It almost took too long for Juliana Mulligan to find the help she needed after an ibogaine treatment gone wrong, because multiple hospitals refused to believe that she, a 27 year-old woman with no history of heart problems, was going into cardiac arrest.
After finally being admitted into the fourth hospital, Mulligan went into cardiac arrest six times, revived by a defibrillator after each one, over a period of 36 hours. Eventually, she was put on an external pacemaker to return her heart activity back to normal.
What happened to Mulligan was preventable. The root of the problem, she explains, is that the clinic she went to in Guatemala, where ibogaine is not a regulated substance, didn’t properly understand ibogaine’s possible cardiotoxic effects, or adhere to basic safety protocol.
Despite the clinic’s shortcomings, Mulligan, like many other ibogaine patients who seek treatment for opioid addiction, emerged from the experience feeling liberated from her cravings for opiates. She went on to dedicate her life to work in the ibogaine field by working in clinics, becoming a safety and mental health protocol consultant and educator, and providing ibogaine treatment preparation and integration to those seeking treatment.
Is Ibogaine Safe?
“Ibogaine carries inherent risk, unless treatment is done by physicians with expertise and prowess to handle those risks,” says Dr. Jeffrey D. Kamlet, MD, board certified American College of Addiction Medicine physician and leading expert on ibogaine administration and safety. When administered properly, following rigorous safety protocols, “no patients need ever die from ibogaine.”
Kamlet, who serves as chief medical officer at the Mexico-based ibogaine clinic Beond, has established what has been called the “Kamlet Safety Protocols,” which he and other doctors – including Felipe Malacara, MD, Beond’s chief clinical and operations officer – have been practicing for decades with thousands of patients without a “single death.”
Proper safety protocols performed by qualified practitioners can transform otherwise risky procedures into safe and scalable treatment options. As an example, Kamlet suggests colonoscopies, which are safe when performed by a gastroenterologist who has specifically trained in that speciality and procedure. “Ibogaine can be safely accessible to the general public when administered by trained physicians in a safe, ethical, and science-based model of treatment that meets or exceeds the U.S. standard of care.”
“If clinics use these protocols and make sure there’s a physician at their bedside that can handle any emergencies,” says Kamlet, “the mortality rate can be reduced to possibly zero. This can be done safely. It does work.”
How Does Ibogaine Affect the Heart?
The primary risks associated with ibogaine are its cardiovascular effects. Ibogaine may cause bradycardia, which is the slowing of the heartbeat. In some cases, “it can cause profound bradycardia,” says Kamlet, which can be potentially fatal. It may also cause other cardiovascular issues such as QTc prolongation, HeRG blockade and hypotension during the treatment, complex cardiac arrhythmias and QTc prolongation.
The QT interval is the “time it takes for your heart to reset” in order for the heart to “receive another electrical stimulus” between heartbeats, Kamlet explains. If the QT is prolonged for too long, it could throw the patient into a lethal state of arrhythmia.
“Many medications, such as antidepressants, antipsychotics and antibiotics, prolong the QT interval, and are therefore dangerous to combine with ibogaine,” says Vianey Perez, a registered nurse with ICU and ER experience, and Beond’s head nurse. Trained ibogaine practitioners are aware of all medications and nutraceuticals that may be QT prolongers, and know how to expertly wean the patient off those medications so they no longer pose a risk at the time of treatment, says Kamlet.
Heart conditions that interfere with the way electricity is transmitted to the heart, such as Wolff-Parkinson’s White Syndrome or certain genetic conditions, may make someone ineligible for ibogaine treatment, says Malacara, unless they are able to repair that condition and restore a normal flow of electricity to the heart.
“If the heart has any problem with the way it beats or contracts on the ventricle side, which is what makes blood flow throughout the rest of the body, that will be a total contraindication for ibogaine,” says Malacara.
Ibogaine Safety Protocols
Experts agree that any reputable, safe clinic will extensively test potential patients before treatment, to rule out any possible risks.
“I don’t believe in drive-through ibogaine,” stresses Kamlet, referring to the kind of ibogaine treatment where a clinic administers a one-size-fits-all treatment, without knowing the patient’s full history, and discharges them without therapy or a long-term care plan to achieve sustainable recovery.
