Exclusion Criteria & Risks

Ibogaine is an experimental tool that hasn’t passed clinical trials that have unraveled its exact mechanisms of action; therefore, there is limited knowledge about its risk factors. Much is still to be learned of future scientific studies, the ancestral practice of the Bwiti and the current use of ibogaine in treatment centers.

Physical health risks

The biggest concern of the known risks related to ibogaine use is that ibogaine lowers of the heart rate (bradycardia) and prolongs the QT Interval, a measure of the time between the start of the Q wave and the end of the T wave in the heart’s electrical cycle. Therefore, people with a history of heart attack, heart murmurs, arrhythmia, heart operation or severe obesity should not take ibogaine. An Electrocardiography is the minimum heart test required, but a stress ECG or 24 hour Holter monitor and Echocardiogram increase the possibility to detect important abnormalities. The presence of a skilled medical doctor (preferably specialized in cardiology and emergency medicine) present during the session monitoring the heart increases the safety of this treatment significantly.

Another risk factor is pulmonary embolism. This happens when there are blood clots in the veins, such as those that might occur due to immobilization during long airplane travels, a car accident, or blood-related diseases. When these blood clots are pumped through the body during the ibogaine session, they can end up in the lungs, where they can cause an embolism with the risk of suffocation. The risk of pulmonary embolism can be reduced by doing some sports or movement exercises after long travels and not starting the treatment upon arrival. Individuals with bleeding problems, chronic blood clots or those persons who have recently been involved in accidents which have caused bruises and bleeding should be excluded from this treatment.

Asthma, cancer, cerebellar dysfunction (e.g. Meneire’s disease and difficulty maintaining balance), chronic fainting, diabetes, emphysema, epilepsy, gastrointestinal tract diseases (e.g. Crohn’s, Inflammatory Bowel Disease), gynecological problems, HIV, AIDS, Hepatitis C (if active and with liver enzymes 200% above normal), kidney problems/renal disease, liver problems, lung problems or respiratory disease, palsy, pregnancy, seizures, stroke, thyroid problems, tremors, tuberculosis and ulcers are contraindications in most places, but some centers do accept people with certain conditions, which might increase the risk of the intervention.

Another cause of adverse events is the interaction of ibogaine with other drugs or pharmaceuticals. Before taking ibogaine, the individual should not use his drug of choice for the time period needed for the drug to be sufficiently metabolized. This depends on the drug’s half-life and is different for each substance. The staff of the treatment center where you are going to take ibogaine should assist you in tapering down or stopping the use of drugs and prescription medications in a safe manner. Also, substances or foods that are broken down by the CYP 450 2D6 enzymes should be avoided as they could interact with ibogaine, potentiating its effect of bradycardia and QT prolongation. There are lists available on the internet of such substances. Quinine containing products and grapefruit belong to this group and should be avoided before ibogaine treatment.

As there are many different iboga materials available, working with materials of unknown chemical composition and potency is another risk factor. It is important that the person administering you knows what materials you are being given so that it can be dosed correctly. You have the right to know what materials the treatment provider is using, the potency and doses you will get.

Psychological health risks

Although some centers accept people with psychiatric disorders such as bipolar disorder, borderline personality disorder, etc.—and some report improvement of their condition—nothing is known about the effects of ibogaine on such disorders and the risks involved. It is very risky territory. In general, psychiatric disorders such as the ones mentioned above, as well as people with schizophrenia and a history of psychosis, are excluded from this treatment, as ibogaine could trigger or worsen symptoms. Also, the interaction with certain psychiatric medications can be dangerous. A thorough psychiatric screening is and supervision of a psychiatrist is important before enrolling in an ibogaine treatment if you have any psychiatric conditions and you are on prescription medications.

Aside from the psychiatric risks, ibogaine is a very potent psychoactive compound that can induce an introspective experience that is not always easy. Severe anxiety can come up in such episodes and, in more serious cases, states of paranoia. A skilled facilitator can support the individual in such cases and help him/her overcome the difficult episodes. A proper preparation with the guidance of a therapist can help greatly in gaining confidence, enter the experience with the proper mindset, and be prepared for eventual difficult experiences.

