IBOGAINE: INFORMATION AND GUIDE LINES FOR INTEGRATED THERAPY

IBOGAINE: INFORMATION AND GUIDE LINES
FOR INTEGRATED THERAPY
Developed by I.ACT Aotearoa/New Zealand
2014

[Document title] | 2014
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Table of Contents
BRIEF EXPLANATION OF IBOGAINE ..................................................................................................................2
HISTORY OF THE TREATMENT OF OPIOID CESSATION WITH IBOGAINE IN AOTEAROA.....................................3
INCLUSION CRITERIA AND PRE ACCEPTANCE CONSIDERATIONS ......................................................................3
INCLUSION CRITERIA ................................................................................................................................................4
PRE-ACCEPTANCE CONSIDERATIONS FOR FURTHER INVESTIGATION...................................................................................4
MEDICATION CONSIDERATIONS ..................................................................................................................................4
NOTE ON SYNTHETIC CANNABINOIDS ..........................................................................................................................5
CLINICIAN CONSIDERATIONS TO SUPPORT CLIENT............................................................................................................5
IBOGAINE THERAPY FOR OPIOID CESSATION PROCESS....................................................................................5
EXCERPT FROM THE IBOGAINE DOSSIERON THE EFFECTS OF INGESTING IBOGAINE ........................................7
EARLY RELEASE FORM......................................................................................................................................9
IBOGAINE THERAPY CONSENT FORM.............................................................................................................10
IBOGAINE THERAPY INFORMATION SHEET ....................................................................................................11
POSSIBLE RISKS:....................................................................................................................................................11
RARE AND SEVERE RISKS FROM INGESTING IBOGAINE.....................................................................................................12
FREQUENT SIDE EFFECTS FROM IBOGAINE IN THE USE OF OPIOID W/D...............................................................................12
IBOGAINE THERAPY CLIENT CONTRACTUAL OBLIGATIONS WITH IBOGAINE TE WAI POUNAMU..............................................13
IBOGAINE EMERGENCY RESPONSE ................................................................................................................14
RISK MANAGEMENT FORMS..........................................................................................................................16
SELF-HARM RISK MANAGEMENT..............................................................................................................................16
CARDIAC RISK MANAGEMENT..................................................................................................................................17
PSYCHOLOGICAL RISK MANAGEMENT........................................................................................................................18
SEIZURE RISK MANAGEMENT...................................................................................................................................19
PHYSICAL AND DENTAL PAIN RISK MANAGEMENT........................................................................................................20
PHYSICAL – OPIOID OVERDOSE RISK MANAGEMENT ....................................................................................................21
ONSITE CLIENT CONTACT SHEET ....................................................................................................................22
OBSERVED PHYSICAL..............................................................................................................................................23
SUBJECTIVE OPIATE WITHDRAWAL SCALE SOWS........................................................................................................24
SUBJECTIVE OPIATE WITHDRAWAL SCALE (SOWS) ........................................................................................25
RELAPSE PREVENTION PLAN ..........................................................................................................................25

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Brief Explanation of Ibogaine
Including excerpts from Wikipedia, the free encyclopaedia.
Ibogaine is one of at least 12 naturally occurring psychoactive or psychotropic substance found
in West African plants such as Tabernanthe iboga, Voacanga africana and Tabernaemontana
undulata. Ibogaine is a dream inducing or ‘Oneiric’ substance often referred to as a
hallucinogen with both psychedelic and dissociative properties. Ibogaine is scheduled in some
countries due to these properties, however it has been shown to have a low to zero abuse
potential and no addictive properties have been noted.
In many countries it is being used to treat substance dependence
including methadone, heroin, alcohol, cocaine, and methamphetamine. Derivatives of ibogaine
that lack the substance's hallucinogenic properties (notably nor-ibogaine) are currently under
development.
Ibogaine-containing preparations are used in medicinal and ritual purposes within West
African spiritual traditions of the Bwiti. It was first discovered as having anti-addictive properties
in 1962 by Howard Lotsof. However Ibogaine has western use that predates that by at least a
century.
The prohibition of ibogaine in several countries has slowed scientific research into its anti-
addictive properties. In November 2009 Medsafe1
New Zealand approved the use of ibogaine hcl
under section 29 of the 1981 Medicines Act.2
Ibogaine
1
General Minutes 10:1 http://www.medsafe.govt.nz/profs/class/mccmin03nov2009.htm
2
Section 25 and 29 of the Medicines Act 1981 http://www.medsafe.govt.nz/profs/riss/unapp.asp

