Global Alliance of Ibogaine
Therapy Providers (GITA)
Barcelona 2010
Rationale/Intended Purpose
A document produced for the Global Ibogaine Therapy Alliance
(GITA) in an attempt to standardize the key practices necessary to
reduce risks and solidify the potential benefits of ibogaine-assisted
therapy. It is an independent addendum to the Manual for Ibogaine
Therapy, Second Revision, 2003 produced by Howard Lotsof, Boaz
Wachtel, et. al, and has been updated with new information compiled
since that manual's publication.
The intention of this document is to provide recommendations for
increasing the safety of ibogaine therapy. It is intended to assist
providers by offering a basic framework for safety and emergency
protocols grounded in ethics and recommendations for best
practices. It will outline known and suspected risks associated with
ibogaine therapy and contain general guidelines for minimizing risk
and preventing adverse events. It also includes recommendations for
optimum scenarios, background and/or supportive information, links
to further info and general considerations.
Whilst the following recommendations have come from a
variety of sources, types and styles of ibogaine therapy; a large
part of the focus is on protocols for drug detoxification therapy
as it is a complex issue and deserves much attention because
ibogaine is increasingly used for this purpose.
It should be noted however, that some basic guidelines in this
document are relevant to any kind of ibogaineassisted/enhanced therapy and therefore we highly recommend
that anyone taking ibogaine for any purpose take heed of the
general safety advice contained in this document and in the
above-mentioned Manual for Ibogaine Therapy.
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This document is being compiled and edited by GITA on the basis of
recommendations made by ibogaine therapists.
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These therapists include a wide spectrum of providers from informal
lay therapists and underground providers through to medical doctors
operating clinical type settings.
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These individuals have participated in ibogaine-therapy for reasons
including drug detoxification/treatment, personal psychotherapy,
traditional/cultural, medicinal, religious/spiritual use and a wide
range of other therapeutic applications.
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It is also informed by medical and scientific findings, guiding policy
documents regarding treatment, harm reduction and research,
discussion forums and mailing lists.
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Our intention is to provide a framework for minimal
standards of care and safety whilst respecting
diversity in therapeutic style, program structure,
setting and ethos.
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We understand that if proper care is taken to
protect the physical, psychological, emotional and
spiritual well-being of the individual undergoing
therapy, then the potential for beneficial outcomes
is increased.
We encourage contributions, general feedback and
updates.
 Orientation
 Training
 Ethical Considerations
 Team/Staff Structure
 Intake
 Dosing
 Monitoring
 Emergency Protocol
 Post-therapy Considerations
 Follow-Up
 Record Keeping
 Feedback and Evaluation
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Ibogaine Therapy Providers (TP’s) should demonstrate a capacity to work with
compassion and care, even under challenging situations, throughout the course
of therapy
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The TP’s primary motivation should be the physical and psychological safety of
any individual under their supervision
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They should approach their work with positive intentions, respecting ethical
considerations collectively agreed upon by ibogaine therapists and take into
consideration the multifaceted individual needs and expectations of those in their
care
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They should have a commitment to keeping abreast of recent developments and
findings about ibogaine therapy especially those relating to safety
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They should recognize that ibogaine therapy is experimental in nature and be
prepared to be constantly vigilant in the evaluation, updating and evolution of
their own processes, procedures and protocols
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They should be committed to demonstrating transparency and be candid about
their qualifications, experience and knowledge in their communications with
individuals applying to be under their care
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They should take into consideration their own level of health and wellbeing and
its impact on their capacity to provide an appropriate level of care and support
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Ibogaine Therapy Providers (TP’s) should read and understand the Manual
for Ibogaine Therapy, and keep their knowledge as up to date as possible
through and communicating with other TPs
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They should read and understand the Ibogaine Patients' Bill of Rights
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They should understand the rationale for exclusion criteria and recognize the
importance of detailed and effective screening
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They should understand what fully informed consent consists of
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They should have a clear understanding of the resource requirements
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They should have a minimum of training in Cardio Pulmonary Resuscitation
for Health Care Providers (CPR-HCP). Ideally TPs should also be certified in
assisted cardiac life support, and some level of electrocardiogram
interpretation or be prepared to hire someone with these qualifications as an
Emergency Medical Responder
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Tp ‘s should learn and make an effort to understand as fully as possible
what is known about ibogaine’s mechanisms of action and pharmacology
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They should learn about ibogaine’s potential effects and side effects
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They should understand what the potential risks are and how to prevent
adverse events. They should also learn how to promptly and effectively
respond to adverse events
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They should learn about contraindicated conditions, medications, drugs,
herbs and foods
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They should have an understanding of the variability in individual clients
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They should undergo in-depth training with at least one but preferably
several experienced therapy providers who have established their ability to
provide services in a safe, conscientious and therapeutic manner
Tp’s should have a commitment to safeguarding the health, safety and dignity
of their clients by following ethical guidelines intended to prevent problems
and optimize potential therapeutic benefit.
They should have an understanding of the ethics surrounding the provision of
services to vulnerable individuals and consumer groups.
