There haven’t been many ibogaine-related deaths reported in the last five years, but the ones we do know about all seem to have some elusive factor. The 2014 death of a woman in a Costa Rican ibogaine clinic was actually from a heart attack, but the autopsy report was inconclusive as to whether there was ibogaine in her system when she died. Most reports blame the clinic, which was operating outside of Costa Rica’s regulated licensure program for ibogaine providers. They closed after the woman’s death, suggesting the clinic didn’t properly check the patient’s medical history for pre-existing cardiac conditions.
That same year, an Australian man named Brodie Smith died in his hotel room in Thailand. His girlfriend claimed he died after taking ibogaine and having trouble breathing, but the reports here are also convoluted—some accounts suggest he actually overdosed on methamphetamine (the addiction he was hoping to treat with ibogaine therapy) before ever taking ibogaine or still had methamphetamine in his system at the time of administering ibogaine.
The unknown factors in both cases highlight ibogaine’s biggest weakness—lack of regulation. Ibogaine is still illegal in the United States, so finding treatment generally requires leaving the country. Internationally, ibogaine providers run the gamut from professional clinics to hotel room pop-ups.
But these stories contain other clues regarding risk factors to consider if you’re thinking about ibogaine treatment. Perhaps the most helpful resource on this topic is The Clinical Guidelines for Ibogaine-Assisted Detoxification, published in 2015, which includes all known health risks, exclusion criteria, and recommended health assessments for ibogaine treatment. As in these two stories, the complications explored in this publication often result from a provider not collecting key health information or a patient not being completely honest about their medical history.
Understanding the Risks
The reported number of deaths from ibogaine is relatively low. According to a 2012 report, there were nineteen reported cases of people dying from ibogaine between 1990 and 2008. Even so, it’s important to educate yourself before making decisions about treatment. Some medical conditions, like cardiac disorders, automatically flag you as an at-risk patient whereas the implications of other medical conditions, like depression, are still not understood. The exclusion criteria for ibogaine depends on the specific resources consulted, and researchers say the high number of people with drug dependency and concurrent mental illness necessitates a reconsideration of the exclusion criteria. However, the risks listed here include the National Institute on Drug Abuse (NIDA)’s criteria and offer a discussion on some of the finer points and treatment considerations.
Cardiac disorder is at the top of the list for exclusion criteria largely because the relationship between ibogaine and the heart is still relatively unknown. Ibogaine increases your heart rate and inhibits particular gene channels that affect cardiac action, making cardiac arrest the most common cause of ibogaine-related deaths—of the nineteen deaths reported between 1998 and 2008, six were related to cardiac complications. All of these deaths were related to pre-existing conditions, but a recent case study reported a man who died from cardiac arrest after administering ibogaine with no known history of cardiac problems. Based on this, researchers suggested ibogaine may cause cardiac arrest without preexisting conditions. More research is needed to understand the role of ibogaine in cardiac action, but it is clear that an existing cardiac disorder could be a major disqualifier if you’re interested in ibogaine therapy.
Concurrent Drug Use
Ibogaine is known to intensify the effects of opioids, so it’s extremely important that those undergoing ibogaine therapy do not have drugs in their body at the time of treatment. For this reason, most clinics operate on a “next fix” schedule—meaning, when used as an addiction interrupter, ibogaine is usually administered at the normal time of the “next fix,” so 8 hours after the last dose of heroin or morphine and 24 hours after the last methadone dose. Operating on this schedule, most people are just starting to show symptoms of withdrawal when they go into treatment. Administering ibogaine with substances like heroin, methamphetamines, or cocaine in your system is a serious risk.
HIV and HCV
The reason for including HIV and Hepatitis C (HCV) on the list of exclusion criteria is more out of lack of research than conclusive evidence that ibogaine interacts poorly with HIV or HCV patients. Most studies have not included HIV-positive patients, although there have been reports of non-symptomatic HIV patients who have undergone treatment without issue. While the NIDA originally included HIV and HCV on their list of exclusion criteria, lack of evidence shouldn’t necessarily keep people from undergoing needed addiction treatment.
Mental illness is another major topic of debate surrounding ibogaine. While conservative researchers think mental illness should be an automatic disqualifier, others argue that most people use ibogaine to treat addiction, which often overlaps with mental disorders like depression, anxiety, and PTSD. Lumping all mental illness into an exclusion criteria would discount a large portion of the population that ibogaine seeks to treat, and none of the ibogaine-related deaths recorded thus far showed mental illness as a central factor. More research is clearly needed, but, meanwhile, it is recommended that all patients get mental health and personality assessments before treatment and discuss any implications with their provider.
As with some other psychedelics, ibogaine has a stronger effect on women than men. This does not seem to only be a case of weight to dose ratio; rather, it seems women are actually more sensitive to ibogaine’s effects. Of course, being a woman doesn’t disqualify you from ibogaine treatment, but it’s important to understand that a particular dose may have a stronger effect on you than your male cohort.
Ultimately, these risks are all mitigated with the help of a trained guide or nurse, so it’s important that any clinic you choose has a trained professional on hand should a crisis arise.
What an Ibogaine Provider Should Ask You For
The majority of risks associated with ibogaine could have been mitigated by an improved medical screening process prior to treatment. As ibogaine therapy is still a loosely regulated field, it’s important that patients are assured of their provider’s professionalism and feel comfortable that any medical emergencies will be properly handled.
Basically, the more medical information gathered beforehand the better—not only for your own health but also for a provider wanting to track recovery rates—but there are four key things every provider should ask you for:
- EKG: An EKG tests for electric imbalances in your heart and helps determine if you have an existing cardiac condition. Any patient undergoing ibogaine treatment should be required to submit an EKG to confirm their cardiac health. An ECG is also recommended for patients over 60.
- Bloodwork: Blood chemistry is indicative of a patient’s overall health, particularly their liver health (which is of concern with ibogaine and other addiction treatments). Typically, a patient should receive a SMA-20 test (which evaluates chemistry levels) and a CBC test (which assesses total blood count).
- Medical History: Reputable ibogaine providers should ask for your complete medical history, either in the form of a questionnaire or by accessing your medical files. You should be completely honest when answering all questions to avoid possible risks.
- Mental and Personality Assessments: Ideally, ibogaine providers have every patient complete a Beck Depression Inventory and a Multiphasic Personality Inventory to determine the overall mental health of a patient. Some mental disorders, such as chronic major depression, may be a disqualifier for treatment.
The most important part of the screening process is trust and open communication. As you collect these records and start a conversation with a prospective provider, you should feel certain that all your questions are answered fully and honestly so you can go into treatment feeling confident.
The conversation about ibogaine and health risks is far from over. But even with these risks, it’s clear from research and personal success stories that ibogaine can be effective as an addiction interrupter. It’s only by educating individuals and fostering honest communication between providers and patients that we can mitigate the risks of ibogaine treatment and maximize its unique benefits to society as an addiction treatment.