From magic mushrooms to MDMA and ayahuasca to ibogaine—everything you need to know before (and after) taking the leap.

The stories verge on mythic. A hard drinker eats magic mushrooms and quits the bottle. MDMA unchains a veteran from PTSD. Anorexia and anxiety evaporate in the inner traceries of a hallucination. True, this is psychedelics’ highlight reel; your mileage may vary. But what could you learn by taking your mind for a ride?

To be clear, we’re still in the rehearsal stage for psychedelics as healthcare. These aren’t miracle cures, and like all drugs, they have risks—not to mention, for the most part, they’re illegal. But for the curious, psychedelics are unlike any other treatment we have for mental health. Used therapeutically, they zip-line you to the root cause of your struggle or trauma and, like an inner life coach, help you mystically, spiritually, and neurochemically work on yourself to get well.

Each drug is different, and this primer breaks down the most widely used ones. But there are some commonalities to keep in mind. First, know that you’ll need a therapist or guide if you’re using psychedelics for healing. Ideally, a trip should be sandwiched between one session to prepare you and one afterward to process what came up and integrate it into your life. This protocol has been used in studies showing the power of psychedelics to treat PTSD, depression, and substance use disorders.

How to find a guide? Don’t try Yelp, as much of this movement is still underground. If you have a therapist, they may be able to point you to a good person; so can practitioners who specifically do the integration process. (MAPS has a list. ) Always ask potential guides these questions: What kind of experience do they have? How do they know the drugs they’re providing are safe? Do they screen to make sure you’re a good candidate? Troubleshoot, too: “I would ask, ‘What’s gone wrong in your sessions?’” says Michael Pollan, who broke the cultural ice on psychedelics with his 2018 book, How to Change Your Mind. “And ‘What if I have a heart event? Are you going to call 911?’”

Just as important, agree beforehand on what your physical boundaries will be during a journey. (Maybe you like your hand held, maybe not; anything sexual is expressly off the table.) “You should be given written guidelines for how to prepare for a session, along with information on the substances you will take and aftercare instructions,” says Erica Siegal, founder of NEST Harm Reduction & Consulting (also see “Psychedelic Safety Flags ” for vetting a guide). And if someone throws off “guru” vibes? Run. You don’t need a narcissist; this is about your healing.

Last, keep in mind that psychedelics tend to raise blood pressure and heart rate, so if you have a cardiac condition, check with your doctor first. Most important, nobody who has a personal or family history of psychosis (schizophrenia, bipolar disorder) should try these drugs, because they can cause a psychotic or manic episode. “I wouldn’t advise anyone with a serious mental health history to do this outside medical supervision,” says Joshua Siegel, MD, PhD, who studies the brain effects of ketamine and psilocybin at Washington University School of Medicine in St. Louis. “But otherwise, psychedelics are about connection and ritual and community. And in this digital age, I think that’s what is resonating with people.”

IBOGAINE

What it is: Of all these drugs, ibogaine is the one pushing the front lines of psychedelic healing. Derived from the root bark of the African rainforest shrub Tabernanthe iboga, ibogaine has been used as a sacred plant for centuries and is still a staple in Bwiti ceremonies. It was a 19-year-old named Howard Lotsof who discovered that the substance helped him escape his heroin addiction. Now, more than 60 years later, it’s bridging the political aisle as a controversial Hail Mary for both the opioid epidemic and the soaring veteran suicide rate. “The effects seem just unbelievable,” says Johns Hopkins’s Barrett. “We don’t want to use the C-word, but, like, people are cured of opioid use disorder.”

How you take it: It’s dried and ground up and can be taken as is, with water, in a tea, or by capsule. Consider the journeys like road trips; they can last from 24 to 72 hours.

Whom it can help: People who want to get off opioids, and people with PTSD and traumatic brain injuries.

How it feels: Ibogaine is heavy equipment compared with other psychedelics, churning up the consciousness like a Cat long-reach excavator. It’s also cardiotoxic and almost killed a 27-year-old named Juliana Mulligan—but opioids were about to do the same. She’d gotten hooked as the pill mills moved into her Southern Florida hometown and spent seven years running from the sickness of withdrawal—overdosing, homeless, getting thrown in jail for petty theft, and cycling in and out of rehab. She finally found rock bottom in Bogotá, Colombia, eating whole fentanyl patches and any other opioids she could get, which seemed limitless. “Finally, I was tired,” she says. She’d heard about ibogaine and flew to a clinic in Guatemala, where she was given a few capsules of the drug that sent her off into a journey. She remembers coming to in a hospital, where her mother (after a frantic flight) found her hooked up to a pacemaker. She’d had six cardiac arrests.

