DOSE:
repeated
Methadone
repeated
Kratom
repeated
Ibogaine
BODY WEIGHT:
167 lb
Methadone Withdrawal with Kratom and Ibogaine
This report tracks the successful and largely withdrawal-free methadone detox of a forty-six-year-old, 167 lb. woman with hepatitis C who had been addicted to Methadone (concurrently with Xanax, cigarettes, and coffee). The detox broadly went through three stages: a methadone taper, a substitution of Kratom for Methadone, and an Ibogaine experience to detox from the Kratom.
Detox Stage I: Methadone Taper
The detox began with the subject attempting to taper off of Methadone. Some false starts were observed, such as when she thought she could taper one milligram per day. Also, bureaucratic problems slowed down the process as the clinic made it easy to increase her dose, but requests to decrease her dosage required the staff to conference, and this process could take weeks if they did not outright lose the request. The taper that worked once it finally got started took her from 125mg to 55mg on a schedule of 5mg every two weeks. Her plan was to continue tapering until she could discontinue usage altogether; however, at 55mg, she was no longer able to taper and had her clinic hold. The subject had read of Ibogaine years before in a magazine, and decided to consult a chemist knowledgeable about the drug, who informed her that there would be a wait for Ibogaine, but that Kratom had been used successfully to detox from Methadone. She decided to try the Kratom in the interim.
Detox Stage II: Kratom Substitution
The problems that plagued the switch to Kratom all had to do with delivery methods, but once those were worked out, it proved a superior replacement for Methadone, covering all the necessary receptors. After a test dose bought online, she was convinced that Kratom would work, and so decided to use it to get off methadone. From Internet research, it seemed that Balinese Kratom was the type most frequently used in Methadone detox. Also, it appeared that in the cases of most of the differing forms of Kratom sold, whether in cake, powder, extract, or leaf form, that the level of processing alone accounted for most of the price differences; therefore, the least processed form of Bali Kratom, the crushed leaf form, was purchased and processed at home.
The subject purchased a Mr. Coffee grinder, a scale, and a kilo of Commercial/Bali dried, crushed Kratom leaf. The grinder ground the crushed leaf into a powder fine enough that wisps of smoke-like powder escaped into the air. The powder was boiled for thirty minutes in 2.5 cups of water during each of five extractions. The resulting infusion was poured into a glass jar, straining through a coffee filter, inspecting the opacity, and then adding the product to a pitcher with level marks on it at the five and ten-cup levels. On the fifth extraction, the tea looked very weak, so the remaining grounds were discarded, and then a bit of water was added until the level came up to the ten-cup mark on the pitcher. This would make it easy to do the math. A cup would equal ten grams of leaf. As was later learned, it would have been much better to boil down the infusion to a more manageable volume. Once the subject experienced nausea from drinking Kratom tea, the smell and taste of it became nearly intolerable, and then the actual volume she needed to drink became critical.
The morning after preparation of the tea, the subject went to the clinic, where she dosed on 55 milligrams of methadone and got six days worth of take-home doses. These would be the safety net should she not tolerate the Kratom. She went through her day as usual, sleeping most of it away, then slept all night. The idea was to start taking Kratom just as the first pangs of Methadone withdrawal made themselves felt.
The beginning of her detox was documented in detail, but for the most part, it will be handled in summary. On the first day, the subject had planned to take her last dose at the clinic and begin Kratom about 30 hours later, reserving the six take-home methadone doses in case she had to discontinue the Kratom for any reason. When it was time to administer the first dose of Kratom, it was discovered that she had doubled her dose of Methadone the day before and had already double-dosed for the day, which left her short two doses should the Kratom have to be discontinued. This removed any comfort level or margin of error. Even after double dosing for two days, she began making a case that she should start using the Kratom while double dosing on the last of the Methadone. The remaining methadone was removed and the top on the pitchers were taped with layers of packing tape so as to make any tampering evident.
