What is Ayahuasca? Benefits, Risks, Side Effects

For at least one millennium, indigenous people native to the Amazon have ingested a mystical and potent plant-based brew called ayahuasca. Often sipped during carefully curated ceremonies hosted by a plant medicine facilitator or shaman, ayahuasca is often intertwined with immense healing and profound spirituality. Although the origin story of ayahuasca has been befuddled by the passage of time and lack of archaeological evidence, the various traditional shamanistic rituals that guide the usage of this plant-based brew remain not only important—but necessary—to the experience.

Over the span of a few decades, ayahuasca has expanded beyond the confines of indigenous communities scattered across South American countries. Tourists from all over the Western world are flocking to ayahuasca retreats in countries like Peru, Costa Rica, and Brazil to find healing and a heightened sense of their own spirituality. This demand for ayahuasca has posed many questions in regards to its medical benefits, potential risks, and tourism’s impact on traditional ayahuasca practice.

What is Ayahuasca (Iowaska)?

Native to South America, ayahuasca (also called yagé) is a psychotropic brew traditionally consumed for religious and healing purposes by indigenous Amazonian people. It’s typically made from an amalgamation of two main plant-based ingredients: Banisteriopsis caapi and Psychotria viridis. 

The psychoactive component of the brew is typically a shrubby plant called Psychotria viridis, which in some instances is substituted by Psychotria carthagenensis or Diplopterys cabrerana. The leaves of this plant contain the extraordinarily dynamic and mind-morphing hallucinogen DMT. 

The Ayahuasca Vine

Banisteriopsis caapi is a vine that doesn’t actually create any psychedelic effects, but rather is used as an MAOI, or monoamine oxidase inhibitor. Our bodies naturally contain the MAO enzyme in the stomach, which would keep the DMT from reaching the bloodstream. Without the MAO inhibitor, the DMT would get broken down by these enzymes in your liver and dampen the psychedelic and spiritual experience.

History of Ayahuasca

There is an abundance of evidence to suggest that hallucinogenic plants were used in the Ecuadorian Amazon as early as 1500-2000 B.C., but the earliest chemical evidence of ayahuasca preparation dates back one thousand years. In 2010, a well-preserved bundle of ritual tools dating back to 1000 C.E. was found in a cave in southwestern Bolivia; it contained traces of several psychotropic substances including two ayahuasca ingredients, harmine and DMT. Still, it is entirely possible that ayahuasca use dates back further.

Some of the earliest writings about ayahuasca in modern history were published beginning in the 1850s by Ecuadorian geographer Manuel Villavicencio, followed by English botanist Robert Spruce, who encountered its use among Tucano, Guahibo, and Záparo tribes. Around this time, interest in natural products chemistry was also taking off as Western scientists avidly isolated compounds in plants for the research and development of new medicines. The door of Western curiosity would be flung wide open, ushering in an era of scientific and spiritual interest in powerful, mind-expanding plant medicines.

How is Ayahuasca Used?

The intent of ayahuasca use varies from group to group and includes traditions of healing, strengthening community bonds, group worship, celebration, and vision seeking. The experience of ayahuasca is deeply complex and personal, involving one’s individual psychology, as well as intentions shaped by cultural understandings of ayahuasca. 

For example, one small survey of North American ayahuasca ceremony participants found that most individuals pursued the experience with the intent of self-exploration, spiritual growth, healing, and curiosity. Although such a small sample cannot possibly represent the many nuanced reasons North Americans seek out an ayahuasca experience, these interests are largely reflected in Western media’s focused narrative on its curative properties relating to PTSD, addiction, depression, and other aspects of self-growth. 

The cultural entry point into the ayahuasca experience, however, is an important factor. As Mark Hay reports in JSTOR Daily, informed by Peruvian archaeologist Rubén Orellana, “Ayahuasca traditions were developed for people coming from specific cultural backgrounds. As such, even though the brew itself, and even some of the ritual practices surrounding it, may have similar raw effects on anyone, they will likely generate very different overall experiences—different risks and benefits—for outsiders than for insiders.”

Intention for use also varies between indigenous tribes, and these traditions and rituals have evolved over time. In this way, there is no singular use for ayahuasca as its meaning and utility vary across time, space, and cultures.

What Are the Effects of Ayahuasca?

Usually, the ingestion of ayahuasca, often referred to as a “plant spirit,” launches the individual into an enigmatic realm that reflects the wisdom and harmony of Mother Earth in many forms. Commonly referred to as “realms,” these powerful hallucinations tend to help people unwrap past traumas that have been suppressed, allowing them to re-enter their normal state of consciousness with a reinvigorated outlook on everyday life. 

