Hallucinating Away a Heroin Addiction

PART I

It’s been 56 hours since Grace Bergere’s last shot of heroin—too long.

Curled into a fetal position on an outdoor, candle-lit matt in Costa Rica, the 18-year-old trembles in fear. A petrified grimace wrinkles the white clay adorning her face. Her rail thin body, wrapped in a ceremonial red sheet, looks paralyzed at points—then, without warning, her limbs thrash in revolt, as she tries to keep the demons haunting her at bay. But it’s too late. The demons are just getting started.

Twenty people surround Grace, all of them intently studying her trance state. Neighbors, friends, and locals from San Jose: tonight, they’ve become a tribe.

Clothed in animal skin, paint, and feathers, they move with rapid footsteps before twirling—their African skirts fluttering like laundry in the wind. The pulsing sound from their tsokais (African rattles) and bells join the African beat blasting from a nearby silver MacBook. The noise is so loud it nearly drowns out a horrified howl from Grace. It’s the leader of the ceremony, Dimitri Mugianis, who hears her struggle. He stops, bends down and leads her through the darkness.

GALLERY: Escaping Heroin: Inside a 18-Year-Old Ibogaine Ceremony (PHOTOS)

“You’re okay, Grace—you’re safe, you’re loved,” Mugianis says, turning her lifeless face toward his. “You’re okay. You’re here.”

Three days ago Grace entered this ceremony looking as sick as she felt—a junkie, hooked on heroin for the last two and a half years. Now she’s been given an arguably more potent drug—ibogaine. If successful, the three-day waking trance will eliminate her chemical dependence on heroin.

In the meantime, there is excruciating, unspeakable pain.

***

Named after the Latin word heros (allegedly for the hero-like feeling it inspires), heroin is a depressant with a withdrawal that, in extremely rare cases, can be fatal. According to the National Institute on Drug Abuse, the morphine derivative is the most addictive drug in its class. Once in the system, it binds with opioid receptor cells that send endorphins shooting through the body. A lifetime of physical pain or severe anxiety vanishes in an instant.

Heroin users describe the high as a feeling of all-encompassing well being. It’s a sensation that the 23 percent of those who become dependent after trying it know all too well. In the last decade, heroin abuse in the U.S. has soared.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of heroin users more than doubled from 2007 to 2012, to 669,000. In 2012, an estimated 467,000 people reported being dependent on the drug, a number on the rise after a crackdown on prescription drugs.

Most of those using are trying to get help. In 2012, 450,000 people reported receiving treatment for heroin. But the typical plan, rehab and detox, rarely works. According to a 2010 study, over 90 percent of those with opioid addiction relapse in the first year. In 59 percent of those cases, the relapse occurred within the first week. Many blame this high recidivism rate on heroin’s infamous withdrawal. Diarrhea, vomiting, constipation, nausea, fever, severe muscle pain, chills, cramps, watery eyes, runny nose, and involuntary spasms are just some of the ailments that plague those detoxing. Going “cold turkey" is extremely difficult, but only life-threatening when previous medical conditions are present.

Alternative options are not cures as much as management systems. An acyclic analog of morphine called methadone can prevent withdrawal symptoms. But many users get addicted to that, too, forcing them to take it daily for the rest of their lives. Suboxone, a prescription painkiller used to treat opiates, isn’t much better. With its high cost, low availability, and a long-lasting withdrawal, it’s considered by many to be trading one bad addiction for another (this one legal, and more expensive).

***

Then there is ibogaine.

Ibogaine comes from a naturally occurring psychoactive drug derived from the root bark of a Central West-African bush called iboga. For centuries, shamans have used iboga to rid people of evil spirits and heal the sick. In Gabon, West Africa, the drug is also central to Bwiti, a religious way of life for people who take it. For these forest dwellers (pygmies), it’s a rite of passage into adulthood. In the West, it’s been used as something quite different—an antidote to addiction.

While the exact date that ibogaine (an alkaloid of iboga) entered the U.S. is debatable, many point to clandestine mind-control studies performed by the Central Intelligence Agency beginning in the ’50s. One such investigation, Project MK-ULTRA, centered on finding a substance capable of manipulating human behavior—mind control, in other words. As a part of its research, the CIA allegedly tested a new group of psychedelics, including ibogaine, on 10 African-American men in 1960. As the story goes, it cured all 10 morphine addicts of their chemical dependence.

In 1962, the drug landed in the hands of a 19-year-old heroin addict and NYU student named Howard Lotsof. He knew only that the drug came from Africa and induced a 36-hour trip. After trying it with his friends—whom he marketed it to simply as a fun, long-lasting opiate—Lotsof awoke in shock, completely free from the desire to use drugs. He spent the rest of his life (he died in 2010 of liver cancer) convincing any drug researcher he could find to test the anti-addiction properties of ibogaine. He wrote letters, made phone calls, and beseeched every major pharmaceutical company—not a single one was interested. Lotsof eventually took the drug to the Netherlands, where some of the first ibogaine clinics were born.