After taking the kratom tea, the first day off of Methadone left the subject completely amazed. After 11 years of Methdone use, it seemed like a �miracle� that she could leave it behind for a legally available herb. The subject started taking Kratom roughly a cup at a time just before noon, and by 11:00 in the evening, she had drunk tea made from about 50 grams of Kratom. Early in the day, she was in good spirits. By the evening, she was showing some anxiety, but it was manageable and nowhere near what she would be experiencing with methadone withdrawals. There was no nausea. After talking to her, it appears the anxiety might have just been from not being able to sleep as many hours as she was used to. She would often sleep approximately 16 hours a day, and now, without methadone combining with the Xanax, it appeared she might not know what to do with all of the extra hours in the day.
The later evening doses were closer to 1.5 cups and were augmented by smoking Kratom joints. She began complaining of an intermittent headache at about 9:00 PM. At this point, we didn�t know whether she might have taken too much, causing a headache, or taken too little, causing a headache, or if the headache was unconnected to the Kratom. She was generally plagued by headaches even before the withdrawal. By about 11:00 PM, she decided she would try to take less Kratom until she felt she really needed it. With her opiate tolerance, Kratom never produced the same opiate high she was used to. She leveled to a dose that kept withdrawals away instead of a dose to produce an opiate plateau. She went to bed around midnight after administering 8mg of Melatonin. She slept soundly for three hours.
It became evident that the supply of tea was running out quicker than anticipated, so another extraction was conducted, this time with 200 grams of the leaf. Although dripping it through a paper coffee filter produces a clean, smooth brew, the filters clog up and it is messy. A French press pot can be used with a coffee filter over the plunger section, speeding up the process. Paint strainer bags are the same thing as nut milk bags but much cheaper, and they also work for straining the tea faster than coffee filters. However, after an incident of violent, convulsive vomiting from the Kratom, the subject had serious problems ingesting enough Kratom in tea form again. It became a terribly unpleasant thing for her to drink much of the tea, yet she struggled through. Preparing enough sheer volume of Kratom tea for a liver-compromised person who has been on Methadone for so long was also very demanding.
Since she would be ingesting Kratom for a significant length of time in tea form, we decided to boil the tea down to a concentrate and shoot it quickly. This makes the process labor-intensive, and eventually she started to get �high� from the Kratom, which could have fed into her developing the Kratom addiction.
For these reasons, although one does not get as much cost-effectiveness when taking the Kratom powder in gelatin capsules, and although it is still a big job, it is much less labor-intensive to make capsules from the powdered Kratom. Gelatin capsules (gel caps) also made dosing easy for the subject. Once they were ingested, they did not produce nausea; the nausea seemed to be an effect of the flavor and smell more than a sensitivity of the digestive tract. Also attempted were making various shapes and sizes of mud pie using cornstarch and various flavorings such as chocolate, but nothing really masks the Kratom flavor, which is liable to provoke vomiting and gagging. One thing that worked was the �toss-and-wash� method, which consists of throwing the Kratom powder into the mouth and chasing it with liquid. This is effective and uses minimal labor; however, the powder tends to stick to the throat and caused the subject to have some mild paralysis in the swallowing mechanism for days. This could be minimized by wetting the powder first, but it was not an option in this case because the flavor was too strong wet. Smoking Kratom also was effective, but led to chest pains. It is simply too harsh to smoke in any significant quantity although it is valuable during emergencies for quick delivery.
One of the first phases of the withdrawal was the subject�s speeding. At lower doses, Kratom produces a stimulant effect. Although the dose later increased to produce relief without stimulant effects, at the beginning she expended much of her energy cleaning, and she remarked about how great she felt and how happy she was to be off of Methadone; however, after a few days, she began to wear out and get breakthrough spasms in the night until she began taking much larger doses, sometimes 60 grams or more at a time. With her hepatitis C, her liver might not have been metabolizing the Kratom very efficiently, but this is not clear as her liver enzyme levels have always tested very low.