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History of the Treatment of Opioid Cessation with Ibogaine in
Aotearoa
In November 2009 Medsafe reclassified Ibogaine hydrochloride as a non-approved
prescription medication to be used in the treatment of chemical dependence on substances,
primarily opioids. This document is specifically designed for clinicians working in the area of
substance use. Ibogaine Therapy is beneficial to those wishing to cease or interrupt their
dependence on opioids.
Ibogaine Aotearoa Charitable Trust or I.ACT was set up in September of 2009 to support
bringing the option of ibogaine to consumers wishing to cease their dependence on substances,
notably opioids. I.ACT developed a good practise model specifically around the status of
ibogaine in Aotearoa/NZ and the provision for integration into the existing therapeutic options.
This was designed to implement an environment for ibogaine therapy to move forward locally
and globally in a sustainable and respectful way.
Clinical practice guidelines are “guides” only and may not apply to all clients and all
situations. As part of a shared decision-making approach, it may be appropriate for the clinician
to inform a client that a particular recommendation may not be applicable, after considering all
circumstances pertinent to that individual.
Inclusion Criteria and Pre Acceptance Considerations

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Inclusion Criteria
Tangata Whaiora, the Person Seeking Help
 Has a desire to cease dependence on opioids, is motivated to change and who
understands that ibogaine therapy alone is not a ‘cure’
 Signs an informed consent and has a clear understanding of the risks and
benefits of ibogaine therapy
 Is willing to be a part of a process that includes adhering to provider and
clinicians requests to attend appointments and do the appropriate medical testing
and comprehensive assessment with utmost honesty
 Takes the responsibility of engaging with any services that they have been
referred to and continue with ongoing self-care.
 Understands that the provider obligations will end at 6 weeks post ibogaine
therapy unless prior formal arrangement has been made for extended support.
 Is self-funded or willing to seek out funding privately for their tx
Pre-Acceptance Considerations for Further Investigation
• Cardiac issues; investigate, prolonged QT interval, pericarditis, history of cardiac
issues and cholesterol levels
• Kidney, gastro-intestinal disease
• Compromised liver function. Active chronic hep c where normal levels are above
4 x the normal range.
• History of active neurological or psychiatric disorders, such as cerebellar
dysfunction, epilepsy, psychosis, bipolar illness, schizophrenia, organic brain
disease or dementia that require ongoing treatment.
• Currently pregnant or breastfeeding unless a weaning plan is incorporated into
the therapeutic plan prior to tx
• Inadequate home environment to return to i.e. living alone with no support, living
situation indicative of continued drug use (partner/whanau/flatmates still in active
use) In this case extra support plans and risk management plans must be put in
place prior to tx. Residential care post ibogaine tx should be discussed in this
case
• Currently taking prescribed and non-prescribed medication (supplements and/or
street drugs) contraindicated with ibogaine. Discuss on a case by case basis
Medication considerations
• Levels of methadone over 50 mgs must reduce to <50 mg’s prior to tx and where
possible switch to short acting opiate (SAO) e.g. oral morphine sulphate tablets
• The lower the opiate dose the easier the tx and recovery, however the risks and
benefits must be weighed up (risk of being unstable and client ‘topping up’ for
example)
• Suboxone/subutex clients must switch to SAO for no less than six weeks prior to
ibogaine tx and for methadone for no less than one week. Dosage to be
determined by their opioid substitute treatment (OST) prescribing Dr (generally
1:4 or 1:5 ratio)

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• last dose of methadone (if no SAO) on the day prior to therapy in the am, (SAO
switch preferable or dosage and tx duration will need to be extended)
• Exclusion for medications contraindicated with ibogaine, primarily
anticonvulsants, anti-epileptic drugs, antidepressants, neuroleptics etc.
• If uncertain whether medications have contraindications seek further investigation
Note on Synthetic Cannabinoids
Due to popularity and a deficit in medical knowledge/contraindications around ‘synthetic
cannabinoids’ and ‘herbal highs’ clients who present that use these substances will be excluded
until they can prove abstinence for a period of 10 days or until more research has been released
on the safety of these products. In these cases a similar protocol to alcohol detox will be
established for prior to ibogaine therapy. Cannabis/Marijuana is not included in this as it has
been shown to have no known negative interactions with ibogaine.
Clinician considerations to support client
 whanau inclusive practice
• risk management plans
• relapse prevention plan
• assertiveness and stress management
• diet and lifestyle advice or referral to natural health provider
• include Hep C support services
• advice and support about reducing their methadone and other medications
Ibogaine Therapy for Opioid Cessation Process
1. Client presents as interested in ibogaine therapy. Provider is contacted.
2. Once inclusion is established and medical and psychological tests have been sighted the
planning process begins.
3. The clients current OST clinician to have at least one consult with the ibogaine provider
to develop consistent and holistic aftercare plans, with client consent and/or client
attendance on a 1:2 basis. General Practitioner Authority (GPA) clients to inform Dr and
consultation between Dr and clinician to be arranged.

