The document provides information on conducting safe and effective ibogaine treatment, including: 1. Guidelines for screening patients, determining inclusion/exclusion criteria, monitoring safety, and developing an aftercare plan. 2. Details on the typical phases and visions experienced during ibogaine treatment, and the importance of qualified medical staff and proper facilities. 3. A list of needs for an ibogaine treatment location and protocols for patient monitoring, medical record keeping, and ensuring patient safety and comfort during the session.

2. “ Chasing the dragon” to no where Photo: B.W.

3. Heroin overdose of a young women, New York City 1992 Photo: B.W.

8. African use & knowledge Scientific pre-clinical (animals ) 1980’s - present Semi clinical settings (with doctors) 1993 - present Data from Clinical trials– yet to arrive Underground treatments 1988-present Ibogaine Data Evolution 1. Lotsof anti-addiction discovery Hundreds of years Early 60’s

10. Bwiti Initiates Bwiti Missoko - gonde initiation Photo – Dan Liberman

11. Map of indigenous use of Iboga in Africa

12. Both primary and secondary vision experiences are an integral part of Bwiti culture Bwiti : an Ethnography of the Religious Imagination in Africa James W. Fernandez Princeton University Press, 1982 21 8 I walked or flew over a long multicolored road or over many rivers, which led me to my ancestors, who then took me to the great gods . 4 34 13 Heard and saw various of my ancestors . They walked with me and instructed me on my life in Bwiti and elsewhere 3 21 8 Heard many voices, a great tumult, and recognized the voices of ancestors . Saw nothing 2 24 9 Saw nothing and heard nothing 1 % n = 38 CONTENT

16. - Lack of standards causes unqualified people to open Ibo clinics - The legal status of Ibo causes many treatment providers to work underground without proper medical knowledge, facilities or the ability to maintain high treatment standards: 1. Pre treatment – screening, motivational level, get to know the person behind the addiction 2. Treatment – provide safe and pleasant environment + use qualified personnel with experience 3. Post treatment – send to his/her psychologist or psychiatrist. Try and form support group with Ibo treated people. Make yourself available on the phone for on line consultation and support Maintaining medical standards for each stage, along side compassion are the foundation of good work with Ibogaine.

17. Information on the inclusion and exclusion criteria from the manual of Ibogaine therapy. The latest developments indicate that an echo cardiogram must be given to determine cardiac health deficits that would not show up on a normal EKG or EKG stress test. NIDA in their Ibogaine protocol set the exclusion criteria at 400% of normal liver enzyme values. However, the core safety issue is cardiac health . Further, patients must be under continuous cardiac monitor with particular attention directed to prolonged QT interval. A cardiologist should be included as part of the core medical staff. This is not the do all and end all but, only a best efforts analysis

18. new | Search | Science | Opinion | Literature | Links | Treatment | Bookshop | Feedback The purpose of this document is to provide information . Treatment providers and patients are solely responsible for their actions . Manual for Ibogaine Therapy Screening, Safety, Monitoring & Aftercare Second Revision by Howard S . Lotsof & Boaz Wachtel Contributing Authors Marc Emery, Geerte Frenken, Sara Glatt Brian Mariano, Karl Naeher Martin Polanko, Marko Resinovic Nick Sandberg, Eric Taub Samuel Waizmann, Hattie Wells © 2003

22. Exclusion Criteria - continue 9. Patients who have clinically significant laboratory values outside the limits thus specified by normal laboratory parameters. 10. Patients who have any disease of the gastrointestinal system, liver or kidneys, or abnormal condition which compromises a function of these systems and could result in a possibility of altered metabolism or excretion of Ibogaine will be excluded . As it is not possible to enumerate the many conditions that might impair absorption, metabolism or excretion, the provider should be guided by evidence such as: A. History of major gastrointestinal tract surgery (e.g., gastrectomy, gastrostomy, bowel resections., etc.) or a history or diagnosis of an active peptic ulcer or chronic disease of the gastrointestinal tract , (e.g. ulcerative colitis, regional enteritis, Crohn's disease or gastrointestinal bleeding). B. Indication of impaired liver function. C. Indication of impaired renal function . 11. Patients with active tuberculosis . 12. Pregnancy

24. Closed cycle Audio-visual monitor (used by ICASH & NDA during the early 90’s) – a must in every treatment. Use bigger screens if possible.

30. *3% - 12%, 6 days post Rare No No No 5% (moderate) No Post 20 Hrs ibogaine Acutre/motion related No No *16% - 25% 3% Yes No Rare No No No No No Post 20 Hrs ibogaine Acutre/motion related No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Chronic Yes Yes Yes Yes Yes Diarrhea Yawning Rinorrhea Piloerection Lacrimation Mydriasis Shivering Restlessness Vomiting Muscle Twitches Abdominal Cramps Sweating Anxiety Sleeplessness Ibogaine + Opiates Ibogaine Opiate Withdrawal Signs Objective Opiate Withdrawal Signs and Ibogaine Signs: Human Observations

31. Common living conditions of the staff during the underground treatments (Rotterdam 1990)

32. Howard being interview by ABC News in Liden 1992 Sisko from ICASH talking to a women under the influence

33. Howard in the witte house hotel liden where many treatment took place also with Prof. Baastians

34. ICASH and NDA’s under & above ground treatments Liden NL 1992

35. ICASH – Bob Sisko and NDA’s Howard Lotsof during an ibogaine treatment in Rotterdam 1989 Below - the presenter at the same Orianne Hotel, Rotterdam

36. Room at Novo Hotel Amsterdam where a number of ICASH and NDA treatments took place (including my own)

37. Always seek local support like here from the squatters community NL.

38. “ typical” hang out in Amsterdam

39. Addict’s art and view of addiction

40. H. Lotsof, J. Baastians, Norma LAexander,Nico Adreas and Dr. Djolich at a meeting in Liden 1992 Bob Sisko (Icash) H. Lotsof (NDA) and Wachtel who worked with both organizations from 1988-1993

41. Herta Frank, Norma Alexander and Howard Lotsof infront of Herta’s apartment where few treatments took place. 1992

42. Dr. Debra Mash and Staff during the first phase clinical trial U of Miami

43. First urine sample at the U of Miami during the first stage of phase one clinical trial

44. Demonstration in-front of New York court against Mandatory Minimum law NYC 1992. From right to left: Howard Lotsof, Dana Beal, Boaz Wachtel and Bill Junior. Ibogaine activism includes human rights and progressive drug policy.

45. Social/medical revolutionary Nico Adrias (founder of the Junky union) Rotterdam 1993

46. Professor psychiatrist Yan Baastians and Howard Lotsof Holland 1993