The purpose of this document is to provide information. Treatment providers and patients are solely responsible for their actions.
Manual for Ibogaine Therapy
Screening, Safety, Monitoring & Aftercare
Second Revision
by
Howard S. Lotsof & Boaz Wachtel
Contributing Authors
Marc Emery, Geerte Frenken, Sara Glatt
Brian Mariano, Karl Naeher
Martin Polanko, Marko Resinovic
Nick Sandberg, Eric Taub
Samuel Waizmann, Hattie Wells
© 2003
Table of Contents
Introduction to the Second Edition
Preface
Treatment
Intake and Safety Issues
Dose and Effect
Opioid Withdrawal
Opioid withdrawal tables
Post Ibogaine Treatment Therapy
Discussion
Overview
Inclusion Criteria
Exclusion Criteria
Treatment Regimen and Dose
Product Identity
Post Ibogaine Therapy
Invitation to Contributing Authors
Appendices
Selections NIDA Draft Ibogaine Protocol
Related Protocol Bibliography
Additional Document links
Introduction to the Second Revision
The Second Revision of the Ibogaine Manual follows a year and a half after the publication of the First Revision providing new information to the field.
This revision of the manual offers additional information on ibogaine therapy as well as, differing philosophies of ibogaine providers and their approaches to therapy. There is consensus as to the benefits of post ibogaine therapy but, no agreement that any one therapy offers benefits over others to a majority of subjects. Many authors feel the exclusion criteria indicated in the draft protocol of the National Institute on Drug Abuse (NIDA) are not realistic to allow treatment of today’s chemically dependent drug users who may be depressed or display other psychiatric disorders nor does it allow for the prevalence of HCV and/or HIV to allow those individuals to be treated with ibogaine. The authors review broader ibogaine dose regimens and their advantage than were presented in the First Revision of this manual. The new material is principally found in the Discussion Section that may be referenced from the links of the Table of Contents above though some changes and corrections have been made throughout the text as a whole. Opinions of authors remain diverse.
Links to a medical encyclopedia as well as, both the home edition and Centennial/Professional edition of the Merck Manual are included in the Additional Documents section. “The Merck Manual, the textbook of medicine most widely used by health care professionals provides vital information about diseases, diagnosis, prevention, and treatment.” The Ibogaine Manual now also contains a link to a redacted version of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) to allow better understanding of mental disorders that may be concurrently seen in persons who are chemically dependent.
Though the Internet allows rapid publication it also has a component of rapid disintegration with web pages linked to the manual being withdrawn from the web by original authors. Therefore the authors of this manual have included where possible multiple links to any particular subject in the appendices so as to maintain information access for the reader.
All links that will take the reader outside of the Ibogaine Manual will highlight on mouseover with most but, not all browsers. These links are found only in the Additional Document section. Links that will take the reader outside of the Ibogaine Dossier web page will appear in separate windows with the Manual remaining visible in the background.
Preface
Ibogaine therapy has emerged in the last twenty years as a viable option for motivated chemically dependent individuals who wish to cease their dependence. The extremely costly regulatory approval process and the reluctance by major pharmaceutical firms to pursue regulatory approval in the West has led to the formation of non-medical ibogaine treatment movements in many countries. This document is intended for medical doctors as well as, for lay-healers who have little or no medical experience, but who are nevertheless concerned with patient safety and the outcome of Ibogaine treatments. The NIDA draft clinical protocol, however, may be useful to researchers in formal drug development.
It is the responsibility of those treatment providers to safely conduct the procedure despite possible limitations of clinical knowledge, patient compliance, money, time etc. The safety of Ibogaine treated patients is the primary objective of this document. Reported Ibogaine-related problems or fatalities might very likely be avoided if simple screening, dosing and monitoring guidelines are adhered to. However, this must be taken in some context as, in 1999 there were 116,000 drug related fatalities in United States hospitals associated with FDA approved medications.
This manual includes selected portions of the National Institute on Drug Abuse (NIDA) Draft Ibogaine Clinical Protocol obtained under a Freedom of Information Act (FOIA) request. Selections are principally directed towards safety issues. Aspects of the therapeutic sessions from the NIDA protocol are included as well as, bibliographical citations relevant to the sections from the protocol. More recent reports providing updated information are included in the Additional Documents section.
Any comments of the author(s) within the selected protocol text are indicated by “[ ]” brackets. The “*” asterisk is used to indicate tests procedures or surveys not included in NIDA’s 1993, draft protocol but, suggested either in discussion with the FDA or by later publication.
In a memorandum dated March 10, 1995, Dr. Curtis Wright, Medical Review Officer, Pilot Drug Evaluation Unit, FDA wrote, “I think that ibogaine research will be propelled forward by its advocates, as it will be very hard to make a case that it is unsafe to take a drug into man when there is such substantial documented human experience. I agree with the speaker [March 1995, NIDA Ibogaine Review Meeting] that it is a risk-benefit analysis, but all such development decisions are finally reduced to this basis. The Development question is if ibogaine can be given safely, and if so, will it provide some benefit.”
Ibogaine has been propelled by its advocates since then, and administered in many countries often outside the medical establishment. Unfortunately, safety issues are not frequently addressed or evaluated properly. Our objective is to provide basic guidelines and improve patient safety with information. This information is made available for the benefit of the treatment provider and their patients.
Treatment
Intake and Safety Issues
Needless to say, it is evident that most persons outside of a research institution would not be able to undertake the testing presented in the NIDA ibogaine protocol. The primary issue the authors are attempting to address is that no medical testing is the norm for many persons receiving ibogaine therapy. This leaves both providers and patients at risk. Risk cannot be eliminated but, as inferred by Dr. Curtis Wright in the introduction to this article, risks must be weighed against benefits. It is apparent from the actions of both ibogaine providers and chemically dependent persons who seek treatment that the benefits are significant. However, with no less than three documented ibogaine-related fatalities, so are the risks. Having safety procedures in effect are not for the benefit of the majority of the patients who will go through ibogaine therapy with no problems but, to assure the survival of a small minority of the patients who may experience some form of adverse medical event that may be life threatening.
One of the recorded fatalities was reported to have taken place in 1989 in France. The patient, a forty year old woman was provided a dose of 8 mg/kg of purified ibogaine for purposes of psychotherapy from which she died approximately four hours after administration of ibogaine. The dose given was the lowest dose associated with an ibogaine related fatality that has been recorded and the autopsy found significant blockage of the main arteries to the heart. It was indicated that the patient had a history of cardiovascular disorders that may not have been investigated. This immediately indicates two areas that should be given priority attention by ibogaine providers: 1) A medical history and 2) an electrocardiogram (EKG).
The most common form of a medical history is usually a questionnaire required of every patient visiting a doctor for the first time and your doctor’s office is an excellent source of such a document. Among the information required on such forms are issues relating to heart disease and these questions if honestly answered will provide an alert to the existence of a cardiac disorder. As, previously stipulated because medical conditions may not be known to the patient an electrocardiogram (EKG) should be included in any basic intake for ibogaine therapy. Information on electrocardiograms can be found in documents #6 and #7. Any history of heart attacks should be a reason not to treat a patient with ibogaine.
Whether in a hospital or outside of a medical environment the patient’s safety can be best provided for by continuously observing the patient. A nursing assistant or other trained person should observe the patient continuously for 48 hours or longer if the patient response to ibogaine requires it. During this period pulse and blood pressure should be monitored at regular intervals and at any time that patients indicate discomfort or the observer has concern. The regular intervals may be as short as 30 minutes for the first four hours or until blood pressure and pulse are stable and then at time points of 1 hour to 4 hours thereafter.
Observers should have training in cardiopulmonary resuscitation and be prepared to call a hospital or emergency medical services should the patient’s pulse drop below 50 beats per minute. If you are not prepared to call for emergency medical help you should not be providing ibogaine therapy. A hospital should be called at any time if a patient loses consciousness. The emergency number to be called should be available to all provider personnel at all times. Observing the patient is more work then one person can realistically accomplish. In a hospital setting nursing staff would normally rotate on 8 to 12 hour shifts.
The evaluation of blood chemistry is a standard means of assessing the health of a patient and is often used in medical evaluations of patients during annual physicals or to determine the health of a patient at any time for any purpose. The SMA-20 (a series of tests to evaluate blood chemistry) along with a CBC (complete blood count) with differential now appear to be the tools of choice to provide a wide range of information relating to blood chemistry that includes a liver profile but, does not include a hepatitis or HIV screen. Excellent resources concerning the SMA-20, CBC and definitions to allow an understanding of the associated terminology can be found in #3, #4, and #5 of the document section.
The second recorded fatality was that of a woman in her mid twenties in the Netherlands who received 29 mg/kg in a split dose of 23 mg/kg and an additional 6 mg/kg approximately 3 hours later. The patient died 16 hours after the administration of ibogaine. The autopsy did not determine the cause of death. The unanswered question of the cause of death brings us to another important safety issue. Ibogaine has been shown to increase the effects of opiates as well as opiate toxicity. Ibogaine may also increase the potency and toxicity of stimulants. Therefore patients should be warned that concurrent drug use during ibogaine therapy may be fatal. It does not mean that concurrent drug use will always be fatal as an early report of an ibogaine experience, Reflections on an Ibogaine Experience found in document #8 of this manual indicates concurrent heroin use that did not result in a fatality. It must be recognized that the response to drugs is individual and that each patient may present a dramatic or not so dramatic distinction in how they respond to ibogaine or other drugs. Ibogaine providers should attempt to minimize danger to the patient by eliminating the use of unauthorized drugs by the patient while under the influence of ibogaine. Good luck on that matter in circumstance where you are treating experienced and dependent drug users. This is why it is very important to let the patient know that drug interaction may be fatal.
The third fatality of record occurred in 2000, in the UK. The patient was a 38 year old male who was administered a total of 5 or 6 grams of a 15% total iboga alkaloid extract over a period of six hours. The patient appeared fully recovered, had eaten breakfast, gone to the toilet and suddenly died approximately 38 hours after the administration of the plant extract. The patient had hepatitis C but, exact data on the state of the disease is not available. The subject had been using heroin for 15 years. The most troubling issue relating to this fatality is that it occurred after the apparent recovery of the subject and quite suddenly. The extract has been widely used and there appears to be no greater fatality-related issues associated to it than to purified ibogaine.
NIDA in its draft protocol and the FDA in the protocol it approved in 1993, excluded patients with hepatitis C. One of the authors believes this was not so much a safety issue but, one that would allow a determination of the transformation of ibogaine into its metabolites by the liver and the associated plasma levels to be validated in pharmacokinetic studies within ranges that would be normal and not to have them skewed by a diseased liver. It is reported that the St. Kitts facility excludes HCV and HIV patients. NDA International, Inc. in its work in The Netherlands and Panama accepted HCV and HIV that were not symptomatic for the diseases. As many chemically dependent drug users test positive for HCV and as there has been no known correlation of fatalities with HCV, it does not seem that this is a reasonable exclusion criteria in the real world of chemical dependence. Non-symptomatic HIV patients have also been treated without apparent medical events. NIDA chose to exclude patients with liver enzyme values exceeding 400% above normal from a later study design. A decision to follow NIDA’s footsteps on this matter may be reasonable until more information is available.
Ibogaine appears to be a very safe drug in terms of psychiatric events. One of the authors is aware of a single event from a report where a patient apparently regressed, acted in a childlike manner and urinated in bed for a period of two days, thereafter recovering. An early patient who had been hospitalized on a number of occasions for glue-sniffing related psychosis became paranoid during his first treatment and exhibited behavior distinct from any other ibogaine patient during a second treatment episode. Ibogaine providers should be aware that chemically dependent or not, many persons are going to come to them with underlying and in some cases significant underlying psychiatric disorders. NIDA’s exclusion criteria for “patients with a history of active neurological or psychiatric disorders, such as cerebellar dysfunction, psychosis, bipolar illness, major depression, organic brain disease or dementia, that require treatment”, may be well thought out and these patients should be avoided by persons not having professional skills in psychiatry and psychopharmacology. These matters are further reviewed in the Discussion section of this manual.
Anything that can be learned about the patient prior to treatment is valuable. And, anything learned before treatment will most likely allow a greater interpretation of events after treatment. To this end the Beck Depression Inventory, document #9, linked in the Additional Documents Section may be valuable as may the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) document #10. The tests are generally only available to persons who are professionally involved in psychology or testing who then provide them to patients. Once provided with a diagnoses it is necessary to understand those disorders. To that extent the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition, better known as the DSM-IV, document #11 is published by the American Psychiatric Association is a standard in the field.
Taking this broad ranging discussion to a brief conclusion, every ibogaine patient should receive an SMA-20 and CBC blood test and an EKG. These discussions are made in the hope of initiating greater associations between non-medical ibogaine providers and medical professionals who can assist them in increasing the safety of ibogaine treated patients. Questions coming out of the London Ibogaine Conference held in December of 2001, concerned the required testing, how to obtain it and how to understand it. The International Coalition for Addict Self-Help (ICASH) in their work in the late 1980s and early 1990s faced the same problems. Their solution was to have the patient walk into an emergency room or community health service with a friend and to have the friend inform the staff that the person with them had a pain in the chest and passed out and when unconscious appeared to go into convulsions. This usually resulted in the patient obtaining a blood chemistry, an EKG and EEG to investigate the possibility of epilepsy and cardiovascular disorders. ICASH would then obtain a written authorization to obtain the medical records from the patient and request the tests results and reports of the results from the hospital where the patient was evaluated indicating that the patient was to be included in a research program. The tests and reports were then usually reviewed by a doctor who had some interest in ibogaine therapy. In any case, with the basic medical testing accomplished there is at least a place to begin in offering safe ibogaine therapy. Patients who could afford to pay for testing and did not want to indicate their chemical dependence would inform a doctor that they were going on a trek in some physically taxing geographical location and that medical testing was required to participate.
Dose and effect
After years of review of reports of hundreds of ibogaine patient treatments, the effective dose for the treatment of chemical dependence, including opioid dependence, has been seen to be between 15 mg/kg and 20 mg/kg of ibogaine. It has been reported by some researchers that lower doses are effective but, this has been disputed. Effects of ibogaine generally will make themselves evident within 45 minutes to as long as, three hours after administration. In most cases opioid withdrawal signs will be reduced within 45 minutes of ibogaine administration. Ibogaine is usually administered in place of what would be the next scheduled dose of narcotics. This would provide for an ibogaine administration schedule 8 hours after the last dose of heroin, morphine or demerol and 24 hours after the last dose of methadone. It is expected that the patient would be exhibiting minor withdrawal signs at the time of ibogaine administration. There is no experience with ibogaine in the treatment of LAAM dependence.
Another issue pursuant to dose is that of dose increases, should anticipated effects including the diminishment of opioid withdrawal not be seen. Modification upwards of ibogaine doses have been used occasionally within medical environments and commonly by some lay providers as well as, within the African religious context. The issues remain of ability to respond to medical emergencies and of the experience of the provider to determine the safety at any time of the patient. It may be prudent to allow the primary dose of ibogaine to run its course and then provide a second dose a week later if required. That is, if the patient is still chemically dependent or exhibiting drug craving?
Once ibogaine has been administered, effects follow. The patient will usually want to lay prone and should be encouraged to remain still as nausea and vomiting as well as, being systemic have been seen to be motion related. The skin tends to become numb. Patients will report an initial buzzing or oscillating sound. A period of dream-like visualization lasting for 3 to 4 hours in most but, not all patients is considered to be the first prominent stage of ibogaine effects. This stage ends abruptly should it occur at all. Another aspect of ibogaine effect that is common are random flashes of light that appear everywhere with eyes open. This may last for hours or days. Visualization on the other hand is most common with eyes closed.
The second stage that follows visualization has been described as one in which the subject principally experiences cognitive evaluation or a review of issues that are important to the subject. These may cover every possible scenario from early childhood experiences to current health issues. This period may last for as few as 8 hours or for 20 hours or longer.
The third or final stage of ibogaine effects is that of residual stimulation. This stage, because it tends to leave the subject/patient exhausted is somewhat uncomfortable. Subjects may remain awake for two or more days. Most patients will sleep within 48 hours of ibogaine administration. Some within 24 hours of administration. Usually, there is a long term long term diminishment of the need for sleep over weeks or months. Some patients may require or request sedation. Sedatives that have been used include benzodiazepines, barbiturates and melatonin.
The effects herein described are those of single administration high dose ibogaine regimens. Ibogaine has also been given in regimens of small daily doses of 25 mg to 300 mgs/day and in small daily doses where the dose is increased on a daily basis until the desired interruption of drug dependence is accomplished. These low dose modalities have not been validated for efficacy to the same extent as have the full therapeutic doses of ibogaine. However, these low dose regimens can be traced back some decades to the work of Leo Zeff who in the case of a single patient provided ibogaine on an “as needed” basis via nasal administration to a cocaine dependent patient to substitute for his cocaine use. Lines of ibogaine were somewhat equivalent to lines of cocaine and the patient ceased cocaine use after a week of this daily self-regulated ibogaine regimen. Additionally, reports from Canadian sources indicate multi-week low dose ibogaine therapy 20 mg/day following a therapeutic dose of ibogaine in the treatment of cocaine dependence. Further, reports throughout the ibogaine provider community indicate the use of multiple dosing of varying strength doses over varying time periods in the treatment of opioid dependence. As with all determinations in medicine, decisions must be made on observations of the patient and knowledge of the disorder(s) and the medication(s) used.
Opioid Withdrawal
An issue that all ibogaine providers treating opioid dependent patients will have to address is discomfort due to opioid withdrawal signs, real or imagined by the patient. To this end it may be helpful during a patient intake interview to ask what withdrawal signs the patient has had in previous withdrawal experiences. During ibogaine therapy this information will be more useful if the provider has had experience observing opiate withdrawal signs as well as, observing patients given ibogaine who were not opiate or chemically dependent. The reason being that certain effects of ibogaine may mimic opiate withdrawal. These signs may include inability to sleep, nausea, a feeling of being cold or vomiting. It is the skill of the provider that will enable the provider to determine whether withdrawal signs are real or imagined and to assist the patient in understanding the difference. It must be recognized that elimination of withdrawal signs are not necessarily isolated ends in themselves to heroin or other opioid dependent patients. Being sick is a rational justification for relief and the simple presentation by the patient that they are exhibiting opiate withdrawal to a significant other or peer or other person in their environment has probably been used by the patient to obtain opiates or the money to do so. The conditioned response of obtaining gratification and/or attention by exhibiting opioid withdrawal signs or claiming to exhibit opiate withdrawal signs has been a successful behavioral mechanism for some patients and should be expected. Generally, if the complaint of withdrawal is made it can be expected between the 14th and 24th hour of treatment and may continue through recovery from ibogaine effects.
Two useful surveys that should be included in ibogaine therapy are the Objective Opiate Withdrawal Scale (SOWS) and the Subjective Opiate Withdrawal Scale (SOWS). Examples of these diagnostic tools follow.
***********
Objective Opiate Withdrawal Scale (OOWS)
Instructions: Rate the patient on the basis of what you observe during a timed 10-minute period.
Date:_________________ Time: _________________
ITEM
SCORE 1 POINT FOR EACH ITEM IF:
POINTS
Yawning
present
Rhinorrhea
3 or more
Pileorection (observe pt’s arm or chest)
present
Lacrimation
present
Mydriasis
present
Tremors (hands)
present
Hot flashes
present
Cold flashes (shivering or huddling for warmth)
present
Restlessness
present
Vomiting
present
Muscle twitches
present
Abdominal cramps (holding stomach)
present
Anxiety (finger tapping, fidgeting, agitation)
present
TOTAL OOWS SCORE (Sum items 1 – 13)
***********
Subjective Opiate Withdrawal Scale (SOWS)
Instructions: Answer the following statements as accurately as you can.
Circle the answer that best fits the way you feel now
Date:_____________________ Time:________________
(1 = Not at all) (2 = A little) (3 = Moderately) (4 = Quite a Bit) (5 = Extremely)
I feel anxious
1
2
3
4
5
I feel like yawning
1
2
3
4
5
I’m perspiring
1
2
3
4
5
My nose is running
1
2
3
4
5
I have goose flesh
1
2
3
4
5
I am shaking
1
2
3
4
5
I have hot flashes
1
2
3
4
5
I have cold flashes
1
2
3
4
5
My bones and muscles ache
1
2
3
4
5
I feel restless
1
2
3
4
5
I feel nauseous
1
2
3
4
5
I feel like vomiting
1
2
3
4
5
My muscles twitch
1
2
3
4
5
I have cramps in my stomach
1
2
3
4
5
I feel like shooting up now
1
2
3
4
5
To assist in an understanding of the comparative effects of ibogaine and opioid withdrawal effects, the reader should review Alper et al., #12 of the Additional Document section as well as, the findings from Ibogaine in the Treatment of Narcotic Withdrawal (document #13) by Lotsof, Della Sera and Kaplan presented during the 37th International Congress on Alcohol and Drug Dependence, University of California, San Diego, (1995). The relevant table from that paper is found below.
