I have put together these guidelines, with the incorporation of input from others in the field, to support people in finding the clinic or retreat that’s right for their needs. Safety and experience is of the utmost importance with ibogaine treatment as there are serious medical risks involved. Since there is no way to enforce safety standards in the clinics and providers working worldwide, which are mostly functioning outside of any regulatory or legal body, many of these facilities are not offering treatment safely. Use this guide carefully and thoroughly to ensure you choose a safe and effective facility.
1.) When calling a clinic or provider, ask questions to get a sense for who the staff are, why they are doing this work, and for how long. The main provider on the staff, or the head doctor, should have at least three years of experience.
Question: Who did you train with and how long have you been facilitating treatments post-training?
2.) What type of treatments do they do? If you are seeking a detox or substance use disorder related treatment, they should have most of their experience in this type of treatment.
Question: What types of treatments do you offer and how long is your experience providing each type?
3.) A licensed counselor or therapist should be available throughout your treatment.
Question: Can you tell me about your mental health staff and how available they will be throughout my stay?
4.) Clinics should offer guidance on post-treatment planning and ideally would connect you directly to an experienced ibogaine coach or therapist before your treatment.
Question: Can you directly connect me with a therapist to work with before and after my treatment or do you offer this as apart of the treatment cost?
5.) Medical tests: A clinic must ask for at least an EKG and liver panel blood work. They should also be asking detailed questions about your full medical and psychiatric history, prescribed medications, and the substances that you use. (Cardiac history is of the utmost importance, and if they aren’t asking about this, or for an EKG, that is a major red flag. They must also ask about seizure history, liver health history, prior traumatic brain injuries, and diabetes, to name a few.)
Question: What is your medical screening process and what tests do I need to qualify for treatment?
6.) A clinic’s dosing protocol should be flexible and based on your specific health conditions and your response to a test dose of ibogaine. Clinics should not dose everyone according to a standard milligram per kilo protocol. Dosing should be based upon a client’s EKG, blood pressure, and other health signs. The status of the vital signs after the first, and subsequent doses, should guide the provider as to how much more medicine should be given. There must be flexibility with the dosing and the time allotted for dosing to support each client’s unique needs.
Question: How do you approach dosing and what kind of flexibility is built into your treatment schedule if I am sensitive to ibogaine or if other issues arise?
7.) If the provider suggests doing a treatment within days of regular use of psychiatric medications, such as SSRI's or amphetamines, this is a red flag. Many medications are contraindicated with ibogaine and require a few weeks or more of being out of your system. They should also offer safe tapering recommendations if you are not able to receive these from your psychiatrist.
Question: What is are your recommendations for detoxing off of the psychiatric medications I am on and can you guide me through the process of this detox?
8.) If a provider claims they can detox you directly from alcohol or benzodiazepines this is a major red flag and I would seriously question their ibogaine knowledge. For alcohol, a client must do a medically supervised detox prior to Ibogaine at least one week ahead of time. Detoxing off of benzodiazepines requires a long slow taper under medical guidance, and a client must be completely detoxed for at least 1 month or more before ibogaine ( free of detox symptoms). Because this can be a lengthy process, many are administered diazepam (the safest benzo for ibogaine treatment) during the treatment and begin to taper off of their prescribed benzo after their Ibogaine treatment. It is safe for clients on benzos to be administered diazepam throughout their Ibogaine treatment if the correct protocol is followed.
Question: What is your process for detox from alcohol and benzodiazepines?
9.) If you use fentanyl, or any street opioids in North America, the ibogaine treatment for opioid detox protocol is more time consuming due to safety issues. Any person with fentanyl in their system will need to be stabilized on morphine for as long as it takes for it to leave their system, which has been observed to be anywhere from 4-14 days. If a person does not have access to other prescription short acting opioids at home (such as morphine or oxycodone), this extra time for morphine stabilization will need to happen at the clinic. It is not safe to take ibogaine directly after fentanyl usage. Any clinic incapable of offering the flexibility for morphine stabilization, or that rushes clients through this process, is unsafe.
Question: What is your detox protocol for fentanyl users?
10.) It's important that the provider you speak with on the phone do a full and thoughtful screening to determine if you are a good candidate for treatment. Treatment bookings should never be rushed since it can often take time and careful preparation for a potential client to be ready for treatment. If a clinic is pressuring you to book, this is a red flag.
