The Bufo Alvarius Medicine Codex is a ceremony manual by Gerardo "Dr. Gerry" Sandoval, author of The God Molecule. It sets out how he believes toad ceremonies should be run, drawing on what he describes as more than 5,000 ceremonies. It's worth understanding because many toad providers learned from this lineage. This page summarizes every chapter, leaves out the how-to material, and sets out what holds up and what doesn't.

At a glance

Full title: The Bufo Alvarius Medicine Codex: Guidelines to the Proper Administration of the Sacrament 5-MeO-DMT from Incilius alvarius, a.k.a. "The Sonoran Desert Toad"
Author: Gerardo Rubén Sandoval Isaac, MD, OB-GYN ("Dr. Gerry")
Published: self-published, around 2016 to 2017 (no publisher or date is printed)
Endorsements: Julian Palmer and James W. Jesso
Length: roughly 180 pages
Best for: understanding how many toad ceremonies have been run, and what to question
Reputation note: serious. See below.

A note on the author's reputation

In 2019, an open letter signed by more than 400 people in the psychedelic community made serious allegations against Gerardo Sandoval, including sexual abuse, giving people substances without their knowledge, and misusing money raised for toad conservation (EntheoNation's report). These are allegations, not court findings. This manual was written before that letter, and it condemns "perverted abusers" and "false shamans" in the field. Readers can weigh that for themselves.

The short version

Sandoval argues that toad secretion is the most sacred and powerful medicine on Earth, more complete than pure 5-MeO-DMT because of the other compounds it contains, and that it must be given "properly": in ceremony, by a trained team, with screening, a waiver and close attention to breathing. He wrote it, he says, because new facilitators were serving the medicine carelessly and some were abusing people. The manual mixes genuinely useful points (screening for antidepressants, never standing, recovery position, a woman present for women participants) with sweeping health claims, esoteric practices and advice that contradicts itself from chapter to chapter.

Chapter-by-chapter summary

Dedication

Opens with a song lyric about moving "the toad medicine around the planet in a hurry." It thanks the thousands of people who have trusted him, his organizers in North America and Europe, and figures he admires, including Nick Sand, Rick Doblin, Ralph Metzner and Andrew Weil.

Foreword

Written by the author. He describes the toad experience as a face-to-face encounter with Source that can heal "mind, body, and soul," and claims toad medicine has put autoimmune disorders into remission for up to a month. He says it contains 21 compounds, including "unexplored tryptamines." He explains that at a 2016 conference in Ashland, Oregon, most known 5-MeO-DMT facilitators agreed guidelines were needed because of "charlatans" and "perverted abusers," and that this prompted the book. He says he learned his method partly from the toad itself, and lists seven factors for a ceremony, including astrology, a padded "launch pad," always giving a large amount, and always having both a man and a woman as guides.

History and Etymology

The scientific history of the toad, from its first collection in 1855 to its naming in 1859, and its natural history: range, burrowing, monsoon emergence, breeding. He credits Nick Sand with discovering that DMT could be smoked, and so, he says, with making toad smoking possible. He includes strong welfare appeals: don't run toads over, don't take them from the wild, don't buy black-market secretion, don't keep them as pets.

Toad Venom from Incilius Alvarius

He lists 21 compounds he says have been found in the secretion, including heart-active compounds, and argues these extras make toad different from, and better than, pure 5-MeO-DMT. He prefers the term "toad medicine" to "toad venom," and claims there's "no hangover or harmful effect."

Milking Incilius Alvarius

A how-to on collecting and drying secretion; details omitted. He says it can be done without harming the toad. This sits awkwardly beside his own pleas against taking toads from the wild and his later report of steep population decline.

5-MeO-DMT: The God Molecule

Pharmacology and comparisons with DMT. He says 5-MeO-DMT is "NOT DMT": far stronger, much less visual, and ego-dissolving rather than ego-preserving. He describes visiting Rick Strassman in 2016 to ask him to reconsider calling DMT the "spirit molecule," and suggests 5-MeO-DMT may one day help with inflammatory and autoimmune conditions.

Dosage Table

A dosing guide; details omitted. He warns that large amounts can leave first-timers in "a worse psychological or mental place," which contradicts his advice elsewhere to always give a large amount.

Toad Medicine Ceremonies

A ten-step outline of a ceremony: introduction and Q&A, medical interview and waiver, blessing the space, taking the medicine, the threshold, the peak, the descent, an "imprinting" phase, and closure.

The Experience

His own first toad experience in 2005, ending with the realization that "it is my destiny to share this medicine to the world." He equates the experience with Satori and Nirvana, quotes Martin Ball, and suggests that people who don't reach a full experience lack "spiritual intelligence." He says toad is "not panacea" and can leave permanent effects on the psyche, which is why the facilitator's responsibility matters.

The Math of the Process

Mostly an inhalation technique; details omitted. He writes that "unpleasant people often have particularly unpleasant experiences."

Phases of the Experience

The longest chapter, covering preparation, screening and each phase:

Preparation: smudging, prayer, an altar, an invocation to ascended masters. He says rapé snuff helps beforehand and that cannabis is "NOT contraindicated."
Screening: toad is "NOT for everyone." Psychosis, schizophrenia and mental instability are excluded. Antidepressants, including SSRIs and tricyclics, are "CONTRAINDICATED" because of serotonin syndrome, which "can end up in death or severe brain damage." The interview should cover family mental-health history and medical issues, and a facilitator can refuse anyone on gut feeling.
Threshold: never let anyone take it standing up. Watch airway, breathing, pulse and skin color, and roll people onto their side if they vomit. He describes eye-rolling, tremors and rhythmic jerking as signs of transcendence rather than illness.
Peak: people may scream, climax sexually or try to run, and he says it is "imperative to stop them." If the peak lasts too long, he says to suspect a medication interaction and serotonin syndrome, and describes ice cooling and injected sedatives.
Descent: step back, offer water and blankets, a hand on the arm, and minimal talk.