*******************
Objective Opiate Withdrawal Signs and Ibogaine Signs:
Human Observations
Signs
Opiate Withdrawal
Ibogaine
Ibogaine + Opiates
Diarrhea
Yes
No
*3% – 12%, 6 days post
Yawning
Yes
Rare
Rare
Rhinorrhea
Yes
No
No
Piloerection
Yes
No
No
Lacrimation
Yes
No
No
Mydriasis
Yes
No
5% (moderate)
Shivering
Yes
No
No
Restlessness
Yes
Post 20 Hrs ibogaine
Post 20 Hrs ibogaine
Vomiting
Chronic
Acute/Motion related
Acute/Motion related
Muscle Twitches
Yes
No
No
Abdominal Cramps
Yes
No
No
Sweating
Yes
No
*16% – 25%
Anxiety
Yes
No
3%
Sleeplessness
Yes
Yes
Yes
Post Ibogaine Treatment Therapy
The principal effects of ibogaine treatment that are reviewed in Lotsof’s Clinical Perspectives (document #14), Frenken’s An Ibogaine Treatment Protocol (document #15) and Sandberg’s Introduction to Ibogaine (document #16) will usually run their course within two days. There are exceptions with some patients recovering in as little as 24 hours while others may require an additional day or even have to be coaxed out of bed four days after treatment. Thereafter, the patients are left with the rest of their lives to accomplish and with the majority of individuals needing some form of assistance to figure out how to go about moving forward. Some patients will have a fear of going into withdrawal. This is not a realistic expectation on their part. More realistic is the fear of relapse to drug use and except in rare instances this should be anticipated particularly after only the first treatment with ibogaine.
Addiction has been viewed as a chronic relapsing condition. Ibogaine’s value is not only the interruption of withdrawal but, by mechanisms not fully understood to assist the patient in changing learned behavior and becoming more aware of their behavior in order to change it. After ibogaine therapy many patients become more agreeable to change. Thus, ibogaine provides a unique opportunity. The question to the ibogaine treatment community is how to best make use of that opportunity?
A fundamental question remains. Is any form of adjunct therapy to the administration of ibogaine more advantageous than any other form of post ibogaine treatment therapy? The question becomes more diverse where in the absence, in many cases of the possibility of additional treatment with ibogaine, opiate dependent patients who have relapsed have made good use of methadone maintenance as an effective intermittent therapy so that methadone must also be included in the mix of therapies that have been effectively used by ibogaine treated patients to eventually free themselves from addiction. Thus, we see patients making use of psychoanalysis, psychotherapy both individual and group of varieties as distinct as the persons who provide such therapies, methadone maintenance, and associations such as Narcotics Anonymous and Alcoholics Anonymous. What does appear evident is that contact with non-addicted persons is generally beneficial for patients and that continued contact with users of drugs that cause dependence is detrimental to a goal of abstinence if that is the endpoint desired. This is not distinct from the findings observed in non-ibogaine environments.
Many ibogaine patients themselves indicate that they have a need for and want some form of therapy or support. The issues become more complex in patients whose long term addiction has left them without the skills or education to function outside of a drug user context. Providing ibogaine is a relatively easy short term goal. The time needed to heal patients of trauma they have experienced and to address deficits in the patient’s life is more time consuming and a more long term goal. In many cases the patient’s lack of financial ability to obtain assistance for therapy, education or occupational training will require societal assets or private donations to be made available.
Only recently have agencies such as the Center for Substance Abuse Treatment and the National Institute on Drug Abuse in the United States recognized that the prejudice shown towards drug users is harmful in itself and detrimental to patients seeking treatment. A growing number of individuals question whether prohibition is the greatest harm of all while a greater number of persons are calling for a harm reduction philosophy wherein the minimalization of the level of harm to drug users and society is viewed as a priority over any immediate requirement of abstinence.
Discussion
OVERVIEW
The Second Revision of the Manual for Ibogaine Therapy continues to focus on safety issues while expanding the discussion of dose regimen and forms of ibogaine that include purified forms of the chemical as well as, total alkaloid extracts of varying strengths. These matter are important as ibogaine treatments are taking place in a growing number of countries and under diverse circumstances. Some ibogaine providers in research facilities provide testing as complex as that indicated in the National Institute on Drug Abuse (NIDA) ibogaine protocol. Others in non-medical environments, apartments, hotels or chapels may not include any medical testing at all. This Discussion Section contains viewpoints of all of the authors.
One author in addressing the safety issues of ibogaine states, “The drug is dangerous and shouldn’t be compared to other tryptamines. People definitely have died and there may be more fatalities unrecorded. You need to check liver and heart and be able to assess the results. You need to know resuscitation procedures and be prepared to call emergency medical assistance if necessary.” These statements bring us to central issues: key tests and the ability to understand them. While the authors recognize that virtually every drug product may have associated fatal reactions, the issue with ibogaine is, as it is with all drugs, that the responsibility is not only that of the patient/subject but, that of the provider. That alone should be reason for providers to screen for indicated health disorders.
Safety evaluations may be viewed in terms of an optimal screening/testing protocol and a non-optimal screening/testing protocol. The optimal being as complete and far reaching as possible including medical history, laboratory tests, evaluations by physicians as to general, neurological and psychological health including a broad range of questionnaires to allow such determinations. An excellent questionnaire to begin a structured case history on patients can be found in the the Guidelines for Psychiatric Evaluations of Adults, document #17. Instruments to assist in assessments can be found in The Catalogue of Diagnostic Questionnaires, document #18 and the Brief Psychiatric Rating Scale, document #19. Non-optimal testing would include the bare necessities to investigate areas of medical concern that have been raised in ibogaine literature. These include cardiovascular, metabolic and absorption concerns. Additionally, reports from ibogaine treatment observations also indicate respiratory depression may be an issue as one patient was reported to have stopped breathing before then being revived.
It should be noted that female subjects might be more sensitive to ibogaine due to higher blood levels of ibogaine and/or its principal metabolite (noribogaine) than are seen in male subjects. One, of an excellent series of articles published in The Scientist, The Inequality of Drug Metabolism, concerns itself with this matter, document #20. While absorption and metabolism factors are not distinct to ibogaine and are common to many drugs, individual patient responses to dose and particularly sensitivity of females to ibogaine must be recognized. Obviously, further research is required and the authors request the participation of ibogaine providers to supply relevant reports and data for future revisions of this manual. The FDA in their approval of ibogaineclinical studies in 1993, excluded women. This was in conflict with Institute or Medicine (IOM/United States) guidelines that indicate women should be included in the earliest research testing of drugs. The pharmaceutical industry, principally for issues of liability and cost, tests new drugs only on men in the majority of early clinical studies.
While the drug metabolism for ibogaine and for many pharmaceutical products may be better understood for distinctions between men and women, there is still no fundamental agreement on the responses of men and women to ibogaine. Wells in her very well thought out article, Notes for Treatment Providers, document #21, finds that women appear less responsive and more problematic as patients while Lotsof in his work finds women to be more responsive and less problematic as ibogaine patients. Hopefully, as more people are treated we will see a greater statistical understanding of the patient population.
One author suggests that medical testing should not be included when ibogaine is used as a religious sacrament and that under those conditions a religious exemption to medical testing should be considered valid. The author indicates that persons undergoing religious initiation are questioned at length to their health and not only are they questioned but, those who will accompany them during the initiation are also questioned and advised as to the possibility of death. The author indicates that once the possibility of fatalities are mentioned that usually more significant information is provided as to the health of the initiate. The author also indicates that women initiates are informed they may be at greater risk and are asked should they find the door that allows them to leave this life that they must not take that door as it would be destructive for everyone involved. These descriptions appear to be in keeping with the protocol or rites used within the African Bwiti initiations.
The primary question the authors must address is who may be administered ibogaine?
To that end we must present inclusion criteria for ibogaine therapy or initiation. The terms “therapy” and “initiation” are used, as ibogaine is available in paradigms that include religious initiation, treatment for chemical dependence and administration for psychotherapeutic or “exploratory” purposes.
INCLUSION CRITERIA
“Testing for sexually transmitted diseases is always important in the chemically dependent population,” states an author, “so I would also include VDRL to test for syphilis.”
1. Subject participation must be voluntary and not coerced.
2. Subject must sign an Informed Consent that indicates and understanding of the risks and benefits of ibogaine administration.
3. Subject must undergo a general medical evaluation by a doctor who will provide a report.
4. Subject must supply a copy of their medical history questionnaire (generally required upon the intake visit to a physician).
5. Subject must respond to a Beck Depression Inventory questionnaire.
6. Subject must obtain an EKG (electrocardiogram) and report.
7. Blood tests including:
* albumin: 3.9 to 5.0 mg/dl
* alkaline phosphatase: 44 to 147 IU/L
* ALT (SGPT): 6 to 59 IU/L
* AST (SGOT): 10 to 34 IU/L
* BUN: 7 to 20 mg/dl
* calcium – serum: 8.5 to 10.9 mg/dl
* serum chloride: 101 to 111 mmol/L
* CO2: 20 to 29 mmol/L
* creatinine: 0.8 to 1.4 mg/dl
* direct bilirubin: 0.0 to 0.3 mg/dl
* gamma-GT: 0 to 51 IU/L
* glucose test: 64 to 128 mg/dl
* phosphorus – serum: 2.4 to 4.1 mg/dl
* potassium test: 3.7 to 5.2 mEq/L
* serum sodium: 136 to 144 mEq/L
* total bilirubin: 0.2 to 1.9 mg/dl
* total protein: 6.3 to 7.9 g/dl
* uric acid: 4.1 to 8.8 mg/dl* RBC (varies with altitude): (male: 4.7 to 6.1 million cells/mcl) (female: 4.2 to 5.4 million cells/mcl)
* WBC 4,500 to 10,000 cells/mcl
* hematocrit (varies with altitude): (male: 40.7 to 50.3 %) (female: 36.1 to 44.3 %)
* hemoglobin (varies with altitude): (male: 13.8 to 17.2 gm/dl) (female: 12.1 to 15.1 gm/dl)
8. Upon subject meeting all other inclusion criteria and not being excluded by exclusion criteria, subject will be administered a 100 mg (total) test dose of ibogaine. Should the subject not have an adverse or atypical response, a full therapeutic dose of ibogaine may be considered. See exclusion criteria #4.
9. Ibogaine providers following a medical model may require evaluation of cytochrome P450 enzymes activity. Particularly, P450 2D6 (CYP4502D6) plays a significant role in the metabolism of ibogaine to noribogaine, its active metabolite. Testing allows a determination of whether the patient will be a “poor metabolizer” (PM), “intermediate metabolizer (IM), extensive metabolizer (EM) or “ultra rapid” metabolizer (UM). This testing is now available through commercial laboratories.
EXCLUSION CRITERIA
In order to begin to address the safety of persons being treated with ibogaine, the following indications should exclude treatment with ibogaine. A discussion of these matters by various authors follow the list below.
1. Patients with a history of active neurological or psychiatric disorders, such as cerebellar dysfunction, psychosis, bipolar illness, major depression, organic brain disease or dementia, that require treatment.
2. Patients who have a Beck Depression Inventory score greater than or equal to twenty-four.
3. Patients requiring concomitant medications that may cause adverse ibogaine/other drug interactions (e.g., anti-epileptic drugs, antidepressants, neuroleptics, etc.)
4. Patients with a history of sensitivity or adverse reactions to the treatment medication.
5. Patients with a history of significant heart disease or a history of myocardial infarction.
6. Patients with blood pressure above 170 mm Hg systolic/105 mm Hg diastolic or below 80 mm Hg systolic/60 mm Hg diastolic or a pulse greater than 120 beats per minute or less than 50 beats per minute.
7. Patients who have a history of hypertension uncontrolled by conventional medical therapy.
8. Patients who have received any drug known to have a well-defined potential for toxicity to a major organ system within the month prior to entering the study.
9. Patients who have clinically significant laboratory values outside the limits thus specified by normal laboratory parameters.
10. Patients who have any disease of the gastrointestinal system, liver or kidneys, or abnormal condition which compromises a function of these systems and could result in a possibility of altered metabolism or excretion of ibogaine will be excluded. As it is not possible to enumerate the many conditions that might impair absorption, metabolism or excretion, the provider should be guided by evidence such as:
A. History of major gastrointestinal tract surgery (e.g., gastrectomy, gastrostomy, bowel resections., etc.) or a history or diagnosis of an active peptic ulcer or chronic disease of the gastrointestinal tract, (e.g. ulcerative colitis, regional enteritis, Crohn’s disease or gastrointestinal bleeding).
B. Indication of impaired liver function.
C. Indication of impaired renal function.
11. Patients with active tuberculosis.
12. Pregnancy
* * * * * * * * * * * * * * * * * * * * * * * *
“Regarding the manual I would disagree with some of the exclusion criteria,” says one author. “By excluding patients that are depressed or bipolar you exclude a sizable portion of the addict population. Because ibogaine’s metabolites have been shown to have an antidepressant effect it would probably help these patients. Proper treatment for psychiatric conditions can be administered afterward. You will find below some of the experience we have had with patients taking antidepressants prior to ibogaine and since many patients have psychiatric conditions, we don’t consider it prudent or necessary to suspend psychotropics for longer than 24 hours before treatment. Below are presented three examples of such patients. All of these patients suspended their medications 24 hours prior to treatment and apparently had no different responses to ibogaine or any unexpected side effects.”
1) 22 year old male on Prozac (fluoxetine) 20 mg for 14 months.
2) 38 year old male on Zoloft (sertraline) 100 mg for 2 years.
3) 36 year old female on Paxil (paroxetine) 40 mg for 1 year.
“Since most patients are depressed, a fast acting antidepressant can help in the days after ibogaine. We have found S-adenosyl-L-methionine (SAMe) to be useful. If necessary we also prescribe SSRI’s. These take about two weeks to start working. Another simple but effective therapy is DHA (omega-3 fatty acids). These reduce depression and stabilize mood.”
Commenting on the exclusion criteria, another author states, “I don’t think depression should be taken as a contraindication. I’ve treated a lady with an extreme depression hoping it would help. It didn’t. The condition remained unchanged. Of course, one case – no case. People on Oxycontin often claim depression. No wonder – that’s what the interruption of oxycontin use usually leads to. Ibogaine is needed to eliminate the addiction. I suggest antidepressants be started immediately after ibogaine therapy under the supervision of a physician.”
Further, an author indicates “that Crohn’s disease should not be an exclusion criteria as one patient diagnosed with Crohn’s disease had the disease placed in remission after ibogaine therapy.” While other authors have not had such experience it should be noted that an early report from Dutch Addict Self-Help concerning Hepatitis C being placed in remission resulted in most providers, including then, NDA International, Inc. agreeing to treat patients with HCV whose liver enzymes were not greater than 400% above normal. It must be remembered that we are discussing an experimental medical procedure should that definition be accepted and that medicine itself is diverse in its effects, expectations or adverse events.
A number of authors indicate nonfatal adverse medical events in patients with stomach ulcers. Ibogaine may cause pain and/or bleeding in these patients. Whether this is a matter of irritation to the stomach lining or a more systemic effect is unknown at this time thus, it is unknown whether rectal administration rather than oral administration would ovecome this problem.
TREATMENT REGIMEN AND DOSE
Anticipating that the subject and provider have reached this point in discussion and or treatment, the subject will have met all inclusion criteria and no exclusion criteria. This brings us to actual treatment requirements and dose.
1. The patient should be well rested.
2. All drugs that are not medically required and/or contraindicated should be stopped early enough to be cleared by the subject undergoing ibogaine administration.
3. In the treatment of opioid dependence, short acting opioid drugs should be stopped no less than eight hours before ibogaine administration. Methadone should be stopped no less than 24 hours prior to ibogaine administration.
4. The issue of sedation of the subject particularly in the treatment of opioid dependence is not uncommon. The question of whether sedation, post 30 hours should it be requested or required by the patient, would be beneficial or not to ibogaine therapy has not been answered. Some if not all providers feel that ibogaine effects would be best concluded without sedation. However, patient comfort is an issue and sedation may become a requirement in the treatment of any particular patient.
Ibogaine has been administered safely with various forms of sedation including benzodiazepines, barbiturates, melatonin, valerian and chamomile.
On an adjunct issue, one author comments, “benzodiazepines are useful before, during and/or after the ibogaine dose if there is anxiety. If there is considerable anxiety some days after detoxification buspirone is better because of its low liability for addiction.”
5. A number of authors comment on the issue of hydration or in the inverse dehydration. “Post ibogaine the drinking of water is very important. Initiates are requested to drink at least 3 liters of water a day. This is not only for the purpose of avoiding dehydration but, as it is the feeling of this author that ibogaine loosens toxins in the body and, they are excreted during the initiation and afterwards. The only vehicle to accomplish this is pure water.”
On an issue of safety , states an author, “I would also include avoiding dehydration. Many subjects don’t feel like drinking for some time after ibogaine and if not reminded they would not drink a drop of water for more than 24 hours. This can lead to dehydration even without vomiting. With vomiting I would view the loss of liquids as threatening.”
Continuing, another author states, “I have received patient reports that IV hydration is commonly used at the St. Kitts facility. This is not out of keeping with standardized procedures of hydrating patients undergoing surgery or chemotherapy.”
6. Emesis or vomiting is a patient condition known to all ibogaine providers. Whether a provider believes there is benefit to vomiting as part of ibogaine therapy or ritual is moot if enough of the drug cannot be absorbed to allow the therapeutic experience. To that end various providers have indicated the use of subtances as diverse as ginger tea, gravol/dramamine (dimenhydrinate), motillium (domperidone) and reglan (metaclopramide). This author participated in research involving all except ginger tea and upon reflection am uncertain if dimenhydrinate or domperidone had any effect above that of keeping the patient motionless. Metaclopramide 20 mg IV was the only medication that immediately stopped vomiting in ibogaine patients. No determination was made of whether oral metaclopramide administered prior to ibogaine would have as significant an effect as the IV administration of the drug. I anticipate this should be determined.
7. “As to dose,” one author comments, “given the modest dose range given in the manual (and I agree a publicly presented manual should lend itself to caution), the 15 – 20 mg/kg of body weight will tend to leave 5 – 10% of the opiate withdrawal symptoms. I suggest a test dose of 2 mg/kg of weight be given with an antinauseant an hour before a dose of 13 – 16 mg/kg. The effect of the 2 mg/kg “test dose” will usually produce slight euphoria which lends to a person being more amiable to receive the next and largest dose. Whereas, years ago, during the first series of sessions, after giving the full amount of 18 – 22 mg/kg that followed the 1 mg/kg “test dose”, we found that giving a smaller amount of 13 to 16 mg/kg allows for more comfort for a person who is obviously less traumatized by the intensity of the first stage and more open to receiving a booster of 6 – 8 mg/kg 5 to 8 hours later. On occasion, only when necessary, we administer an additional booster of 3 – 4 mg/kg with 24 hours of the beginning of the session, usually during the early morning hours before sunrise. I have written only a synopsis here as there are reasons, exclusions, etc., every step of the way according to the psycho-physical reactions of the individual as the session progresses.”
8. The use of a multi-dose regimen of ibogaine, over time, particularly for methadone, is in keeping with literature in the field (Kosten and Kleber, Am J Drug Alcohol Abuse 1984;10(2):249-66) indicating physical withdrawal signs to methadone may be precipitatated as long as 14 days after the administration of methadone by a narcotic antagonist drug such as naltrexone.
Included herewith, is a report of a dose regimen used to treat a patient who had been receiving 300 mg of methadone per day, the highest dose of methadone dependence yet treated with ibogaine says one provider.
We have recently used the following regimen to clear a methadone dependent person who was taking 300 mg of methadone per day.
At 52 hours after the patient’s last 300 mg. methadone dose, we gave him 5,200 mg Indra extract.
Over the next 72 hours, the patient has no physical withdrawl as per usual (in other words, no diarrhea, vomiting, sweating, running nose, pounding headache) but felt miserable.
72 hours after the first dose of Indra extract, we gave him 100 mg Ibogaine Hydrochloride.
96 hours after the first dose of Indra extract, we gave him 100 mg. Ibogaine hydrochloride.
120 hours after the first dose of Indra extract, we gave him 3,800 mg. Indra extract.
168 hours after the first dose of Indra extract, we gave him 100 mg. Ibo HCI.
192 hours after the first dose of Indra extract, we gave him 100 mg. Ibo HCI.
By his 11th day here (12 days from his last 300 mg. methadone dose), he was bright, sharp, lucid, no slurring, no signs of any methadone, no withdrawal or craving or discomfort of any kind. Patient said “I like the way I’m thinking now.”
Patient ate little in the 12 days. Lost 25 pounds. Looks robust, healthy skin. “On methadone, I gained 110 pounds” he commented”. The ibogaine is returning him to his regular body weight I feel.
“Something should be said about dose and product,” states another author. “First, some new guides, new to the use of ibogaine, may be confused in dose distinctions between HCl and extract. It would be a very unpleasant death, I suppose, with 4 or more grams of ibogaine HCl on board. Second, in my opinion 29 mg/kg of HCl is too much. I experimented with dosages in the range of 13 to 22 mg/kg and came to the following conclusion – 15 mg/kg is for the first time the optimal dose. It is effective for withdrawal and craving and for the vast majority of patients is neither too weak or too strong. Then, from the second treatment on (which I prefer to administer not earlier than 3 or 4 weeks afterwards) the subject can easily cope with 20 mg/kg and does not feel it as stronger than the first treatment.”
PRODUCT IDENTITY
The proposal of discussion of ibogaine product identity particularly for the benefit of new providers and patients is certainly legitimate as three principal forms of ibogaine of diverse purities are in use in ibogaine therapy. These substances may be, a highly purified form of ibogaine, an extract of T. iboga, that may be as low as 90% or as high as 99% in purity. Most examples of these products are 95% pure ibogaine. These products are available from commercial chemical manufacturers or by custom manufacturing by qualified chemists in university laboratories. Purified ibogaine may also be obtained by direct conversion from voacangine. This product when available had been assessed at 99.4% purity. The second principal form of ibogaine currently available is a crude total alkaloid extract and contains a reported 15% to 20% total alkaloids of which half is ibogaine. As the other iboga alkaloids contained in the total alkaloid products are active, this material should be viewed as having a potency of 15% to 20% ibogaine equivalency depending on source and batch. These total alkaloid extracts have been supplied by sources in Denmark and Canada. The third form of ibogaine material is the crude plant root bark. Depending on potency, this product may contain from 1% to 6% ibogaine. Most root bark will be in the 2% – 4% range. Any person taking ibogaine or providing ibogaine to another person should be certain of the identity of the substance as confusion of purified ibogaine and a less potent total alkaloid extract might cause a fatal reaction or not be sufficient as a dose to interrupt chemical dependence.
