How safe is ibogaine? We asked Clare Wilkins who has facilitated over 700 treatments.

By Psymposia.com

Clare S. Wilkins is a former IV drug user and methadone patient who got rid of her chemical dependency with the help of ibogaine. As the founder of Pangea Biomedics, she has facilitated over 700 treatments and collaborated with MAPS on the Mexico study. Since 2010, Clare has been an active board member of the Global Ibogaine Therapy Alliance (GITA) and is a co-author of the Clinical Guidelines for Ibogaine Assisted Detoxification. Clare is currently collaborating with ICEERS, developing a clinical trial of methadone for ibogaine-assisted detox.

We’ve mentioned that ibogaine can be dangerous, and we even looked at what can happen when proper safety precautions are not taken. Here, we take some time to speak with Clare and go into more depth about the risks associated with ibogaine.

While we hope this interview offers some insight into the safety protocols one should consider before taking ibogaine, we want to emphasize that it should by no means be considered a complete safety guide. Simply reading this interview is not adequate preparation, and we strongly encourage anyone thinking about working with ibogaine in any capacity to take the time to do further research.

Would you like to start by introducing yourself? What is your story?

I was an injectable heroin user before I switched to methadone. I come from a very traumatic childhood with a lot of violence. I discovered heroin at an Ivy League university and it seemed to answer every question I had.

I spent the next 15 years trying to figure out that answer.

Methadone maintenance treatment worked for a while. It was my water lily for 9 years. It saved my life. It made me stop being a criminal and stop being sick. I had a job and I was able to get my life back together.

Anyway, my sister and I had been on heroin and she had already detoxed, but she found out about iboga through Rick Strassman’s work with DMT. It was back when there were only a few clinics in the world. I went to a clinic in Tijuana, which at the time was the Ibogaine Association. There I broke free from the prison of methadone.

After my experience, I saw what might have been missing from the treatment protocol. I didn’t really have anyone to process the experience with. I went home and was in withdrawal for a month. I couldn’t even do my job. So, I called the clinic and told them I’d like to talk to patients who maybe needed to understand the process from a peer perspective. I was in Los Angeles and they were in Tijuana, so I would take the train and sit with people because no one who had taken ibogaine had sat with me.

That was the beginning. I volunteered until I got up the courage to buy the Ibogaine Association name and create Pangea with a full team in a new location. It was a calling, and it seems to be a calling that happens to a lot of people in the drug user movement.

Since then, you have become prominent in the ibogaine community as a provider and consultant. In your professional opinion, is ibogaine really safe?

That’s like asking if electricity is safe, in my opinion. You can cook a hot meal, light up a room, or shock someone with electricity, as they say.

It’s similar with ibogaine. Ibogaine, in and of itself, is not dangerous. There are risks and benefits.

Ken Alper, Jeffrey Kamlet, Deborah Mash, Bruno Rasmussen, Roman Paskulin, and Jamie McAlpin are all medical doctors and ibogaine safety experts. There are many journal articles and presentations by them posted online. To be clear, I am a lay therapist who has worked with an integrative team of medical doctors, naturopathic doctors, psychiatrists, psychologists, and somatic and peer therapists for 12 years.

So what are some of the specific risks? You mentioned the heart, but could you explain in detail the tests people should have before considering taking ibogaine?

Ibogaine increases electricity in the heart, which is one of the reasons reputable clinics perform cardiac tests: to assess how the heart conducts electricity. Ibogaine has some characteristics that require monitoring, and most experts conclude that thorough pre-screening and medical monitoring during the experience are crucial to its safety as a detox treatment.

Ibogaine also induces bradycardia (reduces heart rate, typically by about 10 beats per minute during a typical dose of 12 to 20 mg/kg). The risk of bradycardia is that the heart rate can drop very low. If the heart rate is kept too low for too long, immediate administration of atropine may be required. This is a serious, life-threatening situation that requires medical intervention.

QT prolongation is another major risk of ibogaine. The QT interval is a measure of the heart’s electrical cycle, or the time it takes for the ventricle to prepare from one contraction to the next. During this period, the heart is vulnerable to cardiac arrhythmias and other serious complications. Other legal medications prolong the QT interval, such as methadone. Withdrawal from benzodiazepines and alcohol also results in QT prolongation, so combining ibogaine with an alcohol or benzodiazepine detox can be extremely dangerous.

Many people seeking ibogaine for detoxification are polydrug users. For best results, complete blood and urine samples need to be drawn and analyzed as close to treatment as possible to assess for infection, electrolyte levels, and of course a toxicology screen. What drugs or medications has this person been taking that they may not have told you about?

Liver function and specific liver enzymes are essential. Many patients taking ibogaine have liver problems, are diagnosed with hepatitis C, etc. However, this does not preclude them from receiving treatment, in the experience of many providers. Still, it is critical to keep an eye on liver enzyme counts. I believe Howard Lotsof’s last patent application was for the use of ibogaine to treat hepatitis C. He had data showing a dramatic decrease in viral load counts in those diagnosed with hepatitis C who had taken ibogaine.

