As a psychiatrist and part of the team that collaborated in developing the executive order the Government of Puerto Rico signed today, I want to explain with precision what this order does, what the current scientific evidence says about ibogaine, what we still do not know, and why this first step, taken from a framework of responsible research, is the right one.

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A moment we had been building for months

Today, August 4, 2026, Governor Jenniffer A. González Colón signed Executive Order OE-2026-037, which establishes Puerto Rico's public policy directed at strengthening clinical research, the development of controlled clinical trials, and the scientific capacity of the island's health system in emerging therapies, a category that includes, among others, psychedelic therapies and ibogaine compounds. I had the privilege of contributing the clinical perspective during the development of this order, alongside a team committed to ensuring that any advance in this space is built on scientific evidence and responsibility.

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I want to be precise from the start, because on this topic precision matters as much as hope: this order does not create ibogaine treatment, does not reclassify the substance, and does not authorize its clinical use inside or outside a research setting. What it does is instruct the Secretary of the Department of Health to evaluate, with the support of a new Scientific and Regulatory Advisory Committee, whether it is convenient and feasible to establish a Clinical Research Pilot Program in Emerging Therapies, of which ibogaine would be the line of study. It is the first formal step in a process with several steps: evaluate before deciding, and decide before acting.

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This new executive order creates a framework for Puerto Rico to responsibly research the use of ibogaine, under medical supervision and with strict safety protocols. This allows Puerto Rico to take part in generating the evidence that is still needed.

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What does this order do, exactly?

This is what the order concretely accomplishes today:

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  • It creates the Scientific and Regulatory Advisory Committee, attached to the Department of Health, made up of people designated by the Governor and composed of professionals with experience in clinical research, public health, bioethics, medical sciences, pharmacology, neurology, psychiatry, psychology, and regulatory affairs, together with representatives from the Office of the Veterans Advocate and other relevant agencies.
  • It instructs that Committee to evaluate the scientific evidence available on emerging therapies, explicitly including psychedelic therapies and ibogaine compounds, for serious mental illnesses, substance use disorders, and other health conditions, particularly in patients whose conditions persist after receiving the conventional treatments available to them.
  • It gives the Committee a deadline, counted from its constitution, to submit a written report to the Secretary of Health with the results of that evaluation and its recommendations on the convenience and feasibility of establishing a Clinical Research Pilot Program in Emerging Therapies. The Secretary forwards that report, along with the Secretary's own recommendations, to the Governor.
  • It lays out the full decision pathway: the Committee's report, the Secretary's recommendation, the Governor's evaluation, and, if she decides to move forward, an Implementation Plan with its own timeline. No program skips that evaluation process, and that is what gives seriousness and credibility to what comes next.

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It lays out the full decision pathway: the Committee's report, the Secretary's recommendation, the Governor's evaluation, and, if she decides to move forward, an Implementation Plan with its own timeline. No program skips that evaluation process, and that is what gives seriousness and credibility to what comes next.

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Why These Three Populations?

The order itself recognizes that Puerto Rico faces significant public health challenges related to mental health disorders, substance use disorders, neurodegenerative diseases, and other complex conditions. Below are some figures that help us understand the seriousness this issue deserves:

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  • Veterans: approximately 83,641 veterans live in Puerto Rico, close to 3.1% of the adult civilian population, according to data from the U.S. Census Bureau compiled by Puerto Rico's State Data Center. Nationally, an estimated 1 in 5 veterans of the Iraq and Afghanistan wars lives with post-traumatic stress disorder (PTSD). A study of Hispanic Vietnam War veterans (Ortega & Rosenheck, 2000, American Journal of Psychiatry) found that Puerto Rican veterans had a significantly higher likelihood of PTSD than other Latino veterans, a vulnerability that has not been re-measured using data from more recent generations. That is why the order does include a specific provision for this population: in evaluating the pilot program and in developing future research initiatives, the Department of Health will coordinate with the Office of the Veterans Advocate to facilitate the orientation, referral, and participation of veterans residing in Puerto Rico who are referred by the Veterans Affairs health system or by a duly authorized health professional.
  • Addiction: in 2022, Puerto Rico recorded 2,140 overdoses: 755 fatal (Institute of Forensic Sciences) and 1,385 reversed with naloxone in the community, according to ASSMCA's Mental Health and Addiction Observatory. That is equivalent to one overdose every 4 hours, and a rate of 67 overdoses per 100,000 residents. That year's 755 deaths far exceed the historical average of roughly 75 overdose deaths per year. Nearly 9 out of 10 people affected were men.
  • Neurodegenerative conditions: between 15,000 and 25,000 people live with Parkinson's disease in Puerto Rico, cared for by only a handful of neurologists who specialize in the condition. Added to that is multiple sclerosis (MS): between 4,000 and 5,000 people live with MS on the island, a prevalence of approximately 95 per 100,000 residents, one of the highest in Latin America and the Caribbean.