The following ethical guidelines are internationally recognized in therapy and
research:
• Beneficence: Promotion of wellbeing
• Non-malfeasance: Avoid potential harms
• Dignity: Respect for the person
• Informed Consent: The person's right to information, to ask questions
and to weigh the risks and benefits before making a decision to undergo
therapy
• Confidentiality: Respect for privacy
• Feedback: The person’s right to provide feedback, whether positive
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TP’s should not conduct sessions alone
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Emergency Medical Responder is necessary
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Having staff job/role descriptions helps
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All team members should sign a confidentiality
agreement regarding client’s sensitive info
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Establish a conflict resolution process
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Feedback questionnaire for staff helps inform
development and evolution of policies and procedures
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Regular staff meetings help with organization
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The TPs should make every effort possible to create a clean, quiet and
comfortable therapy environment. Preferably with soft lighting options.
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Earplugs or headphones, eye covers, and a variety of music may be useful
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Phone should be available to be used if/when needed.
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Non-slip stick-ons for bathtub/shower, safety grab bar if possible, flashlight,
etc..
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Conduct fire drills with team, emergency escape route shown to client before
therapy or otherwise clearly marked.
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Sharps container on site if any needles being used to administer drugs such
as anti-nauseant, also in case if needles are found during search
procedures.
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Posted info: emergency contact #'s, escape route, other signs such as hand
washing reminders.
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Advisable to not use soaps in the form of bars, pump style dispensers
reduce the risk of transmitting colds and infections.
TPs should have on location a minimum of the following equipment:
 CPR - First Aid Kit
 Pulse and Blood Pressure Monitor
 Thermometer
 Pulse Oximeter (SP02 – which monitors oxygen saturation in the blood)
Ideally they should also have:
 an AED (Automated External Defibrillator),
 a Cardiac Monitor (EKG/ECG - electrocardiogram)
 Oxygen tank
All Emergency Medical Responders (EMR) should be fully trained and
confident in their ability to use and/or promptly and effectively deploy to
prevent or treat any potential adverse events.
The TP is responsible for regular maintenance, testing and sanitization
of all the above-mentioned equipment.
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Informing
Screening Tools (ie: application form)
Medical Screening
Pharmacological Screening
Psychological Screening
Other important data gathering
File keeping and data storage
Decision-making and acceptance process
Rejection process
Preparation and informing of client prior to therapy
Please share your process and any suggestions or
insights
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Active infections including Peptic Ulcers (such as Gastric, Duodenal, Esophageal),
Pneumonia, or Skin Abscess
Cancer (there is no information regarding how ibogaine will affect this condition and
interact with medications or otherwise affect disease progression)
Cerebellar Dysfunction including Cerebral Palsy, Multiple Sclerosis and Stroke
Cluster Headaches, Severe Migraines
Epilepsy or history of seizures
Heart disease or problems such as arrhythmias, heart irregularities, murmur, palpitations,
history of heart attack, Myocardial Infarction, Pericarditis, Prolonged QT Syndrome,
Alcoholic Cardiomyopathy, etc...
High Blood Pressure - untreated (unmedicated hypertension)
Gastrointestinal disorders such as Inflammatory Bowel Disease,
Crohn's Disease or Irritable Bowel Syndrome
Kidney disease including kidney stones and other compromised kidney function such as
Urinary Infection
Liver disease (dependent on condition - liver enzymes more than 400% above normal
indicate compromised liver function and possibility of toxicity )
Lung disease such as Asthma, Bronchitis, Emphysema or other respiratory problems
Pregnancy
Stroke
Tuberculosis
uncontrolled Diabetes
Vascular disease such as Venous Insufficiency, Deep Vein Thrombosis, Arteriosclerosis,
Lymphedema, Phlebitis, Blood Clots or coagulation abnormalities, etc...
Many different dosing regimens have been developed, please
contribute your findings; include rationale, benefits and
challenges.
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Clients should also be informed of dosing regimen and any
changes that arise during course of therapy
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Record baseline vitals
Pulse, BP, Temp, Stress test, SP02, ECG (if available)
During Therapy - Post Admin
• Pulse, BP, Temp, SP02, ECG (if available)
• Every 15mins during first 2 hrs, every ½ hour thereafter for 8 hrs,
every hour until resolution (at least 36hrs)
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Check for signs of trouble or distress in other ways (ie:
watch/listen to breathing, try to make eye contact
occasionally, simple dialogue /check-in, etc…)
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Record all results and observations in a legible,
comprehensible and organized fashion
Have one!!!
Minimum:
 call emergency services 911, 061, etc…
Optimal:
 Have an EMR: Doctor, Nurse, Paramedic, EMT…
 Be prepared to employ AED
 Prepare emergency protocol with your local
Hospital/Paramedics/Emergency prepared clinic
 Send information and updates to Poison Control Center or
equivalent in your country
 Have a crash cart onsite
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List of emergency contact #’s should be posted in facility, near the
phone.
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Consider setting up protocol with local emergency psychiatric
services (if available)
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Inform client of reduced tolerance and potential for
overdose or other potential adverse effects
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Provide contact information
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Maintain contact if possible – Follow Up
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Consider giving them a package of information to
help support them:
• ie: referrals/copy of tx notes, consent form, contact info,
follow up schedule, info for family and friends, links for
further support and information, self care…
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Try to maintain some form of contact with client
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Collect Data if possible
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Share resulting data if possible
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Considerations:
• Be aware of client-therapist dynamics
• pay attention to your boundaries
• Prepare for what to do if someone is in crisis
Some suggestions:
 Experience
Report
 Measures/Questionnaires
 Staff Evaluation Forms
 Clinical Discharge Report
 File Checklist
 Store
files securely
Elements th help to improve services
 Take time to collect feedback and
consider suggestions for improvement
from clients, staff , other providers and
yourself
 Create some form of evaluation process