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4. The client will be provided with an information sheet, which includes the treatment
contract and consent form. They will have the opportunity to ask any questions about
ibogaine and the therapeutic process prior to therapy.
5. An early leave form is to be sighted and signed in cases where a person choses to leave
during the treatment process against the providers advice, generally prior to 72 hrs post
administration of ibogaine.
6. Ibogaine therapy is currently a non-funded or subsidized treatment. Price structure varies
depending on amount of ibogaine needed and the number of days required for 24hr care,
minimum being 72 hrs post first administration of ibogaine hcl. Costs include
accommodation, food, supplements, prescription fees, related costs such as
communication and travel. This also includes pre tx assessment work, referrals and six
weeks post tx after care support.
7. A non-refundable deposit is required upon medical clearance. This fee covers clinical
hours for assessment work and therapy planning, consultation times with existing
healthcare providers (gp, cads etc) and whanau inclusive consults, informed consent,
preparing and counselling pre ibogaine therapy.
8. The client will receive the amount of ibogaine hcl that is determined by the therapy
provider with considerations on their body weight, the level and longevity of drug use,
physical considerations and sensitivity to ibogaine (decided post 200mg test dose
administration). The dose may be adjusted by the provider at any stage during the
process if necessary.
9. During the time that the client is in the care of the provider they will be monitored closely.
The client will have a sitter/carer monitoring them at short intervals and will be within
close distance at all times for a minimum of 72 hours from the first ibogaine hcl
administration.
10. At any time pre and post ibogaine therapy should the client request a whanau member or
support person to be with them a prearranged (low/no risk) person will be contacted.
During the first 48 hours post administration of ibogaine personal visits will be restricted
for the client’s physical and psychological safety. They can request a support person at
any time however this person must be in line with the safety criteria.
11. Post treatment the client should have at least three weeks off work, preferably longer if
job is physical. The provider/s will remain in a support person/counsellor role for 6 weeks
post ibogaine therapy and will refer the clients to any other necessary after care
supports. It is the clients’ responsibility to continue with the recommended services after
this time.

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Excerpt from the Ibogaine Dossier 3
on the Effects of Ingesting
Ibogaine
Once ibogaine has been administered, effects follow. The patient will usually want to lay prone
and should be encouraged to remain still as nausea and vomiting are systemically motion
related. The skin tends to become numb. Patients will report an initial buzzing or oscillating
sound. A period of dream-like visualization lasting for 3 to 4 hours in most but, not all patients is
considered to be the first prominent stage of ibogaine effects. This stage ends abruptly should it
occur at all. Another aspect of ibogaine effect that is common are random flashes of light that
appear everywhere with eyes open. This may last for hours or days. Visualization on the other
hand is most common with eyes closed.
The second stage that follows visualization has been described as one in which the subject
principally experiences cognitive evaluation or a review of issues that are important to the
subject. These may cover every possible scenario from early childhood experiences to current
health issues. This period may last for as few as 8 hours or for 20 hours or longer.
The third or final stage of ibogaine effects is that of residual stimulation. This stage, because it
tends to leave the subject/patient exhausted is somewhat uncomfortable. Subjects may remain
awake for two or more days. Usually, there is a long term long term diminishment of the need for
sleep over weeks or months. Some patients may require or request sedation. Sedatives that
have been used include benzodiazepines and melatonin.
The above summarizes the experience of a person who has ingested ibogaine for your
information. It is a brief description of what may happen and is intended as a general guide only
as each person has a unique and personal experience during their therapy.
This document represents a culmination of work from Tanea Paterson. This is a collation or her
own experiences as a former methadone dependent person and ibogaine client, an ibogaine
therapy provider and a DAPAANZ registered addiction practitioner. Contributors include the
trustees of I.ACT which include psychiatric nurses, a medical anthropologist and a school
principal. The document has been developed for clinicians working in the fields of addiction and
psychological health.
It is a guide to the procedures and steps that Tanea and the trustees of I.ACT have developed
and outlines protocols conducive to ethical and safety standards considered appropriate with
such an experimental medicine.
Tanea is a current member of DAPAANZ and abides by their code of ethics.4
And recently
served as a board member of the Global Ibogaine Therapist Alliance GITA5
.
Tanea Paterson
Ibogaine Te Wai Pounamu
Director/Provider
DAPAANZ Registered Addictions Practitioner
3
The Ibogaine Manual 2003 http://www.ibogaine.desk.nl/manual.html
4
http://www.dapaanz.org.nz/code-of-ethics/
5
http://ibogainealliance.org/about-us

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Otepoti/Dunedin

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Early Release Form
I ___________________ voluntarily, unconditionally, and irrevocably release and hold harmless
Ibogaine Te Wai Pounamu and the Ibogaine Therapy Provider, officers, staff and agents from
liability for any and all manner of claims, actions or causes of action including physical and
psychological negative consequences arising from or related to my refusal to continue
participation, including but not limited to, claims of active or passive negligence.
I understand that (initial each clause)
• Withdrawal from the program may have consequences to my health including the
possibility that I may experience the symptoms of withdrawal from my chemical dependence and
all associated risks.
• The amount of ibogaine I have taken thus far, before my refusal to continue participation,
may affect the metabolism of other substances and that should I choose to use any substances
that I must do so very carefully knowing that I may be more affected than usual. I understand that
this is due to the ability of ibogaine to potentiate and/or increase the effects of other substances.
• Normal pre-ibogaine tolerance for alcohol and other drugs may be significantly reduced
by the action of the ibogaine and failure to heed this warning may result in harm to myself.
• I have decided to refuse therapy and leave against the advice of the program
director/provider and staff. I am aware of the potential negative consequences and I am willing to
assume responsibility for any negative events that may occur as a result of leaving.
• I will not be reimbursed for any portion of the payment/s made to Ibogaine Te Wai
Pounamu for participation in their program as I have freely decided of my own volition and free
will to discontinue my participation in their program.
• I have made this decision against professional advice and that the payment/s I have
made will be used to cover the expenses of my booking of their services.
I affirm that I have a designated driver and care person by the name of __________________
who will support and care for me after my voluntary withdrawal from participation in the Ibogaine
Te Wai Pounamu Therapy Program.
Signed;
Name: __________________________ Signature: ______________________________
Witness,
Name: __________________________ Signature: ______________________________