While the initial discovery and early research with ibogaine principally used single doses in the 15 mg/kg – 25 mg/kg range of ibogaine, the expanding base of data being presented by ibogaine providers throughout the world propose multiple dosing regimens. These dose regimens make use of purified ibogaine HCl, total extracts and root bark though principally, ibogaine HCl and total extracts except in the African religious model. Doses considered by a variety of providers to be full therapeutic doses may vary from 15 mg/kg – 25 mg/kg for ibogaine HCl and from 3 gram to 5 grams for total alkaloid extracts for the treatment of chemical dependence. For the purpose of this discussion a full therapeutic dose of ibogaine is one that will precipitate all three stages of ibogaine activity in most but, not all patients: 1) The waking dreamlike state, 2) the cognitive evaluation period and 3) residual stimulation eventually leading to sleep. Depending on circumstance and patient need, full therapeutic doses may be administered in a multidose paradigm a week to months apart.
Adjunct dose levels of ibogaine may be mediate or low. A mediate dose would be 300 mgs to 400 mgs of ibogaine HCl or possibly 1.5 to 2 grams of total extract while low doses may be in the range of 25mg to 50mg total dose range for ibogaine HCl and 100 mgs to 300 mgs of total alkaloid extracts. Mediate doses are generally used to boost a therapeutic dose should opiate withdrawal signs become evident or in the cases of some providers for a broader set of issues. Low dose regimens have been implemented for periods of ten to twenty days after recovery from a full therapeutic dose for antidepressant, antianxiety or antiwithdrawal applications. These regimens have been used in the treatment of both opiate and stimulant disorders in furtherance of the full therapeutic dose of ibogaine. It must be recognized that providing ibogaine is an art and a science and that ibogaine providers will use a multitude of doses individually determined on a patient by patient basis in accordance with the experience of the provider.
For additional information, comparative dose and strength tables from the chapter by James and Renate Fernandez found in Vol. 56 of The Alkaloids series published by Academic Press (2001) are shown below.
Alper et al.
Ibogaine dose to facilitate personal growth and change:
10 mg/kg
Ibogaine single dose in self-help network for addiction interruption:
20 mg/kg
Animal studies for neurotoxicity:
Alternate daily dose ibogaine over 60 days [no toxicity]:
10 mg/kg
Ibogaine dose associated with no evidence of toxicity [but decrease in drug self administration:
40 mg/kg
Ibogaine dose associated with cerebellar damage:
100 mg/kg
Lotsof
(personal communication in preparation for ibogaine conference)
Ibogaine dose causing modest psychoactivity with euphoria, altered perception of time:
90-120 mg
Amount of ibogaine ingested by adept that would allow remaining centered enough to assist in initiation ritual:
200 to 300 mg
Ratio of fresh root scraping to dry root bark:
15/1
Proportion of iboga alkaloids in dry root bark (50% ibogaine):
2 to 3%
Rounded teaspoon of root bark:
3 to 4 g
Amount iboga alkaloids in rounded teaspoon per above calculations:
60 to 120 mg
Fernandez
Pick-up dose , iboga alkaloid content of 1 rounded teaspoon of dry root bark:
60 to 120 mg
Large dose for initiation into Bwiti, gradual intake of fresh root scrapings, maximal dose observed:
1000 g [one kilo]
Dose recalculated as dry scraping [1000/15]:
67 g
Content of iboga alkaloids of the above quantity of root scraping, assuming an average 2.5% iboga alkaloid content:
1.675 g
Total maximal Bwiti iboga alkaloid dose calculated per kilo of body weighty in small initiate weighing 50 kilos [hence a high estimate]:
33.5 mg/kg
POST IBOGAINE THERAPY
There is no clarity that any form of adjunct therapy administered during the post ibogaine period following acute ibogaine effects is more efficacious than any other form of adjunct therapy in prolonging periods of abstinence and freedom from drug craving. This is also in keeping with the findings in chemical dependence treatment of non-ibogaine patients. It is the hope of the authors that findings of significance concerning efficacy or advantages of one form of therapeutic modality over another may be addressed in future revisions of the manual. Provider contributions are encouraged.
One author indicates, as for post-ibogaine therapy we have found that it is essential for addicts to quit smoking tobacco. Nicotine has proven to act on receptors that cocaine and other drugs also effect. Statistics show that 90% of addicts smoke and nicotine can cause craving for other drugs. Many patients find that cigarettes taste different after ibogaine and we encourage them to quit by using nicotine patches and Wellbutrin (bupropion HCl).
A second author adds, “With regard to the question of suitable post-ibogaine therapy, my opinion, from personal experience and reading Bwiti literature, is that bio-energetics or other body-based psychotherapies are most useful. The Bwiti dance constantly on iboga in the regular group sessions at the temple (not during the high dose “initiatory” session, you can’t move as I’m sure you’re aware!) and I’m sure this is for a reason.”
“My personal opinion, based on my experience of doing ibogaine, doing quite a bit of therapy afterward, and observing others who’ve done ibogaine with or without therapy afterward, is that there is sometimes a real problem with integrating the ibogaine experience properly and not simply at an ego-level. The tendency towards developing a ‘need’ for alternative belief systems to avoid bodily integration of the experience is, in my opinion, particularly marked in ibogaine users. (ie the individual NEEDS to believe something is true as opposed to being able to simply take or leave an idea)”
“Therefore body-based and emotional release therapies like primal, bio-energetics and encounter are probably highly synergistic with the ibogaine experience, in my opinion. My personal recommendation would be Humaniversity therapy, available at the Humaniversity up on the Dutch coast, and available to addicts as the Residential Addiction Foundation Program (RAF Program) lasting 3-6 months or longer.”
Another author adds, “I constantly emphasize that to take full advantage of a session it is imperative to follow through with therapy. If the 12 step programs appeal to a person then, by all means incorporate the meetings into the post session program. A couple of ingredients apply specifically to people compelled to consume drugs. One, is they do not want to experience any level of pain, i.e. physical, emotional pain is to be avoided at any cost. The second insight is that a percentage somewhere in the 90’s have experienced a deep level of physical and/or emotional abandonment from the same sex parent. Individual therapy, which necessitates finding a same sex therapist to establish the therapeutic relationship which includes transference of initial role model issues within the framework of the relationship is most healing so that by the time the metabolite washes out of the receptors from the session, the deep issues which created the addiction to begin with from the role model relationship in question has solidly begun to be actively addressed. This crucial type of therapy is, to say the least a challenge to create because of the threat it imposes to the very core ego structure. And so in the name of therapy most people will find a counselor who they are comfortable with and not at all intimidated by. This type of talk therapy will not be sufficient.”
A fifth author comments, “It’s frequent that addicted clients think that if they still feel some withdrawal effects or craving after more than 20 hours after ibogaine intake, then it didn’t work out for them and they tend to search for a dose of their drug of choice. The treatment provider must be aware that ibogaine often needs some days to stabilize its effects and therefore should heighten his immunity toward the addict’s heartbreaking performances.”
“It is important to understand the differences between treating addiction as only a physiological medical condition and treating addiction with its related psychological and social issues. In spite of the fact that ibogaine is not far from being a miraculous treatment tool, the way it is generally used is highly ineffective and wastes ibogaine’s potential. I am talking about overnight treatments that do not include an integrated treatment program. Ibogaine simply needs to be incorporated into already existing addiction treatment networks and then it will show its real potential. “
And, a sixth author: “Private therapy is somewhat hit and miss. There are brilliant practitioners out there but not many with any ibogaine experience (if any).” “… bodywork is extremely important.” “So for people that are disillusioned by therapists and group counsellors various forms of bodywork can be extremely effective – acupuncture, rolfing, breathwork (rebirthing or Grofs), dance and movement therapy. Anything that reconnects you with the trauma lodged deep in your body. If you have been addicted for years the ibogaine may bring the reasons for the distress to the surface but that won’t necessarily release them – especially if they are lodged deep – which is why the previously mentioned practices help.”
“I would also suggest that a support group is extremely beneficial. Unfortunately no matter how much I tried I couldn’t get the people that I had seen to form an ibogaine support group and I think this would really help. I have seen it help on the ibogaine list. People able to talk to each other about their experiences on line. Perhaps this is the only way to do it but it would be good for example to have a group… that met once a month to talk about things.”
“To conclude, no three day recovery program in itself can correct years of substance abuse. It is therefore essential to arrange follow up care. The ibogaine experience itself leaves you open and enthusiastic about creating changes in your life. Post treatment bodywork/counselling is essential, as it will help maintain this positive transformation and facilitate a deeper understanding and release of years of abuse.”
While still another reflects, “I think it is important we not only reach for the most significant endpoint in offering ibogaine therapy but, view what we are doing from a harm reduction perspective and a pro-patient perspective in that anything that benefits the patients, short or long-term, should be viewed as a valuable outcome. I think it is universally accepted that multiple ibogaine treatments over time provide better results in most cases than a single administration. This is not to say that a single administration is not dramatic in its ability to interrupt an out of control addiction syndrome. I think it would be fortunate if ibogaine were a legally available medication through both social and private medical insurance programs. Availability coupled with normalization of addiction into mainstream medical treatment will offer the best outcome in our society which is medically directed. Under other circumstance, a religion would do just as well, and that is not to exclude the self-help group or association concept. From what I see of the suggestions of many of the authors, a belief system and the ability to take some action, to allow a sense of power and accomplishment are important.”
Invitation to Contribute
Many questions for which we seek answers remain: How do ibogaine providers best care for ibogaine patients? The primary authors continue to seek a consensus from ibogaine providers and patients as well as, others working in addiction medicine. Is a consensus possible? That remains to be seen but, with each revision of the manual we may come closer.
Submissions should be made to Howard Lotsof. Accepted work will be incorporated into the next revision of this manual and the authors indicated as contributing authors to this manual or not, at their discretion. Revisions shall be made periodically.
APPENDICES
***********
NIDA DRAFT PROTOCOL
Rising Dose Tolerance Study using Single Administration to Assess Safety and Preliminary Efficacy of Ibogaine for the Treatment of Cocaine and/or Heroin Dependency
Developed/Issued
by
MDD/NIDA
(10/19/93)
Introduction Safety and Exclusion Criteria
Preclinical Studies
Exclusion Criteria
Psychological Assessments
Neurological Assessments
Opioid Withdrawal Assessments
General Physical Condition
Assessments During Treatment
Safety and Exclusion Criteria
[ introductory statements ]
To date, there is no published data from a controlled clinical trial that has assessed the safety of ibogaine in the treatment of drug addictions. Information from the anecdotal reports indicates there is a mild transient increase in blood pressure and a minimal effect on pulse and respiration.
To date, there is no published data from a controlled clinical trial that was conducted to assess the preliminary efficacy of ibogaine in the treatment of drug addictions. The initial observations of effects of ibogaine was a narrative account (L.A.C., 1991)of the results of taking ibogaine in the mid 1960s by seven heroin addicts, five of whom several days later reported no signs of withdrawal, abstinence, and no desire to take heroin.
Of the 7 clients in the mid-sixties, 6 received one treatment of ibogaine and the effects were that 2 resumed heroin use 24 hours later, one resumed heron use 5.5 months later and the remaining 3 were drug-free 6 months after receiving ibogaine. One subject reported receiving ibogaine 5 times and reported abstinence from: heroin use for 3 years, cocaine use for 18 months and amphetamine use for 6 months.
Of the 18 clients in a contemporary group, 17 received one treatment of ibogaine and one received 2 treatments. After ibogaine, two clients continued to take heroin and one resumed heroin use 5 days later. Six subjects were drug-free from 2 weeks to 18 months, but contact was lost with them. Two subjects were heroin-free for six months and were awaiting retreatment with ibogaine. One subject was cocaine-free for 3.5 years. The remaining 5 subjects were drug-free for 2-10 months.
return to Manual table of contents
return to NIDA Protocol contents
Preclinical Studies on Ibogaine
Safety Issues
The most salient safety issue is contained in the findings of (O’Hearn et al., 1993) that when rats were administered high doses of ibogaine (100 mg/kg i.p.) glial cells in the cerebellum were activated, thereby suggestive of neuronal damage which the authors hypothesized were most likely the purkinje cells. [see additional documents #1 and #2]
Other safety issues about the effects of ibogaine are contained in the reports of: increased blood pressure and heart rate in conscious dogs and decreased blood pressure and pulse rate in anaesthetized dogs (Gershon and Lang, 1962), decreased blood glucose (ibogaine 20 mg/kg or 40 mg/kg) and increased blood glucose with higher doses in rats (Dhahir, 1971).
Safety Measures – Cerebellar Functioning
Prior preclinical studies indicated that the major safety issue with the administration of ibogaine is the remote possibility of lasting damage to the cerebellum, especially the purkinje cells. The repeated neurological assessments of cerebellar functioning in our subjects will consist of an extensive neurological examination that assesses most of the readily measurable dimensions of cerebellar functioning. The neurological examination was adapted from the application of comprehensive preclinical work on the cerebellum that was summarized in a book by (Ito, 1984) to contemporary texts on neurological examinations (Kaufman, 1990; Scheinberg, 1981). The major neurological signs that indicate cerebellar damage are: dysmetria (inaccurate targeting of goal-directed behavior), delayed movement initiation and delayed reaction time, dysdiadochkinesia (inability to perform rapidly alternating repetitive tasks), hypotonia (reduced muscle tone), disturbances in gait and station, and intention tremor. The check-list for the Neurological Assessment Battery will consist of 12 behaviors that will be evaluated by the following discrete categories of impairment: none, mild, moderate and severe. In addition, while on inpatient status, PET scans will be conducted during the inpatient phase 3 days before and 3 days after the Ibogaine session and during the one-year follow-up assessment battery.
return to Manual table of contents
return to NIDA Protocol contents
Exclusion Criteria
1. Patients with a history of active neurological or psychiatric disorders, such as cerebellar dysfunction, psychosis, bipolar illness, major depression, organic brain disease or dementia, that require treatment or that would make study compliance difficult.
2. Patients who have a Beck Depression Inventory score greater than or equal to twenty-four.
3. Patients requiring concomitant medications that may interfere with a clinical trial or evaluation (e.g., anti-epileptic drugs, sedatives, hypnotics, antidepressants, neuroleptics, methadone, meperidine, etc.) [A significant number of patients treated in the last decade outside of this proposed research study have been dependent on methadone, meperidine or sedatives].
4. Patients with a history of sensitivity or adverse reactions to the treatment medication.
5. Patients with a history of significant heart disease or a history of myocardial infarction.
6. Patients with blood pressure above 170 mm Hg systolic/105 mm Hg diastolic or below 80 mm Hg systolic/60 mm Hg diastolic or a pulse greater than 120 beats per minute or less than 50 beats per minute.
7. Patients who have a history of hypertension uncontrolled by conventional medical therapy.
8. Patients who have received any investigational drug within 6 months prior to entering the study. [The authors received a report of concurrent use of ibogaine and 5 methoxy di isopropyl tryptamine (5meo dipt) that precipitated a medical event of near fatal proportions requiring over a week of hospitalization. Additionally the patient was diabetic and did not monitor blood glucose levels.]
9. Patients who have received any drug known to have a well-defined potential for toxicity to a major organ system within the month prior to entering the study.
10. Patients who have clinically significant laboratory values outside the limits thus specified by the investigators laboratories.
11. Patients who have any disease of the gastrointestinal system liver or kidneys, or abnormal condition which compromises a function of these systems and could result in a possibility of altered metabolism or excretion of the study medication will be excluded. As it is not possible to enumerate the many conditions that might impair absorption, metabolism or excretion, the investigator should be guided by evidence such as:
A. History of major gastrointestinal tract surgery (e.g., gastrectomy, gastrostomy, bowel resections., etc.) or a history or diagnosis of an active peptic ulcer or chronic disease of the gastrointestinal tract, (e.g. ulcerative colitis, regional enteritis, Crohn’s disease* or gastrointestinal bleeding).
B. Indication of impaired liver function.
C. Indication of impaired renal function.
12. Patients who test positive for HIV virus.
13. Patients with active tuberculosis.
return to Manual contents
return to NIDA Protocol contents
Psychological Assessments
1. Interviews
A. Addiction Severity Index (ASI)
B. Diagnostic Interview Scale (DIS)
2. Questionnaires
A. Visual Analogue Scale cocaine craving (VAS)
B. Beck Depression Inventory (BDI)
C. Minnesota Multiphasic Personality Inventory-2 (MMPI-2)*
return to Manual contents
return to NIDA Protocol contents
Neurological Assessments
1. Electroencephalography (EEG)
2. Neurological Assessment Battery
A. Coordination/tremor
a. Finger-to-nose
b. Finger-to-finger
c. Heel-to-shinB. Coordination/tremor, Repeated rapid alteration tests
a. Palm/back hand slap knee
b. Prone/supine forearmC. Coordination /ataxia
a. Heel-to-toe walking
b. Romberg test (feet together, eyes open/eyes closed)D. Muscle tone/hypertonia
a. Resistance to stretch
E. Reflexes
a. Acoustical startle
b. Pupilary light reflex
c. Vestibulo-occular reflex
return to Manual contents
return to NIDA Protocol contents
Opioid Withdrawal Assessments*
1. Objective Opiate Withdrawal Scale (OOWS)*
2. Subjective Opiate Withdrawal Scale (SOWS)*
return to Manual contents
return to NIDA Protocol contents
General Physical Condition
1. History and Physical
2. Electrocardiogram (EKG)
3. Laboratory
Blood Work
a. CBC DIFF
b. AST ALT
c. Hepatitis screen
d. Thyroid panel
e. SMA-18 profile
f. CHEM-25
Urine
a. Routine urine analysis
b. Toxicology screen (positive for target drugs)1. cocaine
2. morphine (heroin)
3. cocaine
4. ibogaine
Dermal Tuberculin (if positive or previously immunized, then chest x-ray)
Breathalyzer
Vital signs with weight
HIV test and counseling
return to Manual contents
return to NIDA Protocol contents
Support staff and design of environment
Generally, the session room should be pleasant and the social interactions with staff members supportive. Pastel-colored walls, comfortable hospital bed, soothing murals, paintings or pictures, a comfortable chair for the staff member or therapist to constantly observe the subject during the ibogaine experience. Dim lighting and quite setting. Dialogue should be initiated by the patient. Reduce the need for walking by having a patient lavatory nearby.
Within this context, allow the patient to sleep and rest peacefully ad lib. Otherwise, when the patient is in the talkative phase, the staff member should attentively and unobtrusively attend to but not initiate conversation.
return to Manual contents
return to NIDA Protocol contents
Assessments [during treatment]
Cardiovascular – Apply ambulatory pulse and blood pressure apparatus that is programmed to obtain and record digital quantities q 30 min for a 24 h period. Apply device just before dosing.
Neurological – Observe for the onset (that is time from the administration of ibogaine) for drug-related changes in neurological functioning (e.g., the onset of changes in speech patterns, nausea and vomiting)
Psychological – Observe and record what patients spontaneously say, Record the onset and duration of the somnolent phase.