Reactions

A list of about two dozen "reaction types," such as the Roller, the Buddha, the Purger, the Screamer and the Exhibitionist, each with his interpretation. Many interpretations blame the participant's character: vomiting linked to people who have "been swallowing emotional & mental shit," screaming to women who are "extremely materialistic," fear of dying to resisting ego death. He states that every outcome, bliss or horror, "will always benefit them."

Imprinting Phase

After the peak, participants may be vulnerable and may see the facilitator with "Messiah eyes," so he advises stepping out of their line of sight and letting them return on their own. There should ideally be two guides, a man and a woman.

Consent Form and Liability Waiver for Detoxification Ceremony and Shamanistic Ceremony

A template intake form and waiver. It asks about medications (including antidepressants and blood pressure medicines), heart failure, stroke, pregnancy, seizures, drug use and psychosis. The waiver releases organizers from liability even for negligence, including death. It never names the substance or describes its specific risks, and says nothing about touch, restraint, recording or emergency medication.

Integrating Methods for 5-MeO-DMT

Grounding suggestions credited to others: food, acupuncture, hot and cold baths, exercise, being held, herbal teas, and, for vulnerable people, psychotherapy and occasionally medication, with prompt referral to a mental health specialist when needed. He reports percentages from "more than 5,000 ceremonies" (80% awe and joy, 65% the most intense experience of their lives) without any method or data.

General Precautions

Practical rules: lie down, never stand; no fluids early; no sudden noise; explain the process several times beforehand; never force the experience on anyone. He warns that two compounds in toad secretion directly affect the heart, then states in the same chapter there's "no risk of heart attack or ... stroke" while listing heart risk factors that must be disclosed. He describes watching lip color for oxygen, calling emergency services and starting CPR if someone turns blue. He recommends video recording sessions, with no mention of consent. He also recommends crystals, 432Hz music, silver helmets and a "photon emission gun." Two helpers should be ready to "tackle" a participant who tries to run.

Schematics & Positioning of a Ceremony

The diagrams aren't in the text. Key rules: a woman participant must always have another woman present. Touch is allowed "only if the participant asks." For intense distress, however, he describes hugging or lying on top of people, ice down the back, "controlled hyperventilation" and, rarely, sedatives. He makes generalizations about women's sexual responses that many readers will find inappropriate. He acknowledges that difficult after-effects can range from anxiety to psychosis and that follow-up may sometimes mean psychiatric hospitalization.

Personal Notes

The most revealing chapter:

Toad decline. He reports a "dramatic drop" in toads, from hundreds or thousands at his sanctuary site to a couple of dozen, blamed mainly on removal from the wild.
No ancient use. He says it's "a fact" that there was no ancient toad use, "not even by the Seri nor the Yaqui," and that no one knew of it before he shared it with Octavio Rettig in 2006. That claim ignores the 1984 pamphlet he cites in his own bibliography. He then makes sweeping, unsourced claims about the Seri community that this site won't repeat.
His foundation. He says he closed the US branch because volunteers only wanted medicine and personal gain, and that the Mexican foundation is building a toad sanctuary and plans to train facilitators.
Combinations. He says mixing with MAOIs is dangerous, then that "brave" explorers have done it "without any danger." He describes a death after toad was combined with other substances.
His conclusion: the medicine is "completely safe in the hands of experienced people" and "the answer the whole world is waiting for."

What holds up

Medication screening. Taking antidepressant interactions and serotonin syndrome seriously is correct.
Never standing, recovery position, watching breathing. Basic physical safety that every session needs.
A woman present for women participants. A sensible protective rule.
"Never force the experience on anyone." True, even if the book doesn't always follow it.
No ancient tradition. The admission that toad smoking is modern is important, even if his claim to have started it isn't accurate.

What to read critically

Contradictions on safety. "No harmful effect" and "completely safe," against the book's own warnings about heart compounds, psychosis, hospitalization and death.
Touch and restraint. "Only if they ask," against lying on people, ice, tackling and restraint.
Consent. A waiver that names no substance and no risks, and recommended video recording without mention of consent.
Medical interventions. The manual expects facilitators to perform CPR and give injected or rectal sedatives, without discussing who is qualified to do so.
Blaming participants. Difficult experiences are repeatedly put down to people's karma, character or "spiritual intelligence."
Health claims. Autoimmune remission and anti-inflammatory claims come with no evidence.
Toad harvesting. A milking guide and "always give a large amount" sit beside his own report of a collapsing toad population. Synthetic 5-MeO-DMT is dismissed rather than considered as a way to protect the toad.
Treatment of Indigenous people. Unsourced, sweeping claims about the Seri.

What it means for choosing a facilitator

This manual shows why the details matter. Ask any facilitator: How do you screen, including for heart conditions and medications? How do we agree on touch before the session? What happens if it gets hard? Who's trained in first aid, and what's the plan for an emergency? Will I be recorded? Where does the medicine come from? See How to Choose a Facilitator, Safety & Screening and Synthetic vs Toad Medicine.

Where to find it

The Codex was self-published, and it's not widely available through mainstream bookshops.

Keep reading

The God Molecule: the same author's memoir
The 1984 Bufo alvarius pamphlet: where toad smoking really began
The Toad and the Jaguar: a more careful account of ceremonial practice
All 5-MeO-DMT book summaries

This summary leaves out dosing, milking, preparation and administration details on purpose. It's a critical summary and review for educational purposes. Allegations described here are reported from the sources linked and have not been tested in court.