Benefits

Ibogaine has been consistently observed to block the acute opiate withdrawal syndrome with one single administration in humans and large body of animal work. Treatment with ibogaine is followed by a period of variable duration of reduced craving for multiple substances including opiates, stimulants, alcohol, benzodiazepines and nicotine. Ibogaine has been reported to have anti-depressant properties after the administration, what is believed to be due to ibogaine’s principal metabolite nor-ibogaine, but this is not always the case. The time frame of weeks to months following the ibogaine administration in which craving is reduced is an extremely valuable opportunity for an addict to regain perspective on his life and remodel it with the support of additional therapy and guidance. Ibogaine has also a strong effect on the cell metabolism, allowing the organism to adapt to a new state (for example in the process of detoxification).

The introspective oneiric experience following ibogaine administration is frequently reported as being profoundly psychotherapeutic. Traditionally they place a mirror in front of the initiate so he/she can look into it. This is exactly what the ibogaine experience facilitates: a confrontation with past trauma, one’s fears, responsibilities, relationship with the parents, children, partner, etc. By facing the obstacles in life that can inhibit a natural growth or well-functioning in society, ibogaine can catalyze a profound change in daily life, direction you are giving to your life, behavior, interpersonal dynamics, etc. For this same reason, ibogaine has also been used in lower dose psycholithic therapy.

Preparation

With the decision to partake in an ibogaine session comes the start of the preparation. It is very possible you will find yourself in a profound transformative experience that can have a drastic impact in your life and initiate structural changes that can turn things upside down. The better prepared you are when going in, the more you will get out of it and the smoother the process goes. Traditionally, the ibogaine experience is believed to bring a process of death and rebirth, in which the initiate ‘visits his/her ancestors’ and gets reborn as an adult or a healed person. The ibogaine experience is often an introspective process in which one deals with his/her past, relationship with the parents, trauma, responsibility, fears, decisions, etc. Focusing on these aspects in your life during the preparation, ideally with the help of a knowledgeable therapist, will allow the ibogaine session to catalyze this process drastically.

Psychological preparation & aftercare plan

People who are fearful can do breathing exercises during the preparation, which will serve them during the difficult moments in the experience. Breathing deeply in the lower part of the lungs, and focusing on the rhythm of the breathing can calm one down and help one not to resist to the experience, but go with the flow.

In a minority of the ibogaine centers, their program includes motivational therapy, family therapy or other techniques. Involving the family or partner in this process can increase the efficacy of the ibogaine session greatly and have lasting beneficial impact in the whole family structure, especially in the case of severe addiction where, very often, guilt and blame deteriorate the relationship with the individual’s relatives.

In order to reach sustained abstinence in case of drug dependency, it is key to develop an aftercare plan with a therapist, or, if you are in a drug rehabilitation program, with your care givers at the center. Without clear strategies to make a shift in personal, professional and social dynamics that were related to drug abuse, it is very likely the abstinence will not last. Ibogaine opens what is called a ‘window of opportunity’ for weeks to months after the actual session in which craving is significantly diminished. It is important to use that time to put the aftercare plan into practice.

Physical preparation

Another important element is the physical preparation; the ibogaine experience is long and can be heavy, so the better one’s physical condition is, the easier and safer it will be. Healthy food, vitamin and mineral supplements, especially mineral salts during the days before the session, and plenty of liquids are ideal.

Regular exercise will also help to improve your condition. On the day of the session, you can drink plenty of water and drinks rich in mineral salts after a light breakfast, so you are well hydrated before the session. After that it is advised to fast and stop drinking a few hours before the session as getting to the toilet can be an extremely difficult task due to the ataxia induced by the ibogaine.

It is EXTREMELY important to be honest about the use of your drug of choice the days before the treatment. Fear for withdrawal can be a reason for addicts to lie about the last shot they have set before the treatment with potentially fatal consequences. The withdrawal will be blocked by the ibogaine.

In the case of opiates, the ibogaine is generally administered when the withdrawal signs are coming up.