Many of the research results he was able to get, including those of one Dr. Stanley Glick, were promising. Some, such as the work of Dr. Deborah Mash, still are. But regulatory approval for the drug, made difficult by its dangerous and unpredictable effects, was never won. In 1967 ibogaine was placed under the Federal Food, Drug, and Cosmetic Act of 1938 (DACA), making it illegal to possess, sell, or manufacture it, except for personal use. Less than one year later, ibogaine was officially banned as a Schedule I substance—a classification that rests on the concept that the drug in question has no accepted medical use.

That, combined with big pharma’s reluctance to campaign for the regulatory approval of a drug that users only need once, has made ibogaine all but obsolete in the U.S.

Americans who know of it today likely either used it themselves, while abroad, or know someone else who did. They’ve seen people transformed—withdrawal evaded, addiction conquered, clarity gained. For a precious few, the experience was remarkable enough to become their life’s work.

Dimitri Mugianis is one of those converts.

***

Mugianis’s story is a lot like those of the drug users he now treats. Raised in ’70s Detroit, the Greek American was first exposed to drugs at the age of 11. Exuberant and creative, he moved to New York City at 19 to become a poet and a musician. Aiming to follow the Beats and the punk rock stars he idolized, he imitated their lifestyles, first with cocaine, then with heroin. “Everyone I admired—from Keith Richards to the Sex Pistols—was doing dope,” he says. In no time, he was hooked.

By the 2000s, Mugianis was 39 years old, living in his parents’ basement, and battling a severe heroin addiction that was slowly stealing his life, the way it had stolen the lives of most of his friends. But it was the death of his pregnant common law wife from endocarditis (a disease of the heart brought on by unclean needles) that sent him over the edge. “I wasn’t just dying,” he says. “I was ready to die.”

On his last leg, Mugianis remembered a Lower East Side anarchist and musician talking about a drug he’d been introduced to in Holland that could cure heroin addiction—ibogaine. With nothing to lose, Mugianis decided to take it. When he arrived in the Netherlands for his treatment, he was raging drunk on free beers from the international flight. What he’d imagined would allow him to live for a few more months changed the course of his life forever.

“I was in Amsterdam with a pocket full of money and I had no desire to use,” he says of the days after his 24-hour trip on ibogaine. “Do you know what that’s like? For a junkie?”

Looking at Mugianis today, it’s hard to imagine that this man with the perpetual smile ever had a heroin habit (as hard as it is to imagine that he’s now leading what is arguably the only successful cure for heroin addiction in the world).

Clean and sober for 12 years, he looks nowhere near 51, eats a healthy diet six days a week and “cheats” one, and stays as active as he can, taking time out of each day in Costa Rica to run the hills. A deep, raspy voice seems the only vestige of the three decades he spent pounding his body with poisons.

After his revelatory visit to the Netherlands, Mugianis returned to New York City and began administering ibogaine in hotel rooms to select groups who passed his rigorous screening process. Heroin addicts, alcoholics, coke heads—all of whom he’d closely canvassed to ensure they were ready to get clean.

“The first thing I try to do is talk somebody out of it, because it’s no joke,” he tells Michael Negroponte in I’m Dangerous With Love, a 2010 documentary about his path to Bwiti.

A reminder of the gravity of ibogaine—and the necessity of having a medical professional attending at each session—came three years ago when a methadone user Mugianis was treating suffered a seizure. After intense training in Gabon following the incident, he dedicated himself to practicing ibogaine ceremonies like the Bwiti. For him, the drug is only as important as the ceremony that comes with it—a “breaking open of your soul,” as Bwitist view it, “in order to be reborn.” Since 2004, he’s performed 600 of them.

As word spreads, his iPhone floods daily with texts and calls from prospective clients, collaborators, addicts, and apostles. But no one appreciates the sweetness of life quite like someone who never thought they would live long enough to get old. So when people like Grace Bergere appear on his doorstep, Mugianis can’t stop letting them in.

His ceremonies, which incur a variety of expenses such as around-the-clock medical care, lodging, and food for the client, he offers on a sliding scale. Some pay as much as $5,500. Others, like Grace, pay less than half. In rare cases, Mugianis does it for free. No one leaves until they’re back up and running, and no one can say ahead of time whether that will be two days or two weeks.

There are other ibogaine clinics. Several good ones, Mugianis says, in Mexico. But he is undoubtedly the kingpin. Those that get into IbogaLife are lucky. The weekend I spent there, the phone rang off the hook.

***

The first time I met Grace, she was still a junkie.

On an icy gray day in February, she invites me to her favorite restaurant—a New York City eatery with scarlet-colored walls and leopard print booths.

We’re here to talk about her life, first and foremost, but Costa Rica, too. Mugianis says it’s up to Grace to decide if she wants me there.