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Ibogaine Therapy Consent Form
I, ___________________________________________, have read and understood the Ibogaine
Client Therapy Information Sheet to ensure that I am informed about the nature of this therapy,
and what will be involved in my participation upon consenting to therapy. I understand and
accept both the terms of my participation and the possible risks to myself in participating, and
give my consent to undergo therapy.
CLIENT SELECTION CRITERIA
1. I am voluntarily participating in this therapy.
2. I am over the age of 18.
3. I have no history of psychosis, nor has there been anyone in my immediate family with a
non-drug-induced psychotic disorder.
4. I have informed my primary health care provider (GP) and ibogaine therapy provider of
any psychological or physical disability or illness.
5. I have not used any illegal or legal substance or drugs 12 hours prior to my therapy
without full disclosure to my therapy provider.
(24 hours for methadone and 72 hours for amphetamines).
6. I do not have any illegal drugs on my person, and I am willing to surrender any
substances I have in my possession.
7. I have been informed that taking ibogaine with other psychotropic (mind-altering) drugs is
dangerous and can result in death.
8. I agree not to take any drugs or medications whilst participating in this therapy, other than
those agreed to by the therapy team.
9. I agree to communicate all my medical conditions and current medications as well as ask
any questions I might have about the therapy at any time.
10. I understand I will feel a level of discomfort during this process and will communicate this
clearly to my sitter if/when it happens.
11. I have read and understood the ibogaine information sheet
I understand that I will be monitored for at least the first 72 hours after taking ibogaine and my
therapy will be determined depending on the type of drug I am detoxifying from and my signs of
recuperation. If I am not feeling well, and if practitioners are concerned about my current
condition, therapy may be discontinued or postponed. If I am asked to see a doctor or other
health professional, I am willing to do so.
Client Signature__________________________________________
Date_____________________
Treatment Team Representative
Name________________________________________
Signature________________________________________
Role______________________________________________________
Date_____________________

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Ibogaine Therapy Information Sheet
The following information is intended for individuals considering / preparing to undertake ibogaine
therapy for opioid addiction. It sets out therapy protocols and client obligations, potential risks
and negative consequences of ibogaine therapy, and provides details of further sources of
information.
1. Informed consent prior to participation in this therapy is necessary so clients can know
the nature and risks of their participation, and can choose to participate in a free and
informed manner.
Clients’ signature on the accompanying Ibogaine Therapy Client Consent Form will confirm that
they have been so informed, both by reading this Information Sheet and being verbally informed
by the provider regarding the therapy.
2. Ibogaine is a naturally occurring substance that is one active alkaloid present in the root
bark of the shrub Tabernanthe iboga, which is native to West Africa. Ibogaine has been
reported to have anti-addictive properties. While ibogaine is considered an oneiric or
dream-inducing substance, it also has effects on neurochemical and neurotransmitter
systems in the brain that are believed to be involved in reducing the symptoms of opioid
withdrawal, depression, and post-treatment cravings.
3. In November 2009 ibogaine was reviewed by New Zealand’s Medsafe. It was decided to
gazette ibogaine and its metabolite nor-ibogaine as a non-approved medicine under
Section 25 of the Medicines Act 1981. This exemption means that a registered doctor
may obtain and supply any medicine to a patient under their care, irrespective of whether
that medicine is approved. This has opened the way for prescription of ibogaine by
licensed medical practitioners.
Possible Risks:
 Ibogaine is considered an experimental substance and has not been approved by clinical
trials.
 Toxicological studies of ibogaine conducted in primates have shown that oral
administration at the doses being used for the therapy of opiate and addiction interruption
appears to be safe. No long-term behavioral or cerebral toxicity has been shown. Clinical
studies in human subjects under controlled conditions have shown no long-term adverse
effects. These results suggest that oral doses of ibogaine (in the treatment range of 10-
22 mg / kilo) are well tolerated within this dose range.
 Intending clients should understand that the usual doses used to treat addiction can
cause distortions in body sensations, perceptions, and thinking. The dosage to be
administered in this treatment will depend on the client’s body weight, and the drug(s)
they are currently taking.

