How the Ibogaine Clinic Learned from Mistakes

By The Third Wave

In this guest post by experienced ibogaine facilitator Jeremy Weate, we hear about the challenges and risks of ibogaine therapy, and the measures that all ibogaine clinics must take to ensure the safe integration of ibogaine therapy into mainstream society.

After first hearing about iboga about ten years ago (from a friend, on a London bus), I knew I would be drawn to it. I had spent 12 years living in Nigeria: and discovering that there was a tradition of African entheogenic spirits – Bwiti – from the neighbouring region of the continent – ​​the Congo Basin – was seismically interesting. Fast forward to 2017, and I met Alvaro de Ferranti at an ibogaine forum in Vienna that I co-organised. Fast forward to July of this year and we find ourselves opening an iboga retreat center in Portugal.

Clare Wilkins

Alvaro’s path to ibogaine had been somewhat different from mine. He had tried both hypnosis and luxury rehab centers, but a visionary dose of iboga wiped out the remnants of a cocaine addiction that had threatened to implode his life as a successful London-based entrepreneur and family man. After an intense period trying to bring ibogaine clinical trials to Portugal, developing a research protocol, hiring a highly skilled team, and engaging senior government officials, but falling at the final insurmountable financial hurdle, Alvaro became an ibogaine supplier. He initially opted for the Airbnb route for ibogaine treatment before deciding that opening a fully-fledged ibogaine clinic was the best way to spend his time.

We both shared the same vision: to offer ibogaine treatments, primarily to addicts, in a holistic setting with a strong focus on pre- and aftercare, avoiding the “ibogaine in the car” too often found elsewhere. Instead of the four or five-day reset these retreats typically offer, we would do a two-week visit at a minimum, meaning repeat visits are less likely and long-term recovery is improved.

Álvaro had purchased a nine-hectare property in a wonderfully quiet and beautiful part of rural Portugal – the Alentejo, in the interior of the Algarve – with ancient rocks, an olive grove and its own stream. A strong motivation was to bring the best of his luxury rehab experience to an ibogaine centre. While many ibogaine clinics eschew traditional rehab methods such as cognitive behavioural therapy, the 12-step method and counselling, Álvaro saw the benefits of conventional addiction treatment, so as not to throw the baby out with the bathwater.

Things worked out surprisingly quickly on the HR front: miraculously, we found a spiritually-oriented Portuguese doctor who was willing to take a chance on an unlicensed field of medicine. Holistic therapists gravitated to us as if sliding down newly constructed ley lines. Our therapeutic offering now includes holotropic breathwork, kundalini yoga, meditation, massage, equine therapy, vocal toning, light therapy, and drum and sound therapy, as well as access to other plant medicines, such as kambo and psilocybin. Again, keeping traditional rehabilitation best practices in mind, we also hired a fitness trainer and counselor-talk therapist to complement our holistic healing offering.

On the medical side, we hired the fabulous Jamie Mac of Iboga Safe (the only ibogaine safety training center in existence) to train the team. It was at this point that we realized that ibogaine treatment can be really difficult. Dosing is not a simplistic matter of staying under a mg/kg limit; each person’s body metabolizes ibogaine (and its sister alkaloids) differently, depending on prior drug use, the presence of a key enzyme, and a host of other factors. There is not enough scientific research or shared wisdom from practitioners on dosing. Providers can swing between both sides of an unpleasant dilemma: play it safe, under-dosing and failing to satisfy the patient; or be bold, de-addicting but risking an adverse effect. Jamie helped us understand the importance of measuring QT intervals before and during treatment, and how to stay safe at all times.

We also worked with an ibogaine counselling service that offered excellent pre- and post-treatment ibogaine counselling, ensuring our clients arrived highly motivated to change their lives.

We felt primed and ready. And then we had our first clients.

A, our first client and from the UK, suffered from a nasty spice addiction (which quickly went into withdrawal if he didn’t smoke every hour) and a cocaine habit. There is very little information available about treating spice addiction with ibogaine (or any other treatment modality). To make matters worse, “spice” is the generic name for a heterogeneous group of research chemicals. We were shooting in the dark. A good way to start!

