Methadone dependence · Mexico City
Ibogaine Treatment For Methadone Dependence
The 1 opioid we will never dose alongside ibogaine, and the only page on this site that argues with itself.
Methadone lengthens the QT interval. So does ibogaine. Putting them in the same body on the same day stacks 1 risk on itself, which is why nobody comes here straight from the clinic. There is a transition first, it is measured in weeks, and it is planned with your own prescriber. This page also says what leaving methadone costs, because the published numbers on that are not small.
The short answer
What is ibogaine treatment for methadone dependence?
Ibogaine treatment for methadone dependence is 1 supervised dose, given only after you have been transitioned off methadone onto a short-acting opioid and that opioid has cleared.
Methadone is never in the body on dosing day. Not at a reduced dose, not at 5 mg, not at all. Both drugs act on the same cardiac channel, and the published study closest to your situation is the reason we treat that as a line rather than a preference.
Everything else matches the rest of the program: 7 nights inpatient in a licensed Mexico City facility, the dose on day 3 with a cardiologist, an emergency physician and an ACLS-trained nurse in the room, continuous 12-lead ECG through the session and overnight, then 90 days of clinical follow-up. The price is $12,500.
It is not a cure, it is not FDA approved, and for a methadone patient it is not the safest available option. It is an option, with a transition in front of it and a screening that turns people away.
First step
A planned transition from methadone to a short-acting opioid, written by our psychiatrist with your own prescriber. Nobody is asked to stop on their own.
How long
Weeks, not days, and longer at higher doses. The length is set for your case in writing before any deposit exists.
Cardiac screen
A 12-lead EKG read by our cardiologist against a written QTc threshold, plus potassium, magnesium and a liver panel. Repeated on arrival and again before dosing.
Medication review
Every prescription you take, because some common prescriptions lengthen the QT interval on their own and stack with both drugs.
Most common answer
Not yet. For methadone patients the reason is almost always an unfinished transition rather than a heart.
Also true
Staying on methadone is a legitimate outcome of this conversation, and we will say so if that is where the screening lands.
Why methadone is different
2 drugs, 1 cardiac channel, and no reason to stack them.
Most of what makes an opioid hard to treat with ibogaine is how long it takes to clear. Methadone has that problem too. But it also has a second one that none of the other opioids on this site share, and the second one is the reason for the rule.
Drug 1
Methadone lengthens the QT interval
It is a known effect of the medicine, it is dose-related, and it is why treatment guidelines tell prescribers to run an EKG at admission, repeat it within 30 days, then yearly, and again for anyone above 120 mg a day. Roughly 2% of people in methadone treatment carry a QTc above 500 milliseconds while the medicine is working as intended.
Drug 2
Ibogaine lengthens it further
Ibogaine blocks the hERG potassium channel in heart muscle, which delays repolarisation and stretches the same interval. That is the mechanism behind every death associated with ibogaine, and it is the reason a cardiologist reads your trace before a date is offered.
A single mechanism, pushed twice, on the day the heart is already under the most strain. There is no clinical reason to accept that when a transition removes 1 of the 2.
This is also why a methadone patient cannot be treated as an ordinary opioid case with the dates moved. The opioid overview covers the protocol that everyone else follows.
The part most clinics leave out
Leaving methadone carries its own risk, and it is measurable.
We are not neutral about this and neither should you be. Methadone maintenance is among the best-evidenced treatments in addiction medicine. If it is working for you, the honest advice is to think hard before trading it for something with a fraction of the evidence behind it.
The largest pooled analysis of this question followed 122,885 people across 18 cohorts on methadone. While they stayed in treatment, all-cause mortality ran at about 11 deaths per 1,000 person-years. Out of treatment it ran at about 36, a little over 3 times higher. Overdose deaths alone were roughly 3 per 1,000 in treatment against 13 out of it.
The window that matters most to you is the 1 right after leaving. In the same analysis the first 4 weeks off methadone carried about 32 deaths per 1,000 person-years, and that is the period a badly planned exit drops you into.
So here is our position, in plain terms. If you are stable on methadone, employed, housed and not using on top, the evidence says methadone is doing its job and ibogaine has nothing published that beats it. We will tell you that on the screening call, and we would rather lose the booking than pretend otherwise.