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 The effects of ibogaine ingestion can include abnormal sensory perception, such as
visual distortions, visual hallucinations, increased sensitivity to light and sounds, auditory
hallucinations, and energetic bodily sensations. Descriptions of this state appear more
consistent with the experience of dreams, rather than hallucinations.
By signing the Ibogaine Consent Form, clients indicate their understanding and acceptance of
the risks of anxiety and confusion which may be caused (on a temporary basis) by ibogaine
ingestion and also the importance of psychological support longer term for the integration of their
experience.
5. The short term effects of ibogaine listed above usually begin 30 minutes to 2 hours after
oral administration and can last up to 12 hours. After the visual dream phase, there is a
period of intellectual evaluation, which can last up to 72 hours. This phase is described
as analytical and reflective. Attention is focused on inner subjective experience rather
than the external environment and attention during this phase is directed at evaluating
the experience of the dreams.
Rare and severe risks from ingesting ibogaine
There have been reported deaths due to acute cardiac failure, a combination of ibogaine and
other drugs and some unexplained reasons (see table in link below).
http://myeboga.com/fatalities.html
NB - This highlights the importance of full disclosure of medical history, recent and current
substance use. It is expected that the client will either not bring any substances with them into
therapy or hand them to the provider before treatment begins.
Frequent side effects from ibogaine in the use of opioid w/d
 Nausea and movement-induced vomiting
 Ataxia (impaired motor coordination)
 Auditory and visual distortion
 Decreased need for sleep for several days/weeks. This is a frequent and
common side effect in opiate detox.
 Impairment of concentration and verbal communication. This is usual
experienced during the first 6 hours.
 Residual w/d’s of restlessness, back and leg aches, temperature fluctuations
Clients should understand that these side effects are transitory and wear off completely after
approximately 24 to 36 hours, although the reduced need for sleep can last for several days or
weeks and may also experience a reduction in appetite.
6. Prospective clients need to be aware that once treated with ibogaine they will be more
sensitive to opiate narcotics, including heroin, methadone, oxycodone, etc. and other
mind altering drugs. A considerable reduction in tolerance to opioids may cause them to
easily over dose.

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Clients are advised that if they take any drugs during the ibogaine therapy there is a genuine
possibility that they could die.
By signing the Consent Form those undertaking therapy agree to hold Ibogaine Te Wai Pounamu
and the ibogaine therapy providers’ or practitioners, including any persons involved in my
referral for treatment harmless of any claims, liabilities, or damages, which may occur or be
determined to have occurred due to the administration of ibogaine.
Those undertaking therapy are also advised that if they experience distressing side effects of any
sort that appropriate medical services will be provided, or they will be referred to the appropriate
professional.
Ibogaine Therapy Client Contractual Obligations with Ibogaine Te Wai Pounamu
The client ……………………… (Name and initial each clause) must
1. Answer all questions within the assessment forms accurately and truthfully or be willing
to take responsibility should any adverse situation happen due to them misleading the
provider.
2. Read, with their clinician and sign the ‘Early Leave Form’ if they chose to leave care
within the first 72 hours of ibogaine administration.
3. Understand that the provider obligations will end at 6 weeks post ibogaine therapy
unless prior formal arrangement has been made for extended support.
4. The provider is obligated to refer and advise the client on further support services that
they feel the client will benefit from. However it is the clients’ responsibility to engage
with these services and continue with ongoing self-care.
Should you have any further questions regarding the information contained in the form or
concerning the treatment in general please contact your ibogaine therapy provider, or access the
information sources listed below.
http://www.ibogaine.org/links.html
http://www.ibogaine.co.uk/

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Ibogaine Emergency Response
About Ibogaine
Ibogaine is a naturally-occurring herbal alkaloid found in the root bark of a plant called
Tabernanthe Iboga, a plant that grows in the equatorial forests of West Africa.
For ~25 years has increasingly been used as an effective therapy for detoxification from drugs
that cause dependence.
Significantly interrupts opioid withdrawal symptoms often within a single dose modality.
Legal Status in NZ
In February 2010 Medsafe scheduled Ibogaine hcl and the metabolite nor-ibogaine as a non-
approved prescription medication under section 29 of the medicines act, primarily for opioid tx
Form used by Ibogaine Te Wai Pounamu
Remogen® brand Ibogaine HCl is produced by Phytostan Enterprises, Inc. (Montreal, P.Q.,
Canada), and is manufactured to internationally recognized standards of Good Manufacturing
Practices (GMP). It has a purity of 99.8%.
It is encapsulated by Wilkinson and Son Pharmacy, Dunedin in 200 mg capsules.
Psychoactive Effects
EEG (electroencephalogram) studies of brainwave rhythms in animals suggest that ibogaine
causes REM (rapid eye movement portion of dreaming/sleep) -type patterns.
Has an oneiric (dream inducing) process is characterized by visual phenomena that some people
experience as vivid dreams, reflections or memories.
5HT2 receptor signalling. Ibogaine does not cause any loss of consciousness or
depersonalization.
It should be noted that not all people who take ibogaine report having dreams or dreamlike
visions.
Effects of Ibogaine
Short term effects of Ibogaine given in therapeutic doses for chemical detoxification last from 6-
48 hours.
Possible Side Effects
Side effects typically associated with therapeutic doses of ibogaine include:
 ataxia (temporary loss of muscle coordination)
 mild tremors (shaking)
 photo-sensitivity (sensitivity to light)
 nausea, vomiting
 slight changes in blood pressure
 sometimes slight back pain (possibly due to lying down for a prolonged period of time,
pre-existing back pain issues and/or the lack of adequate stretching beforehand)
 Sleeplessness (particularly in opiate dependent individuals).
Any side effects experienced subside (fade away/stop) 24-48 hours after onset.
Contraindicated drugs:

