What happens at an ibogaine program

This is the medical-model version of a stay, as described by the 2016 Global Ibogaine Therapy Alliance guidelines, the published hospital studies and the programs' own pages. Ceremony retreats follow a different script with far less of this. Where a program on this site states that it does a step, its profile says so; where it does not, assume nothing.

Checked October 20, 2026. Sources at the end.

Before you travel

The application asks for a full medical and drug history. The programs that publish requirements want a 12-lead EKG, in some cases within 60 days of arrival (Ambio), and a blood panel that includes potassium, magnesium and liver enzymes. The GITA guidelines list the tests a program should consider: a resting 12-lead ECG, taken neither under stimulants nor in withdrawal; a stress test, echocardiogram or 24-hour Holter where there are arrhythmias, ST changes, cardiac history or risk factors; a complete metabolic panel with electrolytes and liver function; a complete blood count; and a thyroid panel.

The guidelines' absolute exclusions include schizophrenia, bipolar disorder with hospitalisation or medication, epilepsy, psychosis, a prolonged QTc (over 450 ms for men and 470 ms for women, the FDA's thresholds), heart failure or an enlarged heart, active blood clots, serious lung disease, uncorrected potassium or magnesium, liver enzymes over 2.5 times normal, kidney disease, active infection, major surgery within six months, and pregnancy. Borderline QTc, arrhythmias, prior heart attack, a family history of sudden cardiac death before 50, a resting heart rate over 120 or under 50, and very high or low blood pressure need a cardiologist's review. The FDA's October 2026 proposal for trials is stricter still: exclude anyone with a baseline QTcF of 430 ms or more.

Medications are reviewed and many are stopped: antidepressants, antipsychotics, stimulants and anything else that prolongs the QT interval. People on methadone, Suboxone or other long-acting opioids are asked to switch to a short-acting opioid first, for days to weeks; the opioid guide covers the windows each program states.

Arrival and stabilisation

Day one at a medical program repeats the EKG and runs a urine drug screen. Opioid patients are then stabilised, usually on oral morphine at the lowest dose that controls withdrawal, for anything from a few days to three weeks. The guidelines want the patient rested, fed, hydrated and off food for 8 to 12 hours before dosing. In the Dutch hospital study, patients spent eight inpatient days on morphine every four hours before the ibogaine. At Ambio, anyone who has been using fentanyl now stays a minimum of 21 days.

The dosing day

Dosing is timed to early withdrawal: the guidelines say not to start until withdrawal is objectively present (an OOWS score of 3 to 7) but not when it is fully expressed. The last morphine dose in the Dutch study was four hours before the ibogaine. An IV line goes in. The guidelines recommend a litre of fluids with magnesium sulphate running from an hour before to two hours after the dose, because magnesium protects against torsades de pointes; the Stanford protocol gave 1 gram of IV magnesium one to two hours before and again about 12 hours after.

Many programs give a test dose of 2 to 3 mg/kg at least two hours before the main dose. Doses in the published series run from 8 to 12 mg/kg (the St. Kitts series), 10 mg/kg (the Dutch study) and about 12 mg/kg (Stanford, with magnesium) to 12 to 20 mg/kg and higher in older reports. The guidelines say doses over 12 mg/kg carry more cardiac abnormalities and never more than 24 mg/kg in 24 hours. The FDA proposes a 10 mg/kg starting cap for trials and states that 5 to 20 mg/kg "lack adequate safety margins".

Monitoring: a cardiac monitor with at least one ACLS-trained person present for the first 12 to 24 hours, until the T-wave changes have normalised for at least an hour (the guidelines); continuous 5-lead ECG for 12 to 16 hours (Stanford); ECG and vitals for 12 hours (the Dutch study). The guidelines say to transfer to hospital if the QTc exceeds 500 ms. In the Dutch study half the patients crossed 500 ms at some point and 8 of 14 were given magnesium.

The 24 to 36 hours after

Effects begin within one to three hours. The guidelines, following Alper's 2001 description, break the experience into an acute phase of 4 to 8 hours, "the most intense and visual part", with pronounced ataxia; an evaluative phase of 8 to 20 hours, a cognitive and mostly emotionally neutral review during which patients prefer to lie still and undisturbed; and a residual stimulation phase of a further 24 to 72 hours of exhaustion and poor sleep. The visions are described as waking dreams, "like watching a film projected on an inner screen". Every patient in the Dutch and Stanford studies had ataxia; it peaked at 2 to 6 hours and resolved within 24 to 48 hours. Nausea and vomiting are common; a reporter at a Tijuana clinic saw veterans spend hours retching into bowls by their mattresses. Tabula Rasa tells patients the experience lasts 8 to 12 hours followed by 24 to 48 hours of processing.

The grey day

Programs call the day after "gray day" or "grey day": a day of rest and recovery with exhaustion, insomnia, body discomfort, trouble keeping food down, and often sadness, anger or numbness, and sometimes the return of the original symptoms. It is managed with sleep, walks, hydration and IV fluids if needed, and without sedatives. The guidelines require vital signs every four hours for 72 hours because the cardiac risk persists. Some programs give a booster of 1 to 5 mg/kg within two to three hours or after 24 to 36 hours, to treat residual withdrawal measured on a withdrawal scale.

Discharge

The guidelines say never before 72 hours after the dose, and not until any serious risk to health has passed. Beond describes a follow-up EKG and blood test within 24 hours of dosing and an average stay of 10 days, 14 for chemical dependency. The FDA's trial proposal would discharge after a 48-hour 12-lead ECG shows no QTc prolongation. One warning is given at discharge everywhere the guidelines are followed: tolerance has been reset, so any later opioid use at the old dose can be fatal.

Afterwards

The guidelines ask for follow-up contact for at least six weeks and encourage therapy, peer support or residential care, which they say correlates with better long-term results. Programs offer anything from a single integration call to 90-day plans with coaching and alumni groups; MindScape sends 10-day patients home with a month of microdoses; Experience Ibogaine describes two take-home booster doses and two therapy sessions. The evidence caveat is that in the Brown and Alper cohort most patients had no follow-up care at home, and the Stanford authors could not separate the retreat package from the drug.

What a ceremony retreat does instead

Root-bark retreats run one to three night-time ceremonies over 4 to 8 days, usually with a facilitator rather than a physician, sometimes with an EKG on the application, sometimes with a defibrillator in the building. They do not stabilise opioid patients on morphine, and most do not take people in active withdrawal. The deaths at Costa Rican retreats on the safety record page happened in this setting.

Sources

Doses and thresholds are quoted from the cited guidelines and studies for understanding, not for use. Not medical advice.