The people we do treat are usually in a different position: on methadone for years, wanting off it, and looking at a taper measured in months that they have already failed once or twice. That is a real problem and it is the one this page is written for. It is still a decision you make with your own prescriber, not with a clinic in another country.
Those figures come from a 2017 systematic review and meta-analysis in the BMJ. They describe populations, not individuals, and they cannot tell you what will happen to you. They are here because a page that sells you an exit from methadone without showing you those numbers is selling you something.
The transition
Methadone out, a short-acting opioid in, then clear.
This is the part that makes a methadone case different from every other case we screen, and it happens entirely before you travel. It is not detox. You are on an opioid the whole way through, and withdrawal is managed rather than endured.
Stage 1
The plan is written first
Our psychiatrist writes the transition with your own prescriber, using your current dose and how long you have been on it. Nothing starts until that plan exists on paper, and no deposit is taken before it does. A clinic that offers you a date before this step has skipped it.
Stage 2
Onto a short-acting opioid
You come off methadone onto a short-acting opioid under your prescriber’s supervision, at a dose matched to where you are. The published protocol other clinicians use for this is a titration onto oral morphine, chosen specifically because it does not carry methadone’s effect on the QT interval.
Stage 3
Methadone clears
The short-acting opioid holds you steady while the methadone leaves. Only when the physician is satisfied it has does a dosing date get confirmed. If you use methadone during the wait, you tell us and the date moves. That carries no penalty and it is not a moral question.
Weeks, not days
Published guidance for this transition puts a 100 mg a day patient somewhere between 1 and 2 weeks on the short-acting opioid before clearance, and longer at higher doses or with a slower metaboliser. We do not publish our own number, because a number on a website gets held against a body it was not calculated for. Yours comes in writing, from the physician, before you pay anything.
Why it takes that long
Methadone does not leave on a schedule you can predict from the label.
Its half-life varies more between people than almost any opioid in common use, and that variation is the reason the transition is planned around you rather than taken off a chart. 3 numbers explain the whole delay.
8 to 59
Hours of half-life
The range across patients. 2 people on the same dose can clear it at speeds that differ by a factor of 7, which is why a fixed waiting period would be right for some and dangerous for others.
24
Hours, the average
Long enough that methadone is still measurably present days after a last dose, even though it stopped holding withdrawal off long before that. This gap is what catches people who try to time it themselves.
5
Days to steady state
Roughly how long the medicine takes to settle at a new level after a change. The same arithmetic runs in reverse on the way down, which is why the taper is slow and why cutting it short is the common mistake.
Buprenorphine has the same problem for a different reason and gets the same answer. If you are on Suboxone rather than methadone, the Suboxone page covers that transition.
The evidence
The study closest to your situation is also the one most against it.
In 2022 a Dutch team published an open-label safety study of ibogaine in 14 opioid-dependent people. 12 of the 14 were on methadone. All 14 were converted onto oral morphine first, for exactly the reason set out above. That makes it the closest published match to a methadone patient sitting where you are, and we are not going to leave it off this page.
14 of 14
Every participant’s QT interval lengthened after the dose. Not some. All of them.
We treat QT prolongation as the expected effect rather than a complication, which is why monitoring is continuous and starts before the dose instead of after a symptom.
102 ms
The median increase over each person’s own baseline.
Your baseline trace is read by a cardiologist before you travel and repeated on arrival. A patient whose starting interval leaves no room for a change of that size is declined, and that decision is made on the number rather than on how well somebody looks.
Half
Half the group crossed 500 milliseconds, the threshold at which arrhythmia risk is considered to rise. Those patients were given magnesium.
Potassium and magnesium are corrected before travel, rechecked on day 1, and correctable again in the room. Low electrolytes deepen this effect, and withdrawal empties both.
6 of 14
Still had a raised QT interval 24 hours after dosing.
Monitoring does not stop when the session does. Overnight telemetry and a morning EKG on day 4 exist because of findings like this one, not as an upsell.
Slow heart rate in half, mild delirium in 4
Both resolved. Neither is unusual during an ibogaine session, and both need somebody watching.
1 to 1 nursing through the session and the night after it, with a crash cart on site and a written transfer agreement to a JCI-accredited hospital 9 minutes away.
No torsades, no deaths
In that group, in a hospital, with cardiologists watching and magnesium on hand.