These figures represent more than numbers to me. They are those of my patients and my community, and they are the reason Puerto Rico needs to be part of the research, not merely a recipient of its results.

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What Is ibogaine?

Ibogaine is a psychoactive indole alkaloid extracted from the root of Tabernanthe iboga, a shrub native to West-Central Africa that has been used for centuries in the Bwiti ritual of Gabon. Contrary to what many assume, ibogaine is not a classic psychedelic like psilocybin or lysergic acid diethylamide (LSD), which act primarily on the 5-HT2A receptor. It is a "matrix pharmacology" molecule: it has moderate to weak affinity across multiple systems at once, including NMDA receptor antagonism, kappa opioid receptor agonism, α3β4 nicotinic antagonism (considered the main mechanism behind its anti-addictive effect), sigma-2 activity (implicated in the cerebellar neurotoxicity observed in animal models), and serotonin transporter inhibition. That unusual pharmacological profile is what has sparked current scientific interest, particularly for conditions where available treatments remain insufficient: addiction, PTSD, traumatic brain injuries, and neurodegenerative conditions such as Parkinson's disease and multiple sclerosis.

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What does ibogaine feel like?

The ibogaine experience is markedly different from that of other psychedelics, and it has nothing recreational about it. Those who have undergone it in a clinical setting often describe it as an accelerated review of one's own life: some therapists sum it up as "ten years of psychotherapy in one night." During the acute phase, which lasts several hours, it is common to relive memories from earlier stages of life, often from a third-person perspective, with a kind of detached empathy toward oneself and toward the other people present in those memories. That is followed by a longer period, up to 24 to 36 hours in total, of introspection and physical fatigue. It is precisely that intensity, and that duration, that requires medical monitoring to extend well beyond the initial dose: this is not an experience that can be taken lightly, or undergone outside a clinical setting.

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Beyond the science and the public policy, there are also human stories that inspire the search for new therapeutic possibilities. We invite you to learn about the personal experience of David Melchor, Co-Founder and CEO of the Pravan Foundation, who traveled to Mexico to receive ibogaine treatment as part of his comprehensive management of Parkinson's disease. His testimony reflects the transformative potential these therapies can hold for some patients, and the importance of continuing to advance rigorous clinical research that will help us better understand their safety and efficacy.

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What the evidence says today

Research on ibogaine is still in its early stages, but it no longer rests solely on anecdotal evidence. And it is important to be precise here, because scientific rigor requires distinguishing between what we know, what we suspect, and what has not yet been proven. In mental health and neurological conditions, human evidence is, to date, limited to single-group observational studies (without placebo comparison), conducted mostly in male combat veterans. No randomized controlled clinical trial has evaluated ibogaine for PTSD, depression, or traumatic brain injury. This does not mean ibogaine is not effective. It means we do not yet have studies capable of determining with certainty how much of the observed benefit is due to the medicine and how much can be explained by other factors. Below are some of the most relevant findings:

