timing of dosing were chosen with the intention of finding a
new and less risky ibogaine treatment, avoiding the higher
doses. Ibogaine was donated to the patient by a private
donor from South Africa (Anwar Jeewa) and by a laboratory
based in Montreal, Canada (Phytostan Enterprises, Inc.)
(note: ibogaine is not scheduled in Canada, South Africa,
and Spain, and in South Africa, it is authorized to be used as
medicine to treat drug dependence). However, the patient
only needs to use the sample from South Africa one. The
chemical analysis (using thin layer chromatography, high
performance liquid chromatography, mass spectrometry,
and nuclear magnetic resonance) showed that it contained
96.3% ibogaine hydrochloride.
An EKG machine with QTc lecture was used for cardiac
monitoring. Ibogaine sessions were performed with medical
supervision for the first four sessions.
The treatment consisted of alternating low but increasing
oral doses (n=5) of ibogaine with decreasing methadone
doses. With this method, she stopped taking methadone and
only when the withdrawal symptoms became physiologi-
cally evident (OWS =23; SOWS =9), she took 150 mg of
ibogaine. One hour after ibogaine administration, all with-
drawal symptoms disappeared (SOWS =0), and reappeared
21 hr afterward (OWS =24) (for a timeline of the SOWS
scores for the first four doses of ibogaine, see Figure 1).
Then the patient took half the basal dose of methadone
(18 mg) and maintained that dose every morning for the
following 3 days. She then ceased self-administering meth-
adone, and when withdrawal symptoms became physiolog-
ically evident, she took 300 mg of ibogaine. This process
was repeated three more times, alternating ibogaine doses
(400, 500, and 600 mg) while reducing methadone doses in
half. The time frame that the patient was administering
methadone between ibogaine sessions varied between 3
and 7 days, depending on her work obligations. After the
last dose of ibogaine (600 mg), the methadone AS ceased
and never returned.
Outcome and follow-up
The patient successfully eliminated her withdrawals from
methadone with ibogaine. Each administration of ibogaine
attenuated or even eliminated the withdrawal symptoms for
many hours (see Figure 1; there are no data for the 600 mg
dose), and reduced the tolerance to methadone until all signs
of withdrawal symptoms disappeared at the end of the
treatment. The lower ibogaine doses taken by the patient
were apparently devoid of visual effects, yet repressed
memories and emotions did surface. There were no psychi-
atric effects according to the BPRS. There were few side
effects according to the UKU. In a scale of gravity from 1 to
3, fatigability, memory impairment, akathisia, and ortho-
static dizziness were rated as 1, constipation and tension
headache were rated as 2, and reduction in the duration of
sleep was rated as 3. The rest of the eventual side effects
assessed by the UKU were rated as 0, and there was no dose
effect. In fact, the most uncomfortable side effect reported
by the patient was difficulty in sleeping after each ibogaine
session, so the patient decided to use a benzodiazepine
(diazepam 2 mg) after the first ibogaine session. After the
other ibogaine sessions, she took cannabis oil orally
acquired from her Cannabis Social Club in Barcelona, Spain
(note: in Spain, the personal use and acquisition of cannabis
in these clubs is not a criminal offense). After recovering
from the last ibogaine session, she did not continue using
methadone, benzodiazepines, nor cannabis oil.
Regarding QTc and BP, there were no clinically signifi-
cant decrements. HR dropped with the 400 and 500 mg
doses from 85 to 53 bpm between the first 2–3 hr. However,
sitting or standing up effectively increased HR. At no point
did the QTc measures reach clinically significant scores.
The highest score (444 ms) was reached with the 500 mg
dose at 3 hr.
The ibogaine sessions appeared to lack visionary content,
although she had psychological insights regarding bio-
graphical events with emotional, non-distressing reactions.
The patient reported feeling comfortable, relaxed, and
Figure 1. Short Opiate Withdrawal Scale (SOWS) scores for every
ibogaine dose after its administration
Journal of Psychedelic Studies 1(1), pp. 29–34 (2017) |31
Detoxification from methadone using ibogaine

completely free of anxiety during the first 6–8hrofthe
experience.