Sitting down at a table in the front, she mumbles about not being hungry because she’s sick—then orders chocolate milk. The oversized olive-green coat she’s wearing is weathered and deteriorating, making her look a bit like an orphan out of Oliver Twist. Her face is gaunt and pale. A silver eyebrow ring matches one at the center of her bottom lip; both adorned with silver balls the size of pen tips. Various scratches and cuts line her arms and face; a pus-filled abscess burns on her right arm. In nervous moments, her hand wanders to a small patch of acne on her forehead, a reminder of just how young she really is.

She hasn’t been this way forever, she tells me—“dope sick.” She grew up in a typical, if bohemian, family. A happy kid with a love for music and a natural talent for guitar. That changed just past 10 p.m. on August 1, 2008, when she’d climbed to the roof of Westbeth, a New York City rent-stabilized artists’ refuge where her parents (both musicians) were raising their only daughter. “I remember climbing the ladder, and then trying to stand up there because I thought it was solid.”

It wasn’t. She fell 14 flights, roughly 147 feet, down the chimney to the soot-filled basement below.

“I remember spider webs on the way down. Lots. But then there was this force, I felt like it was holding me,” she says. “When I woke up I had all these ashes stuck in my throat.” After using her hands to clear her windpipe, she freed her eyes from the embers that were blinding her vision. Spotting a crack in the cement beside her, she remembers pounding it with her clenched hand, thinking this was her only escape to freedom. Her tiny fist was still punching concrete when the police rushed onto the scene a few minutes later. “I remember the firemen being like: ‘Holy shit, she’s alive!’”

Despite eight broken bones in her back, a dislocated hip, and multiple fractures, Grace says she felt no pain. “One of the clearest memories I have is looking up at the breathing mask and seeing that it had blood on it,” she says. “Then I lost consciousness in the ambulance. That’s when they first gave me morphine.”

She was released from the hospital with nothing more than a brace after two months. But the unrelenting back pain she’s endured every second since is surpassed only by the pressure that comes from cheating death.

“I fell down a chimney and survived, so everyone’s like: ‘Now what?!’” Her face reddens as she says this, and all at once she’s nothing but an emotional teenage girl. “I’m like: ‘Nothing! Leave me alone.’”

PART II

For as long as Grace can remember, this has been her secret struggle: giving meaning to a life she never asked to keep.

Dubbed “Amazing Grace” by the Daily News, her life was supposed to be a constant reminder of God’s grace—or at least that’s what she was told, over and over. “You have to do something meaningful, make it count!” strangers would say after hearing her story.

She’d been saved with no explanation, and somewhere along the way, she got lost. School, which she’d already found difficult before the fall, became impossible. In three years she attended three different high schools.

Angry and lost, she kept her spirits up with the dream of one day joining the circus. An internship in circus arts at her third high school provided a little bit of skill, and much needed confidence. So she began to perform on the street, making cards disappear with a brush of her scar-ridden hand, levitating a clear crystal ball—“contact juggling it’s called,” she says.

The money was great, the company even better. “You love hanging out with seedy people who don’t want to hang out with anyone but you,” she confesses. “It feels good.” Homeless kids on the street had pain just like she did, but even more alluring: anger. “We had a lot of fun, we would just get drunk and shit, and fuck shit up. It was nice to have a bunch of angry people to yell at shit with.”

It was a boy who initially led her to heroin—but her own pain that kept her coming back. “I never felt like anybody really genuinely liked me. I always felt like people were lying. But I met this guy who told me he did, and I believed him.”

With a small allowance from her parents (who didn’t yet know she was getting into drugs), she played guitar and juggled her crystal ball for extra cash. With her sweet smile, rosy cheeks, and wavy white-blond hair, she found money was easy to come by. Soon she had enough to pay for her crush’s heroin habit—enough to pay for hers, too. Watching others thrust the needle into their arms night after night turned her on to the idea of trying it. “I remember having… You know when you get sort of horny? I remember looking at the needle like that… I was yearning for it—not in a sexual way at all—I just wanted it that bad.”

So, just three years after her accident and barely 17, she gave in. Or at least, that’s her version of the story. (According to Mugianis, who began getting phone calls from Grace’s dad 2½ years ago, her habit began way earlier, when she was just 15. Junkies, as they are the first to admit, don’t sweat the facts).

Grace claims she sniffed heroin the first time. The next night, she shot it up her veins. “I just remember feeling totally okay for the first time. All the pain was gone. My life was fine. I found a place that I could function in.” For many, it can take up to 10 uses to get addicted. Not for Grace. Just a week or two in, she was shooting up six to eight times daily. Until trying it, she hadn’t realized the amount of chronic pain her accident had left behind. “When you feel pain all the time, you don’t even realize it’s there,” she says. Heroin took it away like nothing had before.

“I remember just relaxing, for once. I felt akin to Lou Reed and Elliot Smith—who I love desperately. I felt like we were all in the same boat,” she says. “And you know, it’s nice to feel like you have a team—whether that team is a bunch of fuck-up alcoholic drug addicts or not. It’s nice to feel like you’re on a team.”