Some centers choose for a guided abstinence for a period of time before the administration in the case of stimulants. This prior detox increases the safety of the ibogaine session significantly. In case of a severe alcohol or benzodiazepine dependency, its use cannot be interrupted immediately with an ibogaine detoxification. An acute withdrawal seizure can be the fatal consequence. The alcohol and benzodiazepine use has to be first tapered down before ibogaine can be administered.

The Session

During the ibogaine administration it is important to follow the guidelines of the facilitator, and if you have any doubts, questions, fears, etc. to let him know before the session starts. Some facilitators work with recorded or live music, others with silence. You might have your personal inquiries regarding the setting. A test dose is administered before the full dose to see how sensitive one is and to detect potential allergic reactions. The test dose reduces withdrawal significantly in most cases. After that comes the full dose.

The experience

The first phase is like cleaning up the folders and files on a computer hard drive. During this phase one is always conscious of the fact he/she has taken ibogaine and the place he/she is. Closing the eyes will allow you to go deeper into the experience; opening them can dampen the experience. When things become too intense this can help connect with the outside world for a moment. Breathing deeply a few times can also help you relax. It is important not to move your head too much as this will cause nausea. Some people vomit during the experience, but this is not always the case.
It is important that there is always a facilitator with the individual during the experience. In the case of a drug detoxification treatment, it is advisable (if possible) to have a medical doctor present during the whole experience. After that a nurse or experienced sitter can continue shifts.

After the first phase has ended, which lasts some 2-8 hours, the integration phase starts. You can now eat some fruit and drink some liquids again. For fast metabolizers, the visions may wear off completely after this phase; slow metabolizers might continue to have visions. It might feel like the visionary phase didn’t provide any insight or therapeutic advancement due to its extremely fast pace, overload of information and lack of emotional integration during this phase. However, even though the visions might wear off, the experience hasn’t finished; in a cognitive process, all this information and experiences of the first phase now starts to fall into place, gain meaning, and reveal insights in the second phase. No therapist is needed for this process, as this might interfere with it. This integration can go on for about 24 hours and is like the defragmentation of the computer’s hard drive. When night falls again, you might still have ‘light trails’ in your vision. Going out into the real world or nature after those 36 hours can be an intense experience as you are highly sensitive. It is important to try to relax, get some sleep. Some people have a reduced need for sleep after the ibogaine experience, but not everybody.

Upon ending the session

It is wise not to call your family or relatives before the 36 hours have passed not to interfere with the process. The facilitator might let them know after the first phase that you are doing ok. In the following days, you should rest, have walks in nature, eat healthy, drink plenty of water and recover. In case of severe drug dependencies such as from methadone, booster doses might be needed during the following weeks to block eventual residual withdrawal.

Integration & Follow up

After the session it is advisable to continue your therapeutic process to properly integrate it and start putting in practice what you have gotten out of the session. Also, in case the family or partner was involved in the preparation process, this should now be continued in the integration and follow up phase in the form of family therapy, or simply in the form of dialogue with the individual. If you developed an after care plan, this should be followed; things like relocation, going to a therapeutic community, social assistance, etc. Some centers offer a continued after care program or collaborate with a local organization, but most of them don’t.

The months after the session you will find yourself in a process of re-defining who you are, where you want to go with your life and the changes you need to make. During the experience subconscious processes occur, which you will later experience when you go back to daily life. This is a process of discovery and remodeling your relationship with your environment and with yourself. This process can take months, so make sure you don’t have a full agenda after the session.

Relapse

If you would decide to go back to using your drug of choice, for whatever reason, be careful with the dosage. Your tolerance will be much lower and taking your regular dose might be an overdose. If a relapse occurs, this doesn’t necessarily means that the whole process has been for nothing; observing why the relapse happened you can learn from it and get back on track. In contrast with substitution therapy such as methadone programs, ibogaine empowers the individual to take control over his own life again. Some people do a second ibogaine session months later to further the recovery process.

There are also reports of people partaking in ayahuasca sessions during the preparation process a few months before and months after the Ibogaine session, potentially complementing the therapeutic process. You find more information for people interested in taking ayahuasca here.