Electrolyte counting is also crucial because ibogaine is a potassium hERG channel blocker. Potassium plays an important role in heart function, and blocking this channel can lead to prolonged QT intervals, arrhythmias, and insufficient electrolytes for the heart to function as it needs to.

Noribogaine, the metabolite of ibogaine, is also an important topic. It appears to stay in the body longer than ibogaine, providing the “window of opportunity” we’ve heard about. Noribogaine has similar qualities to ibogaine in terms of decreasing opiate self-administration. According to Ken Alper and others, it’s important to note the concentration of noribogaine over time, which resembles a curve. Multiple doses of ibogaine in one night increase the area under the curve, indicating a higher concentration of noribogaine in the body for longer periods, which may or may not predict increased danger.

During your time as a provider, did you ever have any adverse events?

Pangea had 3 deaths, on separate occasions, as well as numerous events that required intervention. Thanks to mentors, experts, and teachers, Pangea learned from them. We have not had any adverse events since then because we now use completely different protocols that we have worked diligently on for the past 8 years.

We do not pull the rug out from under the client’s feet when starting treatment. You do not need to go into withdrawal. Prior to treatment, we develop specific protocols to treat the conditions underlying your dependencies. We continue this process during treatment.

Our work with ibogaine is done in a specifically timed manner. For example, with opioid dependencies, we administer morphine and then ibogaine, then less morphine and then ibogaine. As the ibogaine builds up, there is less and less craving for opioids and more time to include the complementary therapies we use. With stimulants, we don’t use the co-administration method, but we do use repeated cumulative doses. It requires an extreme amount of vigilance, but it is far more successful than anything we’ve done before following the traditional model.

Why did these adverse events occur?

Well, first, we were following the traditional model. In the conventional paradigm, you come to treatment in a state of withdrawal and receive ibogaine that evening, before trust with the team is developed, shortly after an ECG, and usually after a long flight.

We had a staff of 12 people, including 4 physicians. We basically had a hospital in a village; it wasn’t for lack of equipment or staff. These were extremely unfortunate and difficult aspects of the learning curve. Deaths were the result of pulmonary embolism, the presence of residual cocaine in the blood, and hypertrophy. All preventable problems, as we now know.

So do you think your current model helps prevent adverse events?

I don’t think so, we know.

There were no deaths or hospital visits in the 8 years since we changed our protocols. We had someone who experienced a hypertensive attack, who already had high blood pressure, and we got it under control within an hour. And another person was vomiting so much that they needed an IV, but that happened almost every week when we were administering ibogaine the old way.

Psychologically, it’s a different story. Clients may regress into their childhood, start acting like children, scream, cry, or behave violently. Staying in an alternate reality for an extended period of time also comes with safety concerns.

What’s different about this alternative protocol?

Well, the traditional treatment model is fast. Patients come in, take their ibogaine, and usually return to their same environment shortly after treatment.

We now emphasize pre-treatment at least a month before they come in. Many people focus on aftercare, but no one seems to talk much about solid preparatory care.

We have had numerous clients follow our preparatory protocol and end up not needing to take ibogaine. We work with naturopaths and develop orthomolecular protocols specific to the 5 major physiological problems that occur with drug dependency. These are depression, pain, anxiety, liver problems, and chronic fatigue.

What we do is called repeated cumulative low doses, which result in a saturation, or a “flood,” at the end. So instead of giving a single flood dose in one night, we do it over days. What that does is show us how someone reacts to the drug, how they metabolize the drug, rather than just based on the result of a blood test. So how do they react at first? Do they cry? Do they feel nothing? Do they say they feel fine? Do they see their dead grandparents? Do they feel calm or anxious at first? Then, as a team, we form a specific protocol based on their body and mind. They teach us.

Is it safe to take ibogaine alongside other medications?

There are many contraindications. Ibogaine potentiates not only morphine, but it seems to potentiate almost everything. A cup of coffee with a microdose of ibogaine in the morning may seem like four cups to some people. Antidepressants and antipsychotics are another category that is restricted to ibogaine. I highly recommend that people do a lot of research on this topic, as it can take a while to try all the medications. The GITA guidelines also have information.

Working with a doctor who supports the use of ibogaine and tapering off other medications, or continuing to use the same, is highly recommended.

There seems to be a lot of controversy and misinformation surrounding ibogaine and benzodiazepines. What’s the deal? Is it safe to detox from benzodiazepines using ibogaine?

Ibogaine doesn’t work as well for benzodiazepines as it does for opioids and stimulants.

Remember, ibogaine electrifies the body. Yes, with the right dosage it can put a person into a parasympathetic state, where they no longer feel fear. However, it is extremely dangerous to use ibogaine to taper off a benzodiazepine, especially quickly. We recommend people check out the Ashton’s manual. Heather Ashton is the world expert on tapering off benzodiazepines.