Even greater than the physical relief heroin gave her was the sense of satisfaction she got from doing it right. Head shaven and clothes dirtied, she camped out on benches, got a pet rat named Smiffy (in homage to Elliot Smith), and started sleeping with a dealer. She wore her wounds with pride, addicted to looking as sick as she felt—a warrior in an interminable battle against herself. “I was finally good at something,” she says. “You can’t be bad at being a junkie. You know what I mean? You can’t fuck that up.”

But addiction is a master at killing the fun. Soon, the euphoria she’d first felt from dope disappeared. Shooting up became a chore, a necessity to her survival. “I found something that took away the pain and it was immediately my life. It’s been my life. Nothing else matters,” she says, as we part in time for her to shoot up.

It’s a plight too many addicts in America face—one that most go alone. “The thought of suicide can get you through a pretty rough night,” she says. “You get addicted to misery.” At some point, one she can’t remember now, her parents got involved. They called a psychologist, a rehab clinic, a detox center. Grace tried to quit, failed, then tried again.

Therapy she saw as a game, never a way to heal. What sort of person could she convince this shrink that she was? “I know exactly what they’re going to say and exactly what they’re thinking. So I monitor what I tell them, subconsciously,” she says. “I can make them think whatever I want about me. “They’re like, ‘OK, so, daddy issues.’”

As her habit worsened, her street money began to run out. Her mother, now a swim teacher at the YMCA and her father, still a jazz guitarist, began pitching in. But between the needles she shoved into collapsing veins, Grace fought tenaciously for a way out.

Her dad, who had heard of Mugianis through the New York independent music scene, kept calling to discuss the possibility of Grace taking ibogaine. For months Mugianis said no, certain that an 18-year-old was too young to make a commitment to getting clean. It was a phone call from Grace herself that changed his mind.

“She’s gone through so much trauma,” he tells me. “But she’s special. This one is special.”

So special that he invites me to Costa Rica, to the ibogaine ritual where he’ll try to interrupt her downward spiral.

PART III

Almost two months to the day after the first meeting with Grace, I arrive at Newark airport for our flight together to Costa Rica. When the stewardess gives a 15-minute warning—at which the doors will be closed—she’s nowhere to be seen. Surreally, a choir of high school students at the gate adjoining ours begins singing a hymnal. “Jesus Lord, take my hand,” they belt. “There’s a race to be run, there’s a victory to be won.”

Five minutes later, Grace bounds down the stationary escalator, clutching a bacon cheeseburger and a Coke. Swimming in an oversized blue blazer and dirty black Uggs, she stops eating to wipe away the sweat on her forehead. “I had no idea you were going to be here. I’m so glad you are,” she says, looking surprised. In the three weeks leading up to the ceremony, she’d stopped responding to me. This is common behavior before such an event, according to Mugianis, part of an attempt to “self sabotage.”

“Everyone is mad at me. Are you mad?” she asks, referencing the cocaine she did last night against Mugianis’ orders (stimulants, unlike heroin, can interact negatively with ibogaine).

With less than five minutes until the gate closes, boarding seems to be the last thing on the 18-year-old’s mind. She’s purchased Sherlock Holmes for the plane ride, she tells me, but wishes she’d gone for chocolate instead. “Why am I sweating so much?” she asks nervously.

Down to two minutes, I’m convinced she’s changed her mind. Later she’ll laugh at me saying this. Explaining that her stalling was simply a desperate attempt to spend the least amount of time possible on the aircraft that soon became her battlefield. I don’t know if that’s true—she probably doesn’t either. The thought of boarding alone is enough to send most addicts sprinting the other way.

For a heroin addict in particular, six hours in flight is war.

Sweat is the first sign of the body’s attack. Nausea is the next assault, a wave so powerful it threatens to rip out your insides. Dizziness follows. Sneezing. Yawning. Then, worst of all, there are the body aches. Hands and legs shaking, convulsing from the fingers to the feet: pleading, praying, for the drug that’s become its lifeline. “I’m sick,” Grace says. “My whole body is sick. Dope sick.”

Before the flight, she’d been high enough on oxycontin to exhibit a fake calm. Reaching for her boarding pass, she’d almost dropped the wad of cash her father sent to pay Mugianis. “Maybe I’ll just take this $900 and go buy drugs,” she told me. “I’m kidding. Get it?!” she burst out seconds later, laughing at my gullibility.

By the time the plane touches down, the oxy has worn off. Six hours without opioids, her body hurts down to the once-broken bones that cause her chronic pain. When on heroin, they’re numb. When in withdrawal, they feel like Styrofoam. “I’m terrified,” she whispers as we pass through San Jose Airport security after landing. The people surrounding us, the couple that rode next to her on the flight most of all, are terrified, too—of her. Both attractive brunettes straight from a Vineyard Vines ad, they all but uttered “ew” when Grace took the window seat on their row.