“When we ingest this medicine we’re entering another dimension and in that realm there are things that aren’t familiar to us,” says Vanessa Caldarelli, the owner of Posada Natura, a Costa Rican wellness retreat that hosts ayahuasca ceremonies. “There are things that we don’t deal with on a daily basis. We see things that are real, but they just aren’t in our normal conscious reality.” 

The content, psychological impact, and personal meaning of an ayahuasca trip differ from person to person, depending on a host of factors from individual biology to cultural framework to expectations.

How Long Does Ayahuasca Last?

An ayahuasca trip typically lasts anywhere from four to six hours, though some may experience a shorter or longer duration. The length of a trip may be influenced by a few different factors, including previous experiences with the brew, body weight, and the potency and composition of ingredients. It may take 30 minutes to an hour for any detectable effects to settle in.

While the acute, consciousness-imploding experience of ayahuasca may only last several hours, many individuals walk away from the experience feeling a deep psychological shift that is long-lasting. Some experience what is called an “afterglow” in the months following; the afterglow phenomenon is unique to each individual, but psychiatrist Walter Pahnke describes it as an “elevated and energetic mood with a relative freedom from concerns of the past and from guilt and anxiety” and an increased willingness “to enter into close interpersonal relationships.”

Longitudinal studies are also seeking to understand ayahuasca’s long-term effects on cognition and emotion, as well as its potential in alleviating psychological distress associated with depression, trauma, addiction, and other issues.

Ayahuasca Ceremony and Experience

Ayahuasca ceremonies have become transcultural, incorporating memories and rituals that reflect the personal and cultural context of the facilitator and participants. The experience of one ceremony may be altogether unlike another, and the details of the session are fully contingent on the plant medicine facilitator or shaman that is guiding participants. 

At Posada Natura, for example, each ayahuasca ceremony is tailored toward the specific group “sitting” that night, and the specific facilitator leading the way. This personalized approach is developed after visitors are screened, with the program and group size contingent upon the experience and mental state of each individual. The length and details of the ceremony also hinge on the retreat and traditions put forth by the shaman or facilitator.

At the SpiritQuest Shamanic Sanctuary, founded by the late Don Howard Lawler, the standard program consists of four ceremonies over eight full days. Posada Natura typically integrates around three ayahuasca ceremonies into its program (which also includes mindful activities like nature walks and yoga), though this is subject to change depending on the group and plant facilitator. 

Aside from the ceremony itself, each program also includes specific guidelines for preparation and integration. Over the weeks prior to ceremony, participants are asked to follow a strict diet (often called a “dieta”) that varies depending on the ritual. It’s also common for participants to abstain from alcohol, nicotine, caffeine, and sex in order to prepare the body for the experience.

Is Ayahuasca a DMT Drug?

DMT, or dimethyltryptamine, is the primary molecule responsible for ayahuasca’s psychoactive effect. It’s produced in the leaves of Psychotria viridis and Diplopterys cabrerana, as well as in the bark of Mimosa tenuiflora.

DMT is believed to be an endogenous molecule—meaning that the body naturally produces small amounts of DMT, and as rodent studies show, this appears to occur in the brain’s pineal gland. Why our brains produce DMT is a question that is still being investigated, though researchers in a 2018 study found that DMT may be a “neuroprotective and/or neuroregenerative agent.” Another 2016 study discusses its role in peripheral and central nervous system functioning.

Ayahuasca isn’t the only form in which DMT is delivered. It can also be smoked or vaporized for immediate effects that last just 10-30 minutes. However, because ayahuasca is ingested—thanks to the MAO inhibitor B. caapi vine—the body processes the DMT differently, resulting in a more long-lasting experience. 

What is an Ayahuasca Retreat?

An ayahuasca retreat typically refers to the multi-day experience of receiving ayahuasca under the guidance of a shaman or facilitator, often involving a small group of participants. Ayahuasca retreats can vary in length of time and cost, typically ranging from a few hundred dollars to a few thousand dollars. Single “drop-in” ayahuasca sessions may also offer a shorter experience at a lesser cost.

Ayahuasca retreats boomed in popularity after the late 90s, especially among Europeans and North Americans. In what is called “ayahuasca tourism,” participants travel to Peru, Ecuador, Costa Rica, and other areas where local indigenous groups have built an established tradition of ayahuasca use. 