Negative Side Effects
Taking large doses provided long-lasting relief throughout the night, but she tended to overdose, and at certain times, she could not walk because of a condition characterized by a loss of ability to keep track of where her joints were. On one occasion, she lost all color, her facial muscles seemed to have been immobilized, and she was barely able to talk. The subject was starting with some memory damage from Morphine use, and part of the problem seems to have been that her short-term memory was shut down while the effects of the Kratom were strong, so she was apparently dosing after forgetting she had already dosed. Concurrent use of marijuana seemed to completely shut down her short-term memory to the point where she could not make it through a sentence without forgetting what she was talking about.
Kratom usage also causes a major increase in consumption of fluids. Although she was generally much more clear-headed on Kratom than on Methadone, she became completely disinterested not only in sex but in contact and her emotions were suppressed greatly. There were the aforementioned perils to the �toss-and-wash� method, which numbed the gag and cough reflexes, leading to problems with aspirating food and water and developing laryngitis. Even without toss-and-wash, the Kratom would leave her coughing reflex suppressed, leading to her aspirating food and water. She would need to be reminded to swallow or cough at times. Another effect she observed was occasionally food would taste nothing like it was supposed to taste. This was startling and disappointing when sitting down to a meal.
The Mistakes
Definitely, for her, a milling operation should have been purchased at the outset, which would consist of a grinder and a Cap-M-Quick capsule maker. The scale turned out to be unnecessary as the constant soon becomes the amount of pills one takes; one simply makes the pills in a uniform way and then figures the dosage by how many pills the subject takes. The Kratom powder gets into everything, so a large tray with high edges would minimize the mess. The crushed Bali leaf is the best form to buy to avoid paying for processing that can easily be done at home. The capsules were bought in bulk. After some problems with fluctuating strengths from our first source, the subject began to order from a new source. Using large doses tended to leave uneasy stretches of time, so the subject started dosing a little lighter three times a day at eight-hour intervals.
Kratom withdrawal differs from Methadone withdrawal. The most marked symptom of Kratom withdrawal is an overwhelming anxiety. The subject became hooked on Kratom and was unable to taper down because of this anxiety and also because of intense spasms. Instead, she began to slowly increase her tolerance and dose. Methadone addicts are terrified of withdrawal, so she insisted on staying on Kratom for far too long. She feels like when she started to actually enjoy the Kratom to get high, addiction was the obvious outcome. All told, the length of her Kratom addiction was about six months, and she acknowledges that becoming hooked on Kratom to avoid the possibility of feeling any Methadone withdrawals was not useful; however, even though she was unable to quit Kratom on her own, there was the silver lining that her Kratom addiction was much easier to dispose of with Ibogaine than a full-blown Methadone addiction.
Detox Stage III: Ibogaine
At first, some residual alkaloids (RA) from the Ibogaine extraction process were provided to use in small doses. This material contained Ibogaine along with other alkaloids. The idea was to boost the Kratom effects as the subject tapered the same way one researcher had been able to boost the effects of Morphine with Ibogaine. The subject is liver-compromised, so dosages may be inflated due to decreased metabolism. We found that the minimum dosage to produce a noticeable effect from the residual alkaloids was 40 milligrams, and this while on Kratom. The first time she felt effects, she seemed a little frightened and expressed the opinion that she either wanted no RA at all or a flood dose.
The next day, she decided she wanted to try another small dose. We administered 40 milligrams, which produced what she called an indestructible feeling, but later said that was inaccurate and it was more of a calmness but hard to describe. She began the RA usage to combat restless and achy legs as she began to taper off of Kratom about seven weeks into a methadone withdrawal.