After being forced to fly next to this leper, their disgust is palpable. Perhaps it’s the abscess on her arm, which has turned a fluorescent yellow by the time we deplane. Or the way her eyes seem to be glazed over. Maybe it’s the sweat, now covering her face and body, that has them appalled. Or the lip piercing she’s playing with while she asks how soon until she can have a cigarette.

It’s painful watching them glare at her—a girl who’s nearly been swallowed whole by addiction. If Grace notices these dirty looks, she doesn’t show it. But later in the week, when Mugianis tells Grace she’ll need to start letting go of the shame that comes with addiction, tears well up in her eyes. So many that, for the first time since I’ve known her, she’s unable to speak. Suddenly, all at once, the Vineyard Vines couple is right in front of her face. Shooting disapproving glances like bullets.

Even worse, I realize days later, they’ve been there all along.

***

Sitting on the bumper of a maroon V6 Suzuki the next morning, our first in Costa Rica, is an athletic-looking stranger. “Hey, I’m Matt,” he says, standing up to shake my hand. Tan and well built, he easily navigates the uneven roads that lead to IbogaLife—the center where Grace is staying and where she’ll take ibogaine. A heroin addict for almost a decade, Matt Mormello underwent an ibogaine treatment in Mexico three years ago, alongside Vice editor Shane Smith. “I was going to kill myself slowly or do it fast, and I didn’t have the balls to do it fast,” he says.

Since then he’s learned the hard way that ibogaine isn’t the cure-all for heroin addiction. “You have to change your entire life. Find a new place, new friends,” he says. “If I was still in Philly, I’d be doing dope for sure.” His statement is a glaring reminder of something that’s often lost in the lore of an ibogaine ceremony: chemical dependence, the part that ibogaine obliterates, is only half the battle.

For most, a full recovery means changing everything about their lives—the place they live, the people they hang out with, the things they choose to do in their free time. For Mormello, admitting this was one of the hardest parts. Just a few months after his first ibogaine treatment, he relapsed. But after undergoing another ibogaine ceremony recently, he’s clean again and happy, working at IbogaLife full time.

The clinic, a large house surrounded by single-family homes, is immaculate, smelling of fresh cilantro and coffee beans. Tiny purple flowers line the open windows, and a gentle breeze fills the room. A black-and-white cat named Chopper sleeps upside down on the porch, his open mouth revealing a row of impossibly tiny teeth. Black-and-tan African murals hang framed on the wall, tribal instruments lie scattered on the floor.

Christine Fitzsimmons, the medical director at IbogaLife, works on a laptop at the long wooden kitchen table. Not long after Matt picks me up from my hotel nearby, Grace (who is staying at the clinic) wakes up. When Fitzsimmons tells her the time, 12:32 p.m., she’s surprised. It’s earlier than usual. “Junkies hate the morning,” Mormello says with a hint of pride.

“Can I have a cigarette?” Grace says. She’s been off heroin for almost 24 hours now, and it shows. Her pale face is gray, her blue eyes bloodshot. “How are you feeling?” Fitzsimmons asks. “I’ll go get you some medicine.”

As she disappears down the hill, Grace shoots Mormello a devilish grin: “What does she have?” Two baby aspirin and 40 mg of oxy are undoubtedly not what Grace was hoping for, but she takes a big gulp of the strawberry smoothie Fitzsimmons has made her to swallow it down anyway.

An hour passes. Mugianis arrives.

In a light-blue linen T-shirt and dark washed jeans, he gives quick bear hugs to each of his team before lighting up a celebratory cigar. Get ready, he tells them, we’re going to the trees.

***

Gym shoes on, the six of us cram into the Suzuki for the five-minute ride to the woods. A loud grumbling of the engine cuts the silence. “That sound is a requirement for renting a car in Costa Rica,” Mugianis jokes to lighten the mood. “They must make that noise in order to be eligible.”

A 10-minute walk down an unsteady dirt path brings us to the tree the Bwiti call “Mama" (the grandmother of the ancestors). Bobby Payne, the director of IbogaLife and a Bwiti music expert, sits down to play the mougongo—an African jaw harp that’s one of the religious practice’s sacred instruments. Michael McKenna, another Bwiti initiate and a facilitator at the clinic, hands out colorful African cloth for each of us to wrap around our waists. Fitzsimmons passes out rattles.

This ceremony, “Introduction to the Forest,” is the first of five that Grace will go through in the next two days. Through offerings to the ancestors, the ceremony sets the stage for the healing process to begin. The point of the ritual is to announce to the ancestors (through “Mama,”) our intentions, and earn their consent to continue. Convincing them that Grace is worthy of being healed is Step One.

To help our cause, we bring treats. One substance at a time we shower “Mama” in love. Orange Fanta (her favorite), silver coins, KitKats, a sourdough baguette, malt beer, and small sugar balls that look like mini doughnut holes. As we spread and spray the offerings around her dense trunk, we shake our rattles and hum—our faces covered in “semen and blood” facepaint (or, as I later learn, clay).

Mugianis blows cigar smoke and shots of rum up a hole in the base of the tree. Encircling it as we sit on the ground, he begins a conversation with the Bwiti. Everyone in the circle offers an intention for the next few days. Grace’s matters most.