The setting is the finding. Everything above happened in a monitored facility and was managed there. It is the argument for doing this in a hospital and the argument against doing it anywhere else.
The authors’ own conclusion was that routine use of ibogaine in opioid use disorder cannot be justified given how strongly it prolongs the QT interval. Researchers from the ibogaine field published a reply in the same journal disagreeing with how those numbers should be read, and the authors answered it. The disagreement is about interpretation and management. Nobody disputes that the effect happened. A later analysis from the same team also found that how fast a person clears ibogaine varies more than 10-fold depending on their CYP2D6 enzyme activity, which is a further argument against fixed protocols and unmonitored settings. The broader opioid evidence, including the studies that are more favourable, is set out on the opioid page and the what we treat page.
The screen
What your EKG has to show, and where the lines sit.
The QT interval is the part of the trace that matters here. It is reported corrected for heart rate, which is what QTc means. A methadone patient arrives having been on a medicine that stretches it, so the starting point matters as much as the threshold.
Room to work with
A trace in the normal range with a clean rhythm is what the screen is looking for. It does not make you a candidate on its own, because the medication list and the transition still have to clear.
Borderline, often correctable
Low potassium or magnesium, a QT-prolonging prescription, or a methadone dose still on board can all push a trace here. These are a not yet. Correct the cause, recheck, and the answer frequently changes.
Above 500, we stop
Methadone prescribing guidance itself treats a QTc above 500 milliseconds as a reason not to continue the medicine. We are proposing to add a second QT-prolonging drug on top, so our line sits below that, and a structural finding on the trace is a no whatever the number says.
The exact threshold we use is written down, applied the same way to everybody, and read by the cardiologist rather than by whoever answers the phone. We do not publish the figure, because a number on a page invites people to take a trace elsewhere and argue with it. You get your own reading, and the reason, in writing.
Who we turn away
Every no on this page is paired with what would change it.
Some of these are permanent and some are a date being moved. The answer comes in writing with the reason either way, any deposit is refunded in full, and where we can we hand you a referral to a clinician near you. Nobody is passed to another clinic for a fee.
Methadone is still on board, at any dose.
Finishing the transition onto a short-acting opioid and letting it clear. This is the single most common reason a methadone patient is told not yet, and it almost always becomes a yes.
A QT-prolonging prescription your own prescriber has not agreed a plan for.
A plan made with them rather than around them. Some medicines can be paused safely and some cannot, and that is their call to make, not ours.
Potassium, magnesium or liver values outside range.
Correction and a recheck. These move quickly and they matter more here than on any other page, because low electrolytes deepen the exact effect we are managing.
A day 1 EKG that does not match the trace you were approved on.
A repeat once the cause is found. If it cannot be resolved the process ends at the facility and the stay is refunded, which is a better outcome than the alternative.
A QTc above our written threshold with no correctable cause, or conduction disease on the trace.
Nothing we can offer. This is the finding the whole screen exists to catch, and it is the reason some people leave the call without a booking.
Structural heart disease, heart failure, cardiomyopathy or a prior cardiac event.
Nothing. A permanent no, whatever the dependence and however long the wait.
Benzodiazepine dependence alongside the methadone.
A benzodiazepine taper under your own doctor first, which takes months. The withdrawal can cause seizures and ibogaine does not shorten it. After that we can screen you.
Pregnancy or breastfeeding, and anyone under 18.
Nothing. No exceptions on either.
Anyone asking us to shorten the transition, dose alongside a reduced methadone dose, or skip the follow-up.
Nothing, and the request itself ends the conversation. The transition is the safety margin. Selling it in parts would mean removing it.
The complete list for every dependence we treat, including the conditions we do not treat at all, is on what we treat.
After day 7
The 90 days, and the door back.
Years on methadone means years of a tolerance that treatment removes. That makes the weeks after discharge the most dangerous part of this for you, and it is the part a clinic has the least control over. What we can do is be honest about the exit route.
Said out loud at discharge
Going back on methadone is not a failure.
If the craving returns, if the sleep does not come back, if life gets loud, restarting methadone or buprenorphine with your own prescriber is a legitimate medical outcome and it is safer than using. We write that into the clinical summary that goes home with you, and the psychiatrist raises it directly on the follow-up calls.
