How Safe is Ayahuasca, Really?

How Safe is Ayahuasca, Really?  

Is Ayahuasca safe?  How safe exactly? Let's take a deep dive into the risks, myths, and precautions for safe journeying with ayahuasca - including a full list of pharmaceutical and over-the-counter contraindications.

Written by Luke DeStefano

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The truth (in context) about Ayahuasca's safety.

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Any google scholar is likely to find, woven throughout all the stories of healing, spiritual awakening, and unimaginable beauty, there are stories where things went wrong during an ayahuasca ceremony.  So, it stands to reason that one of the most common questions people ask when approaching a relationship with ayahuasca is "how safe is it, really?"

Ayahuasca, a once obscure psychedelic drug from South America, is gaining massive global attention as a promising treatment for addiction, trauma, anxiety, and substance abuse. But how careful should be?

People have died in ayahuasca ceremonies.

Tragically, most of these occurrences could have easily been avoided, but finding "death" and "Ayahuasca" in the same sentence on a Google search can be a deterrent to newcomers, and for good reason.  The range of safety measures implemented by Ayahuasca Retreat Facilitators ranges from lab coat professionals, to master spiritual healers, to outright psychopaths. The Ayahuasca space is one where safety should be, but is often not, the top priority of ayahuasca retreat facilitators, shaman, and healers. This is especially true with the boom in ayahuasca tourism.  

Before we dive into this, let's really unpack the question at hand so we can get clear on what we're actually talking about.  Like most anything else, the truth around ayahuasca safety relies greatly on the context in which it's being served: Is ayahuasca safe?

• Safe compared to what?  
• For whom?  
• In what quantity?  
• Under what circumstances?
• And who gets to decide?

The US Drug Enforcement Agency designates DMT, the psychoactive molecule in ayahuasca brews, as a Schedule 1 narcotic along with cannabis, peyote, mushrooms, heroin and bath salts. Schedule 1 is the most severe category of drug legislation reserved for substances that pose the greatest threats under the suppositions of having "no currently accepted medical use and a high potential for abuse."  

But "Illegal" doesn't mean "unsafe."  Alcohol, tobacco, guns, and pharmaceutical drugs, all legal, kill more people in a single day than all the recorded cases of ayahuasca-related deaths in history.

When approached with care, ayahuasca does not hurt people.  People hurt people, be it with malice, ignorance, ego, or just unfortunate circumstances. No matter how safe you believe yourself to be, accidents still happen.  Life isn't safe.

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The questions we should really be asking in regards to ayahuasca's safety comes down to two variables.

1. The current physical and mental health of the ayahuasca user.
2. The competency and experience of the ceremony facilitators.

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When served in a safe environment by a responsible practitioner after a proper medical screening, the risk of something going wrong during an ayahuasca ceremony is extremely low.    

Of course, you must be 100% transparent and truthful in the information provided on your health intake form in order for your retreat facilitators to properly care for you.  If your retreat facilitator doesn't give you an intake or ask you questions about your health, that's a major red flag and a good sign to keep looking.

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So the risks are low, but not non-existent.  What are the actual risks?

Psychological Risks

We all have a few strange fruits in our family tree, but if you have an ancestral history of bipolar disorder, psychotic episodes, psychiatric disorder, schizophrenia, hallucinations, psychosis and depersonalization, you may have an increased risk for the expression of these symptoms during (or after) your experience with the medicine. If this is your case, a high quality medical screening is required to evaluate your risk of having an episode.  

Screening for psychological and physical well-being is something that should take place at least 4-6 weeks prior to the ceremony, but there have also been cases of people who had no known history of psychological health issues who experienced symptoms days, weeks, or months after the ayahuasca experience.

A proper psychological screening should include:  

• An initial screening conversation
• Filling out a more in depth medical / psychological screening
• Medical / Psychiatric review
• Consultation where required

Sometimes discomfort is just part of the healing process - old subconscious energy working itself through.  Sometimes, when a major healing takes place, it feels like we have to figure out how to live in a whole new world, and not having the proper guidance and support can be scary.  

Working with a specialized psychedelic integration provider before and after your experience with mother ayahuascamakes a massive difference in how the changes that occur during a psychedelic plant medicine retreat can serve you in a positive way once you return home.

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Pharmaceutical Risks

One of the most important chemical factors to consider with safe ayahuasca use is the existence of whats called a Monoamine Oxidase Inhibitor (MAOIs), which is a naturally occurring compound in one of the two plants (b caapi) used to make the base of an ayahuasca brew. The other main plant in ayahuasca is psychotria viridis, which contains DMT, the potent psychoactive substance.