“Every patient that I’ve treated, I’ve sat across from and spoken to for hours. For opiates, it requires intensive information gathering,” Kamlet continues. “Before we even talk about your addiction history, we have to get your whole medical history, your personal history, what drugs you are on or have taken, comprehensive lab tests, electrocardiograms, and in some cases more advanced cardiovascular testing. How many times have you been to rehab? Is this your first time seeking recovery? How many times have you relapsed?” That’s just a sliver of the exhaustive questioning required to adequately understand a patient’s backstory.
To ensure maximum safety, the patient must share their full medical history and undergo an electrocardiogram (EKG), which allows the doctor to check the heart for various conditions, says Malacara. “If, in the EKG, we find something that is not suitable, we will ask for another appointment with a cardiologist to get a second opinion” and perform further tests, he says. The patient must also undergo a screening process in which their liver enzymes, blood cell count, and electrolyte levels are assessed.
A big concern is that magnesium and potassium levels are normal, says Malacara, since those help regulate the way the heart beats, and ibogaine ibogaine may affect the heart’s access to potassium. When Mulligan arrived at the clinic, she was “exhausted and underfed,” and therefore lacking the electrolytes, like magnesium and potassium, that one would normally have when properly fed.
Unlike other plant medicine pre-ceremony diets, which suggest eating lightly days before the ceremony, it’s better to be physically fortified before ingesting ibogaine.
“Fasting, as well as excessive sweating (extenuating exercise) can cause a severe water and electrolyte depletion,” says Malacara. Because magnesium and potassium are “extremely involved” in the cardiac contraction and electric flow function, “an impaired balance or deficient ratio between these elements is potentially life threatening on its own,” especially when combined with the QT prolongation effect of ibogaine.
Other conditions that could potentially preclude an individual from taking ibogaine are those that affect the frontal lobe of the brain, such as schizophrenia or certain kinds of head trauma, says Malacara. Liver impairment could also interfere with ibogaine treatment. Patients who have damaged livers due to substance abuse issues, particularly with alcohol, must wait until their liver returns to proper condition before undergoing treatment, he says.
Many clinics, including Beond, administer flood doses, which Kamlet defines as a single oral dose large enough to get the desired effect. “It’s the maximum amount of ibogaine I can give in a single treatment to get the expected results with perfect safety.”
Dosage is also determined by the extent of their usage: how much they use, method of ingestion and how often. “We adjust the dosage of ibogaine according to how much they need to kill their habit,” says Kamlet. “We don’t want to give them more than they need.”
If the patient is not addressing substance issues, dosing is determined by their intentions for taking ibogaine, psychological status, weight, labs, EKG, and a host of other mental and physical factors, Kamlet explains.
How to Know If An Ibogaine Clinic is Safe
Medical emergencies can be avoided if the providers diligently follow comprehensive safety protocols, understand how ibogaine affects the cardiovascular system, and are qualified to handle any adverse event that may come up during treatment, says Kamlet.
For a prospective ibogaine patient, there are clear indications to look for to determine if a clinic is (or isn’t) safe.
An immediate red flag, says Mulligan, is if the clinic doesn’t ask for your medical history – especially your EKG, liver panel blood work, and what medications you’re on – in advance. “This is the most basic thing.”
Establishing relationships before the patient arrives, so that their situation can be fully understood, is also essential, since patients may lie about what drugs they’re taking, and urine tests aren’t always 100% accurate, says Mulligan.
Mulligan also suggests assessing whether the staff is well-equipped to address your needs. How long have they trained, and what kind of training do they have? Do they provide mental support before and after the treatment? “The clinic’s staff should practice trauma-informed training, especially training focused on sexual abuse, because a really high percentage of people who struggle with drugs have had sexual trauma.”
Does the clinic have the money and resources to deal with time-sensitive emergencies? “My provider pawned his computer to pay for an ambulance, since you have to pay upfront,” recalls Mulligan.
Kamlet emphasizes that Beond’s mission is to provide an expert level of safety and care for ibogaine treatment that has not been previously available. “What we’re doing at Beond, nobody is doing.”
“There’s a model of ibogaine treatment where no one ever has to die,” says Kamlet. “That needs to be the minimum standard of care.”
Image: Nicki Adams