The other half of the same conversation: treatment lowers your opioid tolerance. Using again at the amount you were used to before methadone carries a far higher overdose risk than it did before you came. Naloxone in the house, and somebody who knows how to use it, is part of every discharge.
Days 1 to 30
A clinician calls every week on a scheduled day. Sleep, appetite, mood and craving are tracked, because a change in any 1 of them is usually the earliest signal that something is moving.
Days 45, 60, 90
Longer calls with the psychiatrist who saw you in the facility, not a coordinator reading a script. If a second session is ever discussed it starts here, and it is screened from the beginning like the first.
Handover
A written clinical summary goes to your own physician, including the prescriber who ran your transition, plus a referral list of US clinicians. Nobody is passed to another provider for a fee and no ongoing treatment is sold on the follow-up calls.
Post-acute symptoms
Long-term methadone patients more often report a tail of low mood, poor sleep and low energy in the weeks after any detox. It is the most common thing patients raise on these calls, and it is managed rather than waited out.
Common questions
Methadone and ibogaine, answered plainly.
The transition and the EKG decide most methadone cases, and both are settled before anybody books a flight. That is why the screening call is free and why it happens first.
01Can I take ibogaine while I am still on methadone?
No, and this is the 1 rule on this site that has no exceptions. Methadone lengthens the QT interval and so does ibogaine. Giving them together stacks a single cardiac risk on itself on the day the heart is already working hardest. A transition to a short-acting opioid comes first, and the methadone has to clear before a dose is possible.
02How long does the transition off methadone take?
Weeks rather than days, and longer at higher doses. Published guidance used by other clinicians puts someone on 100 mg a day at roughly 1 to 2 weeks on a short-acting opioid before clearance, with the longer figure used when a slower metabolism is assumed. Your own timeline is set by our psychiatrist with your prescriber, in writing, before any deposit. Anyone quoting you a fixed number before asking your dose is guessing.
03Will I be in withdrawal during the transition?
You are on an opioid throughout, so the aim is that you are not. The short-acting opioid replaces the methadone at a matched dose rather than leaving a gap. Discomfort during a switch is normal and it is managed by your prescriber. Nobody is asked to go without cover and nobody is asked to detox alone before travelling.
04Is ibogaine better than methadone?
Not on the evidence, and we will not claim it is. Methadone maintenance has decades of data showing it keeps people alive, and the pooled figures put mortality a little over 3 times higher out of treatment than in it. Ibogaine has small observational studies, no randomised controlled trial, and 1 safety study in methadone patients that concluded against routine use. What ibogaine offers is a different thing: an interruption, for people who have decided they want off maintenance and have a plan for what comes after.
05What did the study on methadone patients find?
14 opioid-dependent people, 12 of them on methadone, all converted onto oral morphine before dosing. Every participant’s QT interval lengthened, by a median of 102 milliseconds. Half crossed 500 milliseconds and were given magnesium. 6 still had a raised interval a day later. Half had a slow heart rate and 4 had mild delirium. There were no cases of torsades and no deaths. The authors concluded that routine use in opioid use disorder cannot be justified. We publish that here because it is the study closest to your case, and because every part of our monitoring is built around those specific findings.
06Can I go back on methadone afterwards if I need to?
Yes, with your own prescriber, and we say so at discharge rather than treating it as a failure. Restarting maintenance is safer than using. It is written into the clinical summary that goes to your physician and the psychiatrist raises it on the follow-up calls. Any clinic that frames going back as a relapse is putting its own story ahead of your safety.
07I have been on methadone for years. Does that rule me out?
No. Long-term patients are most of who this page is written for. What years on methadone does change is the transition, which tends to run longer, and the aftercare, because a long tail of low mood and poor sleep is more common after a long maintenance course. Both are planned for rather than discovered on arrival.
08What does it cost, and what is not included?
$12,500 for the 7 days and the 90 days of follow-up. Not included: flights, the EKG and labs your own doctor orders before screening, anything your prescriber charges for managing the transition, extra nights beyond 7, medications prescribed after discharge, and family accommodation outside the facility. The pricing page itemises all of it. There is no financing and we do not refer anybody to a lender.
Screening costs nothing
Start the conversation before you start the taper.
3 questions on the contact page. A physician or nurse calls you back within 1 business day, tells you which tests to order at home, and explains how the transition would work with your prescriber. The answer comes in writing, whether it is yes, not yet, or no.