How safe is this psychoactive brew?

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

Psychedelic drugs are experiencing something of a renaissance. It’s no longer about turning on, listening and giving up, as the hippie mantra went in the 1960s. Tripping, whether with magic mushrooms, LSD or psychedelic toadstools, is now part of the global wellness industry. It is a way to “find yourself” or deal with a mental or spiritual health crisis.

A psychoactive brew is also in the mix, but perhaps for the more dedicated “psychonaut.” 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 ceremonies have been covered in Netflix shows such as “(Un)Well.”

Ayahuasca is a traditional South American drink used in religious ceremonies. It can be made in a number of ways, but typically the components of two plants – the Banisteriopsis caapi vines and the leaves of the chacruna bush – are combined to produce a bitter ‘tea’ which is drunk during the ceremony.

One of the components is an LSD-like drug called DMT. The other is a monoamine oxidase inhibitor (MAOI), a chemical that prevents the metabolism (breakdown) of DMT. A DMT “trip” usually lasts 35-45 minutes, but the MAOI makes it take 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, sought to fill this knowledge gap. Using an online questionnaire, the researchers sought to examine the side effects of ayahuasca in a much larger and geographically diverse population.

The study ran from 2017 to 2019 and over 10,000 respondents from more than 50 countries participated. Although most respondents come from Brazil (47%), a significant number come from Europe (24%) and North America (15%).

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

Physical side effects are most often found in older people and in people with greater lifetime ayahuasca use. They were also more common in people with existing health conditions, those with a history of alcohol use disorder, and those using ayahuasca unsupervised.

Mental or cognitive health side effects were most commonly reported by people with previous anxiety issues and low lifetime ayahuasca use.

Given that these individuals had ingested a monoamine oxidase inhibitor (most often harmine or a related compound) and a hallucinogen (DMT), it is not surprising that effects were observed on mental health and perceptions. Both types of drugs have well-known effects on the brain.

It is these same shifts in perception and thought that are considered important in these religious events; the psychedelic experience contributing to spiritual growth. But physical side effects can also be considered important for ceremonies, with vomiting and diarrhea being a type of spiritual cleansing (“purging”).

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 reported positive effects of taking ayahuasca, physical side effects are very common. These side effects can be reduced by the proper use of ayahuasca in legitimate ceremonies overseen by experienced religious leaders in group worship.

However, there are effective drugs for treating anxiety and depression, and they have a better side effect profile than ayahuasca. These pharmaceuticals have been the subject of many years of research and have been tested in randomized controlled trials (the gold standard of clinical testing). Ayahuasca has not yet been subjected to such rigorous trials on a large scale.

There is renewed interest in psychedelics as legitimate clinical options, including LSD and psilocybin, and they are considered relatively safe. Future research may show a clinical use of ayahuasca and where it could outperform currently approved drugs, but we’re not there yet.

Provided by The Conversation

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How safe is this psychoactive brew?

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