“I want to be useful,” she says. “I’ve been putting negative things in my body and sending nothing but negative things out.”

Mugianis is impressed by this statement, but doesn’t tell her just yet. Instead he puts his palm on her forehead and begins his sermon. His words, fired randomly and at varying volumes, thunder like a halftime speech.

“We ask permission. We ask permission. We ask the first people of the land. In the spirit of Iboga we ask for permission. And we thank the Bwiti. We ask you to come into the circle for healing. We ask that this be a healing circle for our sister. We ask that you lessen her pain and therefore lessen the pain of all humanity. All species. We ask for a healing and cleansing of the ancestral pain. We ask that this young sister see that she is a part of this, she is a part of you. She is worth it, she is worthy,” Mugianis cries, his volume swelling with each phrase. “She is coming home, she is coming home.”

When the prayer is finished, he lights a nzingu (the shell of an African tree nut) on fire. Blowing it out he puts it in his mouth and chews—the pain from the temperature written on his face. Less than a minute later, he spits the nzingu onto the forest floor. Whichever way the shell lands tells you if you can continue. “We’re good,” he says, looking up from it. “The elders have consented. Let's go."

Watching a group of slightly deranged ex-junkies humbly ask a tree for permission to heal one of their “daughters” feels, admittedly, a little nuts. When Mugianis nearly screams: “SHE IS COMING HOME” my immediate thought is: Where?

It’s not as if Mugianis didn’t prepare me. While his ibogaine ceremonies have come a long way from the dingy hotels where they used to be held, he’s no tribe leader and this is not West Africa. He’s the first to admit this. “I’m the media Bwiti,” he jokes. “The lowest kind.”

Upon leaving, McKenna instructs us to keep looking forward—turning around means we’re not ready to proceed. Grace looks straight ahead as she climbs up the hill. She’s now a “Banzi,” the official term for a Bwiti initiate. “Good work, Banzi,” Mugianis says, patting the “sometimes” tattoo that adorns her upper back.

“Sometimes…?” I wonder aloud, as we reach the car. “Everything,” she says.

***

Back at the clinic after the ceremony, an eerie feeling of calm descends on the house. Grace goes for a swim, then tries (in vain) to take a nap. When she heads outside to meet us on the deck, McKenna and Payne have prepared a heaping pile of leaves on an African sheet near the yard.

It’s the second ceremony, “Preparing of the Ritual Bath.” A silver bucket adorned with indecipherable white symbols sits amid candles and small wooden figures of African gods. Whole branches of pea green leaves and ruby red flowers sit waiting for Grace, ancestral and medicinal plants from the area. “You must break up these plants in tiny pieces,” Payne instructs her. “Each one is a prayer.”

For the next several hours, each person spends time breaking up the leaves, putting them in the bucket, and praying for Grace. The ceremony is meant to represent the breaking of the old, and ushering in the new. There are dozens of branches; it’s no easy task. But when Grace has finished and the bucket is teeming with leaves, fresh spring water, rose oil, and two other mysterious liquids are poured all around it.

The bucket of water-filled prayers she will use three times to “cleanse away her shame.” The first wash is the most important—and also the third ceremony—“The Ritual Bath.”

Behind a wall, Grace strips naked and scrubs her body with the torn leaves, thus removing, the Bwiti believe, the self-hatred she carries. When the Banzi finishes, Fitzsimmons wraps her in a white sheet and headdress, then begins coating her lean limbs with white paint and small dots of red. Grace stands shyly to show off her look when it's complete, whispering to Fitzsimmons that she “doesn’t want the boys to see her.”

Tomorrow comes the ibogaine.

PART IV

The next afternoon, the day before Easter Sunday, it’s time for the fourth ritual, “The Ibogaine Flood Dose.” This one, as the name implies, involves ingesting the long-lasting hallucinogen with the power to interrupt her addiction. To get there, she’ll have to spend anywhere from 15 to 72 hours hallucinating—or, in other words, tripping her brains out.

When Grace wakes late that afternoon, she’s again scared and shaking. “I feel like I’ve done something really wrong,” she says, inexplicably. All that’s left to do is wait, and the stress that she’s feeling for the first time in years won’t be going away anytime soon. The ibogaine ceremony begins when her heroin withdrawal reaches a breaking point. There’s no way to tell when that will be.

Mormello runs to get a deck of cards, which Grace promptly steals from him. Pulling one out, she tells him to remember it. Then, shuffling, she surreptitiously grabs the one he chose with her mouth while pretending to cut the deck. From there she freezes, the card in question dangling from her lips as she waits for him to catch on. The second he does, her giggle sends the Queen of Spades cascading to the brown tile floor below.