A was a difficult client. Childhood abandonment issues came to the fore as we spent the first week weaning him off drugs with holistic treatments and counseling before the ibogaine treatment. It was a little scary to witness the anger come to the surface. In the end, A survived over three weeks with us and is now starting a new life in California. Our baptism included fire.

Our second client, M, was a different story. A decade-long opium addiction had reduced his body to a gaunt husk. Again, we spent a few days putting him through our holistic treatments, such as breathing exercises and kundalini yoga. Then it was time for his treatment. Along with our doctor, I was one of the people attending to him. I witnessed M having a cardiogenic seizure, his jaws locked and his body shaking as his heart stopped. Thankfully, our medical team defibrillated M within a few seconds and he came back to life. Our emergency plan kicked in and M was taken by ambulance to the cardiology ward at the nearby hospital.

It was only later that we discovered that M had been taking the supplement Cava Cava, which interacts very poorly with ibogaine. From that point on, we learned not to trust what clients tell us they have been ingesting as if it were the whole story.

Since then, with every client we have treated, we have learned some difficult lessons. Treating addiction with ibogaine is very hard work that requires a committed and balanced team. Staff need to take time off regularly to avoid burnout. Even in a medical setting, it is not possible to guarantee that there will be no adverse events, even if this setting reduces the risk of death to almost zero.

Here are the main things we have learned:

1. Safety is the number one priority. While we would love for all of our clients to have incredible visionary experiences that take them to the root of their trauma and allow them to transcend suffering through ibogaine, this is, in fact, a pipe dream. Conservative dosing is of utmost importance.
2. Emergency planning is vital. If an adverse event occurs and it is heart-related, you only have seconds to prevent a fatality. Before each client’s treatment, we review the emergency plan so that everyone is aware of it. It’s never pleasant to have to call the ambulance, but the most important thing is that all of our clients stay safe, all the time.
3. Flood doses are not for everyone. While some bodies can handle a high dose (20 mg/kg+) of ibogaine, many people cannot. A brain reset through ibogaine does not require such high doses in any case.
4. Ibogaine does not work in isolation. While we knew from the beginning that ibogaine is not a miracle cure, we were guilty (along with many others in the community) of evangelizing it. We learned that ibogaine is a powerful tool for interrupting addiction, but it is just one tool in a much larger box in terms of long-term recovery. Working with ibogaine makes you less evangelistic and more realistic about its limited (but powerful) benefits.
5. Conventional addiction counseling and holistic treatments are the best combination along with iboga. Clients need to talk and release what is on their minds, but they also need energetic healing (through holistic therapy). In combination with ibogaine, this triumvirate of treatment modalities offers a powerful reset toward a life free of addiction.
6. Pre-treatment therapy is vital, including the ability to postpone treatment if the client is deemed not ready. Pre-treatment therapy, especially the narrative approach that emphasizes dissociation from the addict self and the hero’s journey in taking ibogaine, opens the mind and can prompt the client to deepen their intention and resolve to be substance-free.
7. Aftercare is also vital. One of the best aspects of conventional addiction treatment is community, 12-step movement communities, and peer-support mentoring. We have learned that ibogaine therapy for addiction does not replace these conventional treatment modalities, but rather complements them. It is recommended that weekly therapy meetings be offered with clients online for as long as needed. The vision is that all those who have recovered through ibogaine treatment will join this self-sustaining movement.

Unfortunately, there is a culture of secrecy in the ibogaine community surrounding adverse effects (for obvious reasons: no one wants to lose their reputation, lose clients to other clinics, or be forced to close down). On the road to medicalizing medicine, we must not shy away from acknowledging our own adverse effects, being humble, and learning from our mistakes.

Jeremy Weate is the Executive Director of the Global Ibogaine Therapy Alliance. He is also the Executive Producer of The Ibogaine Stories, an upcoming film project. You can contact Jeremy here