Related Protocol Bibliography
Dhahir. A comparative study of the toxicology of ibogaine and serotonin. Doctoral Thesis. 1971. return to chapter
Gershon S., Lang W.J., A psycho-pharmacological study of some indole alkaloids. Arc. Int. Phamacodyn. 85, 31-62, 1962. return to chapter
Ito, M. The cerebellum and neural control. New York: Raven Press, 1984, Pp. 353-465. return to chapter
Kaufman, D.M. Clinical neurology for psychiatrists (3rd Ed.). Philadelphia: W.B. Sanders Co., Pp 18-20, 1990. return to chapter
L.A.C. Can a psychedelic drug cure drug addiction? The ibogaine story. Drugs, Toxic Chemicals and Health 6, 1-2, 1991. return to chapter
O’Hearn E., Long D.B., Molliver M.E. Ibogaine induces glial activation in parasagittal zones of the cerebellum. Neruroreport. 4, 299-302, 1993. return to chapter
Scheinberg P. Modern practical neurology; An introduction to diagnosis and management in common neurologic disorders (2nd Ed). New York: Raven Press 1981. return to chapter
***End NIDA Protocol Selections***
return to Manual contents
return to NIDA Protocol contents
Additional Documents
1. An evaluation of ibogaine neurotoxicity, including abstracts of relevant papers. Return to chapter
2. Daniel Luciano MD describes neurological observations of treatment with ibogaine. Return to chapter
3. What’s in a blood test? (SMA-20). You are about to find out. Return to chapter
4. A good place to learn the terms used in blood test reports, their meaning and the significance to health related issues. Return to chapter
5. A CBC or complete blood count along with a differential that indicates the breakdown in the types of white blood cells offers a comprehensive view of blood chemistry in conjunction with the SMA-20. Return to chapter
6. A general review of cardiovascular disorders can be found at The Open Directory Project and at The Medical Center Online. The topic is also well covered in Section 16 of the Merck Manual Return to chapter
7. Everything you want to know about electrocardiograms if you could think of the questions. Return to chapter
8. This early report, Reflections on an Ibogaine Experience, provides an excellent treatment overview that includes concurrent ibogaine/heroin use by the patient. The survival of this patient should not be taken to indicate the survival of other patients under similar circumstance. Return to chapter
9. A copy of the Beck Depression Inventory is available as an FDA document. This page automatically downloads the pdf file of the beck depression inventory to your computer. PDF files require adobe reader programs that are available at no costfrom Adobe return to chapter
10. The Minnesota Multiphasic Personality Inventory MMPI-2 may prove a valuable tool in assessing pre and post-treatment behavior of patients. Return to chapter
11. The Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition, better known as the DSM IV, offers detailed descriptions of broad ranging psychiatric disorders. Return to chapter
12. Treatment of Acute Opioid Withdrawal with Ibogaine. Alper et al.’s review article of ibogaine effects on opioid withdrawal signs of subjects from the United States, The Netherlands and Panama over a period of three decades is now available as adownloadable PDF file. In order to read a PDF file you will require an adobe reader program from Adobe. Return to chapter
13. The early paper (1995) Ibogaine in the Treatment of Narcotic Withdrawal by Lotsof, Della Sera and Kaplan provides useful information on the comparative effects of ibogaine and narcotic withdrawal. Return to chapter
14. Ibogaine in the Treatment of Chemical Dependence Disorders: Clinical Perspectives offers an overall view of ibogaine therapy and what may be anticipated during treatment. Return to chapter
15. Frenken, an early ibogaine researcher provides her views on ibogaine therapy in An Ibogaine Treatment Protocol providing a view of the Dutch ibogaine self-help movement. Return to chapter
16. Nick Sandberg presents a thorough review of ibogaine safety, effects and history in his original work Introduction to Ibogaine return to chapter
17. A good place to begin to gain an understanding of a structured report form. Guidelines for psychiatric evaluations of Adults. return to chapter
18. Catalogue of diagnostic questionnaries. return to chapter
19. Brief Psychiatric Rating Scale. return to chapter
20. The Sexual Inequality of Drug Metabolism. The Scientist 16[6]:29. return to chapter
21. Notes to Treatment Providers by H. Wells gives a view of ibogaine treatment issues in the United Kingdom. return to chapter
22. Always of value, a medical encyclopedia. return to chapter
23. “Merck & Co., Inc., is proud to introduce The Merck Manual of Medical Information–Home Edition.. This all-new publication is based on The Merck Manual of Diagnosis and Therapy, Centennial Edition , commonly referred to as The Merck Manual, the textbook of medicine most widely used by health care professionals in the U.S. and worldwide. The Home Edition transforms the language of the professionals’ version into commonly used English while retaining the vital information about diseases, diagnosis, prevention, and treatment.” The reader should review both volumes to determine which best meets your needs. “The Merck Manual of Medical Information–Home Edition, like all the Merck manuals and The Merck Index, is published by Merck & Co., Inc., on a not-for-profit basis. Copyright © 1995-2001 Merck & Co., Inc., Whitehouse Station, NJ, USA. All rights reserved.” return to chapter
24. How to Safely Use Ibogaine, a public document of the Iboga Foundation, a not-for-profit group in Slovenia approaching ibogaine use from a religious perspective.
The Religion of Iboga or the Bwiti of the Fangs
P. Barabe
Chief physician, Professor of Tropical Medicine
Translation from French, “La religion d’Eboga ou le Bwiti des Fanges”, Med. trop. 12(3):251-257, (May/June) 1982. Copyright English translation 1997 by William J. Gladstone
Lecture given at the closing session of the course of instruction for the class of 1981 on July 10, 1981.
Among the different countries of central Africa, Gabon is certainly one of the most fascinating and mysterious. Its geographic location accounts for its equatorial water and climate conditions and the existence of a dense forest which was long a barrier to the establishment of routes of communication and delayed the exploitation of its natural resources. This forest which is penetrable only with difficulty and is the site of an invisible and fantastic world of the spirits has an irresistible effect on the individuals. Also, the different ethnic groups, some forty in all, remain isolated from each other and retain their way of life, traditions, rites and beliefs.
In the words of Bureau, “Gabon is to Africa what Tibet is to Asia, the spiritual center of religious initiations”.
We will concentrate our attention more particularly on two ethnic groups and two regions:
Tsogo land and the Mitsogos;
Woleu N’Tem and the Fangs or Pahouins.
Tsogo land extends from Fernan Vaz lagoon in the West to Chaillu Mountains in the East, named after the explorer Paul Belloni du Chaillu who, from 1857 to 1865, penetrated in the interior of the country. This region is flat and dotted with lagoons along the ocean shores; it becomes rugged and mountainous east of Mouila and reaches an altitude of 1575 meters on Mount Iboundji. It is covered by a thick, oppressive forest which in most places forms a veritable canopy of vegetation.
The mountains are always veiled by mist, and the combination of a low degree of sunlight and a high humidity accounts for the rather low temperature, particularly during the dry season. “It is an unhealthful type of heat, the kind of heat you associate with fever and hospitals”, said G. Simenon in his novel “Coup de lune” in 1932.
Because of the inhospitable natural surroundings, the damp warmth of the valleys, the tribal wars of the last century in which the Mitsogos were driven back by the Bakeles between the left bank of the Ogoue and the Ngounie, the villages are located on the high grounds.
The essential preoccupation of the Mitsogos is the Bwiti, a primitive Bwiti. According to Raponda Walker, the Bwiti of the Mitsogos may be defined as “a male secret society that has its rites, its regulations, its secret sessions and public sessions”. There is no supreme chief for all of the tribes that have adopted it and each village practices the Bwiti independently of the others, under the authority of a local president. To join the sect, you have to take an oath and swear “Na bwiti a besu” (by our bwiti) before receiving an initiation with the sacred plant iboga.
The Bwiti originally belonged to the Mitsogos and also to the Okandes and the peoples of the Eshire group; subsequently, it extended down to the coastal areas, the regions of the Middle Ogoue and the Woleu N’Tem where the Fangs are to be found.
The Woleu N’Tem, the northernmost region of Gabon, is relatively isolated from the rest of the country by the chain of Crystal Mountains. This Plateau is difficult to reach and is situated at an elevation of 700 to 1200 meters. A single winding road goes there. It is along this road, somewhere between Oyem and Mitzic, that Pierre Benoit laid the plot of his novel “Monsieur de la Ferte”.
In this region of Woleu N’Tem, “the novelist describes the equatorial forest as gloomy, hostile, frightful, and evil. Every backwater pool teems with caimans, and as soon as nightfall comes to the bivouac, you can expect at any time to see lizards and snakes fall into the wrought iron mess kits. But, still according to Pierre Benoit, these terrifying and unseen hosts are nothing compared to the men who haunt the Gabon forest”. These men are the Fangs or Pahouins. They probably came from central Africa, perhaps from the regions of Ubangi and Chari, fleeing before Islam in a southwesterly direction toward the ocean. They are sure of their own strength and of their ability to dominate, eager to receive that which is new, convinced that they can integrate all techniques and ideas into their own culture, and it became obvious around 1910 and especially since 1925 that they would take possession of the primitive Bwiti of the Mitsogos and modify it. To it they added their memories, their traditions and introduced ideas and rites that came from Catholicism; finally, they initiated men and women. However, the chants usually remained in the Tsogo language, the official language which is to Bwiti what Latin is to the Church.
Currently, the primitive Bwiti of the Mitsogos is on the decline while the Bwiti of the Fangs is expanding, though perhaps, according to some, it is losing a little of its initial purity.
The Gabon forest is a veritable phytotherapeutic gold mine and its plants are an element indispensable to sylvan life and rites. Among the plants with magical properties, the most widely used is the sacred plant, a type of apocynacea, Tabernanthe iboga, the foundation of the Bwiti and the basis of visions of the next world.
Tabernanthe iboga is a small smooth shrub that grows up to a height of 1.5 meters. The flowers are white with pink spots and the ellipsoid fruits have globular seeds. It has a pivoting branching root that is more or less twisted. When you chew its bark, it has a bitter, astringent taste and produces an anesthetic sensation after a few minutes. The alkaloids are found mainly in the cortex of this root but are contained in every part of the plant. The number of alkaloids known at this time is 22. The principal ones are:
Ibogaine
Tabernanthine
Ibogaline.
Ibogaine and the related alkaloids have very special properties. In low doses, ibogaine reduces sleep, makes it possible to resist hunger and fatigue, activates circulation and respiration, promotes and activates secretions and diuresis.
In high doses, it produces a hallucinatory inebriation with motor incoordination, and sometimes a state of lethargy lasting 4 to 5 days. In massive doses, ibogaine may cause death as a result of bulbar involvement and paralysis of the respiratory muscles. The essential effect is its hallucinogenic property. The drug is a psychodysleptic that produces a state of anxiety and extreme apprehension and a visual hallucination, considerably enhanced by darkness, the ambiance and suggestion. This action is not unlike that of LSD, mescaline and amphetamines.
The current studies by Goutarel, Potier and Dacosta suggest that these are substances of particular interest which produce an increased state of wakefulness without producing side effects.
The Pygmies attribute the discovery of this plant to the warthogs who, it seems, are very fond of it. These animals dig holes at the foot of the iboga shrubs to chew the bark of the roots. They then go into a state of wild frenzy, leaping and fleeing as though they were prey to terrifying visions. Porcupines and gorillas also search for these roots.
This plant was recommended for use in human clinical practices in 1905 by Pouchet and Chevallier who advocated it in the treatment of neurasthenia and in convalescence, and by Kuborn who recommended it in the treatment of sleeping sickness. The iboga alkaloids have their place in the pharmacopoeia under the name of Lambarene and glutaminic Lambarene B2 PP; these products were withdrawn from the market about ten years ago. Iboga is still used as a stimulant by hunters and warriors who stalk at night, by trackers, and by those who paddle canoes and pirogues. Actually, iboga is reserved for the bwiti cult. This sacred plant has served to unify a whole people, and to some extent has enabled it to resist the influence of Western civilization.
Iboga is the very source of the bwiti religion, commonly called “religion of Eboga”. Iboga gives knowledge of the beyond through the spiritual death, in advance of its time, that it produces. By the visions that it brings about, ritual mastication of iboga permits contact with ancestors and gods: Mebeghe is the name of the divinity in the Fangs, a supreme being without mother or father or spouse. It engenders the three divinities by bursting the divine primordial egg.
Nzame-Mebeghe, God, is born with his brothers and sister but remains pure.
Nyingone-Mebeghe, “sister of God”, the female principle of the universe, goddess of fertility and of the night. At the instigation of Evus, she committed Nsem, incest, with None. As punishment, she must carry the earth on her head.
None-Mebeghe, the third individual in the divinity, the male principle, has committed Nsem.
Ekurana has issued fourth from the placenta and umbilical body of the divine egg. It possesses thunder and makes order reign.
Evus, twin brother of Ekurana, has been punished with a thunder clap on orders from Nzame. He is the tempter and initiator of Nsem.
All of these divinities are represented in the temple, the place for night-time ceremonies, the place for celebrations on the occasion of feasts and initiations, the place for funeral dances on the death of a person of standing. The temple may also serve as a meeting room, as a courthouse or a guardhouse. It is called Mbandja. It is a vast rectangular hut, measuring on the average twenty meters in length and ten meters in width, completely closed in the back, partially or completely closed on the sides, and with a wide opening in the front. The dimensions depend on the size of the village, the repute of the chiefs, the number of followers and their wealth. The long axis is laid out northeast by southwest, parallel to the route followed by the Pahouin group during its migration in the last century. The roof is covered with ordinary matting or with raphia leaves or preferably with leaves of sclerosperma, a sort of dwarf palm. The curved canopy must always be made of sclerosperma leaves. The framework is supported by different columns. The great column with a highly sculpted base, situated at the entrance to the temple, partly hidden by the canopy, has an essential symbolism. At the foot of it burns a torch of oleoresin of Copaifera religiosa from the sacred tree Olumi or Andzem. Among the Mitsogos, the column rests on the remains of ancestors (skulls and tibias) and it is strictly forbidden to lean against it out of respect for the ancestors. When it is no longer used because of its deteriorated condition, it is laid down with care and takes its place in a corner of the temple or against the sacred tree.
The sanctuary proper is located in the completely closed back part. This is where the musicians and the chief of the community, the Kombo, will take their places. In the same location, we can see the Bwiti symbolized in the form of small carved statuettes. The side walls of the temple are sometimes bare or may be decorated, painted, or may be hung with emblems: snake skins, trophies, musical instruments. There are often bas-reliefs highlighted by very lively colors and wooden boards decorated with paintings. The use of iboga which gives colored visions may not be unrelated to this decorative art. Despite the sacred character of the temple, travelers or strangers may stop there for a rest, and one often sees old people sitting there, smoking their pipe.
Indeed, everything there is a symbol. Bwiti writings describe perfectly the significance of its principal elements. This temple represents the image of man lying on his back. The ground covered by the canopy represents the legs. The back of the temple, the sanctuary, represents the head. An indoor wood fire is the heart. The navel is depicted by a round piece of basketwork or a bicycle wheel suspended from the roof. It symbolizes the place where all the world’s creatures are connected to the divinity, and what an excellent symbol is the use of the wheel and its infinite number of spokes to express complex metaphysical concepts. The carved main column represents the external sex organ of this man stretched out on his back, as the bwitists say, “a link between the sky and the earth”. It supports the crest of the roof which, with the rafters, represents the spine. Along the axis of the temple, the center of the column is pierced with a hole of 10 to 20 centimeters in diameter which is far higher than it is wide. This is the female external sex organ. Binet has specified its symbolism and has emphasized this complementarity of the sexes. It is the door that every man goes through as he comes into the world. It is the “ozamboga”, the opening to the future hoped for by the Fangs after completing their migration with so many difficulties. At the same time, it is a window that opens out on the beyond which permits communication from one world to the next. A second smaller hole above represents the gate of heaven through which one must pass to join God. It divides the temple into a left and a right part. According to Binet, who has made a particular study of the Bwiti of the Fangs, one should enter on the right side, i.e., the “left foot”, and go out on the left side. The right side symbolizes life, the sun and man: it is the men’s chamber. The left side symbolizes death, the moon and woman: it is the women’s chamber. At the location of the neck is a second pillar that represents Nyingone in a state of expiation for the incest, the Nsem, that she committed with None under the influence of Evus. For this purpose, she must have her hands raised and lift up the earth above her head; the planet is then both a diadem and a burden. Above is a depiction of a knot symbolizing the bond between the here and now and the beyond, between earthly existence and divine existence.
Thus, the first half of the temple presents binary realities, the male side and the female side, with the influence of None and Nyingone. The deepest part, that of the chancel, situated past the fire, has a ternary symbolism, because we also see the action of the sky with Nzame. That is where the breath of God passes.
In the back is the harp player and the two musicians who play the obaka, a sort of sonorous rod symbolizing the sound of the hammer on the anvil originally made by None. That is the place where the Kombo, chief and father of the community, holds office; he will direct all of the ceremonies, dominated by chanting and dancing. The musical instruments are numerous and symbolic. The rattle is carried by the initiates in the right hand. It symbolizes the genital organs of Bunenge who, according to Fangs mythology, died while picking fruit in an “atangatier”. His body was found by his wife Benzogho in the river. The fly-whisk symbolizes the genital organs of his wife Benzogho, sacrificed after taking iboga which had made it possible for her to see her husband again. Benzogho, initiated by the Pigmies, paid with her life for the knowledge she acquired and is responsible for the foundations of the Bwiti. The musical bow symbolizes Nzame, whose wood represents the spinal column. It is very difficult to play this instrument and the Mitsogos are the only specialists. The clear-toned rod or obaka punctuates all events, and notably the bursting of the divine egg. It symbolizes the deafening din of thunder. The eight-stringed harp (Ngoma or Ngombi) issued forth from the body of Benzogho. It is a cithara in which each string represents a part of his body. It also symbolizes maternal and paternal relationships and is a veritable family organization chart. The harp made of Anzem wood is the object of exceptional veneration. It is considered as a living being. Initiated, dressed and bathed, it possesses a celestial spirit within its body.
A high priest poetically described the role of the instrument and the music as follows: “To see God, one must eat the body of God symbolized by iboga, and the cithara, Ngoma, takes us by the hand and leads us toward God. It is a pirogue that takes us from the here and now to the beyond, from the profane world to the sacred world, from the world of the living to that of the dead”. When the harp plays, it is woman who cries, and the woman is Benzogho, the first victim of Eboga. The great moments of the cult are announced by the horn, usually an antelope horn, and the hand bell which plays an essential role and sets the rhythm of the prayers. It notifies the arrival of new participants and the deposit of offerings at the foot of the second column. It symbolizes the heartbeats of God. The audience also sings to the rhythm of tom-toms and cattle bells made of round fruits, sort of leguminous plants with large seeds.
Like most religions, Bwiti has initiation ceremonies, a ritual, a liturgy. The initiation ceremonies remain secret, and among the Fangs take place on a Wednesday or a Thursday. They are followed by several ritual nights. The initiation, which takes place from the age of 10 to 12, the age of discretion, must be received as a great honor and is indispensable for understanding the ways of the “things of the earth”. No one may be initiated without first chewing iboga in a sufficient quantity to bring about visions of the beyond.
The plant of initiation, the Ndjimba, is situated in the midst of the forest, among the Mitsogos. It is the site of secret sessions. It is located in a place fairly far from the village, under a Copaifera religiosa, Olumi or Andzem, a tree with a red trunk whose color contrasts with the green of the forest, the tallest tree, a mysterious tree that resounds when struck because of the hardness of its wood, a tree that insures riches, honors and fame. The resin of its bark is used to prepare torches, and a decoction provides the lustral water necessary for washing the Bwiti statuettes and the purification of the followers. Among the Fangs, the Ndjimba, against the backdrop of the forest, is a short distance from the temple and often right opposite in a place swept perfectly clean, surrounded by tree trunks that serve as benches. That is where the future initiates gather. One always finds there the tree with a straight trunk whose size symbolizes how difficult it is for a man to rise to the divine level.
Between the Ndjimba and the temple is the Otunga, the very place of the sacrifice that must be paid to be accepted for the new spiritual birth. The Otunga is often a tree. It is in fact a trial and symbolically the leader of the chorus is beaten there and thrown to the ground.
The initiation begins with a bath in a forest stream while the cithara is heard. The candidates receive a handful of freshly picked iboga roots, a set quantity chosen for each of them. They use small baskets of woven rattan, the size of saucers, manufactured for this purpose and tied together three by three. The young sometimes show a certain reluctance to chew these roots, and they may be given the contents of a gourd to drink, consisting of water in which the iboga root has been macerated. The boy often vomits, but that is a good sign because “you must vomit (everything) up to the first drop of milk”, meaning that you must totally reject earthly life to accede to another life. Very quickly, highly colored images appear, the initiates lose consciousness of the outer world and fall into a deep sleep on a mat laid out on the ground. The state of lethargy depends on the dose of iboga ingested and may last 4 to 5 days during which time no food is taken. The purpose of absorbing this “beverage of bitterness” is to be able to see the beyond thanks to the hallucinogenic properties of iboga, to communicate with God and the ancestors, and to die on this earth in order to be reborn closer to God.
During the period of lethargy, the initiate sees fantastic apparitions. An endless procession of masked, bony, lame, crippled, grimacing, terrible dead files past rapidly. The belly is always open, as a consequence of ritual autopsy. Gradually, the specters disappear, the visions dissipate and the initiate recovers from his state of inebriation and dazed condition.
The initiates then undergo a thorough examination by the Kombo and must be able to answer the questions to determine whether they have seen Bwiti, how he appeared to them and what he told them. If the answers are satisfactory, the successful candidate is admitted into the sect. In the opposite case, which is rare, a new initiation with iboga must be performed.
However, it is not all over yet for the young initiate. Ibama Ngadi, the thunder plant, a ritual solution that burns like pimento, is poured into his eyes while he stares directly at the sun. The purpose is to show him that now that he has experienced the initiatory light, he can henceforth look at the profane light of the sun without being blinded by its rays.
There are three degrees in the initiation, or three levels of maturity corresponding to childhood, adulthood and old age. The Bandji is the young initiate; when a Bandji proves to have sufficient maturity, he will be made a Nima, and will soon be a Nima Na Kombo. The Kombo is the chief, the patriarch who belongs to the assembly of ancestors. He sees to it in the community that the secrets are not divulged.
This initiation is followed by three Ngozes, ritual nights, whose names are:
the first night, Efun, the genesis
the second night, Mesoso, the bath
the third night, Otunga, the dues.
The ritual nights, or Ngozes, take place from sunset to sunrise. Night, the time of fertility but also the time of the moon and the earth, must be as inconspicuous as possible. The Ngozes are scheduled long ahead of time. There is a calendar of holy days patterned on that of the Catholic Church. Christmas and Easter are major celebrations. The Ngozes usually take place after the initiation rites. A Ngoze can also be held to make up for the initiation of a prematurely deceased relative, or offer prayers to the dead, to find out the cause of a disease and to cure it, to get manioc, fish, and children. Ritual nights are public and anyone may be invited to attend. Actually, non initiates depart before the important rites begin: one cannot remain until dawn for several nights in succession without chewing iboga. By morning on the day of worship, the Mbandja is decorated with garlands, with greenery, particularly from palms and creeping club mosses (lycopodia) or ferns of the Platycerium stemaria type (it should be mentioned that this plant has another purpose and there is a preparation made for the care and preservation of the hair, consisting of ashes of Platycerium stameria leaves and vegetable butter, to be applied in the morning and the evening). The followers prepare to take part in the worship by chewing some pieces of iboga root. Alcohol and wine are also distributed in moderate quantity. Prior to any ceremony, purification by fire is performed by the leader of the chorus. He brandishes a torch of okoume resin, circulating in all directions inside the temple. The women decorate the forehead of the initiates with a red vertical line and a white horizontal line as a symbol of the male and the female sex. The women wear a white robe and the men who rank high in the hierarchy wear a large white robe and a red belt. Once the assembly is gathered, the Kombo gives the news and the instructions for the day. The ceremony, announced by sounding the horn, takes place at night in three stages:
– The Efun, that is to say, the origins, the genesis, the birth and the beginning of God, marks the beginning of the ceremonies. The musical bow and the obaka are heard: this is the bursting of the divine egg. At midnight, at the sound of the horn, the initiates kneel, addressing Nzame in their prayers, thus ending the celebration of the genesis;
– Mvenge, death, the second stage, relates the life and death of the individual, often with scenes that more or less depict the passion of Christ. As the dancing and chanting reach their highest intensity, the cithara is heard and Bwiti will materialize by the appearance in the forest of a cross of straw and wood several meters high which is set ablaze and waved in all directions. It may also appear in the form of banana leaves in an oval design with two torches for the eyes and one for the mouth in the center;
– The third stage is the beyond, or Meyaya. The rites of the descent into the grave are performed before the kneeling assembly. The faithful, torch in hand, then leave the temple and go through the main streets of the village, taking three steps forward and two steps back. This night march when the moon is at its zenith is particularly impressive and majestic. The horn sounds, announcing each move and setting the pace for this retreat in single file.