During this report, 12 months after the ibogaine treat-
ment, she was no longer an MMT patient, and was without
any symptoms of post-acute withdrawal syndrome (PAWS).
Her life has improved in several ways (such as beginning to
study, play music, and volunteer again), and her frequent
use of drugs has been reduced. In an analytical test that
the patient completed 7 months after the treatment, all the
parameter values were within the IRs, including those that
were not prior to the treatment. According to the patient, this
analysis was the only one in the last 17 years where all
the parameters were within the normal ranges, although the
exact HCV viral load was not measured in the analysis.
DISCUSSION
To our knowledge, this is the first time that a protocol based
on low and multiple doses of ibogaine administered inter-
mittently between decreasing methadone doses has been
performed to detoxify from methadone for the purposes of
research and better outcomes. Standard treatments for
detoxifying from methadone require many months to com-
plete, and patients consider it significantly more difficult,
with more protracted PAWS symptoms than that of heroin
or other short-acting opioids (Gutwinski, Bald, Gallinat,
Heinz, & Bermpohl, 2014). The protocol based on low,
multiple, ascending doses of ibogaine may provide a rela-
tively brief but successful alternative to classical methods
based on conventional detoxification. In addition, contrary
to alpha2-adrenergic drugs that reduce abstinence symptoms
but do not eliminate it, ibogaine seems to significantly
reduce and even eliminate AS, returning the system to its
normal physiological state. Because even very low doses of
ibogaine may induce prolongations in the QTc interval and
lower HR, which may be life-threatening (Litjens & Brunt,
2016;Meisner et al., 2016), it is critical and absolutely
required that protocols based on low doses must be medi-
cally supervised.
The ibogaine literature is confusing regarding its effi-
cacy with methadone-dependent patients because authors
do not differentiate methadone-dependent from heroin-
dependent patients, making it impossible to know precisely
whether those for whom the treatment failed were depen-
dent on methadone or not. According to the experience of
the clinicians at Pangea Biomedics, a singular large dose of
ibogaine, even with supplemental doses, over a short
period of time, does not completely eliminate the with-
drawal symptoms of methadone, especially PAWS that
aresocommontoMMTdetoxification (unpublished
observations).
It is not well understood why ibogaine has withdrawal-
mitigating properties. Ibogaine and noribogaine have a
complex neuropharmacology, binding to multiple brain
receptors, among them μ- and κ-opioid receptors, and
increasing brain-derived neurotrophic factor (Maciulaitis,
Kontrimaviciute, Bressolle, & Briedis, 2008). Noribogaine,
the principal metabolite of ibogaine, has been proposed as
the molecule responsible for its anti-withdrawal effects
(Mash et al., 1998). Earlier pharmacokinetics studies
showed that the half-life of ibogaine was of 7.45 hr for
extensive metabolizers, while noribogaine levels stayed in
the 90% range of the C
max
for 24 hr after an oral adminis-
tration of 500 mg (female) and 800 mg (male) of ibogaine
(Mash et al., 2000). A recent study has found a mean plasma
elimination of 28–49 hr across dose groups after adminis-
tration of doses of 3, 10, 30, and 60 mg (Glue, Cape,
Tunnicliff, Lockhart, Lam, Hung, et al., 2016). This long
action of ibogaine/noribogaine may explain the sustained
anti-withdrawal effects of only one dose of ibogaine admin-
istered to heroin and/or other short-acting opiate users.
In this case report, the withdrawal symptoms appeared
again after 6 hr with the initial lower dose, and after almost
24 hr following the incremental doses. There are several
possible explanations for that. First, although it has
generally been established that the half-life of methadone
is 24 hr (Argoff & Silvershein, 2009), a recent pharmaco-
kinetic study found a mean elimination half-life of 59 hr in
methadone-dependent patients (Glue, Cape, Tunnicliff,
Lockhart, Lam, Gray, et al., 2016), so it is possible that
one administration of ibogaine could be insufficient, in
pharmacokinetic terms, to completely counteract the
effects of methadone withdrawal symptoms. Complemen-
tarily, the former studies of Ciba Pharmaceuticals showed
that ibogaine reduced morphine tolerance (United States
Patent Office, 1957), so it is possible that ibogaine could
also reduce methadone tolerance. Therefore, in this case
report, progressively increasing ibogaine doses could pro-
duce an accumulation of noribogaine in the organism, and
thus the withdrawal symptoms would take longer to reap-
pear until they completely disappeared after multiple in-
creasing doses.
