Minimal Standards of Care in Ibogaine Therapy. Global Alliance of Ibogaine Therapy Providers (GITA) Barcelona 2010. Introduction. Rationale/Intended Purpose
Global Alliance of Ibogaine Therapy Providers (GITA)
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 ibogaine-assisted/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.
This document is being compiled and edited by GITA on the basis of recommendations made by ibogaine therapists.
These therapists include a wide spectrum of providers from informal lay therapists and underground providers through to medical doctors operating clinical type settings.
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.
It is also informed by medical and scientific findings, guiding policy documents regarding treatment, harm reduction and research, discussion forums and mailing lists.
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.
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.
Feedback and Evaluation
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
They should read and understand the Ibogaine Patients' Bill of Rights
They should understand the rationale for exclusion criteria and recognize the importance of detailed and effective screening
They should understand what fully informed consent consists of
They should have a clear understanding of the resource requirements
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
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
They should learn about ibogaine’s potential effects and side effects
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
They should learn about contraindicated conditions, medications, drugs, herbs and foods
They should have an understanding of the variability in individual clients
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:
TP’s should not conduct sessions alone
Emergency Medical Responder is necessary
Having staff job/role descriptions helps
All team members should sign a confidentiality agreement regarding client’s sensitive info
Establish a conflict resolution process
Feedback questionnaire for staff helps inform development and evolution of policies and procedures
Regular staff meetings help with organization
The TPs should make every effort possible to create a clean, quiet and comfortable therapy environment. Preferably with soft lighting options.
Earplugs or headphones, eye covers, and a variety of music may be useful
Phone should be available to be used if/when needed.
Non-slip stick-ons for bathtub/shower, safety grab bar if possible, flashlight, etc..
Conduct fire drills with team, emergency escape route shown to client before therapy or otherwise clearly marked.
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.
Posted info: emergency contact #'s, escape route, other signs such as hand washing reminders.
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
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)
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.
Screening Tools (ie: application form)
Other important data gathering
File keeping and data storage
Decision-making and acceptance process
Preparation and informing of client prior to therapy
Please share your process and any suggestions or insights
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
Vascular disease such as Venous Insufficiency, Deep Vein Thrombosis, Arteriosclerosis, Lymphedema, Phlebitis, Blood Clots or coagulation abnormalities, etc...
Serious Psychiatric disorders
Many different dosing regimens have been developed, please contribute your findings; include rationale, benefits and challenges.
Clients should also be informed of dosing regimen and any changes that arise during course of therapy
call emergency services 911, 061, etc…
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
List of emergency contact #’s should be posted in facility, near the phone.
Consider setting up protocol with local emergency psychiatric services (if available)
Staff Evaluation Forms
Clinical Discharge Report
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