After this long walk, they return to the Mbandja. The dancing will continue uninterruptedly until dawn’s early light. The night-time ritual has made them pass from daylight to daylight, from the here and now to the beyond, and night has been erased. The faithful will go to sleep. In addition to the sensations produced by the mastication of iboga, they will feel the inebriation due to palm wine and the smoke of Indian hemp.
Thus, during 12 hours by the clock, from 7 p.m. to 7 a.m., the uninterrupted, endlessly diversified concatenation of chants, dances and rites performed by individuals perfectly familiar with the symbolic actions leaves an impression of impenetrability.
The next day, despite the physical and mental exhaustion, will be a day of feasting and the menu will be presented in a large cooking pot with meat, fish, bananas, taros, prepared exclusively by the women.
Such is the Bwiti. Some conclusions are called for in order to understand this religion better.
By definition, the doctrine of a secret society is reserved solely for the initiates. The fear of punishment is a major obstacle to the disclosure of secrets, by deference to the ancestors and the pride of keeping such “great secrets”.
The Bwiti is, first and foremost, a remembrance of great ancestors whose skulls and tibias are piously preserved, but although that is the primary goal, it is not the only one.
This society which includes the notables of the village permits a discussion and a better understanding of the social problems relating to the clan, the village and the ethnic group and particularly relations with other clans, villages and ethnic groups.
The Bwiti has brought about changes in social structures, and the mystical bond that unites the initiates often eclipses blood ties. It has played a major political role. Some see it as a veritable State religion, as a national cult.
The liturgical rites are not very demanding and consist of chants and dances. It is adapted to modern life and the strictly occult side of the secret ceremonies is of diminished importance in relation to the outward opening of the ritual nights.
The Bwiti is not antichristian nor racist, and Europeans may join. Its universalist tendency blurs the distinctions between races and between sexes. The spirits in the next world are described as white, and during the ceremonies the initiates cover their faces with white powder, showing that they have penetrated in the beyond.
While the Catholic Church assembles its masses, the Bwiti cult is more of a family affair that assembles relatives and friends. With its chapels, it permits the heads of households to reunite their families and to give their authority a religious and sacred character that had become blunted since ancestor worship had been on the decline. Many excellent Christians see this cult as a complement to religion.
The Fang Bwiti is dynamic in the face of the universal religions, it is individualistic and feminist, and preserves the community spirit; this religion of Eboga is well adapted to society and is in full expansion. The Bwiti, which is favorable to individual accomplishments, has the further advantage of integrating all of man, and what the Christian derives from reading the Bible, the Bwitist knows through iboga.
General bibliography
1. Benoit, P.: “Monsieur de la Ferte”, Albin Michel Publishers, 1934.
2. Binet, J.: “Drogue et mystique. Le Bwiti des Fangs” (Drug and Mystical Practices. The Bwiti of the Fangs), Diogene 86:34-57, (April/June) 1974.
3. Bureau, Rene: “La religion d’Eboga” (The religion of Eboga), doctoral thesis in literature and the humanities presented at Paris V University, 1971, Vol. I: “Essai sur le Bwiti Fang” (Essay on the Fang Bwiti), 321 pages, Vol. II: “Lexique du Bwiti Fang” (A Fang Bwiti lexicon), 237 pages.
4. Prince Birinda: “La bible secrete des Noirs” (The secret bible of the Blacks), one vol., Champs-Elysees Pubs., Paris, 1952.
5. Raponda Walker, A., and Sillans, R.: “Rites et croyances des peuples du Gabon” (Rites and beliefs of the peoples of Gabon), 1 vol., Presence Africaine, 42 rue Descartes, Paris, 1962.
6. Simenon, G.: “Le coup de lune” (Moonstroke), 1932.
7. Thomas, L.V.: “Les religions d’Afrique noire. Texte et tradition sacres” (The religions of Black Africa. Sacred text and tradition), 1 vol., Fayard Denoel Publ., 1969.
8. Traorf, D.: “Medecine et magie africaine” (Medicine and African magic), 1 vol., Presence Africaine, 25 bis Rue des Ecoles, Paris, 1966.
9. Walker, A., and Sillans, R.: “Les plantes utiles du Gabon. Encyclopedie biologique” (Useful plants of Gabon. Biological Encyclopedia), 1 vol., Paul Lechevalier Publ., Paris, 1961.
10. “Rencontres internationales de Bouake. Les religions africaines traditionnelles” (Bouake International Meetings. The traditional African religions), 1 vol., Seuil, 1965.
Bibliography on Iboga
1. Dacosta, L., Sulklaper, I., and Naquet, R.: “Modifications de l’equilibre veille-sommeil du chat par la tabernanthine et quelquesuns de ses derives” (Changes in the wakefulness-sleep balance in the cat with tabernanthine and some of its derivatives), Rev. EEG Neurophysiol. 10(1):105-112, 1980.
2. Delourme Houde: “Etude de l’Iboga, Tabernanthe iboga H. Bn.” (Study of Iboga, Tabernanthe iboga H. Bn.), doctoral thesis in pharmacy, Paris, 1944.
3. Gaignault, J.C., and Delourme Houde: “Les alcaloides de l’iboga, Tabernanthe iboga H. Bn.” (Alkaloids of Iboga, Tabernanthe iboga H. Bn.), Fitothrapia 48(6):243-265, 1977.
4. Goutarel, R.: “Recherches sur quelques alcaloides indoliques et leur relation avec le metabolisme du tryptophane et de la dihydroxyphenylalanine” (Research on some indole alkaloids and their relation to tryptophan and dihydroxyphenylalanine metabolism), Doctor of Science thesis, Paris, 1954.
5. Khuong Huu, F., Cesario, M., Guilhem, J., and Goutarel, R.: “Deux nouveaux types d’alcaloides indoliques. l’ibophyllidine et l’iboxyphylline retires des feuilles de Tabernanthe iboga Baillon et de Tabernanthe subsessilis stapf” (Two new indole alkaloids, ibophyllidine and iboxyphylline, obtained from leaves of Tabernanthe iboga Baillon and Tabernanthe subsessilis stapf), Tetrahedron, Vol. 32, pp. 2539-2543,
__________________________________________________________________________________________________
An Introduction to Ibogaine
ISBN 0-9538348-1-6 www.ibogaine.co.uk
This piece is not subject to copyright and may be reproduced
Written in 2001, and occasionally updated
Chapters
Introduction
Ibogaine
The Problems of Developing Ibogaine
Casual Ibogaine Treatment
Ibogaine Treatment
How Ibogaine Works
The Bwiti
Ibogaine for Self-development
Iboga Visions
Bibliography
Addicted? Need Help?
Click Here to Find
Addiction Treatment Centers
Or call: 
Introduction
Ibogaine is a psychoactive indole alkaloid derived from the rootbark of an African plant – Tabernanthe iboga. In recent years it has been increasingly noted for its ability to treat both drug and alcohol addiction. Both scientific studies and widespread anecdotal reports appear to suggest that a single administration of ibogaine has the ability to both remove the symptoms of drug withdrawal and reduce drug-craving for a period of time after administration. In addition, the drug’s psychoactive properties (in large doses it can induce a dreamlike state for a period of hours) have been widely credited with helping users understand and reverse their drug-using behaviour.
Studies suggest that ibogaine has considerable potential in the treatment of addiction to heroin, cocaine, crack cocaine, methadone, and alcohol, with some suggestion that it further be useful in treating tobacco dependence. It has also been suggested that the drug may have considerable potential in the field of psychotherapy, particularly as a treatment for the effects of trauma or conditioning.
A single administration of ibogaine typically has three effects useful in the treatment of drug dependence. Firstly, it causes a massive reduction in the symptoms of drug withdrawal, allowing relatively painless detoxification. Secondly, many users report, and scientific studies confirm, a marked lowering in the desire to use drugs is experienced for a period of time after taking ibogaine, typically between one week and several months. Finally, the drug’s psychoactive nature is reported to help many users understand and resolve the issues behind their addictive behaviour.
Ibogaine can be easily administered, in capsule form, and has no addictive effects itself. It is essentially a “one-shot” medication and, used in a clinical setting with proper client screening procedures, the drug thus far appears to be safe to use. Whilst it is rare for an individual to stop using drugs permanently from a single dose of ibogaine, as the initial component in an overall rehabilitation programme the drug would appear to offer much potential.
Although approved for clinical trials (trials on humans) for the treatment of addiction in the US in the early 1990s, problems with financial backing have so hindered the development of ibogaine that, as of mid 2001, it remains undeveloped and thus unavailable to the majority of addicts worldwide. There are however a couple of private clinics, located around the Caribbean and in Mexico, that offer ibogaine treatment at prices starting around £4,000, and some lay treatment providers offer lower cost treatment, without medical facilities, in Europe. In addition, ibogaine, either in pure form or as a plant extract, has become available from some lay sources on the internet.
Ibogaine’s current legal status in the UK, and much of the rest of the world, is that of an unlicensed, experimental medication, and it not therefore an offence to possess the drug, though to act as a distributor may be breaking the law. Ibogaine is a restricted substance (possession is illegal) in some countries, including the US, Switzerland, Sweden and Belgium.
Ibogaine
Of the various substances that have, at one time or another, been proposed as being useful in the treatment of drug or alcohol dependence, ibogaine would certainly appear to be the one offering the greatest real potential. A slightly psychoactive indole alkaloid derived from an African plant, the drug, in plant form, has been used by indigenous groups for millenia. The Bwiti, a Central African religious group, use the rootbark of the Tabernanthe iboga plant for a variety of social and religious purposes, most notably as the central component of a “rite of passage” initiation ceremony intended to confer the status of adulthood upon new group members. In the West, ibogaine is usually administered in the form of the hydrochloride – a fine off-white powder either lab synthesized or chemically extracted from the rootbark.
When administered to persons seeking to beat addiction to heroin, methadone, cocaine or alcohol, a single dose of ibogaine typically achieves the following. Firstly, the complete removal or severe attenuation of the symptoms of drug withdrawal, allowing painless detoxification (occurs with approx. 90% of subjects). Secondly, the removal of the desire to use drugs for a period of between one week and three months (occurs with approx. 60% of subjects). Finally, the revealing of personal issues underlying drug-using behaviour, leading to long-term drug-abstinence (occurs with approx. 30% of subjects).
Ibogaine is not itself addictive and the drug may be taken a second time to help preserve a drug-free state. It should be noted, however, that relatively few people permanently beat addiction solely through using ibogaine, and the treatment should thus be regarded as simply an initial component in an overall rehabilitation strategy.
The discovery that ibogaine could treat drug addiction is usually credited to Howard S. Lotsof – a New York based former heroin user who first took ibogaine in 1962. Lotsof took ibogaine believing it to be a new recreational drug but, 30 hours later, suddenly realized he wasn’t experiencing heroin withdrawal, and had no desire to seek drugs. Subsequent casual experimentation by addict friends revealed that this effect was common to others.
Some 20 years later, Lotsof returned to his discovery and set about trying to bring it to the market. He initially set up a charitable foundation with the aim of promoting and developing ibogaine as an anti-addiction medication but, dismayed by the lack of interest shown, later decided to form a company, NDA International, believing a business concern would more likely attract the necessary financial backing. NDA filed patents for the use of ibogaine in the treatment of addiction and began to carry out treatments to better evaluate the drug’s potential.
Because, by this time, ibogaine had been made a Schedule 1 restricted substance in the USA (ibogaine was banned along with LSD and psilocybin in the early seventies) NDA chose to carry out experimental ibogaine treatments in Holland. Jan Bastiaans, a highly-regarded Dutch psychotherapist, partnered him and, over the early years of the nineties, they treated some 30 addict volunteers, the results of which were later medically assessed by Dr Ken Alper in a scientific paper (see How Ibogaine Works for ref).
The nineties, after a promising start, proved to be a tough time for ibogaine. In 1991, the US National Institute for Drug Abuse (NIDA), impressed by case reports and animal studies, began studying ibogaine with a view to evaluating its safety. They constructed protocols for the treatment of addiction. In 1993, the US Food and Drug Administration (FDA), who oversee the development of new drugs, approved clinical trials with ibogaine, to be carried out by Dr Deborah Mash of the University of Miami School of Medicine, on behalf of Howard Lotsof’s corporation, NDA International.
It was at this point that things started to go astray. The death of a young female heroin addict during treatment in Holland brought an abrupt end to the Dutch project. A subsequent inquest did not find the project organizers guilty of negligence but the lack of scientific knowledge about the effects of ibogaine hindered the establishing of an actual cause of death. (It was believed that the surreptitious smoking of opiates during treatment may have been responsible).
The approved clinical trials commenced but contractual and funding problems that arose between NDA International and the University of Miami brought the trials to a close before completion, (the drug’s safety was not an issue). A lengthy legal battle between the two ensued, and developmental work came to a standstill.
In March 1995, after several years spent progressively becoming more interested in ibogaine, a review committee at NIDA suddenly decided to greatly reduce further activity with the drug, apparently having been influenced by critical opinions from the pharmaceuticals industry. Officially, it was reported that the death in Holland was of concern, and that NIDA were disappointed that ibogaine was only shown to keep people off drugs for a period of months, not forever. Howard Lotsof has subsequently pointed out that the death, whilst tragic, was likely caused by concurrent opiate usage and, with regard to the second point, that any drug that could put, say, cancer or AIDS into complete remission for a period of months would be being developed as a matter of national urgency.
Over the last five years, very little has happened. The escalating legal battle between NDA International and the University of Miami, each suing the other for alleged breaches of contract, appears to have ended with the bankruptcy of the former. Yet, as of mid 2001, the precise outcome is not clearly established.
Meanwhile, widening knowledge of the effects of ibogaine has resulted in casual treatments being provided by various individuals in different countries. Though usually undertaken with good intentions, these treatments have frequently been carried out by people with little medical knowledge, and this may have resulted in further tragic incidents.
A couple of small countries, notably Panama and St Kitts, have made ibogaine treatment legally available at private clinics, but only at prices starting around UK£7,000 per treatment (approx US$10,000. Unlicensed medical clinics in Mexico currently offer the treatment slightly more cheaply). As of mid 2001, ibogaine remains in a legal nowhere-land, desperately needed by millions of addicts worldwide, but, tragically, little closer to becoming easily available.
The Problems of Developing Ibogaine
Ibogaine development has been beset with hold-ups for years. The existing legal disputes may now be close to resolution, but ibogaine still needs the participation of a pharmaceutical company for it to make it to the mass market. The business of developing new medications is solely in the hands of the private sector – the pharmaceutical corporations – and the problems that drugs companies appear to have with ibogaine are many.
Firstly, as a drug derived from a natural source, patent options are more limited than they would be for a drug that can only be created in the lab. Potentially, this greatly reduces the level of financial return that the drug could provide, of serious concern considering the degree of backing needed to bring a new drug to the market. Whilst, in the West, there are governmental provisions in place to encourage companies to develop drugs that could be socially useful, to date no one seems interested in taking advantage of them for ibogaine.
Secondly, ibogaine is not a maintenance drug – it is not taken repeatedly over a short period of time – and is usually administered only once. As a general rule, medications developed by the drugs companies, for whatever purpose, are maintenance drugs, for only maintenance drugs allow sufficient financial return to justify the necessary prior outlay on research and development.
Thirdly, industry insiders relate that there are public relations concerns when developing medications for groups that are negatively socially marginalized in the way drug addicts have become. Drug companies, like most modern corporations, are acutely image-sensitive and there are thus concerns that developing medications for addicts could bring about a deterioration in their overall market value.
Finally, some believe that bringing an addiction medication of ibogaine’s potential to the market may present “conflict of interest” problems, of dubious moral worth, to other corporate bodies involved with the sale of licensed recreational substances such as alcohol or tobacco.
The root of the problem that ibogaine faces in becoming available is that our society lacks any mechanism by which a substance of this nature, offering high social benefits but only marginal direct financial return, can be developed. Drugs companies are shareholder based, and so can only develop medications that offer sustained, direct financial return. Whilst ibogaine potentially offers immense savings to government in terms of reduced spending on social welfare and crime prevention, there is no mechanism by which this saving at a public level can be used to induce a corporation to develop the drug.
Assuming the absence of corporate backing, about the most likely route by which ibogaine might become legally available is via projects carried out by local government drug dependency units. Projects of this nature, once started, would allow addicts access to safe, low-cost treatment and, as each project generated more knowledge and data, so drug treatment centres in other areas could make use of the same to develop their own ibogaine protocols. As of mid 2001, however, no projects of this nature are underway, although East European countries appear to be at the forefront of those interested. In addition, the medical laws of some countries allow registered practitioners to prescribe an unlicensed medication like ibogaine, usually providing the subject has given their “fully-informed consent.”
Casual Ibogaine Treatment
With ibogaine treatment now more available than ever before, in an ever-widening range of settings, more and more knowledge about the drug is gathering. At the time of writing, March 2007, one thing that is becoming increasingly clear is that there is a reasonable degree of risk associated with taking the drug. At least 12 people are recorded as having died in connection with taking ibogaine or other iboga substances over the last decade or so, and there is reason to believe that the number may be higher, with other deaths having occurred in non-clinical settings and without being recorded.
Here is some safety-related information about the drug:
– There is an inherent level of risk with ibogaine treatment. Twelve people are known to have died in connection with taking ibogaine or other iboga alkaloids. In actuality, the figure is likely higher, given that ibogaine is frequently administered in surroundings where people may be reluctant to contact the authorities in the event of something going wrong. Statistically, a ballpark figure for deaths during treatment is probably of the order of 1 in 300. (This is based on 12 recorded deaths having occurred within 3611 recorded treatments, outside of Africa, as of March 2007). The following factors have been identified as having caused death:
-
having a pre-existing heart condition, sometimes one not detectable by EKG
-
using opiates when on ibogaine, or shortly afterwards
-
using the rootbark or iboga extract. Ibogaine HCl is statistically much safer
-
taking ibogaine outside of a clinical facility. Persons taking ibogaine need constant supervision and, ideally, online heart monitoring
– Ibogaine is principally recognised for its ability to vastly reduce the symptoms of drug withdrawal, thus allowing addicts to detox relatively painlessly. Any other claims made for the drug, such as that it creates long-term drug-abstinence, or removes the effects of trauma or conditioning in either addicts or non-addicts, may have a degree of truth but are a great deal less substantiated.
– You must be medically tested before you take ibogaine. Proper clinical testing of heart and liver function are the absolute minimum. The site author is not aware of any reputable treatment provider who would allow you to take ibogaine without prior medical testing. Do not go with someone who does not insist on it. Ideally, you should have constant monitoring of heart function whilst on the drug, and medically-trained staff present.
– Beware of listening excessively to the advice of just one individual when deciding whether or not to take ibogaine. Ibogaine’s effects can be life-changing, and it is common for someone who has had a very positive experience to do their utmost to “spread the message,” possibly allowing their enthusiasm to override the very real concerns about safety.
– If you are thinking of taking ibogaine for personal development and haven’t yet been involved in proper therapy (therapy where there’s an open admission by the individual of the presence of emotional issues), be aware that you may be being attracted to a “quick fix” strategy that avoids really dealing with deeper issues. If this is the case, ibogaine could possibly make things worse. For some, using psychoactive substances can invoke disturbing reactions as the mind’s defences struggle to keep down rising repressed material. Drugs like ibogaine, ketamine, LSD and MDMA (Ecstasy), have been used in the past by therapists, but only as one component of an overall therapeutic strategy. Using the drug out of this context could cause more harm than good.
Ibogaine Treatment
(This article has been reproduced for interest value only).
Ibogaine, an indole alkaloid derived from an African plant source, has for many years been recognized for its ability to interrupt drug dependency. Specifically, it can be effective in the treatment of withdrawal from heroin, methadone, cocaine (inc. crack cocaine), amphetamine, and alcohol.
Although it is slightly psychoactive, ibogaine should not be confused with drugs like LSD or psilocybin. Ibogaine’s effects are far longer lasting and can be intensely physical in some users. The drug should be treated with respect and not administered by persons unfamiliar with basic medical procedures. Because vomiting can be a problem with ibogaine treatment, persons administering should ensure especially that they are fully familiar with resuscitation procedures and have rapid access to the emergency services should they be required. It is important persons interested in receiving ibogaine treatment are properly screened. Failure to do so may have resulted in previous tragic accidents. Heart (EKG) and liver (Blood) screening are the absolute minimum.
PREPARATION OF THE CLIENT – The prospective client should attend several informal interviews to ensure he or she is fully aware of the following information relating to ibogaine treatment:
(i) – that ibogaine is principally a detox tool and that, whilst it can help with drug-craving for brief periods as well as help a person understand why they started using drugs, it will still be up to them to stay off. As a general rule, addicts who regard ibogaine as simply something which is supposed to “cure them” rarely have success.