MAOIs are, to put it simply, a class of drugs that inhibit the breakdown of neurotransmitters like serotonin, norepinephrine, and dopamine, giving them an antidepressant effect. When too many neurotransmitters accumulate in the brain, serotonin syndrome can occur.  Serotonin syndrome is rare, but can range from mild to life-threatening.

Ayahuasca is not a recreational drug. MAOIs become harmful or fatal when they are mixed with:

• Other MAOIs, including those from plants
• Certain pharmaceutical medications or supplements
• Foods high in Tyrosine

(See the full list of contraindications below.)

Its very important to know that harmful interactions can happen even if weeks have passed between stopping the SSRI and taking the MAOI. People that are receiving treatment with SSRIs, MAOIs (including natural MAOI containing products like mucuna and syrian rue) or anyone under the effect of any drug that acts on the serotonergic system should consult with a doctor and be extremely cautious when considering drinking ayahuasca tea.  

All pharmaceutical drugs must be discontinued for 4-6 weeks prior to ayahuasca consumption, unless otherwise cleared by a medical doctor.  Of course, you should always consult with a doctor before altering or discontinuing any pharmaceutical protocol.

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Physical Risks

Aside from the psychological and pharmaceutical risks, those with heart, liver, kidney, pancreatic, or other serious GI conditions may be at risk of harm.  If you have chronic high blood pressure, strokes, tuberculosis or are pregnant, you should abstain attending an ayahuasca ritual.    ‍

If you have a physical disability, allergy, or need assistance moving around, this should be made clear to your retreatfacilitators long in advance.  

Note to diabetics: MAOIs may change the amount of insulin or oral diabetic medication that you need.  Again, the importance of a proper medical screening cannot be understated and should be a non-negotiable entry requirement for any properly run retreat center.

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Dietary Risks

There are many different schools of thought on the best diet to follow before drinking ayahuasca, but for our purposes, we will narrow our focus on foods that can actually cause harmful interactions with the brew's naturally occurring MAOIs.

The only known considerations for dangerous food-based interactions are for any foods high in tyrosine, an amino acid found in:

• Aged cheeses
• Fava beans, broad beans, snow peas, and most soybean products
• Dried or overripe fruit (raisins, dried apricots, squishy avocados)
• Fermented and pickled foods such as sauerkraut, kimchi, miso, pickles, pickled vegetables, fish sauce, soy sauce, tofu, and concentrated yeast extract products such as Marmite and Vegemite
• Beer and alcohol
• Protein supplements and supplemental products, especially those promoted for weight loss and body-building. Check the ingredient list for any form of tyramine, including L-tyramine, N-Methyl-L-Tyramine HCL and N-Methyltyramine HCL.

These foods should be completely eliminated for at least 2 weeks before ceremony.

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Safety on Retreat and in Ceremony

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Even with all the right medical and dietary boxes checked, there are still safety considerations to be made for the ceremony itself.  A safe space for an ayahuasca ceremony should be one where you are always within eyesight of the facilitators and assistants, in a place where nobody can wander off into the wilderness and get lost in the middle of the night.  There should be no cliffs, ledges, or balconies on or near the ceremony space.      

It's also common to travel out-of-body during ayahuasca, which presents a challenge if/when you need to use the bathroom .  This is why many people prefer smaller groups or private ceremonies; to make sure there's always someone there to take care of you, should you need it.

The retreat facility should also have a stocked First Aid Kit, and be easily accessible to medical care in the event of an unexpected emergency.  There should always be someone on-site who is not partaking in the ceremony if someone needs to be driven to medical care.

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Looking for safe, legal, and expertly guided ayahuasca retreats? We'd love to speak with you:

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Ayahuasca contraindications (the long list).

Since ayahuasca has been found to be incompatible, dangerous, or fatal with certain street  drugs, prescription or over-the-counter medications and supplements, please read carefully the list provided below. Please note that the following list is by no means complete. It includes the  drug name and some of the brand names available in different countries. If you are not sure or any of your medications are not listed, please let your doctor know. You certainly should not suddenly stop  taking prescribed medications (including antidepressants) without consulting your doctor.