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  • Stanford's MISTIC study (Cherian et al., Nature Medicine, 2024): 30 male veterans with traumatic brain injury (mostly mild) received a single dose of ibogaine with magnesium, along with complementary therapy. At one month, most showed very large improvements: 86% no longer met criteria for PTSD, 83% for depression, and 83% for anxiety. There were no serious cardiac problems under this protocol. Despite being the most cited work in this field, its results should be interpreted with caution, since it is observational research without a control group, conducted in a small, self-selected sample.
  • Does the effect hold over time? This is the most important open question. The Stanford team's 12-month follow-up is already available as a preprint and still awaits peer review. The most informative published evidence to date comes from a clinical program in Mexico (Davis et al., 2023), which followed 86 veterans treated with ibogaine followed by 5-MeO-DMT and documented significant improvements in PTSD, depression, and anxiety at one month, with the benefit persisting at six months. As is typical at this stage of research, these are open-label studies, without a control group, and with more than one intervention in the same protocol, so the effect cannot be attributed to ibogaine alone. That is exactly what a controlled trial would allow us to establish.
  • Addiction: there are roughly 24 clinical studies of ibogaine in substance use disorders (about 705 patients), but only three are randomized controlled trials. The two conducted in opioid dependence used noribogaine, the active metabolite: an ascending-dose phase I study and a crossover trial in 27 patients on methadone, which showed dose-dependent QT interval prolongation and reductions in withdrawal that were not statistically significant. The only double-blind trial with a positive result was in cocaine. Interest in opioids comes from another source: multiple independent open-label studies, with different teams and protocols in the United States, New Zealand, and the Netherlands, document the same pattern in series of up to 191 patients: most patients stop showing signs or symptoms of withdrawal within the first 48 to 72 hours after a single dose, with a marked reduction in craving. It is a striking and reproducible finding, but all of these studies are open-label, without placebo, with patients who knew what they were receiving, and within a detoxification protocol from which the drug's effect cannot be separated. For that reason, it is important to recognize that in opioids, ibogaine is not unstudied: it is unproven. That is the gap this pilot program seeks to close.
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  • Neurodegenerative conditions: here the human evidence is, by far, the earliest of the three populations, limited to case reports. In multiple sclerosis, a two-patient report (Chen et al., 2025) documented a reduction in the size of a white matter lesion and MRI changes that the authors interpret as consistent with remyelination. In Parkinson's disease, a case report (Erny et al., 2026) describes a 52-year-old woman treated for 80 days with low doses (up to 75 mg/day), with improvements in motor symptoms, quality of life, fatigue, and depression, worsened sleep, and no adverse events recorded. The current evidence consists of isolated cases without a control group or blinding; the imaging changes are nonspecific, and lesion burden in MS naturally fluctuates. There are no larger series or clinical trials for either condition. What does exist is a preclinical mechanistic basis: in animal models, ibogaine increases GDNF expression in dopaminergic circuits (Marton et al., 2019), the same factor that sustains the neurons lost in Parkinson's disease. Even so, that mechanism has not yet been tested in an animal model of Parkinson's disease, and in animals high doses affect balance and coordination, an additional reason for caution in patients with gait difficulties. It is a coherent hypothesis, though it does not constitute a clinical promise; and precisely because the current level of evidence would not justify any other type of access, it justifies studying it seriously.
  • Texas, IMPACT consortium ($50 million, UTHealth Houston and UT Medical Branch Galveston): a two-year, state-funded multicenter clinical trial that began enrolling patients in 2026 to study ibogaine in addiction, traumatic brain injury, and other behavioral health conditions, part of a new generation of studies designed with cardiac safety controls built in from the start.
  • Federal executive order (April 18, 2026): President Trump signed an order directed at accelerating regulatory review of psychedelic therapies, explicitly naming ibogaine, with a commitment of at least $50 million through ARPA-H for research and to support states that develop their own programs.

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Today Puerto Rico joins that movement, not as a spectator, but as a potential protagonist, with the advantage of a pharmaceutical, academic, and clinical ecosystem capable of sustaining high-rigor research.

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The risks we cannot ignore

It would be irresponsible of me to talk about ibogaine without talking about its risks. The main risk is cardiac: ibogaine can alter the heart's electrical rhythm and trigger serious arrhythmias, even in people with no known heart condition. The literature documents at least 27 deaths associated with its use (Litjens & Brunt, 2016). Most occurred in settings without prior cardiac evaluation or medical monitoring, but cases have also been reported under supervision. Monitoring does not eliminate the risk, but it does make it possible to detect it and act in time.