The next 40 produced relief but also pronounced sleepiness, and she began to ask for it for relief. She began taking 60, which again was followed with long sleeps, this time with considerable unease, and at one point she reported that sound was painful. Still, she got relief from withdrawal symptoms in an alternate space wherein she would think about things logically and dispassionately. She took 100, and said that this level made her feel like she was �tripping.� Originally, the plan was to take low doses of the RA to boost the Kratom�s effects during taper as per Schneider�s paper; however, the subject says it does not �boost� so much as, �take your mind off of it.�
Iboga Life
Low dose Ibogaine RA being perceived by the subject as ineffective, and tapering from Kratom as intolerable, the subject decided to try to detox with an Ibogaine provider. Upon first contact, the Ibogaine provider was surprised to hear that one could use Kratom to withdraw successfully from Methadone. Their usual method is to suggest their Methadone patients taper and switch from Methadone to poppy pod tea. Although the tea is every bit as addictive as heroin or morphine, it is still shorter-acting and therefore easier to detox from than Methadone. The providers prefer to detox people from �natural� drugs like poppy tea or, in our subject�s case, Kratom. Basic requirements for an Ibogaine experience with providers are a recent electrocardiogram, an exact weight, and a taper to as low a dose as possible. Ibogaine is not inexpensive, but providers are committed people who have lowered the cost to within reach of many more addicts. The provider was very experienced, and was certainly worth the expense.
Preparation of the Space
Preparation of the space consisted of securing privacy, making a comfortable bed, blocking out as much light as possible, and acquiring a large prayer candle in a large glass. This type of candle will burn longer than the three days it will be needed. The provider was adamant that the space needed to be private, though short family visits on the second day were permitted. Ibogaine causes light sensitivity, so the space needed to be as dark as possible, which was accomplished with blackout curtains. Aluminum foil also makes a very efficient light blocker. Later, the subject remarked repeatedly about how critical it had been to remain in muted lighting conditions. The candle provided not only a tolerable source of light, but providers also advise using the candle as a focal point if the visions become undesirable and that if the subject doesn�t like the visions, he or she can simply open his or her eyes. The subject was advised that if the visions became disturbing, she could just open her eyes and look over at the candle.
The Experience
Our provider seemed to retain some minimal ritual elements, probably based on the Bwiti religion�s Iboga rituals. The only strictly ritualistic part was the exchange of money for the Ibogaine. The person taking the Ibogaine must physically hand the payment to the provider as he hands the medicine to the patient. Then the patient is instructed to place her best intentions for the outcome of the experience into the medicine while it is in her hand. In this case, the medicine was in the form of gel-capped powder. The candle, apart from its utility, may also be part of the ritual.
The experience started after sundown to take advantage of the most darkness for the visionary stage, when the patient is most light-sensitive. In most cases, people on a flood dose of Ibogaine are unable to walk. The subject�s experience, however, was atypical in that even during the flood dose, she was still able to walk without much trouble with a little help, and this state dissipated rapidly. The entire course of the Ibogaine experience seemed to go ahead of schedule. She felt the effects almost immediately from the test dose, whereupon the flood dose was administered, and since the flood dose�s full effects were soon in coming, the final dose was administered quite rapidly after. Throughout the process, the provider would check her wrists and ankles for both temperature fluctuations.
The initial visionary phase seemed uncharacteristically pleasurable. The subject smiled widely, and laughed at times. Her first vision was of �the Ibogaine announcing its presence,� appearing as a kind of logo of the root shape. Next, she had a vision of the �primordial ooze.� Soon after, she looked at her hands, and they were covered with a pattern reminiscent of neon-green moss. She said she was able to see through the skin of her arms and see the bones and veins within. At the beginning, when she looked over at the candle, she began to notice an energy zooming around it. Much of what followed is not a blank to her, but after hours, the energy vision culminated as a rounded, blue-green lozenge shape with some depth and about four feet wide, hovering very close to her above the bed. She does not remember this as a hallucination and experienced it as completely real and tangible.
