The considerations in this chapter, and in any section titled “Intake” in the previous chapters, are considerations for receiving the patient in person and the beginning of the treatment process.
Informed Consent
As mentioned before, informed consent about the risks present is one of the most important ethical considerations when administering ibogaine. A copy of the written informed consent document already provided to the patient should be reviewed and signed in person with the patient and one staff member as a witness.1Under certain legal conditions video confirmations of informed consent can demonstrate that the patient was not “under duress” at the time the signature was provided. The primary emergency contact information should be confirmed again for use in case of emergency.
Secondary Screening
Electrocardiogram
Another ECG should be taken upon arrival to confirm the results of any that were submitted during the application process. Throughout the treatment process, the same exclusion criteria and risk considerations will be followed before any administration of ibogaine (Ch. 2)
Urinalysis
A urinalysis test should be administered to screen for pregnancy and all substances, including benzodiazepines, buprenorphine, and EtG and EtS (test for alcohol), to verify information submitted via the application. Analysis via GCMS or GCLS is generally available within 24-hours.
It is important for clinicians to be aware that many synthetic substances do not appear on the standard ELISA lab test. Oxycodone and fentanyl will not appear as opiates, and neither will buprenorphine unless specifically requested. Clonazepam and adavan will not appear as benzos.
Additionally, qualitative testing reveals the presence of a substance, while quantitative testing can reveal the concentration of that substance in the system. Sometimes slow metabolizers return positive for drugs after the recommended preparation periods mentioned in the previous chapters. Quantitative testing provides sufficient detail to verify if the patient’s reporting is accurate.
Personal Belongings
Patients should be asked to turn over any and all medications, food, or drugs, including nasal sprays, diarrhea medications, or others. Also, many therapy providers prefer that patients report or turn over any electronics that they have with them, as well as anything else that may provide major distractions for them or other patients during the treatment process.
Patients are known to try to hide unmentioned substances in their luggage for many reasons. Many people are concerned that the treatment won’t work as planned and want to be prepared to alleviate their withdrawal symptoms if they get uncomfortable. These types of situations should be expected.
Conducting a baggage search in the presence of the patient to look for any item or substance that could cause harm to them or anyone else during their stay is one way to try to avoid drugs from entering the treatment environment. However, even with a very thorough search it is not always possible to ensure that drugs aren’t present, and conducting a search at the outset of the treatment may, for some patients, create an environment of distrust if not introduced with great care.
A less invasive alternative is to simply observe the patient carefully during an extended stabilization period. This time can also be beneficial for developing a therapeutic relationship.
Medical Examination
A physician should conduct a physical exam, and a review of clinical history and preparation protocols. It is advisable to re-administer blood tests if they are older than 14 days, and especially if the patient has done any other detoxifying therapy. Up to date blood tests and a current ECG should be reviewed prior to receiving clearance for treatment.
Stabilization
Patients should be stabilized on short acting opiates, preferably morphine sulfate, for at least 24 hours in order to observe the patient’s psychological condition and to build a therapeutic relationship.
Refer to preceding chapters for instructions on stabilizing for opiates (Ch. 3), benzodiazepines (Ch. 4), alcohol (Ch. 5), stimulants (Ch. 6), antidepressants (Ch. 7), steroids (Ch. 8), and other medications (Ch. 9).
Clinicians should be prepared to stabilize for a longer period if unreported drug use is detected on the urine screen.