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• CYP2D6 metabolized drugs (inhibitors in particular, caution also with inducers
and substrates)
• Opioid-based drugs, including morphine, heroin, methadone, oxycodone, etc.
• Caution with QT prolonging drugs
• Centrally acting drugs
• Serotonergic drugs
• Antipsychotics
• Caution with steroids, hormones and depo-injection drugs.
• Corticosteroids may induce psychological disturbances
• Substances that induce hypokalaemia or hypomagnesaemia
Treatment guidelines for ibogaine-related emergencies:
Ventricular Tachycardia: Lidocaine
Torsade de Pointes: Magnesium
Ventricular Fibrillation: Defibrillation Electrolyte corrections
Arrhythmia: Atropine
Notes:
• Benzodiazepines have little to no effect! Unless the individual is dependent
and going into seizure due to withdrawal from benzodiazepines
• Atropine will stop or slow down subjective psychological effects, may also be
useful in Tx of arrhythmias
• Naloxone is contraindicated as it is an inhibitor of the metabolic pathway

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Risk Management Forms
Self-Harm Risk Management
Self-Harm Triggers
 Hurting self
 Leaving premises without consent and
before therapy has completed
 Knowingly putting self in risk situations
 Anxiety +++
 Relapse or hanging out/withdrawal/PAWS
 Psychotic episode
 Irritable/angry/confused
 Client left alone
 Whanau contact without support
Early warning signs What works
 Trying /planning to leave early
 Feeling like in w/d when not
 Voicing concerns
 Isolating/not talking
 Feeling helpless/hopeless
 Anxious, frustrated or confused
 I.ACT Early leave form sighted and signed
 1:1 at all times
 2 available carers
 Alarm systems, secure
environment/knowledge of exits and
windows
 Maintaining communication
 If client is insistent on leaving someone is
to go with them
 Make emergency plan with client prior to
tx
 Note trusted friend/whanau member for
emergency contact
 Emergency – call police and have detailed
description of client and clothes
What does not work Client
 Leaving client alone
 Leaving client alone after social/whanau
contact
 Access to unsafe objects (knives, blades,
poisons, drugs.)
 Not completing emergency plan
 Informed consent/safety plan made
 Client made aware of
distorted/heightened perception during tx
 Client to decide who they trust for
emergency contact and contact details
written in to Client Tx Record Sheet

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Cardiac Risk Management
Physical - Cardiac Triggers
1. Cardiac Issues 1. History of heart problems.
2. Drug interactions.
3. Poor health
4. Dehydration during tx process
1. Chest pain
2. Breathlessness
3. Arrhythmia, tachycardia,
bradycardia
1. Assessment and screening system
in place.
2. Consult with G.P. ECG – echo
cardio gram
3. Hydration with an I.V drip
Emergency Information
-Ventricular Tachycardia: Lidocaine
-Torsade de Pointes: Magnesium
-Ventricular Fibrillation: Defibrillation
Electrolyte corrections
Not screening thoroughly
Not responding to health needs
Dismissing expressions of
discomfort/pain as drug seeking
Full physical health check with GP
Good therapeutic alliance with provider,
communication open

Page | 18
Psychological Risk Management
Psychological Issues Triggers
 Anxiety
 Psychosis
 Fear
 History of psychological issues
 Negative psychedelic experiences (“bad
trips”)
 Voicing fears/memories
 Panic attacks
 Withdrawal
 Expressing anxiety
 Delusional thinking
 Shallow/sharp breathing
 Fight or flight/freeze symptoms
 Panic attack
 Hallucinations, distorted perception
 Psych health screening (comp assess)
 Thorough explanation of process and
questions answered clearly
 Talking to peers who have experienced
ibogaine about process
 Motivational interviewing prior to tx
 Calm environment
 Familiar objects around (photos, blankets,
ornaments)
 Active listening
 Relaxation/breath work techniques
practised prior to tx
Emergency Plan – (New Zealand Only)
Ring Police 111 or Emergency Psychological Services
4740999 in crisis
 Ignoring/dismissing anxiety and or
psychotic symptoms
 Not listening to fears
NB: Medication Overdose Risk – Consult Provider
before administering any anti-anxiety or other
psychological medications.
 Client given information to read and offer
to connect them with someone who has
already had the experience (peer matching)
 Client discloses past psychological
experiences or issues