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Pharmaceutical drugs found dangerous if combined with Ayahuasca:

• Actifed
• Adderall
• Alaproclate
• Albuterol (Proventil, Ventolin)
• Amantadine hydrochloride  (Symmetrel)
• Amineptine
• Amitriptyline (Elavil)
• Amoxapine (Asendin)
• Atomoxetine (Strattera)
• Benazepril (Lotensin)
• Benadryl
• Benylin
• Benzedrine
• Benzphetamine (Didrex)  
• Bicifadine
• Brasofensine
• Brofaromine
• Bupropion (Wellbutrin)
• Buprenorphine
• Buspirone (Buspar)
• Butriptyline (Evadyne)
• Carbamazepine (Tegretol, Epitol) o Chlorpheniramine (ChlorTrimeton) o Cimoxetone
• Citalopram (Celexa)
• Clomipramine (Anafranil)
• Codeine
• Cyclobenzaprine (Flexeril, Fexmid,  Amrix)
• Cyclizine (Emetrex, Migril, Marzine)
• Dapoxotine (Priligy)
• Desipramine (Norpramin)
• Desvenlafaxine (Pristiq)
• Dextroamphetamine (Dexedrine) o Dextromethorphan (DXM)
• Dibenzepin (Noveril)
• Dienolide kava pyrones
• Desmethoxyyangonin  
• Diethylpropion (Tenuate)
• Disopyramide (Norpace)
• Disulfiram (Antabuse)  
• Dobutamine
• Dopamine (Intropin, Myocard-DX) o Dosulepin (Prothiaden)
• Doxepin (Sinequan)
• Duloxetine (Cymbalta, Irenka)
• Entacapone
• Ephedrine (Akovaz)
• Epinephrine (Adrenalin)
• Etorphine
• Escitalopram (Lexapro)
• Gabapentin
• Femoxitine
• Fenfluramine (Pondimin)
• 5 Hydroxytryptophan/ 5HTP
• Flavoxate Hydrochloride (Urispas) o Fluoxetine (Prozac, Sarafem)
• Fluvoxamine (Luvox)
• Furazolidone (Furoxone)
• Guanethidine
• Guanadrel (Hylorel)
• Guanethidine (Ismelin)
• Paroxetine (Paxil)  
• Hydralazine (Apresoline)
• Imipramine (Tofranil)
• Iprindole
• Pargyline (Eutonyl)
• Parnate
• Iproniazid (Marsilid, Iprozid, Rivivol,  Propilniazida)
• Iproclozide
• Isocarboxazid (Marplan)
• Isoniazid (Laniazid, Nydrazid)
• Isoniazid rifampin (Rifamate,  Rimactane)
• Isoproterenol (Isuprel)
• L-dopa (Sinemet)
• Levodopa (Dopar, Larodopa)
• Linezolid (Zyvox, Zyvoxid)
• Lithium (Eskalith, Lithobid)
• Lofepramine (Gamanil, Lomont)
• Loratadine (Claritin)
• Maprotiline (Ludiomil)
• Medifoxamine
• Melitracen
• Meperidine (Demerol)
• Metaproterenol (Alupent,  Metaprel)
• Metaraminol (Aramine)
• MMethamphetamine (Desoxyn)
• Methyldopa (Aldomet)
• Methylphenidate (Ritalin)
• Mianserin (Tolvon)
• Milnacipran
• Minaprine
• Mirtazapine (Remeron)
• Moclobemide
• Montelukast (Singulair)
• Nalbuphine
• Naloxone (Naltrexone)
• Nefazodone
• Nialamide
• Nisoxetine
• Nomifensine
• Norepinephrine (Levophed)
• Nortriptyline (Aventyl)
• Oxybutynin chloride (Ditropan)
• Oxycodone (Percocet)
• Oxymetazoline (Afrin)  
• Oxymorphone
• Orphenadrine (Norflex)  
• Pemoline (Cylert)
• Pethidine (Demerol)
• Phendimetrazine (Plegiline)
• Phenergen
• Phenmetrazine
• Phentermine
• Phenylephrine (Dimetane, Dristan  decongestant, Neo Synephrine)
• Phenylpropanolamine (in many cold  medicines)
• Phenelzine (Nardil)
• Procarbazine (Matulane)
• Procainamide (Pronestyl)
• Protriptyline (Vivactil)
• Pseudoephedrine
• Oxymetazoline (Afrin)
• Quinidine (Quinidex)
• Rasagiline (Azilect)
• Reboxetine
• Reserpine (Serpasil)
• Risperidone
• Salbutamol (Ventolin)
• Salmeterol
• Selegiline (Emsam, Eldepryl,  Zelapar)
• Sertraline (Zoloft)
• Sibutramine
• Sumatriptan (Imitrex)
• Terfenadine (Seldane D)
• Tegretol
• Temaril
• Terfenadine (Seldane, Triludan, Teldane)
• Tesofensine
• Theophylline (Theo Dur)
• Tianeptine
• Toloxatone
• Tramadol
• Tranylcypromine (Parnate)
• Trazodone (Desyrel, Oleptro)
• Tolcapone (Tasmar)
• Tricyclic antidepressants  (Amitriptyline, Elavil)  
• Trimipramine (Surmontil)
• Triptans
• Vanoxerine
• Venlafaxine (Effexor)
• Zimelidine (Zelmid)
• Ziprasidone (Geodon)  
• Zoloft (Sertraline)

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Medicines for colds, sinus problems, hay fever, or allergies.

