How safe is this psychoactive brew?

Ayahuasca: how safe is this psychoactive brew?

Ayahuasca ceremonies have grown in popularity. Credit: Cassiohabib/Shutterstock

Psychiatric drugs are experiencing something of a renaissance. It’s no longer a matter of turn on, adjust and release, as was the hippie mantra of the 1960s. Tripping – whether on magic mushrooms, LSD or psychedelic bags – is now part of the global wellness industry. It is a way of “finding yourself” or dealing with a mental health or spiritual crisis.

Psychedelic brews are also part of the mix, but perhaps for the more dedicated “psychedelic”. Because the effects are quite extreme, Westerners who take ayahuasca usually do so in ceremonies led by a shaman known as an ayahuasquero or curandero. These activities have been discussed in Netflix shows such as “(Un)Well”.

Ayahuasca is a traditional South American drink used in religious ceremonies. It can be made in a variety of ways, but usually the elements of two plants – the Banisteriopsis caapi vine and the leaves of the chacruna bush – are combined to produce a bitter “tea” that is drunk during the ceremony.

One component is an LSD-like drug called DMT. The other is a monoamine oxidase inhibitor (MAOI), a substance that prevents the metabolism (breakdown) of DMT. A DMT “trip” usually lasts 35 to 45 minutes, but the MAO brain makes it last much longer (about four hours).

Ayahuasca has been studied to determine if it can help with a variety of mental health issues, such as depression, anxiety, or addiction, and many studies report positive effects. However, few studies have focused on side effects and these studies are often small with participants only from South America.

A new study published in the journal PLoS Global Public Health, has sought to remedy this gap in knowledge. Using an online questionnaire, the researchers sought to examine the side effects of ayahuasca in a much larger and more geographically diverse population.

The study ran from 2017-19 and involved over 10,000 respondents from more than 50 countries. Although most respondents came from Brazil (47%), a significant number came from Europe (24%) and North America (15%).

The most common physical side effects were nausea and vomiting (reported by 62% of respondents), headache (17%) and abdominal pain (13%). Two percent of participants required medical attention for these physical problems. Mental health side effects were also common: 42% reported “emotional-cognitive” side effects (such as having nightmares or disturbed thoughts) and 38% reported altered perception.

Physical side effects are most often found in older people and in people with more lifetime use of ayahuasca. They were also more common in those with current health problems, those with a history of alcohol use disorder, and those who used unsupervised ayahuasca.

Mental health or cognitive side effects were most often reported by people with previous anxiety disorders and less lifetime use of ayahuasca.

Given that these people had ingested a monoamine oxidase inhibitor (usually harmine or a related compound) and a hallucinogen (DMT), it is not surprising that effects on mental health and perception are seen. Both types of drugs have well-known effects on the brain.

It is precisely these changes in perception and thought that are considered important in these religious events; psychic experiences that promote spiritual growth. But the physical side effects can also be considered important to the activities, with vomiting and diarrhea as a form of mental cleansing (“purification”).

Is it worth it?

So do the potential positive effects on mental health and well-being outweigh the side effects of taking ayahuasca?

Despite the positive effects of taking ayahuasca, the physical side effects are very common. These side effects may be lessened by proper use of ayahuasca in legitimate ceremonies overseen by experienced religious leaders as part of group worship.

However, there are effective medications for treating anxiety and depression, and they have better side effects than ayahuasca. These drugs have undergone many years of research and have been tested in randomized controlled trials (the gold standard of clinical trials). Ayahuasca has not yet undergone such rigorous and extensive research.

There is a resurgence of interest in psychedelics as legitimate clinical alternatives, including LSD and psilocybin, and they are considered relatively safe. It may be that future research shows clinical uses for ayahuasca and where it may be better than currently approved drugs, but we are not there yet.

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