(ii) – that ibogaine is an experimental medication, not recognized as a licensed medicine anywhere in the Western world, and that other options for treating their addiction exist.
(iii) – that deaths have occurred in association with ibogaine treatment, and that it must therefore be regarded as having a definite level of risk, though proper client screening procedures should be able to keep this to a minimum. Specifically, anyone with any history of heart problems should be very wary of taking ibogaine. In recent years there have been several reports of mysterious deaths associated with cardiac problems.
A basic level of physical and psychological screening is essential prior to a person being considered suitable for ibogaine treatment. A blood test should be undertaken to check for liver abnormalities and to ensure general health is good. An EKG should be undertaken to check heart function. Problems with the liver, heart or lungs should result in exclusion from treatment unless subsequent professional medical opinion advises to the contrary. Many long-term addicts may have developed medical health problems which would make ibogaine treatment in a non-clinical setting dangerous. These tests can be often be organized by drug dependency units or private doctors.
Attention should also be paid to the clients’ mental state. Persons exhibiting signs of significant mental disorder should be excluded from treatment.
DOSAGE – Assuming the client is sufficiently well to be treated, their bodyweight in kilos should be measured, and a suitable dose of ibogaine calculated.
Pure ibogaine HCl is typically administered at doses of around 10 milligrams per kilo bodyweight (mg/k) for men, and 9 mg/k for women. To calculate the dose, multiply the client’s bodyweight in kilos by either 10 (for men) or 9 (for women) and you will have the dose in milligrams.
Example: An 8 stone female alcoholic will require about 460mgs of ibogaine HCl, a little under half a gram. (8 stone x 14 = 112 lbs. 112 / 2.2 = 50.9 kgs. 50.9 x 9 = 458mgs)
Note that this is for pure ibogaine HCl, one of two forms of the drug commonly available in Europe. The other is the “Indra iboga extract,” which is believed to be approximately one quarter the strength of pure HCl, meaning clients will require roughly four times the amount. Although the “Indra” product is becoming increasingly available in Europe, it is known to induce more vomiting than the HCl. In January 2000, a 40 year old heroin addict died in London after vomit clogged his airways some 40 hours after taking a dose of this extract.
For opiate addicts, such as those using heroin or methadone, the dose of ibogaine HCl is typically doubled, to around 20mg/k for men, and 18mg/k for women. This is because the opiates in a person’s system partially block ibogaine’s effect.
It is recommended that ibogaine only be given as a single dose, in the range of 9-10 mg/k. From what is known, this appears to be the safest way to take the drug, bearing in mind that higher doses can always be taken in subsequent sessions if necessary. When re-dosing, it is recommended to wait at least one month as ibogaine and its metabolites linger in the body.
TREATMENT PREPARATION – It is very important that the client’s drug intake be regulated for 24 hours prior to taking the main dose of ibogaine. This will prevent the ibogaine from reacting with any other drugs still in the body, which research indicates may lead to adverse reactions. This means that no heroin, no cocaine and no other drugs should be taken for a minimum of 12 hours prior to taking the main dose of ibogaine. No methadone for a minimum of 24 hours. Drug use for the days prior to treatment should therefore be planned in advance to ensure this is possible. In addition, no stimulants should be taken for at least 24 hours prior to taking the main dose of ibogaine. Normal doses of benzodiazepines like valium can safely be taken prior to ibogaine to assist in reducing anxiety or to help the client sleep if necessary.
Ibogaine is recognized as having the ability to potentiate other drug reactions, meaning it is very important persons under its influence do not get access to drugs. Any level of opiate or cocaine usage whilst on ibogaine could be very dangerous.
24 hours prior to taking the main dose of ibogaine, a test dose of about 100mg of the drug should be taken. Allergic reactions have not been reported to the best of the writer’s knowledge but, in the event of one occurring, the treatment should not proceed. Some minor level of ataxia, (difficulty in standing upright), nausea, and aural amplification may be experienced at this dose level. This is quite normal.
Food consumption should cease about 12 hours prior to the main dose of ibogaine being taken. To make this easy to bear, many people take ibogaine first thing in the morning, as a replacement for their morning fix. 1 hour prior to taking the main dose, an anti-nauseant such as domperidone (or similar travel sickness medication) may be taken to try and reduce nausea.
The treatment setting is important in that the client should feel relaxed and relatively easy in themselves. This will help to limit anxiety. Noise should be low throughout (ibogaine causes sounds to be heard much louder than usual), and the light level adjustable. Remember that ibogaine incapacitates some people for several days, so make sure that peaceful, dimly lit conditions can be maintained.
A “sitter” should be present with the client for the duration of the experience, which usually lasts between 20 and 30 hours, but in some cases has been known to go on for 3 days. This should ideally be someone experienced in ibogaine administration, or otherwise a close friend. It is unlikely much communication will be attempted in this time and the client should therefore be attended in peace. Requests for water may be fulfilled but nothing else should be taken.
THE EXPERIENCE – The client will likely experience the drug taking effect after between 30 minutes and 2 hours. Withdrawal symptoms should be eliminated or easily manageable. There will likely be ataxia (problems getting upright) accompanied by a buzzing noise in the ears. Sounds will become louder, bright light hard to bear. Some people report feeling nauseous and there may be a sensation of pulsing in the body, rather as though it were being “cranked up to a new frequency.” These sensations are quite normal.
Vomiting within 3 hours of taking the main dose may result in some of the ibogaine leaving the body before it can be absorbed. In such circumstances, giving more may be considered or perhaps the treatment aborted. Examining the vomit may reveal if the drug has left the body. Be aware of the dangers of both overdosing and using stepped doses if considering giving more ibogaine to make up for that lost in vomit, especially if this is the first time someone has used the drug.
The experience of taking ibogaine varies so much from person to person, it is difficult to prejudge just what will happen for any one individual. However, there are generally two, distinct phases to the experience.
First, the “oneirophrenic” or “dream-creating” phase. This generally lasts several hours and usually consists of the user experiencing dream-like visions with eyelids closed, which disappear once the eyes are open. The visions may appear to be actual memories running, rather as though a film of one’s life was being shown inside the head, or may take the form of characters acting out roles, rather as though a play was taking place inside the head. However, many people report no visual sensations and this is not a problem. People may experience feelings and sensations associated with childhood and early life.
Secondly, the “processing” phase, which follows once the first stage is concluded. This phase is characterized by high levels of mental activity – interiorized processing that allows the material revealed in the first phase to be assimilated and interpreted. People frequently experience comprehending for the first time the reasons why they became involved with drugs. Though ibogaine affects different people in different ways, the oneirophrenic phase typically starts 1-2 hours after taking the main dose, and the processing phase about 3-6 hours later, usually lasting for between 8 and 14 hours. People sometimes experience very negative feelings on ibogaine. If this appears to be happening, the person attending could try to give them reassurance that things are OK. Whatever arises will pass.
What is described above is a typical session but it is by no means unknown for people to be up and moving around within a few hours of taking the main dose, apparently having experienced very little. Alternately, some remain in bed for half a week. In addition, opiate addicts frequently experience little or nothing of the “oneirophrenic” phase. Sessions that are over quickly are usually less effective, and ibogaine does appear to have very little effect on some individuals, regardless of dose level.
Potential treatment providers please note: It is important to realize just how variable the drug’s effects can be on different people. Tragic incidents can occur if safety procedures become lax after a string of successful treatments. Because, when ibogaine works, its effect can seem quite miraculous, it is very easy for people who are not medically experienced to start to relax pre-treatment screening procedures in their keenness to treat people and this is dangerous.
POST IBOGAINE – If the treatment has been successful, the client should be clean having experienced little or no withdrawal. In addition, many experience no desire to use drugs for a period of weeks afterward. Furthermore, some users report gaining insights into their drug-using behaviour. As a general rule, ibogaine is most effective for older addicts, a casual study indicating that those over 35 have a far better chance of staying clean than those in their twenties.
In cases where the treatment has been successful, but the client begins to experience the desire to use drugs again after some weeks, repeat dosing with ibogaine can be undertaken. Remember that persons not currently using opiates require ibogaine at a maximum dose of around 10mg/k. Re-dosing with ibogaine at less than one month intervals may be risky, as metabolites of the drug can remain in the body for this length of time.
Melatonin and B vitamins have been suggested as useful after using ibogaine. Some believe they help sustain the drug’s effect.
POST IBOGAINE REHAB AND THERAPY – A single dose or multiple doses, given over a period, of ibogaine will occasionally be enough to keep someone off drugs permanently. But for most the truth is that, unless suitable post-ibogaine work is undertaken, a fairly rapid relapse to old ways is likely.
It is simply not possible to give guidelines that will be valid for everyone, for we are all different. However, for many, the addict should ideally enter rehabilitation as soon as possible after the treatment. In the writer’s opinion, the best rehab program, and likely the one most suitable for those who have just taken ibogaine, is the Residential Addiction Foundation (RAF) program run by the Humaniversity in Egmont-aan-Zee, Holland, see http://www.humaniversity.nl for further details.
Other alternatives include any long-term (six months and up) residential rehab program available locally. Where residential rehab is not desirous, or not an option, suitable therapy should be seriously considered. Observations of the ethnic, religious use of the drug and first and second hand experience indicate to the writer that the most suitable types of therapy will be body-based and work around catharsis, confrontation and emotional release. “Talking only” type therapy, such as counselling may be effective in some cases but usually less so. Encounter therapy is often highly suitable for recovering addicts, as is primal therapy, bioenergetics, and indeed anything that sets out to assist the individual contact and release repressed emotions, frequently the root cause of addiction. More gentle, integrative work may also be useful. Dance structures such as 5 Rhythms or Biodanza may be helpful, either as a back-up to deeper work or on their own.
Attention should also be given to pleasure. Long term drug use will have likely had the effect of causing the addict’s dopamine system to have been “hard-wired” to associate pleasure with drug use. This is the reason why many who have beaten addiction in the short term frequently relapse. A brief period of exposure to drug-using stimuli, especially at a time when a former addict feels vulnerable, often results in a return to addiction. Everyone needs pleasure and so the recovering addict must take steps to ensure they can get enjoyment out of life without using drugs. For the majority this will mean work on their sex lives. Sexual stimulation, and particularly orgasm, is the principle means by which the healthy body gains pleasure and releases tension. Work to increase the former user’s ability to be intimate, both socially and sexually, is very important. Tantra workshops, touch therapy, or other intimacy-focussed processes are an excellent idea.
POST IBOGAINE PROBLEMS – Feelings of deep contentment – although less common with long term heroin users, many people using ibogaine feel in very high spirits for a period of days or sometimes weeks after taking ibogaine. Clients report feeling that their life is now totally straightened out, they don’t need to do rehab, and everything is going to be just wonderful. Unfortunately, this feeling usually passes after a week or so. It is important to remember this as some people feel so good for a week or so after using ibogaine, they barely notice when they start to get the urge to use drugs again and so quickly relapse.
Learned behaviour or conditioning – ibogaine is widely noted as having the ability to “reset” a persons learned behaviour patterns, leaving them free from compulsive urges, drug-related or otherwise. Again, this usually only lasts for a period of days or weeks, and so attention should be paid to any drug-using stimuli in one’s environment after this time.
Feelings of anxiety or paranoia – for some users the experience can prove quite harrowing. The drug can have the effect of radically altering the way a person looks at themselves and the world around them. Deep-rooted feelings of insecurity that may have been present since childhood can be uprooted and, when this happens, it can leave a person feeling disorientated and anxious for some time afterward. This will clear and is actually an indication that the drug has worked well.
Sleeplessness – many people find they require less sleep for a period of time post-ibogaine. This is quite normal.
RETURNING TO DRUG USE – If a return to drug use is anticipated post-ibogaine, it is imperative the client does not restart at the dosage level they were using prior to treatment. Ibogaine “resets” many brain functions relating to drug usage and to return to heavy usage could easily result in overdosing, and possibly death.
How Ibogaine Works
Just how ibogaine works is a long way from being completely understood. However, enough work has been done for it to be possible to present some insights from the fields of neurology and psychology.
Neurology – Animal studies have revealed ibogaine to be active at many receptor sites associated with drug dependence and its treatment. These include the kappa and mu opiate receptors, serotonin receptors, dopamine receptors, sigma receptors and the NMDA ion channel. Being active at so many sites, ibogaine does not lend itself to easy scientific evaluation, and it is thus likely to be years before scientists develop a good understanding of just how the drug works. However, basic conclusions have been reached by some scientists, and interesting new lines of research uncovered by others.
Through analysing the urine of people undergoing ibogaine treatment in Holland and St Kitts, Dr Deborah Mash believes she has identified the powerful role played by the metabolite, noribogaine. Noribogaine remains in the body for much longer than ibogaine itself and has a higher affinity for many of the receptor sites mentioned above, including the opiate receptors. It may be that an individual’s ability to metabolize this substance from ibogaine, which takes place via enzyme activity in the liver, is important in determining just how successful treatment will be long-term.
In addition, scientists at the US National Institute of Drug Abuse (NIDA) have also studied the way that drugs, like ibogaine, which are active at the n-Methyl-d-Aspartate (NMDA) receptor apparently have addiction-interrupting effects. Other psychoactives are also known to be active at this site. Ibogaine’s effect on the dopaminergic system, known to be influential in addiction, has also been studied in animals. Some have commented that the drug appears to have a kind of “reset button” effect, temporarily overwhelming craving and learned behaviour patterns.
In total, around 170 studies of the effects of ibogaine on animals have now been published. The conclusions of these papers are well summarized in Chapter 3 of the of the 1999 edition of The Alkaloids – Pharmacology of Ibogaine and Ibogaine-related Alkaloids, Piotr Popik and Phil Skolnick, (1999).
In addition, four clinical studies of the effects of ibogaine have been published. They are:
Luciano, DJ. (1998). Observations on treatment with Ibogaine. (American Journal of Addictions 7, 89-90).
Alper, KR, Lotsof, HS, Frencken, GMN, Luciano, DJ, and Bastiaans, J (1999). Treatment of Acute Opioid Withdrawal Syndrome with Ibogaine. (American Journal of Addictions 8, 234-242).
Luciano DJ, Della Sera, EA, and Jethmal, EG (2000). Neurologic, electroencephalographic and general medical observations in subjects administered ibogaine. (Bulletin of Multidisciplinary Association for Psychedelic Studies 9, 27-30).
Mash DC, Kovera CA, Pablo J, Tyndale RF, Ervin FD, Williams IC, Singleton EG, Mayor M (2000). Ibogaine: complex pharmacokinetics, concerns for safety, and preliminary efficacy measures. (Ann N Y Acad Sci 2000; 914:394-401).
In the last paper, online at www.ibogaine.co.uk/mash.htm, Dr Deborah Mash presents data demonstrating ibogaine’s effectiveness in the treatment of opiate and cocaine withdrawal and subsequent drug craving in a case study of 27 patients. As of early 2001, she has treated over 100 people with ibogaine at the Healing Visions clinic in St Kitts.
In attempting to sum up the scientific research that has thus far been done, it might be said that the role of the metabolite noribogaine is likely important in achieving elimination of drug withdrawal syndrome, that activity at the NMDA receptor may be significant in understanding ibogaine’s psychoactive effects, and that the drug’s effect on the dopaminergic system is likely very influential with regard to the reduction of drug craving and alterations in learned behaviour.
Psychological – Psychologists attached to drug-dependency units have frequently noted that substance abusers very often show signs of having suffered considerable childhood trauma or conditioning. Research in this field has well summarized by Jane Wilson of the University of Stirling in her paper Childhood Trauma, Adult Psychopathology and Addiction.
Trauma is usually a single negative event, the memory of which and associated feelings are repressed. Conditioning is the process by which parents seek to alter their child’s behaviour by repeatedly punishing certain acts, usually to try and ensure the child’s successful integration into society.
One problem in treating the effects of both trauma and conditioning is that, because the original traumatic event or act of conditioning is repressed, the individual has no conscious memory of it having taken place and a person’s defences may make any entry into this area difficult. Ibogaine treatment has frequently been reported to assist in the recall of repressed memories and further aid their processing, thus potentially giving the drug a major role in psychotherapy. However, whilst the cognitive retrieval of repressed material may take place, in the writer’s experience most users do not experience a significant degree of emotional connection to the repressed event or events either at the time of ibogaine ingestion or later. It is therefore recommended that ibogaine not be administered in isolation, but rather as simply one stage of an wider therapeutic strategy.
In addition, it is recognized that, regardless of the degree to which the processing of repressed material has taken place, ibogaine does open up virtually all users to open and frank discussion of personal problems for a period of at least a week or so after use, an effect which may be put to good use in therapy.
Psychologically, the drug is essentially “oneirogenic” in that it induces dream behaviour with the ego perspective relatively intact. Modern theories of dreaming often relate that dreams appear to be pseudo-sensory experiences that serve to diffuse the stresses resulting from unresolved emotional conflicts of the day before. In a similar way, it seems to be that ibogaine induces dreams that serve to try and reduces stresses whose origin is much earlier. Ibogaine visions frequently lend themselves well to the principles of dream analysis derived from Jung and others.
The Bwiti
The Bwiti are a Central African religious group whose usage of Tabernanthe iboga, the plant source of ibogaine, forms an integral part of their culture. The rootbark of the plant is known colloquially as “iboga” or “eboka.” It contains approximately 12 different alkaloids, of which ibogaine is merely one. Others, such as tabernanthine or ibogamine, are also likely psychoactive.
The word “Bwiti” refers both to the religion – the Bwiti religion, and the group that practice it – The Bwiti. There are estimated to be approximately 2-3 million Bwiti members scattered in groups throughout the countries of Gabon, Zaire, and the Cameroun. Most are from the two principal tribal groups of the area, the Fang and the Mitsogho. Fang Bwiti and Mitsogho Bwiti may be distinguished by their ritual practices and beliefs. It is generally believed that iboga use only spread to these local tribespeople over the last few centuries, having originated with pygmy groups in the jungles of the Congo basin many thousands of years earlier. This migration is understood by the plant’s indigenous users as resembling its function, Bwiti myths frequently using images of the lightly wooded grasslands and the dense Congo jungle as symbols of the conscious and the unconscious mind.
Iboga is used for an assortment of purposes within the group, notably as an aid to concentration and to stimulate recovery from illness. Its principal sacramental use is as the central component in the so-called “Bwiti initiation ritual” – an intricate 3-day “rebirth” ceremony, the completion of which is a necessity if one is to become a member of the group. Both sexes are initiated, typically between the eighth and thirteenth birthday, and the ceremony usually begins on the Thursday, ending Sunday morning.
Prior to the ritual’s commencement, certain preparatory exercises are undertaken for the purpose of reinforcing the experience. These include the writing and symbolic burning of a “confession” – a written record of all one’s moral transgressions, and the undertaking of various rituals, notably one in which the initiate crawls through the legs of local women whilst immersed in a nearby stream, an exercise intended to symbolically reproduce the journey of the sperm to fertilization.
During the ritual itself, iboga is eaten on the first night and may be further consumed on subsequent nights should it be deemed necessary. The initiate’s consumption of iboga is supervised by the “nganga,” a priest of the Bwiti religion who, being knowledgeable of the effects of iboga, can tell when the initiate has had sufficient.
The overall aim of the ritual is to cause the initiate to be both emotionally and spiritually “reborn,” such that they may take their place within the group as a true adult. The consumption of a high dose of iboga is intended to help achieve this by bringing about a deep, dreamlike descent into the world of the unconscious with the effect of both bringing into awareness repressed material and causing a reconnection to the world of the ancestors. If the initiation proceeds well, it is believed that the initiate will actually “meet the Bwiti,” envisioned as the primordial male and female originators of the religion, residing in the depths of the unconscious.
The Bwiti initiation ritual, as this “rebirth” ceremony has come to be known, has in recent years attracted the attention of some Westerners who find themselves romantically drawn to the notion of travelling to the region and undertaking it themselves. Anyone considering doing this should be aware of three things. Firstly, that both the Cameroun and Zaire, two of the three countries where the Bwiti are located, are now regarded as being acutely dangerous for Westerners (Zaire especially). Secondly, that, in Gabon, the remaining country, only the least reputable groups would usually consider initiating Westerners, and then almost certainly only undertake the task for financial gain, likely in a half-hearted fashion. Finally, it should be remembered that each year some local initiates are believed to die during the ceremony, bizarre court cases between parents and priests frequently resulting.
Ibogaine for Self-development
The use of ibogaine is not restricted to those seeking to beat drug or alcohol dependence. Individuals seeking personal development, access to more “spiritual” sides of their nature, or a breakthrough in overcoming a psychological block may also find the drug useful.
What is especially interesting about ibogaine is that it allows the user access to the unconscious with the ego perspective relatively intact, that’s to say, in relatively normal consciousness. In addition, the intensity of the experience can usually be regulated to some degree, the dreamlike visions normally ceasing once the eyes are opened. Another interesting aspect is that, despite its origins, the visions that occur with ibogaine do not appear to feature the “plant teacher” figures common to the visionary experiences associated with entheogens like ayahuasca or peyote, but rather appear to consist of a more direct encounter with one’s self.
These benefits have resulted in ibogaine being used as an adjunct to therapy by a handful of psychotherapists over the years, most notably Chilean psychiatrist Claudio Naranjo, who details some sessions in his book, The Healing Journey. The objective of an ibogaine session is invariably to allow the individual to become aware of unconscious processes that may be blocking their personal development. Ibogaine appears particularly suitable for this task with users frequently reporting that the drug gave them a “hotline to their own personal guru.”