That’s an old one, she tells us. There are many more she used on the street while earning money to pay for dope. “So, you were a magician?” I ask. “Still am,” she says with conviction. Minutes turn to hours and Grace’s condition worsens as the sun goes down. Mind racing and sweat staining the underarms of her long sleeve orange T-shirt, she’s on her 20th Lucky Strike when Mugianis makes the call. The last oxy she’d taken was at noon (seven hours ago), her last hit of heroin 48 hours earlier. It’s time for the flood dose of ibogaine.

Gathering supplies, Fitzsimmons grabs me and the other women, people from the “village” who have come to help heal Grace. Before we head down to the fire for her last ritual bath, Fitzsimmons gives Grace her first bit of ibogaine—a tan-colored pill filled with powder that smells of sawdust. She swallows it down with a huge glass of water. This “test dose” is a common practice at IbogaLife. A precautionary move aimed at perfecting how much more the Banzi will need to take in order to reach an optimal high.

In a half-circle around a blazing campfire, the women shake rattles in creepy unison. Slowly, Grace undresses. A gust of smoke dances around her naked frame as she bathes for one final time in the prayer leaves. When she’s finished, Fitzsimmons wraps her in a sheet, this one red, then once again coats her body in white. A wreath of green leaves is placed on her head where a red band stands out against her white-blond shaved head. Sitting tall on the bench, surrounded by smoke and the people of this “tribe,” the performer in Grace has never been more apparent. Mere minutes away from life-altering visions, she’s a statuesque picture. White hair, face, and chest, she looks almost angelic—until, suddenly nervous, she requests a cigarette.

When the final bathing and dressing is complete, the men join the women—and Grace, now smoking—at the fire. As Mugianis, chanting again like a coach, explains the ibogaine ceremony over the rattles, he’s interrupted by the Banzi herself. “Can we, um, go up to the deck?” she says slightly falling toward the bench she’s sitting on. It’s suddenly silent, save for the last faint sound of the rattles. “I’m already tripping like, a lot.”

Mugianis and the others rush to her side to help her, and direct the rest of us to go ahead up to the deck. At once it’s clear, her body is there, but she is not. She’s somewhere else—dropped into the middle of her pain by the only thing standing between her heroin addiction and death: ibogaine.

McKenna and Payne carry Grace to the small mattress lying at the center of the majestic outdoor deck where the lights of faraway San Jose flicker like fireflies. It’s here on this bed where she’ll meet her visions, here where we will watch it happen.

“You are the root, you are the plant,” Mugianis tells Grace. In a square red hat with a gray feather, covered in animal skin, white paint, and beads, he looks every bit the tribal leader he is tonight. “We are here for you. Here until the sun comes up,” he says, bending down to give Grace one more dose of ibogaine.

The rest of the ceremony centers on watching her—sometimes sitting, sometimes standing, shaking instruments, dancing in circles, waiting anxiously for the spirits to come and go. As we wait, Payne plays the muongongo with his jaw, matching the beat of the African music he’s streaming from iTunes on his laptop.

Soon it becomes clear that, although there are 20 people surrounding her, Grace will face this mountain alone. It’s for this reason, Mugianis believes, that taking the ibogaine itself is not enough. To break one drug ritual, you need another. This one involves walking through supernatural visions, and trying with every bone in your body to figure out what they mean.

In the first stage of the ibogaine trip, which lasts four to eight hours, users experience fantasies like walking on water, through fire, or flying. In the next stage, which can last anywhere from eight to 48 hours, users contemplate—usually with images from childhood—the meaning of what they saw. It is during this time that many discover the underlying reasons for their addiction, and, ideally, work through them.

So Grace trances, we watch, the Bwiti music plays. She howls afraid, we play instruments to keep her calm. For many minutes, she’s frozen and silent. The faces of the village soft and solemn around her. Then suddenly, without warning, terror invites itself. Her eyebrows furrow with pain, her mouth falls open in shock, her hand reaching out to be saved. For the next few days, this is her reality.

“Imagine all the pain she’s been numbing, for all of these years,” Mugianis tells me as we sip hot chocolate during a break inside. “She’s feeling all of that pain now. Ibogaine puts you in the middle of your struggle, in the middle of your pain. You feel it. And you have to find your own way out.”

In the fetal position, she begins shivering from the brisk wind. After 20 minutes of no movement, Fitzsimmons covers her in blankets and tucks her in on all sides. Over and over again she gasps, afraid of things no one else can see. The soft cry from her quivering lips meets the rhythmic beat of our rattles: the battle cry of her living nightmare.

Jerking legs, quiet gasps, shaking arms, she’s convulsing in pain. Mugianis checks in frequently, trying to bring her back to this space and remind her she’s okay. “She’s in no withdrawal. Zero.” he tells me, after leaning down to speak with her. After this long without opiates, she’d be vomiting every other minute if she was.

“She’s working a lot of stuff out right now, do you see her, she looks like an infant?” Mugianis says to me. He’s right. Intermittently sucking one finger, she’s begun cooing like a baby who’s yet to find words. The Bwiti believe the ceremony is a rebirth—at this moment, it’s easy to see why.