Of course, several therapies can be combined to detox from benzodiazepines, but we have found that a gradual reduction, over time, is the safest with long-acting benzodiazepines. Withdrawal from benzodiazepines includes QT prolongation, anxiety, fear, insomnia, seizures, and even death. When a person who is dependent on benzodiazepines takes ibogaine, they need to be stabilized with a long-acting benzodiazepine to keep the QT interval in a safe range. A short-acting benzodiazepine can leave the system during a “flood” quickly, increasing the risk of seizures and arrhythmias. It can also remain in the system and be potentiated by ibogaine.

This all depends on each person’s body and metabolism, as well as the dosage of benzodiazepines. We don’t know unless we go slowly. There is some debate around this topic, so it would be wonderful if clinics that work well with patients taking benzodiazepines could come together and share their knowledge with other providers and patients.

Many people hide their benzodiazepine use, even if it is only occasional, in order to be accepted into clinics, and this is dangerous. If you look at Ken Alper’s report on deaths, you will see that benzodiazepines are linked to many of the deaths associated with ibogaine; specifically, you will see that they were not used during treatment, but were found in the toxicology report afterwards. I call benzodiazepines the snipers of ibogaine deaths.

This topic is controversial because there is one doctor who says one thing and one clinic that says another, and so on.

What about other psychedelics? It seems to be a growing trend, taking ibogaine with other visionary substances. How safe is this?

Ibogaine is safe to take with certain psychedelics. But it is completely unsafe with others.

There appear to be dangers surrounding the administration of 5-MeO-DMT, kambo, MDMA, and ayahuasca in close proximity with ibogaine. There have been complaints, including one fatality, associated with the use of these drugs alongside ibogaine.

Ayahuasca and kambo are both purgatives, so issues of dehydration and overstimulation may be factors related to the safety of ibogaine treatment. There has been an increase in the use of these drugs together in recent years. Some practitioners seem to combine the higher risk substances well, with no reported adverse effects. Much research remains to be done.

There is also debate over the use of ketamine, which is a dissociative, while taking ibogaine or shortly after. Many clinics have witnessed clients move from heroin/opioids to ketamine after taking ibogaine, and from stimulants to 5-MeO-DMT and/or DMT as a form of psychedelic substitute. Aside from the physiological complications that can arise from these combinations, there is the psychological component.

Experiences with certain substances can take months or longer to fully integrate. Often, ibogaine is not enough to accomplish the mission on its own, to treat years of a chronic illness. It is essential to use complementary therapies to create an integrative experience for the client. This, of course, takes time.

A lot of people talk about microdosing ibogaine. Are the risks the same as with a higher threshold dose? Should someone get screened before starting a microdosing regimen?

The risks may be the same, yes. They are much less significant, of course, because the dose is much lower than traditional “flood” doses.

However, there are people who simply cannot and should not take ibogaine, period.

Even small doses can exacerbate a heart condition, anxiety, or insomnia. Ibogaine is cumulative, so as it builds up (if you microdose regularly), it eventually overwhelms the body and it feels like you took a larger amount that day than you actually did. I know people who used it daily, with one day off per week, and others who had a panic attack with a first dose of just a few milligrams. Although this is not a microdose, a death recently occurred with a dose of as little as 200 mg of ibogaine hydrochloride, which is considered less than a “booster dose.”

It is important to rest, integrate, sleep, dream, and allow the cascading effect of ibogaine to work wonders. A guide or facilitator is highly recommended. Others prefer to find their own inner guide, their inner doctor, so to speak. Ibogaine takes us back to the root of our inner voice, which we sometimes lose in this cacophony of modern life.

There seems to be a lot of misinformation about ibogaine, specifically about the safety protocol. What do you think are some of the most common misconceptions people have about ibogaine in general?

That they will be free from lifelong addiction. That they will understand the root causes of their dependencies and can easily move forward from those conclusions. That they can integrate their experience back into their normal life, as if it were a piece of cake from there.

One myth is that everything is fine and perfect after it is over. With ibogaine, yes, in one night, over the course of a few hours, you will be free of most withdrawal symptoms and cravings. But after that is when the real work begins.

Those are some of the main ones. Most people don’t know how to integrate what happened to them while taking ibogaine into their life. It’s difficult. That’s why if you look on our website, we have a page called ‘The Family’. The family is an organism, and if we notice that a family member doesn’t want to talk and be included in therapy, we begin to understand that the user may be the scapegoat. Dependency is a complex family issue to address.

Ultimately, would you say that taking ibogaine is worth it despite the safety risks?

Ibogaine is for the person who is drawn to it, who identifies with it, as with a food, a country, a friend, a plant, a potential lover, an ally.

After taking ibogaine, one can feel more of the world around them, see more clearly, and experience a new self-awareness that grows or appears suddenly.

We need more people who feel right now. Who see more deeply. It is urgent. The risk is worth it.

For me, it certainly has been.