Red Flags: When to Walk Away

This page is not about any provider you might be considering. It is built from what a regulator found when it looked at one, and from what the research says about how these decisions go wrong.

Start with the case that has a public record

In 2013 a woman of 45 died at an ibogaine clinic in New Zealand. The Health and Disability Commissioner published its findings in 2015, and they read as a list of things that could have been asked about beforehand.

The written protocol was one page. In the Commissioner’s words: for such a complex and intensive treatment, the documented policies and procedures were minimal, and amounted to only one page.

The protocol was exceeded with no record of why. It allowed no more than 1,600 mg over four hours. She received 2,200 mg over about 24 hours, and there is no note explaining the departure.

Nobody wrote anything down. No observations were recorded after 4.11pm. She was last seen alive at 3pm and found at 6am.

And the doctor left. He left the premises five hours after the final dose, leaving monitoring to a person with no medical training.

The Commissioner’s summary judgement is the sentence to carry into any conversation with a provider:

The lack of comprehensive protocols and failure to comply with what protocols were in place give the overwhelming impression that it was a sloppy operation with little regard for professional standards.

The claims that should stop the conversation

A success rate. Any figure. No study has ever produced one that survives scrutiny. The largest follow-up of people treated for opioid use found that seventy per cent relapsed, and the measured effect on drug use across published cohorts is at its maximum at one month before declining. Why there is no success rate explains what a real one would require.

An accreditation or certification. Nobody accredits ibogaine providers. Anywhere. The organisation whose guidelines the sector cites is a British company in strike-off proceedings, registered under the activity code for conference organisers, whose guidelines have not been revised since 2016 and state in their own text that they are not suited to be used as sufficient standards. A certification claim is a claim about something that does not exist.

That it is proven safe. The clinic in that case told patients, in writing, that ibogaine is well proven in many thousands of cases in many different countries to be safe at the doses given. No such proof existed then and none exists now.

That the risk is managed by screening. Eight published case reports describe ventricular arrhythmias in people with no pre-existing cardiac condition or family history, and in the best-monitored study half the patients crossed the threshold at which cardiologists act despite exclusions being applied. Pre-treatment screening covers what screening cannot catch.

The vaguenesses that matter

A provider who is imprecise about these three is telling you something.

Monitoring hours. Not “we monitor you closely”. How many hours after the dose, how many ECG leads, and what happens on night two. Published deaths occurred up to 76 hours afterwards and no published protocol monitors that long.

Who is in the building at 4am. A name, a role, a qualification, and where it is registered. In a survey of psychedelic retreats, two organisations told researchers their health professionals could not legally practise under their licences in that context.

The written protocol. Ask to read it before you travel. A provider who will not share it has one of two problems, and both are the problem in the case above.

Pressure, and why the timing one is specific

Urgency is a familiar sales technique and here it has a distinct danger.

You will be asked to stop your medication. One published protocol lists diuretics, CYP2D6-inhibiting drugs, serotonergic drugs, calcium channel blockers, beta-blockers, benzodiazepines, stimulants, corticosteroids and all psychiatric medications.

That washout should be planned by the person who prescribed those drugs, at a pace they set. Compressing it into a booking window is how people arrive in withdrawal from something nobody accounted for. What a treatment involves sets out why.

Reviews are not the check you think

The instinct is to look at what other patients said. The research is unflattering.

A study of dental practice websites collected 1,798 patient testimonials and every single one was positive. Separately, online ratings of cardiac surgeons showed no correlation with their risk-adjusted death rates.

And there is a bias specific to this treatment: the people least able to leave a review are those for whom it went worst. Reading clinic reviews critically sets out a method.

The one that is hardest to act on

If a provider makes you feel that asking is ungrateful, or that scepticism means you are not ready, that is the flag.

The regulator’s finding above turned on three things a patient could have asked about: was the protocol written down, was it followed, and who was watching. None of those questions requires medical knowledge, and all three were answerable in advance.

How to evaluate a clinic turns them into a list you can take with you.