The ceremony goes on this way until the sun comes up. In the meantime, the tribe intermittently dances around her—butts shaking and hands in the air, shimmying away the dark thoughts. At times she looks demonic—screaming and thrashing like an overacted Lady Macbeth. In other moments, she appears angelic, as candlelight dances on her cherubic cheeks. In these quiet moments, Grace looks up to make sure she’s not alone. Like clockwork, one of the tribe rushes to sit by her side. No talking is involved, no touching. Just sitting and being, so she knows someone is there.

When her screams get louder, which happens at least once an hour, Mugianis covers her in the smoke of a sage leaf to “clear out the bad energy.” In moments of sheer desperation, when even the soft sounds and scents of the deck where she lies cannot calm her, he spews rose water into the air above her bed. When it falls to her body below, Grace cries out as if it’s lava. “OW!!!!” she howls.

“That’s iboga. You’re awake in the dream,” Mugianis says. Silently, he moves to grab a kombo (a whisk broom instrument)—then, softly, he taps her shoulders and head. “You’re okay, Grace, you’re safe. You’re loved. You’re okay.”

Her thrashing, her dark visions, her frightened gasps will continue for the next 36 hours. There was no way to know that then—and no point in telling her. So Mugianis continues: “You’re okay, you’re okay.”

***

The unspoken confidence in that phrase—comforting at the time—haunted me afterwards. The truth, which I know as well as he does, is there’s no way to know if she will be okay. In three weeks, when she leaves to fly home to New York City, no one will be there to stop her from immediately calling her dealer for dope.

The next part of her recovery, change, is a cross she’ll bear alone. Her chemical dependence on heroin, at least for now, will be gone. But the demons that drove her to it—and the ones that convinced her to stay—might not be.

***

A week after the ceremony, I get a phone call from Grace, who’s still at the center in Costa Rica. Her voice sounds lighter, her thoughts noticeably more coherent than the first time we met. “I feel great. Life is beautiful,” she says serenely.

Still in the midst of her trip when I left, she’s now lucid and nine days heroin free. “I was still really out of it until like two days ago,” she says. “I was like a vegetable.”

Mugianis wasn’t clear whether she’d be up for the fifth ceremony; “Celebration and Reporting of Visions,” which is essentially what we’re doing now on the phone. She is. Without my having to ask, she launches into a long explanation of the things she saw:

“It started out and I felt like I was deep, deep underground. But it wasn’t like I was underground, it’s like I was the ground. I remember next being a seed, and going through each stage of evolution. Basic plant matter to basic creatures until I was sitting on top of the earth. I kept seeing space and time in a weird way—things just snapping into existence. At one point it felt like I was in Africa, no, but actually, I was in Africa. I looked up at the sky and I found myself in different planets. Then I was in the desert and everything was moving fast. It wasn’t scary. It was like I already knew all of it, but I’d forgotten.”

Those visions, from the first phase, were more uncomfortable than scary, she says. But the one that seems to have changed her—stuck with her—is the one of her fall down that chimney. The first time she told me about the incident two months ago, she seemed resentful and bored, reciting it like a pledge. This time, with her description, comes audible awe—and pride. “Now it’s something I can actually feel and relate to myself. I realized that the story of my fall was the story of a story I told people, because they asked,” she says. For so long, it had been their story—the firefighters who found her, the ambulance driver that rushed her to hospital, the Daily News reporter who wrote about it, her dad, her mom. Their story—a heroic one—now, finally, hers. “Someone gave me props for surviving, and I was like, ‘Holy shit, I did. How does that happen?’”

Finding these things, seeing them, wasn’t easy. “My whole body was on fire. I was in so much pain,” she says. But living through them seems to have changed, at least for now, the way she sees the world. “What this did, it gave me a perspective. That was the whole point of my trip I think, perspective,” she says. “Decisions are not good or bad, but what you hold them up against. I have a choice if I want to keep using and that’s fine, but if I do, it’s going to suck. This is the only life I have, as far as I know, and I’d at least like to give it a shot.”

Suffering impacted bowels (a delayed reaction to the ibogaine) and still figuring out a plan for her chronic pain, her life is by no means perfect. “I don’t know for sure if I’m going to stay sober, I want to, and that’s a big deal. A big fucking deal,” she says. “It’s so great to not be dependent. But I need to figure out how to manage my pain because I’m going to relapse if I don’t, I know it,” she confesses. So far, her plans only extend to moving to California shortly after she leaves Costa Rica. She’s not positive she’ll go through with it.

As for the trip? “I wouldn’t recommend it to somebody who is trying to have fun,” she says dryly. “If you want your body to explode into 1,000 pieces and rebuild itself into something beautiful, then yeah—but don’t expect it to be pleasant.”

Editor's Note: An earlier version of this article incorrectly cited Greek as the origin of the word heroin. In reality, it's widely believed to be Latin. It also implied that heroin is the most abused drug in its class, which is no longer accurate. Going "cold turkey" off of heroin, while difficult, is not impossible—and very rarely fatal.