Page | 19
Seizure Risk Management
SEIZURES Triggers
 Having a seizure during tx
 NB seizures due to head injuries and/or
epilepsy included in exclusion criteria.
Consult with specialist Ibogaine Dr
imperative if considering going ahead
with tx
 Drug induced seizures not an exclusion
 Heat
 Dehydration
 Benzodiazepine/Alcohol/Methamphetamine
withdrawal
 Flashing lights
 Noise
 Going into status
 Client experiencing auras
 Metallic tastes
 Previous seizure experiences
 Screening client
 Constant care provider 24hrs for the first
72hrs
 Quiet environment
 Appropriate temperature of room
 Benzo/alc/meth use managed and ceased
prior to tx (n.b. if discontinuation of benzo’s
is an issue they can be safely used/managed
during tx)
 Carer responsible for locking up medication
 Offer fluids and keep fluid intake record
 IV drip if dehydration becomes severe
 Alcohol and Synthetic Cannabinoids
W/d at least 7 days prior to ingesting
ibogaine.
 Not monitoring
 Seizures
 Lack of fluids
 Unsettled environment, over
stimulation
 Informed consent
 Access to medical records
 Transparency of past seizure experiences
(drug induced or otherwise)

Page | 20
Physical and Dental Pain Risk Management
Physical - general and dental pain Triggers
1. Physical Pain
2. Dental Health
1. Pre-existing pain issues
possibly masked by
opiate/drug use
2. Drug use affecting teeth
1. Voicing pain, discomfort
2. Injuries noted on physical
history assessment or current
pain issues
3. Teeth pain, halitosis, odd or
bad taste in mouth. Broken
teeth.
1. Plan for pain management
prior to tx.
2. Alternatives may be muscle
relaxant or benzodiazepines,
acupuncture, massage, bath,
relaxation techniques, soothing
music. Magnesium
supplement.
3. Dentist appointment prior to tx
to eliminate emergency
procedures
Not screening thoroughly
Not responding to health needs
Dismissing expressions of
discomfort/pain as drug seeking
Full disclosure of previous serious
injuries
Recent dental check up
Understands that there will be some
level of discomfort during the tx
process
Clear communication during process

Page | 21
Physical – Opioid Overdose Risk Management
Physical Health – Opioid Overdose Triggers
 Overdose
 Final drug binge prior to tx
(common)
 Taking usual amount of opiates post
ibogaine that was normally
consumed prior to tx (low tolerance
risk)
 Alcohol/benzodiazepine/other drug
overdose
 Not enough ibogaine administered,
client in w/d
 Availability to alcohol/drugs/drug
users
 Relapse
 Contraband on premises/person
 Falling asleep/nodding off
 Losing or lost consciousness
 Low BP
 Low pulse
 Clear information given on ibogaine
process
 Check person for contraband
 Lock up all medications
 Information given to client on
low/no tolerance post ibogaine and
contraindicated drugs interactions
 Relapse prevention on place prior
to tx
 Follow up appointments, phone
calls and txt messages
 Boundaries in place with drug using
friends/family members
 Not giving information
 Not following up with after care
 Access to alcohol/drugs
 Client willing to be transparent re-
drug use and hand over any drugs
in their possession
 Education on ibogaine and other
substances contraindicated

Page | 22
Onsite Client Contact Sheet
Name- DOB-____________
Initial Contact
Integrated Services
CADS
G.P
Tinana/Physical
Weight
Medication including prescribed/non-prescribed and Supplements
Substances ASI
CBC, Liver Panel, Preliminary Ecg
Hinengaro/Psychological
Relationships
Relevant Past Diagnosis
BDI
Whanau/Family/Social
Partner
Children
Wairua/Spiritual
Beliefs

Page | 23
Observed Physical
Date/Time Pulse and
BP
Fluid Intake
Urine/Bowel
Notes Medication
Administration
If at any time heart rate drops below 40 bpm seek urgent medical attention – call 111.

Page | 24
Subjective Opiate Withdrawal Scale SOWS
See attached
Notes-
Emergency Contacts (NZ)
Ambulance - 111
EPS – 4740999 ask for emergency psych services
Tangata whaiora support person
Name: Number:
NB: contact between provider and support person has been established yes/no
If no contact has been made an appointment is to be made and an information briefing and safety plan
made prior to tangata whaiora entering therapy.
Attach OWS forms and any other relevant treatment notes to this form.
Anyone who has entered information onto this form must name and sign it below.
Name ___________________________ Date __________
Signature _______________________________________
Name ___________________________ Date __________
Signature _______________________________________