11.) A clinic must have a doctor who they consult with and who is present for the treatment. There should also be an RN present to assist and monitor treatments. The doctor should have at least 1 year of experience, and ideally more if no other staff has more years of experience.
Question: Do you have a doctor on site and how long have they worked with ibogaine? What other medical staff do you have on site?
12.) A clinic’s treatment preparation protocol is key. They should emphasize proper hydration pre-treatment with electrolyte supplementation, they should be asking about your medications and supplements (and the detox process from those if applicable), and they be asking how your digestion and bowel movements are. Fasts, enemas, and Kambo in the three days prior to Ibogaine can be dangerous because of the electrolyte depletion that occurs. If any of these are a part of the protocol of the clinic this is a red flag. Eating healthy normal meals and staying hydrated is crucial to prepare your body for ibogaine
Question: What do I need to do to prepare for treatment?
13.) The basic medical equipment a clinic should have on site is an EKG machine, an AED, IV equipment, and an oxygen tank.
Question: What medical equipment do you have on site?
14.) Emergency protocol: The closest hospital must be under a 15 minute drive away. The clinic should have a relationship with the hospital so that they are prepared for the specific circumstances of an Ibogaine related emergency and ideally there would be a cardiologist at this hospital.
Question: What is your emergency protocol and how close is the nearest hospital?
15.) For a non-detox ibogaine treatment, a clinic should have you on site for at least 2-3 days before giving you ibogaine and they should keep you for 3-4 days afterward. These time periods increase if a client is detoxing off of medications and substances. (Further guidance on fentanyl and long acting opioids is below, and other specific substance detox protocols can be found here.)
Question: How long will my treatment be and can you share the schedule I’ll be on?
16.) If a clinic says they can treat you directly from long term use of suboxone or methadone in less than 4 weeks after last taking those medications, then this is a major red flag. Doing ibogaine too soon after long acting opioids is dangerous and will result in weeks of withdrawal symptoms post-Ibogaine. (The exception to this rule is a clinic that uses the Low Dose protocol that provides longer multi-week treatments.) Clients should be off of suboxone or methadone for at least four weeks or more before Ibogaine depending on the length of time on those medications and the dose. (Some clients switch to short acting opioids they procure themselves for those weeks, and occasionally a clinic may be able to stabilize clients on morphine for that time.)
Question: What is your protocol for methadone and suboxone? Do you offer pre-treatment morphine stabilization?
17.) All clinic’s offering detox treatments should have clients on cardiac monitoring equipment. For non-detox lower risk treatments, they should check your vital signs (pulse, blood pressure, and oxygen) every 20 mins. Client’s should be monitored closely for a full 36 hours following ingestion of the first Ibogaine dose.
Question: What is your monitoring protocol?
18.) If staff members previously had substance use issues and went through ibogaine treatment themselves, ask how long has it been since their treatment. If this person is the main provider(s), I recommend 3 years+ since their own treatment and a one year minimum for peripheral staff. (Keep in mind that these are rough guidelines. You should ultimately trust your intuition through the interactions that you have with the staff ahead of time to assess their stability.) All staff should be engaged in their own therapy and under supervision.
Question: Do you or your staff have a history of substance use issues and how long has it been since? Are you and your staff under supervision?
19.) Staff should have gone through thorough training, apprenticeships, or mentorships.
Question: What type of training have you and your staff undergone?
20.) When interacting with a clinic or provider, use your intuition and get to know the people well through a series of phone calls. Don’t hesitate to ask if they have any past clients who they would be willing to connect you with.
Basic pre and post treatment recommendations:
When planning for an ibogaine treatment it's important to understand that what you do before and after your treatment is just as important as the actual ibogaine experience. I recommend planning to be in a place after treatment in which you will be surrounded by safe and supportive people, which sometimes may mean the beginning of a process of making big lifestyle changes. It’s also key to begin work with a therapist, counselor, or coach before your treatment, regardless of why you are seeking ibogaine. This will support you in making the best use of the insights and realizations gained from this medicine. Focusing on a healthy diet, regular exercise, and activities that bring you joy are integral elements in your treatment process as well. If you have a therapist, or even a really supportive friend or relative available, sit down with them and come up with a pre and post treatment plan together as a first step.
