Proposing this to a relative/friend

If we consider that one of our relatives or friends can benefit from iboga treatment, we have to inform ourselves thoroughly about potential risks and exclusion criteria, which you can find in interested in taking iboga and get in touch with professionals in this field.

In general we recommend a visit to a health professional who helps to determine a therapeutic strategy that best fits the needs of the patient. If iboga is considered as part of this therapeutic process it is necessary for the professional to know this treatment tool and in the post-iboga phase deal with the materials that have come up during the experience in the psychotherapy sessions.

A mutual understanding between the different professionals involved in the therapeutic process is vital. Certain health professionals might be reluctant to the use of iboga or other tools that alter the consciousness. Therefore it is important to discuss this openly, allowing the therapeutic process to unfold fruitfully.

It is also important to understand that the use of iboga is not a definite solution on its own. It can provide an important therapeutic opening and facilitate the detoxification process, but following the experience should come a multifaceted therapy program that can be extended over the time needed, in which the person as well as the family should be implicated. It is important to take this into account before initiating a treatment that involves the use of iboga.

Iboga should never be presented to anyone as a miracle solution but as a tool or catalyst for addiction treatment. The decision to take iboga should always be made by the person him/herself.

How to support a therapeutic process

Drug addiction is a phenomenon that is not limited to the addict only; the environment, family and relationships that the patient has all play an important role in maintaining the addiction. It is for this reason that a therapeutic approach should always address all of these areas.

As family, we should be open to collaborate in the therapeutic process and play our part in it by accepting our role in the situation and being open to making personal changes and undergo our own therapeutic process. This can be challenging for the whole family structure, but it provides an opportunity to adjust the situation to one of increased balance satisfaction for all members involved.

Approaching the therapeutic process in a positive way means being open to changes and assuming our part of the responsibility in the situation. The therapist will decide which focus or interventions they believe will have the most satisfying results, and if those require our participation in the psychotherapy it is vital to do so.

It might occur that, as a result of the treatment process of the patient, a member of the family feels the need to start a personal therapeutic process. In this case, it is a good idea to do so, as this will not only benefit that person, but also the other members of the family structure, including the (ex-)addict.

Criteria for the selection of an appropriate place

There are different types of centers and people that offer iboga sessions in diverse contexts. As you can read in the section interested in taking iboga, there are risks associated with its use. Therefore, it is important to choose a proper place for the session and to make sure that the patient is in hands of capacitated professionals.

In an ideal situation, the ibogaine center satisfies the following requirements:

• informs the patient properly about the potential risks and benefits of the iboga treatment.
• Asks for or offers a medical and psychological examination before accepting a patient (including heart tests such as a stress ECG or 24 hour Holter monitor, blood test, liver panel, medical history, use of medication, etc.)
• Does not offer any miracle cures or guarantees.
• Has qualified professionals, such as a medical doctor, psychiatrist, psychologist, nurse and therapists. Their qualification and professional experience should be available for you to consult.
• Have the needed installations: medical equipment such as a heart monitor and defibrilator, a room for psychotherapy or group therapy, comfortable and clean rooms, etc.
• Offering a service of preparation for the experience as well as integration and follow up session, or direct you to a capable therapist for that process.
• Works according to a code of ethics: consulting with ex-patients that have undergone treatment in the center can be a valuable source of information regarding this aspect.
• Have a broader therapeutic approach beyond the ibogaine administration, taking into account the patient, his/her family and environment.

In reality, an ideal situation is not always possible for financial or legal reasons. It is important to realize that the closer the real situation in which you are going to take ibogaine comes to the ideal one, the safer and more efficient it can get. If one of the first three of the above requirements is not met, this should be a big sign of warning.

Adverse events. What to do?

The use of iboga implies certain physical and psychological risk factors. The selection of the center and professionals with whom you will do the session is a key factor in reducing the severity of eventual adverse events. A well-prepared center with a knowledgeable staff, proper monitoring of the patient and necessary medical equipment will usually be in the position to respond more efficiently to eventual adverse effects than one sole person doing a treatment in a house or hotel room. In the case one would do a session in these underground or non-medical conditions, it is important to be aware of this risk and make sure the person offering treatment has an emergency plan and a strict protocol of monitoring vital signs.

The main adverse effects on a physical level have to do with changes in the cardiovascular system. There have been cases of fatalities due to heart failure, as well as pulmonary embolism. Therefore, an exhaustive test with a 24-hour Holter monitor, or, if not available, a stress electrocardiogram (ECG) or regular ECG, as well as a blood test and liver panel before taking iboga is very important. More information about safety can be found in the section interested in taking iboga.

Another very serious risk factor is the use of drugs or certain medications immediately before or during treatment. Some centers or treatment providers might do urine or blood tests before the session, while others might do a voluntary drug search. If a patient lies about drug use or the use of medications, this can be potentially fatal. So, even if your medical examination does not indicate any conditions falling into the exclusion criteria, the place where the session will be done should have the needed medical equipment and team or trained person to do cardio-pulmonary reanimation. You can directly ask for the safety conditions: whether the person will be monitored during the experience, whether they dispose of trained personnel for emergencies, or whatever doubts that may emerge regarding safety.

Other types of adverse effects are of psychological nature. The iboga experience can be very intense and, in some cases, be prolonged over a longer time period than expected. In healthy individuals without history of mental illness or related crises, this isn’t necessarily a problem. If the session is done in a prepared context, the situation can be sustained without major issues. Reactions of fear, panic, anxiety, paranoia, etc. can take place in people under the influence of substances that alter consciousness.

Occasionally, a person that has taken iboga can experience a period of emotional instability that extends over a longer period than usual. The weeks after the experience are crucial in the therapeutic process and should be given special attention. Intense emotional reactions are part of the natural process of integration, so they do not have to be seen as a problem, but rather as opportunities that allow profound change to occur.

Traditional psychiatry interprets these symptoms as manifestations of psychological pathologies, and therefore the objective is to suppress them using antipsychotic medication, which goes generally accompanied by a diagnosis that can be lifelong. However, the therapeutic potential of ibogaine is based on the processing of repressed subconscious material, which therefore has to be accessed and experienced. It is therefore important to carefully evaluate the seriousness of the situation before taking it to a hospital.

It is equally important to take into consideration that not all psychological processes that emerge should be supported. If the person has a clear disconnection from reality, with ideas of reference (e.g. “everybody looks at me”), delirium (e.g. “there is a conspiracy to kill me”) accompanied with disorganized thoughts (incoherent thinking or lack of clear sense), and these symptoms continue over a prolonged period of time, it is necessary to seek help of a psychiatrist.

Especially for people going through a process of rehabilitation it is of vital importance that they can count on therapeutic support. In case we find ourselves in the situation where a relative or friend has taken iboga and is having difficulties during the days after the experience, a good strategy is the following:

• Provide the person with an adequate context: space and information. Create a safe space where he/she cannot hurt him/herself and have sufficient privacy to continue his/her process without having to deal with other people or external situations. Transmit the idea of the healing potential that the process he/she is going through holds.
• Accompany the person in his/her process, allowing it to unfold without repression; listening and offering support.
• If the situation does not improve over the course of days, or it is necessary to seek help, contact a professional who is familiar with these types of situations. It is important that it is someone experienced in dealing with altered states of consciousness who knows the treatment with iboga.
• As soon as things have seemingly returned to normal, a professional should be consulted, the use of iboga interrupted and a structural integration process initiated.