Page | 25
Subjective Opiate Withdrawal Scale (SOWS)
Instructions: Answer the following statements as accurately as you can.
Circle the answer that best fits the way you feel now
Date:_____________________ Time:________________
(1 = Not at all) (2 = A little) (3 = Moderately) (4 = Quite a Bit) (5 = Extremely)
I feel anxious 1 2 3 4 5
I feel like yawning 1 2 3 4 5
I'm perspiring 1 2 3 4 5
My nose is running 1 2 3 4 5
I have goose flesh 1 2 3 4 5
I am shaking 1 2 3 4 5
I have hot flashes 1 2 3 4 5
I have cold flashes 1 2 3 4 5
My bones and muscles ache 1 2 3 4 5
I feel restless 1 2 3 4 5
I feel nauseous 1 2 3 4 5
I feel like vomiting 1 2 3 4 5
My muscles twitch 1 2 3 4 5
I have cramps in my stomach 1 2 3 4 5
I feel like shooting up now 1 2 3 4 5
Relapse Prevention Plan
Recovering from substance dependence takes time. You did not develop this problem overnight
and it will not go away that quickly either. It is important to remember that no one can recovery
perfectly and there will be slips and lapses during the recovery process. This is normal and it is to

Page | 26
be expected. The Relapse Prevention Plan is something that may be helpful to you in preventing
a relapse.
Things Which May Cause Slips and Lapses or Triggers
Stress, dealing with the underlying issues in therapy, becoming overwhelmed by feelings and
emotions, death of a family member, friend, etc.
Marital and family problems, feelings of loneliness, shame, guilt, anger, and abandonment.
People’s reactions to changes you are making in your life, fear of change and/or living without
the substance
These are a few things that can cause someone to have a slip or relapse. At the time, the person
may be overwhelmed by any of the above and end up resorting to old methods of coping.
List each situation that may cause you to relapse on the left and on the right, list a healthier way
of dealing/coping with it. (You may list more than on way to cope for each situation.)
Most people with substance problems are very hard on themselves. Putting themselves down,
calling themselves names, convincing themselves they are a failure, etc., are all things that can
lead to slips and relapses. The section below will be a difficult one to complete, but it is important
to try and change negative attitudes you have about yourself into positive ones.
On the left side, list the negative dialogue you use on yourself or hear. On the right side,
challenge those same negative statements and replace them with positive ones. When you find
yourself overwhelmed with negative thoughts, take out this list and practice telling yourself the
positive ones. Even if at first you do not believe them, the more positive messages you give
yourself, the more likely you are to start believing them.

Page | 27
NEGATIVE POSITIVE
Whenever you find yourself making negative comments to yourself, be sure to pull out this list
and write down the negative statement and turn it into a positive one. Try to do it each time you
catch yourself being hard on yourself so that you do not spend the whole day, week, etc. with this
negative thought going through your head. By being able to take the negative statement and turn
it into a positive one, you will be taking the necessary steps towards learning to love and accept
yourself for who you are. The more positive messages you give yourself, the better you will start
to feel about yourself.
In times of crisis, it can be difficult to remember healthy ways of coping. Many people in crisis do
resort to familiar ways of coping. Making a plan ahead of time can be helpful. Make a list of 8
things you can do instead of using the substance as a way to cope. After the list is completed,
keep it in a place where it can be accessed when needed. (i.e. refrigerator, cupboard, etc.)
1._____________________________________________________________________
2._____________________________________________________________________
3._____________________________________________________________________
4._____________________________________________________________________
5._____________________________________________________________________

Page | 28
6._____________________________________________________________________
7._____________________________________________________________________
8._____________________________________________________________________
Reaching out helps to remind you that you are not alone. Below write down names and numbers
of people you can reach out to. You may find it difficult to reach out, but the more you do it, the
easier it will become
NAME PHONE NUMBER
During the recovery process it is not always possible to avoid slips and relapses. Many people
tend to be very hard on themselves if they do have a slip or relapse. It’s important to remember
that no one can recover perfectly. If you have a bad day, you can forgive yourself, put it behind
you, and continue to move forward in your recovery.
A good saying to remember is, “Yesterday is but a dream. Tomorrow a vision of hope. Look to
this day for it is life.” We cannot change yesterday so it is important not to dwell on what
happened yesterday, we cannot spend time worrying about relapsing in the future, because we
cannot predict the future. All any of us have is today and we must live for today.
Below is a list of things that you can do if you experience a slip or relapse.
Sit down and try to figure out how you were feeling before the slip/relapses occurred.
Write about how you felt before, during and after.
Make a plan of how you will handle the situation, feelings, emotions, etc. when it happens again,
but in a healthier way.
Call someone and talk about what happened and how you feel. (i.e. friend, therapist, family
member, etc.)
Remind yourself that just because you had a slip/relapse, does not mean that you have failed. It
only means that there are feelings inside that need to be dealt with.

Page | 29
Be gentle with yourself and do something nice for you. (i.e. soak in hot bath, take a nice walk,
read a book, etc.)
Remember that there is no shame in having substance problems, there is no shame in having a
slip or relapse and it is okay to reach out and talk about it
Below make a list of things that you can do to help yourself get past the feelings you may
experience after having a slip or relapse:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Remember that you are not alone and even if you do have a slip or a relapse, you will get
through it.
Recovery takes time, but if you want to recover, you can and will. I trust that this relapse
prevention plan will be a helpful tool for you in your recovery process.

Page | 30
Early warning signs Triggers
Try these things first If I do relapse I will
Positive Affirmations Contact List

Page | 31

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