Throughout the visionary phase, the subject intermittently thought there was an imaginary stray hair of bright pink energy in her mouth, and she would absently try to remove it, never able to actually see it. She mentioned a �mosaic jig,� and later she explained that she meant a jpeg computer image with the square pixels like a mosaic. At one point she said, �I�m realizing some really amazing things,� but it was very difficult for her to put anything into words. She had a vision of squirrels running around chaotically, and she knew she had to impose some order on them. She also noted horizontal and vertical line patterns, and associated them with the horizon and the forest with its vertical trees. The horizontal and vertical line patterns �posed the question� to her of how she would accomplish the task. The thing she needed to find to impose order on the squirrels was the �motive� for them to form a civilization or home, and upon later reflection, she believes she was interacting directly with the most basic levels of her consciousness and thought processes.
After the visionary phase leveled off a bit, the provider said it was then necessary to leave her alone for a while. This may be part of the Bwiti ceremony as well, but the subject seemed to be looking forward to it, saying, �I want to be alone with just me and the planets.� At this point, the provider placed a baby monitor on the bedside table, and we left the room. The subject periodically needed help to the bathroom, and drank water regularly through a straw. Straws are very important as people on Ibogaine are often unable to drink from a glass without one.
The Binding
The coming down or �binding� process, when the mind reorders itself and the receptor �reset� is supposed to happen, was much more difficult than the visionary phase, and was marked by agitation, unpleasant sensations, aches, and anxiety, but the unpleasant feelings were made tolerable because of her thoughts of being �one with the universe.� The provider suggested we wait as long as possible to restart her Xanax dosing so as to take advantage of the possibility that the Ibogaine might withdraw her or at least lower the necessary dose of Xanax as well. The lack of Xanax was probably responsible for extra anxiety. However, she went at least 24 hours without Xanax, and her heart rate and physical steadiness remained healthy. Only after she began to tremble, become unable to take an even breath, say that it felt like she was in withdrawal, and insist on Xanax did the provider okay the dose. After the experience, the Xanax dose went right back to where it had started. In this subject�s case, Ibogaine had no effect on Xanax dosage except during the visionary phase and part of the reset phase. As the subject slowly returned to normal, the Xanax addiction returned in full force.
There was some tossing and turning, but very little compared to most patients according to the provider. The subject referred to a binding effect centered at mid waistline between navel and solar plexus, and said it was difficult to move or get up and go to the bathroom. Ibogaine did not cause her to soil the sheets, and trips to the bathroom are fine with some assistance. Assisting her to the bathroom required some physical strength.
There was some crying, but in this case there was no revisiting of past indiscretions or traumas. The subject was crying simply out of frustration that the recovery was taking so long. This is a very arduous phase, though it cannot be compared with withdrawals. The unpleasant sensations were difficult for her to describe but had to do with struggling through every inch of the process of �coming down� from the Ibogaine.
Recovering
There was indeed, as warned, a period of insomnia. This is very daunting for the patient, even though in this case she slept for at least a few hours at night after the first few days. Melatonin can help to facilitate sleep, although it cannot be counted on. The subject was sleeping about 3 hours nightly until she insisted upon filling a prescription for Ambien on the 24th, ten or eleven days later. She had some success sleeping for about three hours before that by taking small doses of Elevil.
On the 25th, the subject had still not expressed any interest in Kratom, Methadone, or any other opiate. She continues to use Xanax, Nicotine lozenges, Donatol, and has added Ambien as needed. She has some irritability and frenetic energy that she is not well able to focus, but her thoughts and focus are clearer daily. Dosing on Ibogaine was a difficult process, but well worth it for all concerned.
Exp Year: 2010ExpID: 86136 Gender: Female Age at time of experience: 47 Published: Aug 18, 2010Views: Not Supported [ View PDF (to print) ] [ View LaTeX (for geeks) ] [ Swap Dark/Light ]
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