Whilst ibogaine may seem like an ideal “personalized high-speed psychotherapy” to some, there are however problems with using ibogaine for personal development work, especially outside of the professional psychotherapeutic context. The dose for therapeutic use is usually around 5-8mgs per kilo bodyweight, and whilst this is undoubtedly a far safer amount than the 20mg/k dose sometimes used to treat opiate addiction, the experience can still prove both physically and emotionally gruelling for some. It is important that the individual’s physical and psychological integrity is reliably assessed prior to taking the drug, or, when ibogaine is being considered as a “last ditch” strategy, a risk-benefit assessment made with regard to any potential gain or loss that may occur.
For those thinking of taking ibogaine for personal development who haven’t yet been involved in therapy, it is important to be aware that using the drug may appear attractive simply because it represents a treatment that avoids the formal psychotherapeutic process. If this is the case, there is a possibility that ibogaine could make problems worse. When a lot of repressed material is present, and for many brought up in the West this will inevitably be the case, psychoactive drug usage can sometimes invoke dangerous reactions as defence mechanisms struggle to keep down rising painful material. This can result in delusional or neurotic beliefs that persist long after the session is over.
It is also important to realize that using ibogaine alone will unlikely be sufficient to bring about deep personal transformation. The drug typically gives people mental insights into repressed aspects of their psyche, but without significant emotional connection. Other therapeutic work, ideally something with a strong cathartic element, is highly recommended to allow the experience to be properly processed.
Iboga Visions
Interpreting the dreamlike visions of the ibogaine experience can prove a fascinating yet difficult task. The “oneirophrenic” phase of the session frequently throws up much material from the unconscious, and whilst the later, “processing” phase of the session, characterized by many hours of frenzied mental activity, may shed light on the meaning of what has been seen for some, as often as not the individual emerges from the session little wiser as to the significance of what they have experienced.
Because ibogaine visions frequently reveal the presence and nature of deeply sensitive issues, cloaked in symbolism, their subsequent misinterpretation is understandably common. This section will therefore cover some basic aspects of the iboga visionary experience such that individuals using the drug might better benefit from the experience.
It is worth remembering that, no matter what they may appear to be about, ibogaine visions invariably contain much personal content. One symbolic device that often appears to be used by the drug is the cloaking of personal issues as world affairs, frequently either political or ecological scenarios that appear to threaten the planet.
One example of this is that of the opiate user who experienced being shown that mankind was an evolutionary mistake that was now destroying the world – the revealing of deep-rooted feelings of lack of self-worth. Another example is the individual, whose father had exerted a excessively controlling influence over his childhood, who experienced being shown that the world was under the control of elite banking groups. Whilst the scenario experienced may appear valid to the individual, and may indeed even be valid, it should be remembered that there will invariably be much personal significance.
Psychologically, the action of ibogaine is always to attempt to bring repressed material to light – to make conscious what is unconscious. This it does at a rate frequently too fast for an individual to fully process and integrate during the session itself. Experience also indicates that for many this release appears to continue long after the drug has left the system. Consequently, even when little has been experienced visually, it is common for the individual to emerge from the session with their defences overwhelmed by rising unconscious material. It is for this reason that I recommend that the drug only be used by those regularly involved in therapy, and particularly therapeutic structures revolving around the cathartic release of emotions and their bodily integration – Bioenergetics, Primal Therapy, Dynamic Meditation, Lowen Technique, Humaniversity Therapy, or similar. Where this is not undertaken, the inexperienced user may find themselves drawn to bizarre belief patterns or perhaps excessively concerned with issues of “control” for a period of time, perhaps even years, after taking ibogaine. Issues relating to mother or father may be projected onto younger women or older men and there may be a tendency to retreat “into the head,” to avoid confrontation with issues of sexuality and personal power. All such patterns should pass with time, and the process of integration may be considerably speeded up by undertaking suitable therapy.
Bibliography
Ali, S.F. (editor) (2000). The Neurochemistry of Drugs of Abuse: Cocaine, Ibogaine, and Substituted Amphetamines, New York Academy of Sciences.
Alper, K.R & Glick, S.D. (editors) (2001). Ibogaine: Proceedings of the First International Conference, Academic Press, San Diego, California.
Beal, D & DeRienzo, P. (1997). The Ibogaine Story, Autonomedia 1997.
Bureau, R. (date unknown). Péril Blanc, publisher unknown.
Fernandez J.W. (1982). Bwiti: An Ethnography of the Religious Imagination in Africa, Princeton, Princeton University Press.
Fernandez J.W. (1972). Tabernanthe iboga: Narcotic Ecstasis and the Work of the Ancestors, in: P.T. Furst (Ed.), Flesh of the Gods. The Ritual Use of Hallucinogens, Praeger, New York & Washington.
Mary A., (1983). La naissance à l’envers. Essai sur le rituel du Bwiti Fang au Gabon, Paris, L’Harmattan.
Naranjo, C. (1973) The Healing Journey, Ballantine.
Popik, P & Skolnick, P. (1999). Pharmacology of Ibogaine and Ibogaine-related Alkaloids in: The Alkaloids, Academic Press.
____________________________________________________________________________________________________________________
Ibogaine
Basics
by Erowid
Ibogaine is a hallucinogenic chemical that can cause profound and long-lasting hallucinations. In its pure form, it is a white, bitter-tasting powder. It occurs naturally in a number of plants native to West Central Africa, includingTabernanthe iboga and Voacanga africana. Ibogaine-containing plants have a history of traditional use in West Africa in initiation ceremonies and religious rituals. Though there has been limited interest in ibogaine as a recreational psychoactive due in part to its long duration of action, Ibogaine has received attention in Europe and the U.S. since the 1960s as an anti-addiction therapy especially for the treatment of opiate addiction.
When ingested in traditional religious ceremonies, ibogaine doses are highly variable. In TiHKAL, Shulgin and Shulgin describe typical doses of pure ibogaine HCl as “at or above 1000 milligrams”, but also describe profound effects at 200 mg, orally. In the Manual for Ibogaine Therapy, Lotsof and Wachtel recommend 15-20 mg/kg for opiate addiction treatment. An ibogaine clinic reports administering a dose of 16-22 mg/kg. Note: Pure ibogaine dosages are much smaller than those of iboga powder, which is around 1% psychoactive alkaloids by mass.
Ibogaine is rarely found on the black market for recreational use.
Law #
Ibogaine is illegal to possess and sell in the United States (Schedule I) and in several other countries. It became a regulated substance in the U.S. in 1967.
The chemical name for ibogaine is 12-Methoxyibogamine (C20H26N2O). It is a naturally occurring indole alkaloid in the tryptamine family.
Ibogaine is slowly metabolized by the liver into noribogaine and other metabolites, some of which may be psychoactive. Ibogaine acts on numerous receptor systems, including the dopaminergic, serotonergic, nicotinic, GABA, and muscarinic systems. Some studies have found evidence that ibogaine may interrupt the mechanisms of opiate dependence.
Ibogaine is generally extracted from plant material, but may also be synthesized.
History #
The T. iboga plant has been used ritually in Africa since at least the nineteenth century, perhaps much earlier. There are several contemporary iboga churches such as the Bwiti which use iboga as a sacrament and initiation tool. Ibogaine was first extracted from T. iboga in 1901. An ibogaine-containing extract was sold as an antidepressant called Lambarene in France beginning in 1939. During the 1960s ibogaine was briefly investigated as adjunct to psychedelic therapy. In the last few decades there has been continuing interest in Europe, North America, and Mexico in the use of ibogaine for addiction therapy.
Brand Names:
Lambarene.
The Substance:
Ibogaine.
The Experience:
No common terms known.
When taken in a strong dose, ibogaine often causes nausea and vomiting which may be followed by numbness of skin, mild auditory and dreamlike visual hallucinations lasting for 3-4 hours. This is frequently followed by an intense autobiographical inventory of the events and significance of one’s life, lasting from 8-20 hours. Lingering physical effects such as difficulty sleeping may persist for an additional day or two.
When taken orally, the effects of ibogaine usually begin within 45 minutes to three hours.
The most intense effects of ibogaine may last 24 hours or more, during which time a user may be immobilized. After-effects may last an additional day or two.
Visuals Summary Needed.
Several deaths have resulted directly from ibogaine ingestion. Users frequently experience extreme nausea. Depending on dose, users may be incapacitated and/or immobilized for many hours. High doses (beginning at 75-100 mg/kg) have been shown to have neurotoxic effects in rats and non-human primates, although therapeutic doses may not be neurotoxic.
-
Individuals with a history of heart ailments, high blood pressure, aneurysm or stroke, glaucoma, hepatic (liver) or renal (kidney) disorders, or hypoglycemia may be at higher risk.
-
Do not operate heavy machinery. Do not drive.
-
Due to its strong effects, Ibogaine should generally not be taken without a sober sitter present.
-
Individuals should consider carefully before taking Ibogaine in situations where they are solely responsible for themself or anyone else.
-
Individuals in the midst of emotional or psychological upheaval, or with a history of psychological illness, should use extreme caution in taking ibogaine or any other powerful psychedelic.
Ibogaine is not believed to be physically addicting nor likely to cause psychological dependence. Withdrawal effects following discontinuation have not been reported.
Long Term Health Problems Summary Needed.
There are several known fatalities due to ibogaine use. Some deaths have occurred in clinical or quasi-clinical environments. A 40-year-old woman died of heart failure after being administered 8 mg/kg in a psychotherapy session. In 2006, a 38-year-old man died of pulmonary thrombosis during ibogaine addiction treatment at a clinic in Tijuana, Mexico. Traditional iboga use is reported by some West Africans to be occassionally fatal, and there is at least one documented case of a fatality following ingestion of iboga root bark.
Erowid Basics pages are summaries of data gathered from site visitors, government documents, books, websites, and other resources. We do our best to keep this information correct and up-to-date, but the field is complex and constantly changing. Information should always be verified through multiple sources.
__________________________________________________________________________________________________________________________
A Personal Testimonial about ibogaine
PB’s Iboga trip, from chat, will edit soon…
7:40 pm: [pissybee]> ao who wants the full iboga trip report in chat?
7:41 pm: [lsd_freak]> sure, lets hear it pb
7:41 pm: [pissybee]> I did it last year
7:41 pm: [pissybee]> well someone was curious so I figured I’d share with all
7:42 pm: [pissybee]> Okay…
7:42 pm: [pissybee]> so, I took my last dose of methadone th morning of the flight…
7:43 pm: [pissybee]> I had been slowly driopping 2 mg’s a week for the last several months and was down to 12mgs a day from 100mgs
7:43 pm: [pissybee]> I was dropping 5mgs every two weeks before that
7:43 pm: [shedthemonkey]> weening off of H?
7:43 pm: [pissybee]> til I got down to 30
7:43 pm: [pissybee]> methadone
7:44 pm: [pissybee]> I had been H free for about two years before weening down the methadone
7:44 pm: [pissybee]> so I flew to A-dam a 13 hjour flight and got there in the am, whe I would normally bne taking my normal daily dose
7:44 pm: [pissybee]> I was feeling sick and my ride was late so I just chilled and worried
7:45 pm: [pissybee]> but Sara showed up and I instantly felt better
7:45 pm: [pissybee]> after the ride to her house I got minor withdrawal, which I was used to since I was weening for weeks before hand
7:45 pm: [pissybee]> so she said you don’t feel good?
7:46 pm: [pissybee]> lemme give you the test dose to make sure you have no allergies
7:46 pm: [pissybee]> she gave me a ball of the alkaloid extract, maybe a gram or less
7:46 pm: [pissybee]> so soon after, I felt like I took a dose of methadone. felt normal
7:47 pm: [pissybee]> We went to visit Soma the Cannabis breeder
7:47 pm: [pissybee]> his daughter was taking the treatement a dayu befor i arrived or so
7:48 pm: [pissybee]> I smoked the best ganja with him and he gave me a spliff since we wwere leaving and he gave Sara some shroom tea, for after our trip
7:48 pm: [pissybee]> so we get back and smoked her powerplant and talked til the evening came around and I was ready for the full dose
7:49 pm: [pissybee]> she yold me to decide what I wanted to take, because only i could decide what was acceptable for me, she told me a few ways that seemed like some shamanic mumbo jumbo and also told me some of her past treatments and their experiences
7:51 pm: [pissybee]> one huge guy did 12g of extract, but I wasn’t ready for that, so I decide on 5grams, since she had success on three and the highest was 12, which was for the trip, not addiction therapy
7:51 pm: [pissybee]> so she put the 5 grams in capsules and I swallowed em quickly and smoked more herb whichj was being done in abundance
7:52 pm: [pissybee]> after an hour I started getting kind of slow vibrationas and buzzing
7:52 pm: [pissybee]> so I went to lay down
7:52 pm: [pissybee]> I got up after laying down for a half hour, but was getting bored…
7:53 pm: [pissybee]> and when I stood up I got like white flashes, was gettimng hard to concentrate and had weird white flashing patterbs, they saiud go lay down so I copmplied
7:54 pm: [pissybee]> after a few hours I was seeing weird visions, but soon it started to get violent
7:54 pm: [pissybee]> I saw middle eastern people shooting off heavy artillery and weird conflict, I saw huge fat mideastern guys that were fat and having a feast
7:55 pm: [pissybee]> all the people were fat and gluttonous
7:55 pm: [pissybee]> so while I saw the heavy artillery shooting I was in bed trying to hide under my imagined sand bunker
7:56 pm: [pissybee]> then the puking and nausea came, I was out of it and remember little but puking for hours and hours
7:56 pm: [pissybee]> every few minutes I puked my guts out
7:56 pm: [pissybee]> had trouble getting to the bathroom, but eventually when i calmed down I could lay down and the nausea would subside for awhile
7:57 pm: [pissybee]> after 18+ hours of on and off puking with periodic visions
7:57 pm: [pissybee]> I slowly becamne lucid and I could understand what was going on around me
7:57 pm: [pissybee]> I then felt rushes of feelings and guilt
7:58 pm: [pissybee]> I cried
7:58 pm: [pissybee]> another patient brought me in headphones with some tracy chapman and it helped me cry out all my guilty feelings
7:58 pm: [pissybee]> over the next evening I slowly came around
7:59 pm: [pissybee]> and eventually I felt starved
7:59 pm: [pissybee]> had been damn near two nights and a whole day of puking
7:59 pm: [pissybee]> so I got up and started to rejoin the living
7:59 pm: [pissybee]> I felt cold and weak and very hungry but my jaws were very sore and it was hard to eat anything
8:00 pm: [pissybee]> maybe an orange or a few small pieces of bread
8:00 pm: [pissybee]> I had some crap but not too bad diarrhea or anything
8:00 pm: [pissybee]> I never felt I was gonna die
8:01 pm: [pissybee]> so after that I had minor anxiety and agitation
8:02 pm: [pissybee]> but after the trip my ,mind was telling me that I didn’t need all the man made drugs and crap, nor did I need the sugar and all the guilty pleasures that were associated with my brains reward system, I felt it was all just a trick and decided to change my ways
8:03 pm: [pissybee]> but the discomfort and my drug addict mind told me to figure out a way to get dope, just for a night of relief
8:03 pm: [pissybee]> I was given a valium and slept well the first night after
8:04 pm: [pissybee]> then the next day I talked friends into scoring me some dope
8:04 pm: [pissybee]> it was shitty, wouldn’t break down without vinegar
8:04 pm: [pissybee]> so I ended up smoking it after the first shot
8:05 pm: [pissybee]> but it got me way high off a lil bit and I felt guilty again
8:05 pm: [pissybee]> when it was time to go I had just ran out and I started feeling crappy at the airport again
8:05 pm: [pissybee]> so I went to the bar and had a few drinks before my flight
8:06 pm: [pissybee]> when I was on the flight i had some minor withdrawal but nothing too bad, just stomach bubbles and stuff
8:06 pm: [pissybee]> when I got home I was like I am done…
8:06 pm: [pissybee]> no more opiates
8:07 pm: [pissybee]> I took a few vicodins when i got home to help the minor symptoms
8:07 pm: [pissybee]> and herb helped a bunch
8:08 pm: [pissybee]> I went to the methadone clinic to tell em I was better and ended up scoring two bags of dope, which I did the same day
8:08 pm: [pissybee]> the next day I felt guilty again and suffered throughout the day
8:09 pm: [pissybee]> then I had some powdered methaodne pills from a big batch I bought for doing dead tour
8:09 pm: [pissybee]> I took just a pinch on the tongue, maybe a few milligrams a day ovber the next week
8:09 pm: [pissybee]> and when it was gone, I stopped
8:10 pm: [pissybee]> no real wd’s afterwards
8:10 pm: [pissybee]> nothiong herb didn’t handle
8:10 pm: [pissybee]> and now a year+ after I am clean
8:13 pm: [shedthemonkey]> pb, where did you hear about iboga?
8:14 pm: [pissybee]> the net
8:14 pm: [troutlips]> and how much did it cost?
8:14 pm: [shedthemonkey]> would you recommend it?
8:14 pm: [shedthemonkey]> do you think it was the reason you kicked the bad dope?
8:15 pm: [pissybee]> the total trip with plane tickets and stay and herb and food, everything, was about 2,200 bux
8:15 pm: [pissybee]> yes shed it wokred, I never been through such an easy detox
8:16 pm: [pissybee]> and I could have had another dose, which was recommended for such a long addiction and especially to methadone such a long acting opiate
8:16 pm: [pissybee]> but I wasn’t ready then
8:16 pm: [pissybee]> just came out, and my stay was only for a week I needed a longer stay to be more sure, but my determination pulled through
8:17 pm: [pissybee]> no piece of cake cures, but with short acting opiates, many addicts come out cured totally
8:17 pm: [pissybee]> one dose
8:17 pm: [pissybee]> no bad feelings
8:18 pm: [troutlips]> would it work for other addictions?
supposed to work for a number of drugs, including cocaine, opiates, alcoholism, and possibly even benzos… I only read claims, not enough actual hard data…
_______________________________________________________________________________________________________________
SCIENCE
Ibogaine lab research
Ibogaine clinical research and experience
Seminars, conferences and presentations
Social sciences
Patents
Other articles
Ibogaine: The Book
-
Following the New York University School of Medicine’s International Ibogaine Conference held in 1999, Drs. Kenneth R. Alper of NYU and Stanley D. Glick of the Albany Medical College edited submissions and additions of the proceedings now published by Academic Press. The Alkaloids, Volume 56 brings together the world’s experts on ibogaine. This book represents the state of the art. View the Table of Contents from where you can link to individual PDF files of each of the book’s 16 chapters and index.
-
By special permission of Academic Press The Ibogaine Dossier presents A Contemporary History of Ibogaine in the United States and Europe. The chapter by Kenneth R. Alper, Charles D. Kaplan and Dana Beal portrays the amazing and exciting story of ibogaine development. This selection is of Chapter 14, Volume 56, The Alkaloids, Ibogaine: Proceedings of the First International Conference.
Ibogaine lab research
-
The Ibogaine Dossier continues its historical document collection with the seminal literature review of ibogaine, opioid and stimulant interaction, providing a long unavailable copy of the 1984 Literature Report by Doris H. Clouet, Assistant Director, Testing and Research Laboratory, New York State Drug Abuse Control Commission, Brooklyn, New York. The 1984 Report was supported by a grant of the Dora Weiner Foundation to Dr. Clouet and reviews early literature not readily availale elsewhere. We therefore present The Clouet Report – 1984. The Clouet Report was the first document used to garner scientific support for the use of ibogaine in the treatment of substance use and dependence disorders. Clouet’s review includes thirty peer reviewed papers published between the 1950s and 1980s. The report is in PDF format.
-
A Chronology of Selected Abstracts, Ibogaine: Rapid Method for the Interruption of the Narcotic Addiction Syndrome. The Chronology is an excellent collection of abstracts relating to the use of ibogaine in the treatment of narcotic dependence as well as, addressing safety issues. The document was originally presented at the 20th conference of the American Association for the Treatment of Opioid Dependence (AATOD) held in Orlando in October 2004. It is also available as a downloadable PDF document file. PDF files require an Adobe Reader. I you don’t have one, a free version may be obtained from Adobe.
-
An important paper by Stanley Glick and Isabelle Maisonneuve in PDF format Mechanisms of antiaddictive actions of ibogaine
-
Pharmacology of Ibogaine and Ibogaine-Related Substances. A review by Piotr Popik and Phil Skolnick. Appeared as Chapter 3 in “THE ALKALOIDS”, Vol.52, 1998.
-
Selected abstracts 18-Methoxycoronaridine and some full-text papers. Review data on this synthetic iboga alkaloid congener developed by the Albany Medical College research group.
-
Ibogaine is one of the psychoactive indole alkaloids isolated from the shrub, Tabernanthe iboga. Preclinical studies demonstrate that ibogaine reduces self-administration of both cocaine and morphine, as well as attenuates the symptoms of morphine withdrawal. Several anecdotal observations in humans seem to support the hypothesis that ibogaine may have antiaddictive properties.
Now available online: a review article by Piotr Popik and Stanley Glick. -
Ibogaine a brief history. This easy to read review summarizes the qualities of Ibogaine. It includes research conducted in 1995 and 1996.
-
An evaluation of ibogaine neurotoxicity, including abstracts of relevant papers.
-
The Ibogaine bibliography. References to over 130 scientific articles, most with abstract. Now with coverage of NMDA-receptor review articles. The NMDA-receptor complex has been implicated in the ‘psychological dependence’ pathway.
-
A number of articles have been selected to appear in our special abstracts section because of their thought provoking content.
-
In continuation of the Ibogaine Dossier’s Historical Document Project we are pleased to present an English translation of the first paper published on the extraction and identification of ibogaine. The authors, in fact, named the alkaloid in their 1901 publication: Concerning Iboga, its excitement-producing properties, its composition, and the new alkaloid it contains, ibogaine by J. Dybowski and Ed. Landrin. Also available in PDF format. This article is presented for historical value and not scientific accuracy as much has been learned about ibogaine and its use since 1901.
