Acute Confusional State After Ibogaine Treatment of Patients on Opiates: About Three Cases

Dr. Fransisco Lopez Martin

These three patients, all males, were treated during the last six months of 2011. All were users of opiates specially oxycodone, heroin and morphine.

They were treated with HCl Ibogaine orally and the total dose was calculated according to their body weight until reach a total dose of 22 mg / K. And we used small boosters for remaining symptoms (no more than 30 mg / K as a total).

In the beginning we took away all medications and put them just on oxycodone to stabilize them in quantities required by each one.

They were required to do the appropriate bowel cleaning process and we were sure they were not impacted.
The patients developed the acute confusional state during the following 48 to 72 hours of the administration of ibogaine.

The three patients showed an acute alteration in conscious and attention levels and dysfunction in thinking, orientation and memory, changes in autonomic system (sweating, pallor) and difficulties in speaking and expression. All of them complained of stiffness and one patient developed a myoclonic state. This syndrome was swinging from improvement to worsen along the day.

They were treated with IV solutions (saline and dextrose) and Valproic Acid orally obtaining a very fast response. The three patients were completely well after five days without withdrawal, craving or permanent damage at all.

According to the medical literature consulted this Acute Confusional State is a very common syndrome caused by a wide range of factors and is not a sickness by itself. Withdrawal of drugs can precipitate this syndrome in vulnerable persons. The neurobiology of the syndrome involves alterations of neurotransmitters in the brain as low cholinergic levels, low serotonin levels and unbalance in dopamine, endorphins and glutamate levels.

The ventral tegmental area in the brainstem has gabaergic interneurons that are inhibited by opiates and the related neurons release dopamine as a part of the reinforce circuits, but once the opiates are washed out by the action of ibogaine on opiates receptors these interneurons have a rebound and suppress the release of dopamine causing the stiffness and the basal ganglia manifestations observed in these patients like the myoclonic jerkcs.

The exact role of valproic acid is not clear but we decided to use it because his therapeutic value in the treatment of myoclonic jerks.

Dr. Francisco Lopez graduated from University of San Carlos of Guatemala in 1990. He made his post graduate studies in internal medicine at The General Hospital San Juan de Dios. There he also studied Neurophysiology. He then studied Neurobiology at CIREN in La Habana, Cuba. He also has a specialization in therapeutic narrative from University Rafael Landivar. He returned to the University of San Carlos to receive a specialization in Addictology and to teach Neuro-Anatomy and Psychopharmacology in the psychology department.

He is a member of Guatemalan Society of Biological Psychiatry. He has developed his own studies of P.A.W. Post Acute Withdrawal Syndrome, and has had success treating patients with the P.A.W. protocol that he developed. He is currently perusing new studies to understand the neurobiological process related to chemical and affective behavioral addictions.

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