Finally, there is a discrepancy between this case and the
lack of significant effects in the only clinical trial that
assessed the anti-withdrawal properties of noribogaine
(Glue, Cape, Tunnicliff, Lockhart, Lam, Hung, et al.,
2016). Noribogaine and ibogaine have a different neuro-
pharmacology. A recent study using oral doses of noribo-
gaine in rodents found that it is necessary to administer high
doses of noribogaine to reduce withdrawal symptoms (the
half-efficacious dose was 13 mg/kg) (Mash, Ameer, Prou,
Howes, & Maillet, 2016). It is possible that it may be
necessary to combine both the effects of ibogaine and
noribogaine to obtain a complete anti-withdrawal effect.
A recent study showed that noribogaine, in contrast to
ibogaine, is a weak μ-opioid receptor antagonist and an
efficient κ-opioid receptor agonist (Maillet et al., 2015).
Since ibogaine and noribogaine have different actions on the
brain, it could be speculated that both of them “cooperate”to
reach a final anti-withdrawal effect, at least in patients
dependent on opioids with a long half-life. Thus, it is
possible that because of the agonist action of ibogaine at
μ-opioid receptor subjects may first experience a relief of
withdrawal effects, and the action of noribogaine on
κ-opioid receptors may be the responsible mechanism for
reversing tolerance (Fujita-Hamabe et al., 2010). This sug-
gests that it may not be necessary to use high doses of
ibogaine to briefly reverse withdrawal, and that repeated
doses of ibogaine would be necessary to reverse tolerance in
methadone-dependent patients, so that noribogaine can
32 |Journal of Psychedelic Studies 1(1), pp. 29–34 (2017)
Wilkins et al.

sufficiently accumulate in the brain until reaching the
necessary levels to completely reverse/eliminate withdrawal
symptoms. Because of the undesirable side effects of ibo-
gaine, including emotional and memory processing, even
at low doses, it is more tolerable for the patient to alternate
the doses of ibogaine with periods of methadone, thereby
progressively reducing the opioid dose until dependence
has definitively been eliminated, and psychological inte-
gration is achieved. The use of benzodiazepines may be
indicated to counteract insomnia and psychostimulant side
effects. Our patient preferred to use legal cannabis, which
may have anti-withdrawal properties as well (Scavone,
Sterling, Weinstein, & Van Bockstaele, 2013). Clinical
trials comparing single doses with multiple doses of ibo-
gaine are necessary to establish which approach is the
safest and most efficient in treating opioid withdrawal and
dependence.
Acknowledgements: The authors would like to thank the
patient for her kindness in allowing us to supervise her
treatment, and Sarita Wilkins and Douglas Greene for their
invaluable assistance with manuscript editing. They would
also like to thank Anwar Jeewa (South Africa) and Phyto-
stan Enterprises, Inc. (Montreal, Canada) for kindly donat-
ing the ibogaine.
Ethics: The patient signed a patient consent form giving her
permit to publish this case report.
Conflict of interest: CW is the Director of Pangea Biomedics
(Nayarit, Mexico), a clinic that runs legal ibogaine treatments
in Mexico. RGdS is a Fellow of the Brazilian National
Postdoctoral Program (PNPD/CAPES) and member of the
ICEERS Advisory Board. JS, PC, EM, MAA-C, and JCB are
ICEERS employees or collaborators. ICEERS is a non-profit
organization that promotes the scientific research of ibo-
gaine. JECH received a CNPq (Brazil) Productivity Fellow-
ship Award. For the remaining authors, none were declared.
None of the authors received any specific funding for
participating in this investigation. All authors had full access
to all the data in this study and had final responsibility for the
decision to submit for publication.
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