Ayahuasca has a reputation for being a difficult ride. Visions, vomit, and looking into the darkest depths of our psyches and souls isn’t the most attractive route to healing or insight. But the truth is using psychedelics can get messy.
Ayahuasca demonstrates this extremely well while exposing a potentially limited view of what we commonly know as “side-effects.”
Ayahuasca Benefits vs Side Effects
For example, we assume that vomiting is a negative side-effect after taking a medication. Indeed, vomiting implies toxicity. Yet, from another perspective, it is the body removing built-up toxins, “purging” or “cleaning”, as it is known in plant medicine circles.
Likewise, the “hallucinations” created by psychedelics are known as “visions” to others, who sometimes find great meaning within them. Clearly, not everything we see on psychedelics is true. But to say that difficult psychological material, hallucinations, and even vomiting are not part of the healing experience of ayahuasca ignores the view of cultures stewarding the brew, along with their explanations of how it works and heals.
Indigenous Views and Western Views of Healing
Exactly how indigenous and the Global North views of medicine will meet is difficult to predict. But in the meantime, keeping our minds open to learning remains essential, particularly when approaching healing with plant medicines.
For example, a recent survey titled Adverse effects of ayahuasca: Results from the Global Ayahuasca Survey examines ayahuasca’s adverse effects and shows how going through something challenging can lead to growth. Authored by Dr. José Carlos Bouso and Dr. Daniel Perkins of the University of Melbourne, along with many others, the paper gives valuable insight into what many people are experiencing with ayahuasca.
We reached out to Dr. Perkins who says ayahuasca has the potential to produce highly accelerated emotional processing. He explains that:
“While this is often the reason people seek out the brew, integrating such a vast quantity of personal material can be emotionally and psychologically challenging, although this is typically not severe and resolves quickly, with most feeling it to be part of a positive process of growth or healing.”
Challenging Experiences and Mental Health Improvements
The survey covers 10 000+ people across 50 different countries, highlighting ayahuasca’s global spread. Dr. Perkins says compiling such data is now more crucial than ever as policymakers are asking very reasonable questions about ayahuasca — how exactly should a legislator respond to a dark, bitter, psychedelic brew from the jungle inducing vomiting and visions?
Ideally, the many decisions being made around ayahuasca in the coming years will be based on the facts, not longstanding stigma. This is tricky, as ayahausca is a uniquely difficult psychedelic to study, as no two brews are the same. Any mechanistic view of how it works remains elusive, but what Dr. Perkins makes clear is the vast majority of drinkers value the challenges it presents them.
Working with ayahuasca is a process, and cannot be understood without examining its long-term effects. Some survey participants reported that “adverse mental health effects” continued for weeks and even months following ayahuasca. While this seems intimidating, 88% of people consider these effects to be an overall “positive process,” resulting in some form of personal growth or integration.
Indeed, drinking ayahuasca isn’t about pleasure. Dr. Perkins writes that “traditional cultures have used it throughout history not to escape from reality, but to better adapt to it.” He says that ayahuasca can be tough, but that is why we value it and “despite being challenging, these experiences seem to be pivotal to ayahuasca’s therapeutic effect.”
Physical Adverse Effects of Ayahuasca
No doubt eyebrows raise when 69% of people report vomiting after drinking ayahuasca. Also common are nausea and diarrhea. Other phenomena like tingling or electrical sensations are reported, along with changes in body temperature or dizziness. These might be seen as warning signs of toxicity, yet, ayahuasca is generally considered safe.
Another fact is that in traditional medicine circles, these effects are dubbed “la purga,” or “the purge.” Dr. Perkins makes note of the connection between many of the physical effects and what an indigenous perspective calls “spiritual cleansing.” There is no data confirming or denying the validity of this perspective, but for those interested in a deeper look at how purging is integrated into a larger system of healing, Evgenia Fotiou explores the topic from an anthropology lens in Purging and the body in the therapeutic use of ayahuasca.
Ayahausca Risks and Side Effects
All this isn’t to say ayahuasca is without risk. Within the survey, there was a notable 2.3% of participants requiring follow-up medical attention. Dangerous reactions have occurred, like seizures, respiratory arrest, and cardiac arrest. And while three deaths are in the survey, the survey concludes that “it has been impossible to directly relate a single death to ayahuasca.”
Citing a paper by Rafael Guimarães dos Santos, the authors explain details such as if other substances were involved or if pre-existing conditions could be a factor context for reported deaths are missing. Part of the challenge in analyzing ayahuasca involves the fact that it is a combination of plants.
Ayahausca is an impressive concoction, as it contains orally active DMT, a compound the body usually rapidly renders inert. Typically, a brew contains the ayahuasca vine Banisteriopsis caapi and DMT-containing chacruna (Psychotria viridis) or chaliponga (Diplopterys cabrerana). The ayahuasca vine contains monoamine oxidase inhibitors which slow the metabolization of the DMT contained in the plants.
Yet, for researchers working on the ayahuasca puzzle, there is not only considerable variability between the growing conditions of various foraged plants but a potential for many other plants to be added to a brew. The vegetalistas of the Amazon who brew, serve, and sometimes ship ayahuasca internationally can and do add over a hundred other plants, including extremely dose-sensitive ones like tobacco or datura.
Some survey participants reported that “adverse mental health effects” continued for weeks and even months following ayahuasca. While this seems intimidating, 88% of people consider these effects to be an overall “positive process,” resulting in some form of personal growth or integration.
Ayahuasca Adverse Effects – A Cultural Divide?
Ayahuasca does contain extremely potent alkaloids and, without a doubt, has contraindications with certain physical and mental health conditions. It’s also true that for those who use ayahuasca, adverse effects are an integral part of the experience and, for most people, mild and short-lived.
Accepting that adverse experiences are part of ayahuasca matters not just for understanding more about healing and therapeutic processes but also for recognizing the still gaping rift between indigenous and western approaches to plant medicine.
Dr. Perkins writes that “Western countries are trying to incorporate medical knowledge from other cultures into their informal self-healing practices.” He acknowledges that cultures are importing medical systems to heal the conditions of a globalized world. The point speaks to not only gaps in knowledge of the global north, but an opportunity for open dialogue between academics and traditional knowledge.
He also calls for parallel streams of research between clinical and naturalistic use of ayahuasca, and reciprocity initiatives that specifically seek input from and give back to, traditional ayahuasca-using groups and communities.