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The only study that monitored the heart closely (Knuijver et al., 2022) shows just how real this risk is. Half of the patients reached levels considered high-risk, while in several, that risk remained elevated for more than 24 hours after the dose. In addition, all of them needed assistance walking for several hours, something worth considering especially in patients with Parkinson's disease or multiple sclerosis, who already have a higher risk of falls.

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Another factor to keep in mind is that each person metabolizes ibogaine differently depending on their genetics, so the same dose can affect two people very differently. Certain common medications, such as some antidepressants, and low potassium or magnesium levels, can further increase the cardiac risk.

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That is why a regulated research framework matters so much. The difference between a tragedy and a truly transformative treatment almost always comes down to medical supervision: cardiac evaluation before the dose, continuous monitoring, trained staff, and the ability to respond quickly in an emergency. That is exactly what a well-designed pilot study can offer.

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What still doesn't change?

To be clear for our community:

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  • At the federal level, ibogaine remains classified in DEA Schedule I, the most restrictive category, reserved for substances with no recognized medical use. This order does not alter that federal status, nor does it reclassify ibogaine within Puerto Rico's controlled substances system.
  • Ibogaine is not, and does not become today, an approved treatment. It will not be available in pharmacies or medical offices. Seeking it out or administering it outside of any future authorized research program remains illegal and clinically dangerous.
  • There is still no Research Pilot Program to enroll in. What exists, as of today, is an Advisory Committee with clear instructions and a deadline of 45 to 120 days to evaluate whether that program should be created, and how.

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That process takes time, and it should.

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Why this matters to me, as a Puerto Rican psychiatrist

I would sum all of this up in one word: hope. But the hope of a well-taken first step, not that of a promise made ahead of time. Ibogaine has a real and promising scientific signal for addiction and certain neuropsychiatric conditions, and Puerto Rico now has, for the first time officially, a mechanism to help find out, seriously, whether that promise holds up. That is exactly what a responsible process does: it does not promise cures, it does not sell false hope, but it also does not ignore a real possibility. It evaluates carefully, before deciding, so it can answer with certainty, setting aside both enthusiasm and fear.

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As a psychiatrist, I see in this class of medicines something psychiatry has sought for decades: the possibility of combining, within a single experience, the pharmacological work and the psychotherapeutic work we normally do separately; one that acts on brain chemistry, and another that processes meaning, gradually, sometimes over years. When both happen together, a window opens to evaluate and explore things that would otherwise take much longer to surface. That is why I believe this generation of treatments could represent a turning point for our field, not through magic, but because it combines, in a single supervised session, two tools we have historically used separately.

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I work every day with patients living with treatment-resistant depression, trauma, and addiction, people for whom current options, while valuable, are not always enough. As an integrative and interventional psychiatrist, I have seen up close both the potential and the limits of emerging therapies. That is why I believe the right question is never "does ibogaine work?", we do not yet have enough evidence to answer that with certainty, but rather "are we willing to evaluate it, and eventually research it, with the rigor, safety, and scientific humility it deserves?"

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Today, Puerto Rico answers yes, but with the same rigor that good science demands: with data, with medical supervision, with transparency, and with patient safety as the priority. That is the commitment I took on by collaborating on this executive order, and it is the same commitment that guides the Pravan Foundation in every one of our research, education, public policy, and innovation projects.

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We will continue keeping our community informed, with the same rigor and the same hope, as this process moves forward.

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Paulina D. Rullán-Farinacci, MD ‍

Psychiatrist, Co-Founder and Medical Director of Sattva Clinic, a clinic for Integrative and Interventional Psychiatry. Director of Education and Research at the Pravan Foundation.

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Bibliography:

  • Administración de Servicios de Salud Mental y Contra la Adicción [Mental Health and Anti-Addiction Services Administration]. (2024, February). Sobredosis revertidas y fatales en Puerto Rico, 2022 [Reversed and fatal overdoses in Puerto Rico, 2022]. Observatorio de Salud Mental y Adicción de Puerto Rico.
  • Boletín Administrativo Núm. OE-2026-037. Executive Order of the Governor of Puerto Rico, Hon. Jenniffer A. González Colón, establishing public policy directed at strengthening clinical research, the development of controlled clinical trials, and the scientific capacity of Puerto Rico's health system in emerging therapies, and providing for an evaluation of the feasibility of a clinical research pilot program. August 4, 2026.
  • Brunt, T. M. (2026). Rare but relevant: Ibogaine and cardiovascular complications. Addiction.
  • Chen, D. Q., Inzunza Domínguez, J. A., Valle Uzeta, J. M., Pushparaj, A. P., & Dickinson, J. E. (2025). Case report: Significant lesion reduction and neural structural changes following ibogaine treatments for multiple sclerosis. Frontiers in Immunology.
  • Cherian, K. N., Keynan, J. N., Anker, L., et al. (2024). Magnesium–ibogaine therapy in veterans with traumatic brain injuries. Nature Medicine, 30(2), 373–381. https://doi.org/10.1038/s41591-023-02705-w
  • Davis, A. K., Xin, Y., Sepeda, N., & Averill, L. A. (2023). Open-label study of consecutive ibogaine and 5-MeO-DMT assisted-therapy for trauma-exposed male Special Operations Forces veterans: Prospective data from a clinical program in Mexico. The American Journal of Drug and Alcohol Abuse.
  • Erny, T., Cano Montenegro, E. Y., Barth, J., & Noller, G. (2026). Ibogaine for the treatment of Parkinson's disease: A case report. Journal of Psychedelic Studies, 10(2), 206–212. https://doi.org/10.1556/2054.2025.00478
  • Fundación de Esclerosis Múltiple de Puerto Rico [Multiple Sclerosis Foundation of Puerto Rico]. (n.d.). Registro de Personas con Esclerosis Múltiple de Puerto Rico [Registry of People with Multiple Sclerosis in Puerto Rico]. https://fempr.org/registro/
  • Glue, P., Lockhart, M., Lam, F., Hung, N., Hung, C. T., & Friedhoff, L. (2015). Ascending-dose study of noribogaine in healthy volunteers: Pharmacokinetics, pharmacodynamics, safety, and tolerability. Journal of Clinical Pharmacology, 55(2), 189–194.
  • Glue, P., Cape, G., Tunnicliff, D., et al. (2016). Ascending single-dose, double-blind, placebo-controlled safety study of noribogaine in opioid-dependent patients. Clinical Pharmacology in Drug Development, 5(6), 460–468.
  • Knuijver, T., Schellekens, A., Belgers, M., et al. (2022). Safety of ibogaine administration in detoxification of opioid-dependent individuals: A descriptive open-label observational study. Addiction.
  • Knuijver, T., ter Heine, R., Schellekens, A. F. A., et al. (2024). The pharmacokinetics and pharmacodynamics of ibogaine in opioid use disorder patients. Journal of Psychopharmacology.
  • Köck, P., Froelich, K., Walter, M., et al. (2022). A systematic literature review of clinical trials and therapeutic applications of ibogaine. Journal of Substance Abuse Treatment.
  • Ley Núm. 4 de 23 de junio de 1971, según enmendada [Act No. 4 of June 23, 1971, as amended], Puerto Rico Controlled Substances Act.
  • Litjens, R. P. W., & Brunt, T. M. (2016). How toxic is ibogaine? Clinical Toxicology, 54(4), 297–302.
  • Ortega, A. N., & Rosenheck, R. (2000). Posttraumatic stress disorder among Hispanic Vietnam veterans. American Journal of Psychiatry, 157(4), 615–619.
  • Primera Hora. (n.d.). Alrededor de 25,000 personas padecen de Parkinson en Puerto Rico [About 25,000 people have Parkinson's disease in Puerto Rico].
  • Texas Health and Human Services, & UTHealth Houston. (2026). Consorcio IMPACT: Ensayo clínico de ibogaína [IMPACT Consortium: Ibogaine clinical trial] [Program description].
  • The White House. (2026, April 18). Accelerating medical treatments for serious mental illness [Presidential action]. https://www.whitehouse.gov/presidential-actions/2026/04/accelerating-medical-treatments-for-serious-mental-illness/
  • U.S. Census Bureau, & State Data Center de Puerto Rico. (n.d.). Veteranos y veteranas en Puerto Rico [Veterans in Puerto Rico] [Infographic]. https://censo.estadisticas.pr/node/442