Ibogaine clinical research and experience
-
The Ibogaine Medical Subculture by Kenneth R. Alper, Howard S. Lotsof and Charles D. Kaplan is available in web page format. For your pleasure and information we present The Ibogaine Medical Subculture published in the Journal of Ethnopharmacology. The paper is also available in its original pdf format
-
The first long-term study of ibogaine effects. Udi Bastiaans’ paper, Life After Ibogaine discusses the medical, psychological, social and legal history of patients treated with ibogaine. This report is in PDF format.
-
A report by Howard Lotsof on dose and dose regimens for both ibogaine HCl and total alkaloid extracts in PowerPoint slide show format: Ibogaine Therapy: Forms and Dose Regimens
-
Ibogaine therapy has emerged in the last twenty years as a viable option for the treatment of chemical dependence. The Manual for Ibogaine Therapy – Second Revision by Lotsof and Wachtel is intended for ibogaine providers who are concerned with patient safety and the outcome of Ibogaine treatments. The manual presents medical safety data and clinical discussions with links to additional resources. Now also available as The Ibogaine Manual in PDF format. Just click to download. Includes active links.
-
Ibogaine, Trauma and Abreaction: The Treatment of Chemical Dependence.H.S. Lotsof, C.A. Smith F., J. Bastiaans; presented at 40th International Conference on the Prevention and Treatment of Dependencies, ICAA, Amsterdam, 1996.
-
Sometimes the ability to understand a subject comes from being able to understand its beginnings. We are now able to provide a copy of Reaching a State of Wellness: Multistage Explorations in Social Neuroscience This paper by Charles D. Kaplan’s Erasmus University Rotterdam working group provides insight into the early Dutch addict self-help ibogaine scene with a comparison to traditional Tibetan medicine.
-
Treatment of Acute Opioid Withdrawal with Ibogaine. Alper et al.’s review article of ibogaine effects on opioid withdrawal signs of subjects from the United States, The Netherlands and Panama over a period of three decades. Adownloadable PDF file is also available.
-
We are pleased to present Ibogaine: Fantasy and Reality , Claudio Naranjo’s chapter on ibogaine from his out of print book, The Healing Journey. A new Introduction by Naranjo as well as a Foreword by Lotsof are included.
-
Long unavailable, Claudio Naranjo, M.D.’s paper, Psychotherapeutic Possibilities of New Fantasy-Enhancing Drugs is now available thanks to the Canadian Research Knowledge Network. Naranjo’s paper was the first to report outside of Africa of the psychotherapeutic benefits of ibogaine.
-
A Preliminary Investigation of Ibogaine: Case Reports and Recommendations for Further Study. A peer reviewed Journal of Substance Abuse Treatment article.
-
Daniel Luciano MD describes observations of treatment with ibogaine
-
Ibogaine in the treatment of chemical dependence disorders: clinical perspectives (A Preliminary Review) H.S. Lotsof. The primary purpose of this paper is to provide general information to the clinician who will be using ibogaine in the treatment of addiction.
-
Alexander Shulgin and Ann Shulgin’s description of ibogaine is scientific but engaged. “Here is an example of a most remarkable material that has allowed people to have some rather complex and dramatic experiences.” An excerpt from their book Tihkal, the sequel to Pihkal, a Chemical Love Story.
-
A fascinating account by Sarah Emanon, a psychotherapist who speaks about her own experiences with ibogaine – both as a facilitator and as an experiencer- and her plans to direct an ibogaine clinic in Central America. Interviewer is Primal Therapist Donald A. Allan.
-
Deborah Mash answers Frequently Asked Questions about ibogaine research.
-
Ibogaine in Drug Detoxification. From Preclinical Studies to Clinical Trials
Deborah C. Mash, Ph.D. -
Phase I trial conducted at the University of Miami. Juan Sanchez-Ramos, Ph.D., M.D. and Deborah Mash, Ph.D.
-
Ibogaine, een oplossing voor het verslavingsprobleem? A literature review in dutch.
-
Stephen Snelders. Het gebruik van psychedelische middelen in de jaren zestig.
Netherlands Hallucinogen Research (in dutch) -
Ibogaine in the treatment of narcotic withdrawal
H. S. Lotsof, E. Della Sera, C.D. Kaplan -
Pharmacodynamics and therapeutic applications of iboga and ibogaine
For the Frenchlanguage version. Robert Goutarel[Biographical notes] -
The Necessity of Addict Self-Help Involvement in Ibogaine Treatment Procedures.
INTASH
Seminars, conferences and presentations
-
A Calendar of ibogaine conferences, forums and meetings is now available. Conference presentations are listed immediately below.
-
Kenneth R. Alper reviews the Significance of Unofficial Ibogaine Treatment Scenes.. A PowerPoint presentation.
-
Rick Doblin’s presentation A Non-Profit Approach to Developing Ibogaine into an FDA-Approved Medication. An excellent how-to manual for drug development. A PowerPoint presentation.
-
Comparative Development of Ibogaine, Methadone and Buprenorphine. H.S. Lotsof’s presentation from the NYC Iboga and Ibogaine Forum. A historical review of why the government backed the development of some medications and not others. A PowerPoint presentation.
-
What does the future hold? One vision is 18-methoxycoronaridine (18-MC). Jon Friedlander provides his PowerPoint presentation 18-MC: A Review
-
-
The Conference on Ibogaine will be held on November 5 and 6, 1999 at the New York University School of Medicine. It is the first meeting to be devoted to the subject of ibogaine to be held at a US academic medical center.
-
The Lindesmith Center Drug Policy Seminars, Winter 1998. March 2: Ibogaine Treatment. The feasibility and effectiveness of ibogaine in treating chemical dependence.
-
Innovative approaches for the treatment of substance abuse for the twenty-first century. U.S. Probation Symposium, New York, June 5, 1997.
-
ICAA 1996 AMSTERDAM. Speakers & abstracts.
The 1996 International Institute on the Prevention and Treatment of Dependencies Conference Ibogaine Sessions. Meet the researchers and listen to their most recent hypotheses.
Social sciences
-
The Danish Drug Users Union (BrugerForeningen) hosted drug user advocates from around the world to celebrate International Drug Users Day and the Conference on Drug User Activism. Concurrent to these events were the General Assembly of the International Network of People who Use Drugs (INPUD) and the fifteenth anniversay celebration of the Danish Drug Users Union. Among the presentations given during the conference was a unique ibogaine slide show directed towards those who would benefit most from ibogaine. Please see: The Ibogaine Community Worldwide – User to User.
-
While the majority of the people of Gabon are familiar with the Bwiti religon and its sacrament Iboga, very few are familiar with ibogaine science. Howard Lotsof, the discoverer of ibogaine’s antiaddictive effects now presents that information. The PowerPoint slide show is available both in english and french. Please see: Iboga and Ibogaine: From the Forest to the Laboratory or L’iboga et l’ibogaïne: De la forêt au laboratoire
-
Sacrament of Transition (SofT) Protocol for Ibogaine Initiations, a report authored by Anže Tavčar presents information on this European ibogaine based religion not previously available. The report is provided in both aweb page format and in a PDF format
-
Bwiti: An Ethnography of the Religious Imagination in Africa by James W. Fernandez contains a superb account of the ibogaine experience in the West-African Bwiti society. We are extremely happy to have the complete Chapter 18 available online. Introductionby Howard S. Lotsof
-
The Religion of Iboga or the Bwiti of the Fangs by P. Barabe, Chief physician, Professor of Tropical Medicine.
-
Pharmacodynamics and therapeutic applications of iboga and ibogaine Robert Goutarel [Biographical notes] For the French language version of this article.
-
Georgio Samorini’s The Bwiti Religion and the psychoactive plant Tabernanthe iboga (Equatorial Africa). Originally published in Integration, 5: 105-114.
Patents
-
Jurg Schneider’s Patent assigned to Ciba (PDF file) Tabernanthine, Ibogaine Containing Analgesic Compositions
-
Rapid Method for Interrupting the Narcotic Addiction Syndrome
-
Rapid method for interrupting or attenuating poly-drug dependency syndromes
-
Compositions for the treatment of hepatitis C – a patent application (PDF file)
Other articles
-
A chronology of psycho-active substance use.
OPINION
-
Ibogaine Development: Politics, Policy, Prejudice, Profit and Science A PowerPoint slide show from the 2006 New York City Ibogaine Conference provides an overview of ibogaine, its politics and science. The effects of stigma and discrimination on the drug dependent population and medication development are also discussed. (5 mb file)
-
To some, there is no stronger representation of opinion than expressed in art and to that end the Ibogaine Dossier has established an art gallery. The Dossier is pleased to introduce paintings inspired by the ibogaine experience, photographs of Bwiti initiation rites and other celebrations in Gabon Africa as well as, examples of ibogaine political graphics. Please visit our gallery for these presentations.
-
Key to the growing ibogaine scene in Great Britain is treatment provider Hattie Wells. Patient Jonathan Horsley describes what ibogaine did for him in Trip of a Lifetime.
-
David Scott’s production of the documentary film Detox or Die depicting years of heroin addiction and chemical dependence and his release from that vortex by ibogaine was broadcast by the BBC to an audience of two million viewers. Journalist Roz Paterson writes the story: Alive and Kicking.
-
As part of the Ibogaine Dossier’s Document Archive Project we present Bob Sisko’s Treatment on Demand: Realistic Goal or Impossible Dream. Sisko was the founder of the International Coalition for Addict Self-Help (ICASH).
-
Could the root of an obscure African plant contain the secret to combatting addiction? An Independent on Sunday article (March 1999).
-
Is ibogaine the greatest pharmaceutical discovery of the late 20th century, or will it turn out to be just another story of a maverick visionary. A syndicated article by Simon Witter.
-
Fight to develop drug addiction therapy. A reprint from Nature Medicine.
-
Heantos. A Vietnamese medicine man gets addicted to drugs in an attempt to find an all-natural cure for addicts. The United Nations Development Program has said it will spend $400,000 to test the substance.
-
Reflections on an ibogaine experience. “I heard about ibogaine from a friend in New York and then requested treatment for me and my boyfriend. We were the first people to be treated in Holland. My ibogaine treatment took place on October 25, 1989, in a hotel room in Amsterdam. My boyfriend had been succesfully treated the day before.”
-
For centuries a strongly hallucinating potion made from leaves and lianes has been used in the South American jungle. This potion is called yage or ayahuasca and it is mainly used in religious settings. Some information about ayahuasca and a personal report by Hannah Bouma.
-
Eric Fromberg, Trimbos-instituut, Netherlands Institute of Mental Health and Addiction
Mijn eerste confrontatie met het bestaan van ibogaine was de vermelding ervan in het onvolprezen boek van Emboden: “Narcotic plants” en dat leerde me niet veel meer dan dat Tabernanthe iboga, een struik uit west Afrika, een hallucinogeen bevat met de naam ibogaine, totdat ik bijna 20 jaar later een briefje van Simon Vinkenoog ontving, vergezeld van enige papieren die handelden over het gebruik van ibogaine bij het afkicken. -
John Morgan, Professor in Pharmacology, City University of New York Medical School.
Initial disbelieve has changed after reviewing research results. “I can now balance my skepticism with some appropriate optimism and look forward to the NIDA studies.” -
Rick Doblin, MAPS. Now that NIDA has decided to enter the field of ibogaine research, it is sparing no expense in gathering the required data. Its leisurely timetable, however, leaves something to be desired.
-
NIDA and Ibogaine, by Bob Sisko.
Excerpts of Bob Sisko’s remarks on May 12, 1993 to the 54th meeting of the National Advisory Council On Drug Abuse at the National Institutes of Health, Bethesda, Maryland -
Bob Sisko writes about the First International Ibogaine Treatment Symposium.
-
Howard Lotsof, NDA Inc. describes the Endabuse Procedure in the development of ibogaine to treat addiction.
-
The history of ibogaine an African American Perspective. A reprint from City Sun
-
INTASH discusses the necessity of Addict Self-Help involvement in Ibogaine treatment. They represent the New York based International Coalition of Addict Self-Help (Intash)
-
Barbara E. Judd CSW discusses the need of psychotherapy in the Ibogaine treatment of substance-related disorders
-
In Memoriam Nico Adriaans, by Jean Paul Grund.
In the night of January 22, 1995, my friend and brother-in-arms Nico Adriaans passed away. Nico Adriaans was the founder and chairman of the “Rotterdamse Junkiebond” (Junkie Union), the first advocacy/activist User Group in the Netherlands. -
John A. Speyrer asks: Ibogaine: Does This Psychedelic Drug Portend the End of Primal Therapy?
-
The Ibogaine Factor. Washington bureaucrats and Harlem activists debate the controversial “Cure for Addiction”
-
Deborah Mash about ibogaine and clinical testing in a slightly outdated article from Omni magazine, February 1994.
______________________________________________________________________
18-Methoxycoronaridine
Synthetic iboga alkaloid congener
The ibogaine research team at Albany Medical College has developed a synthetic iboga alkaloid congener, 18-methoxycoronaridine (18-MC). Animal research shows that 18-MC shares ibogaine’s anti-addictive properties, possibly withoutibogaine’s hallucinogenic effects, possibly not. View the molecular structure at bottom of page.
The most recent research indicates that 18-MC may have anti-HIV activity thus providing a very interesting perspective as a medication capable of treating two vector related disorders: Chemical dependence and HIV. We now await the testing of ibogaine and other iboga alkaloids and congeners to determine if they may also have such broad spectrum activity and to what degree.
The following is a list of selected publications.
1. Anti-HIV-1 activity of the Iboga alkaloid congener 18-methoxycoronaridine. Silva EM, Cirne-Santos CC, Frugulhetti IC, Galvao-Castro B, Saraiva EM, Kuehne ME, Bou-Habib DC. Planta Med. 2004 Sep;70(9):808-12. Abstract
2. Anti-addictive actions of an iboga alkaloid congener: a novel mechanism for a novel treatment. Maisonneuve IM, Glick SD. Pharmacol Biochem Behav. 2003 Jun;75(3):607-18. Abstract
3. Metabolism of 18-Methoxycoronaridine, an Ibogaine Analog, to 18-Hydroxycoronaridine by Genetically Variable CYP2C19. Zhang W, Ramamoorthy Y, Tyndale RF, Glick SD, Maisonneuve IM, Kuehne ME, Sellers EM. Drug Metab Dispos 2002 Jun 1;30(6):663-669 Abstract
4. Antagonism of alpha3beta4 nicotinic receptors as a strategy to reduce opioid and stimulant self-administration. Glick SD, Maisonneuve IM, Kitchen BA, Fleck MW. Eur J Pharmacol 2002 Mar 1;438(1-2):99-105 Abstract
5. Drug discrimination studies with ibogaine. Helsley S, Rabin RA, Winter JC. Alkaloids Chem Biol 2001;56:63-77 Abstract
6. 18-MC reduces methamphetamine and nicotine self-administration in rats. Glick SD, Maisonneuve IM, Dickinson HA. Neuroreport 2000 Jun 26;11(9):2013-5 Abstract
7. Pharmacological comparison of the effect of ibogaine and 18-methoxycoronaridine on isolated smooth muscle from the rat and guinea-pig. Mundey MK, Blaylock NA, Mason R, Glick SD, Maisonneuve IM, Wilson VG. Br J Pharmacol 2000 Apr;129(8):1561-8 Abstract
8. Synthesis of enantiomerically pure (+)- and (-)-18-methoxycoronaridine hydrochloride and their preliminary assessment as anti-addictive agents. King CH, Meckler H, Herr RJ, Trova MP, Glick SD, Maisonneuve IM. Bioorg Med Chem Lett 2000 Mar 6;10(5):473-6 Abstract
9. 18-Methoxycoronaridine (18-MC) and ibogaine: comparison of antiaddictive efficacy, toxicity, and mechanisms of action. Glick SD, Maisonneuve IM, Szumlinski KK. Ann N Y Acad Sci 2000;914:369-86 Abstract
10. Development of novel medications for drug addiction. The legacy of an African shrub. Glick SD, Maisonneuve IM. Ann N Y Acad Sci 2000;909:88-103 Abstract*
11. Acute iboga alkaloid effects on extracellular serotonin (5-HT) levels in nucleus accumbens and striatum in rats. Wei D, Maisonneuve IM, Kuehne ME, Glick SD. Brain Res 1998 Aug 3;800(2):260-8 Abstract
12. Effects of 18-methoxycoronaridine on acute signs of morphine withdrawal in rats. Rho B, Glick SD. Neuroreport 1998 May 11;9(7):1283-5 Abstract
13. Attenuation of alcohol consumption by a novel nontoxic ibogaine analogue (18-methoxycoronaridine) in alcohol-preferring rats. Rezvani AH, Overstreet DH, Yang Y, Maisonneuve IM, Bandarage UK, Kuehne ME, Glick SD.Pharmacol Biochem Behav 1997 Oct;58(2):615-619. Abstract
14. Time-dependent interactions between iboga agents and cocaine. Maisonneuve IM, Visker KE, Mann GL, Bandarage UK, Kuehne ME, Glick SD. Eur J Pharmacol 1997 Oct 8;336(2-3):123-126. Abstract
15. 18-Methoxycoronaridine, a non-toxic iboga alkaloid congener: effects on morphine and cocaine self-administration and on mesolimbic dopamine release in rats. Glick SD, Kuehne ME, Maisonneuve IM, Bandarage UK, Molinari HH. Brain Res 1996 May 6;719(1-2):29-35. Abstract
Check Medline here to find out about the most recent publications.
__________________________________________________________________________________
Iboga Tabernanthe
Iboga
Kingdom: Plantae
Division: Magnoliophyta
Class: Magnoliopsida
Order: Gentianales
Family: Apocynaceae
Gender: Tabernanthe
Species: T. iboga
With a height of 1 to 5 meters in height, Tabernanthe iboga is a shrub that has a latex copious, foul-smelling white. Its leaves are between 9 and 10 cm long and 3 cm wide, are oval and greenish-yellow on the underside. The leaves are ovate. A yellowish, pink or pink-stained white. the flowers appear in groups of 5 to 12 and have a twisted corolla lobes crater. The fruit is ovoid with the tip yellow-orange and appear in pairs, becoming as large as olives. Their roots are yellowish.
In tropical forests.
Gabon, Congo, Zaire, Cameroon and Equatorial Guinea.
At an ambient temperature of 30 ° C fresh seeds germinate easily. In some cases it may take up to two months to germinate. Sunlight should be indirect and the humidity should be high. In general you should grow in an environment as close to tropical or subtropical climates because if the temperature reached temperatures of 0 º C the plant would die.
For use shamanic used the root bark of both fresh and dried and reduced to dust or chips.
The major indole alkaloid of Tabernanthe iboga contains ibogaine is also contains:
Voacangina, tabernantina and ibogamina among others.
This is a controlled substance and its chemical formula is C20H26N2O.
In the dried root is between 1 to 2.6% of alkaloids, while the root bark of 5-6% of them.
Strong stimulant and aphrodisiac.
In excess of 6.25 g ibogaine (the main alkaloid) is a visionary substance.
During the sixties the Chilean psychiatrist Claudio Naranjo introduced the use of ibogaine as a drug that gave positive results in psychotherapy by stimulating the individual’s imagination and the ability to recall circumstances of the child buried.
Has also studied the use of ibogaine in addiction therapy to heroin and cocaine.
Aphrodisiac, stimulant, euphoria, muscle strength doubled and high doses is a powerful entheogen.
African hunters consume small amounts of iboga to stay awake during long hours of night fighter, which is why any American writer has called the coca Tabernanthe African iboga.
Orally ingested the dried root powder and it tastes bitter as it is best to mix it with hot water and a little honey.
The Congo native ingest pure or soaked with palm wine.
An overdose would cause convulsions and respiratory paralysis. May cause death.
Ibogaine is entheogenic above 1 mg / kg.
0.5 to 1 gram of dried root bark for the uninitiated to evaluate the degree of sensitivity to this plant, in successive tests can increase the dose to an amount of 2 to 5 gr., Enough to test the stimulation and the aphrodisiac effect.
5 to 15 gr. can cause visual changes and entheogenic effects.
30 to 50 gr.
There is an antidote that is used when needed during the ceremonies.
Some poison control centers in the World:
Spain (Madrid), contact your local poison control telf.91.562.04.20
Mexico DF , contact your local poison control center (AMIFAC-Sintox) Tel. +52 (55) 55.98.90.95, 55.98.72.65
In Argentina (Buenos Aires) contacting Toxicology Unit Tel: (011) 4962-6666
Colombia (Bogota) Emergency Toxicology Advisory Centre Tel: +57 1 218 6246 or 236 1259 or 257 6818 or 610 7050
The iboga, which has a great social influence in Gabon and the Congo mainly essential part of worship bwiti and other secret societies which employ up to 50 times the recommended “normal.” To enter the worship, the natives started or Banzi (angels), should see Bwiti, the god of initiation, which appears to them during the ceremony that is consumed iboga.
The elaborate ceremonies and tribal dances that are associated with the consumption of iboga vary from town to town, all music is central to all worship
The word is used by iboga bwiti to name all worship, ndzie-boka (high drug) means a member of the cult; nyiba-Eboko is the name of religion surrounding the iboga.
In Equatorial Guinea the Tabernanthe iboga is prohibited.
A little less than half a century the Germans found the iboga north of Gabon (in Cameroon) and in 1898 reported that the root caused an excitatory effect on the nervous system so it could be advisable to use against the fatigue of long walks.
Plants of the Gods, RESchultes, A. Hofmann.
Pharmacotheon, J. Ott.
Hallucinogenic Plants, Luis Otero Aira
________________________________________________________________________________________________________________________
ZoSo's TRUTHTALK13 