• Actifed DM
• Benadryl
• Benylin
• Bromarest-DM or DX
• Chlor-Trimeton (no longer available in the US)
• Compoz (Diphenhydramine)
• Dimetane-DX cough syrup
• Dextromethorphan/DXM, DM, DX or B-Tuss  
• Dristan Cold & Flu
• Phenergan with Dextromethorphan
• Robitussin-DM
• Tylenol cold/cough, cough and flu preparations
• Vicks Formula 44-D
• Any medication containing Pseudoephedrine

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Plants or over-the-counter supplements to be avoided:

• Boswellia
• Cannabis
• Ephedra
• Ginseng
• Horny Goat Weed
• Kanna
• Kava
• Kratom
• Licorice Root
• Mucuna pruriens
• Melatonin
• Nutmeg
• Peganum harmala
• Rhodiola Rosea  
• Sinucuichi
• Scotch Broom
• St. John's Wort  
• Tryptophan  
• Turmeric
• Yerba Mate
• Yohimbe
• 5HTP

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Dlug Classifications that cause adverse interactions of Ayahuasca (MAOI).

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• Alcohol
• Anesthetics
• Anticonvulsants
• Antipsychotic Medication
• Antihypertensive drugs (high blood pressure medicine).
• Appetite suppressants (Diet Pills)
• Bronchodilators (asthma medications, cough medicines)
• Central Nervous System (CNS) depressants
• Diuretics
• 5-MeO-DMT (Bufo Alvarius)
• MAOIs
• Opiates (opium, heroin, morphine, codeine, barbituates)
• Painkillers synthesized from thebaine
• Psychoactive drugs/substances/plants: (cannabis, LSD, magic mushrooms, San Pedro, DMT, etc
• Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
• Serotonin Receptor Antagonists and Reuptake Inhibitors (SARIs):
• Selective Serotonin Reuptake Inhibitor (SSRIs) or precursors.
• Sleeping pills or tranquilizers
• Stimulants (cocaine, amphetamines, MDMA)
• Tricyclic antidepressants
• Vasodilators

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If you're looking for safe, legal, and transformative retreats with ayahuasca in idyllic locations like Costa Rica, Mexico, or Portugal check out all of our upcoming psychedelic retreats.

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References

The pharmacological interaction of compounds in ayahuasca: a systematic review. S. Ruffel, N. Netzband, C. Bird, A. Young and M. Jurena. Brazilian Journal of Psychiatry. July 3, 2020.

- Developments in harmine pharmacology - Implications for ayahuasca use and drug-dependence treatment. D. Brierley  & C. Davidson. 2012. Progress in Neuro-Psychopharmacology & Biological Psychiatry 39, 263-272

- Ayahuasca and Psychosis. R.G. dos Santos & R. Strassman. The ethnopharmacology of ayahuasca. Kerala: Transworld Research Network; 2011. p. 97-9.

- Possible Risks and Interactions of the Consumption of Ayahuasca and Cannabis in Humans. R.G. dos Santos. The  Ethnopharmacology of Ayahuasca. Kerala: Transworld Research Network; 2011. P.87-95.

- The Serotonin Syndrome. E. Boyer & E. Shannon. New English J Med. 2005; 352:1112-20.

- Pre-clinical Interaction of Ayahuasca, a Brew Used in Spiritual Movements, With Morphine and Propofol. J.M. Pires, F.  Mendes, A. Pires, A. Yonamine. Braz. J. Pharm. Sci. 2018 *** http://dx.doi.org/10.1590/s2175-97902018000117174  - A Fatal Intoxication Following the Ingestion of 5-Methoxy-N, N-Dimethyltryptamine in an Ayahuasca Preparation. J.  Skelerov, B.Levine. Journal of Analytical Toxicology, Volume 29, Issue 8, November-December 2005, Pages 838-841 - Ayahuasca Preparations and Serotonin Reuptake Inhibitors: A Potential Combination For Severe Adverse Interactions. J.  Callaway & C. Grob. J Psychoactive Drugs. 1998; 30:367-9 American Psychiatric Association

- Identification and Prevention of Serotonin Syndrome. M. Iqbal, S. Osmany. International Journal of Emergency Mental  Health and Human Resilience, Vol. 17, No.2, pp. 563-566, ISSN 1522-4821

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