What Mulligan didn’t have, though, was anywhere near the withdrawal she normally suffered. And as she woke up with wires all over her, all she could think was This medicine is the future of opioid use treatment. Mulligan attributes her cardiac arrests to mistakenly being given double the safe dose of ibogaine. (The clinic is no longer there.) Although she didn’t initially remember the journey, it delivered a life purpose—to make ibogaine treatment safely accessible to more people. “That was in November of 2011, and I haven’t used an opioid or had a craving for one since,” she testified last July to big applause, having become a licensed psychotherapist. She was speaking at a public hearing for the Kentucky Opioid Abatement Advisory Commission where she crossed paths with veterans like Marcus Capone.

A former Navy SEAL, Capone served 13 years with six combat tours, only to come home to a war in his head. “Some things you can’t unsee, undo,” he says, “and there’s guilt, shame.” He found himself extremely depressed, flying off the handle, and drinking a lot as his marriage crumbled. Even with all the antidepressants, other pharmaceuticals, and treatments, he seemed to be getting worse. “He had become more or less like a monster,” says his wife, Amber, who felt suicide was imminent. With nothing left to lose, he went to a medically staffed clinic in Mexico and did a session of ibogaine with a second psychedelic, 5-MeO-DMT, vomiting the whole time. “You’re puking trauma, right?” he says. “It was awful. But it just pulled me out of a dark hole, almost immediately.” Amber instantly saw the change as he walked toward her after the journey. “He was that lovable, charismatic, easy-to-be-around guy again, the one I’d fallen in love with at 17,” she says.

The Capones started Veterans Exploring Treatment Solutions (VETS) in 2019, a nonprofit that has now sent nearly 1,000 former Special Ops members and their spouses for ibogaine treatment in Mexico. They also teamed up with Nolan Williams, MD, an associate professor at Stanford Brain Stimulation Lab on a groundbreaking study that came out in January—the first to measure the effect of the drug on traumatic brain injury (TBI) and its debilitating effects. Williams’s team assessed 30 special ops veterans with TBI—19 of them having thought about suicide, with seven having attempted it. After a session of ibogaine, given with magnesium to help prevent heart complications, they went from mild to moderate disability on things like memory and problem-solving to none, and their PTSD, depression, and anxiety all improved dramatically. “It’s a pretty wild set of findings not expected by any of us going into the trial,” Williams says of the study, published in Nature Medicine.

How it works: There’s comparatively little research on how ibogaine impacts the brain. It seems to affect multiple neurotransmitter systems and, like other psychedelics, increase brain-derived neurotrophic factor (BDNF), which is a key player in brain plasticity. “What ibogaine does in particular is called ‘the slideshow’ or ‘life review,’ where you view old memories as a neutral party,” says Williams. Looking at your trauma without judging yourself, you’re able to understand why it happened and think about it differently. “Also, say you had a big disagreement with your ex. Remarkably, you have insights about how they were thinking about it.” As for making opioid withdrawal disappear, again, it’s not clear. But there are several published cases and reports on people for whom it worked.

Safety note: Ibogaine is the riskiest psychedelic because it can lead to irregular heart rhythms and cardiac arrest. Between 1990 and 2020, 33 deaths were reported, mostly from the drug being taken without proper monitoring or precautions. Advocates stress that patients get screened for heart issues and do treatment in a medical setting. “There are ways to make it completely safe,” says Williams.

Legal status: Ibogaine is federally illegal. The state of Colorado and a few cities across the U.S. have deprioritized or decriminalized personal possession, although that doesn’t include providing it as treatment. W. Bryan Hubbard is crusading to change that, working to spearhead the clinical research necessary for eventual FDA approval. As a son of Virginia’s Appalachian coalfields and the descendant of a family whose history has been blighted by substance misuse, Hubbard, who became a lawyer and a leader in Kentucky state government, saw opioids stub out the soul of his people. “Ibogaine is not a forever cure,” he says. “What it does is provide the very best possible start to long-term, durable recovery.”

Last year, he made waves leading Kentucky’s Opioid Abatement Advisory Commission and gaining bipartisan support to use a small portion of the conservative state’s settlement funds to drive ibogaine research. It looked promising until he was replaced by the incoming attorney general in December. But within days, Hubbard was contacted by several other states, he says, including Ohio, which has almost double the fatal opioid overdoses as the national average. Now he’s been retained by Ohio’s Treasurer’s Office and REID Foundation to show through research that ibogaine, in a controlled medical setting, can be a safe, innovative approach to helping victims of the opioid epidemic, as well as those with PTSD and TBI.

Meanwhile, people aren’t waiting. Most are seeking treatment at ibogaine clinics in other countries, where the legality can be a gray area. (Here’s a good list of questions to ask if you’re considering one.) Like all psychedelics for healing, this treatment is not like entering a car wash and driving away shiny and clean. “Ibogaine can open up a lifetime of issues you’ve been trying to hide from, and people who aren’t prepared will run back to whatever drug they’re using as fast as possible,” says Mulligan, now 39. “For this to make a difference, you need to be doing some work on yourself.” O

This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. It should not be regarded as a substitute for professional guidance from your healthcare provider.

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