Ibogaine is a powerful medicine both physically and psychologically, which is how it’s effects can address both physiological and psychological aspects of addiction. However, because of these physiological effects there are certain precautions that need to be taken to make sure that ibogaine can be administered safely.
Screening and Precautions
Minds Alive is a medically support facility that staffs doctors and registered nurses. Our medical team is present during screening, intake, and throughout the treatment process to help assess and minimize any potential risks.
Our team follows the Clinical Guidelines for Ibogaine-Assisted Detoxification that was produced by the Global Ibogaine Therapy Alliance (GITA). This document represents a consensus in the ibogaine-therapy community about risk management, and it informs all of our medical practices.
Our online application asks a series of basic questions about substance use and medical history. This is the first step in the screening process that allows us to provide an honest assessment of the level of risk in ibogaine therapy.
After the initial application we request that patients send us a recent electrocardiogram, as well as a complete blood panel that includes potassium and magnesium. These tests allow us to determine a patient’s cardiac health, as well as their electrolyte levels. With this information we are able to confirm acceptance into our program.
When patients arrive at our center we conduct a complete medical intake, including a physical, and review all of the information and tests that were sent with the application. While patients are under our care we have all of the resources, including medication and trained medical staff to assist with any adverse events.
Potential Risk Factors
Pre-existing heart conditions
Ibogaine is one of a class of substances that prolong the “QT interval”. This refers to a part of the heart rhythm. While having a long QT interval isn’t a noticeable or even a problematic medical condition, having a QT interval that becomes overly prolonged can lead to cardiac arrhythmias. Patients who have prolonged QT intervals, who are taking other medical that can prolong the QT interval, or who have suffered from arrhythmias, heart attacks or other conditions that can affect the cardiac rhythm, may not be considered candidates for ibogaine therapy.
Prior to therapy we always require that patients send us a recent electrocardiogram.
Certain other medical conditions
There are a small number of other serious medical conditions that can affect our ability to provide ibogaine. These can include certain respiratory conditions, or viral infections such as HIV. These conditions don’t always meant that a patient has to be excluded completely from therapy, but in some cases certain preparation or accommodations will have to be arranged.
In our online application we ask for a complete list of any previous health conditions or diagnosis, and follow this up with a complete medical intake upon arrival at the center.
Co-administration of other substances
Many of our patients are actively using substances, and that is ok. We are able to work with anyone where they are in terms of substance use. However, we must be able to establish open and honest communication about all substances and when they have been recently used. Taking opioids too close to ibogaine, during ibogaine, or closely after ibogaine can be problematic. Ibogaine can dramatically increase sensitivity to these substances, which can result in an overdose.
Also, we do whatever we can to equipped people with the resources that they need to stop using substances if it is their desire to do so. When patients leave our clinic we also prescribe naltrexone which prevents the absorption of substances like alcohol or opioids. This aids in preventing future substance use. However, we still have to warn patients that if they decide to use substances again, after ibogaine their tolerance has been reset to a pre-addicted state. If they chose to use substances again they must only use a dose that would be appropriate for a first-time user, rather than what they became accustomed to taking.
Withdrawals from alcohol or benzodiazepines
Ibogaine is very helpful in managing withdrawals from some substances, especially opioids or stimulants. However, there are certain substances for which ibogaine is not able to manage withdrawal symptoms. This includes alcohol and benzodiazepines, both of which can cause seizures during detox. Even patients who would not normally be at risk of seizures need to exercise extreme caution, because the ibogaine experience will increase sensitivity to seizure reactions.
In order to prevent this it is important that patients who are detoxing from alcohol use benzodiazepines to stop their alcohol intake at least 5 days in advance of treatment. For patients who are using benzodiazepines it is important that they continue to take the appropriate dosage to stabilize their benzodiazepine use throughout ibogaine treatment. While seizures present a medical emergency while under the effects of ibogaine, benzodiazepines are not contraindicated, so continuing to take them is the safest option.
For patients who wish to stop taking benzodiazepines, we recommend a long controlled taper, which we can help with planning after the ibogaine treatment is completed.
Dehydration and electrolyte depletion
It’s important to enter into ibogaine treatment fully hydrated, and have balanced electrolyte levels. Electrolytes, especially potassium and magnesium, are an important part of modulating cardiac rhythm, and are involved in QT prolongation. We check for the levels of these electrolytes during our intake process, and continue to encourage people to hydrate with electrolytes prior to treatment. Having too many of these electrolytes is equally problematic, so we assist our patients in beginning treatment with a healthy balance.
It is important that patients are aware of these potential complications, but it’s also important to know that these risks are identifiable and manageable. We screen patients who we believe are not good candidates for taking ibogaine, and assist with all levels of preparation, and monitoring in order to create a safe and tranquil environment for ibogaine therapy.