Ayahuasca Tourism

The issue of ayahuasca tourism is one of debate. As psychologist Ralph Metzner of the “Harvard Psychedelic Club” writes in the introduction of Sacred Vine of Spirits: Ayahuasca, “Ayahuasca tourism has come in for its share of criticism from those who decry naive and possible exploitative intrusions into indigenous cultures, and those who warn tourists of being duped by ignorant fake shamans…On the side of indigenous cultures, the ayahuasca tourists, like other tourists, contribute desperately needed funds to local South American economies. Ecological preserves are being set up to protect the rainforest and all its medicinal and psychoactive plants.” 

Author Bani Amor argues that ayahuasca tourism does not actually benefit the local communities or the preservation of their resources, but instead damages them: “Tourists arrive in the Amazon by the thousands each year and pay up to $4,000 per person to white, foreign-owned retreats where yoga, saunas, and Wi-Fi are all available…Meanwhile, the popular vine and shrub are disappearing from parts of Peru, with opportunists wandering through the jungle cutting off vines and leaving the rest to rot.”

How to Make Ayahuasca (Iowaska)

Making ayahuasca (or ayahuasca tea) involves collecting, cleaning, and boiling its ingredients over several hours. The B. caapi vine, which is the MAO inhibitor, is generally sectioned, softened, and boiled with the Psychotria viridis leaves and other desired ingredients in layers. The preparation of ayahuasca may also involve other traditional practices, such as prayer or customs around how the ingredients should be collected. 

The potency and effects of an ayahuasca brew can vary from batch to batch, depending on the chemical content of the ingredients, as well as the skills and techniques of the individual(s) brewing the mixture. 

Ayahuasca Preparation

Not all ayahuasca preparations are the same, and recipes vary among facilitators, cultures, and regions. A shaman may choose a particular combination based on the purposes of use, such as illuminating illness or to tone down the intensity of visions. 

Ayahuasca preparations may even exclude DMT-containing ingredients altogether, and others may substitute the Psychotria viridis with another source of DMT such as Diplopterys cabrerana (or Chaliponga or Chagropanga) or Mimosa tenuiflora.

Other ayahuasca admixtures include Brugmansia (Toé), Nicotiana rustica, and Justicia pectorali. A long list of plant ingredients associated with ayahuasca preparation has been curated, demonstrating the diverse ethnobotany behind this ritual brew. 

Studied Benefits of Ayahuasca (Iowaska)

Despite the highly specific tradition that surrounds this psychedelic, the ayahuasca experience has benefited people from all walks of life. This plant medicine has demonstrated potential for those dealing with conditions such as depression and PTSD. There’s a fair amount of research that scratches the surface of these benefits, along with treasure troves of anecdotal accounts from participants who experienced life-altering effects from ayahuasca.

Here’s a closer look at the studied benefits of ayahuasca in treating addiction, PTSD, depression, and anxiety—as well as other potential physiological and spiritual benefits.

Ayahuasca for Addiction

Multiple studies have also shown that ayahuasca could be a useful tool in fighting addiction to substances like alcohol, cocaine, and nicotine.

In a 2014 study that included interviews with therapists who administered ayahuasca for addiction treatment and 14 individuals who underwent said treatment, researchers discovered that ayahuasca could support recovery and prevent relapse when taken under “carefully structured settings.” 

Another report observing ayahuasca-assisted treatment for substance abuse within a Native Canadian community in British Columbia came to a similar conclusion, showing that subjects displayed positive psychological and behavioral changes after undergoing ayahuasca-assisted therapy.

Read: Can Ayahuasca Heal Grief?

Shelby Bryant, an artist and healer who participated in an ayahuasca ceremony at Posada Natura, tells DoubleBlind that the experience had reshaped her views on alcohol use. Although she never considered herself to have a severe issue with alcohol, the plant medicine helped awaken her true calling, one that required her to change her drinking habits in order to reach her own personal potential.   

“The big realization I had on ayahuasca was about alcohol. I drank normally like other people drank, but I had this overwhelming knowing that the light I was meant to spread in this lifetime is being hampered by alcohol,” she explains. “That experience with ayahuasca was a switch flipped. I completely lost interest in alcohol.”

The success that Posada Natura has had with treating addiction has prompted the retreat to launch specialized long term plant medicine programs for addiction recovery and veterans. Outside ayahuasca ceremonies, the initiative will offer long-term care through supportive tools and resources that include experienced mental healthcare providers from the United States. Other retreats have also had similar success in treating substance dependency issues.

Ayahuasca for PTSD

Akin to the positive effects that ayahuasca sessions appear to have on depression, sparsely available evidence also portrays this plant medicine as a useful tool for PTSD patients. In one study published in April 2018, researcher Antonio Inserra postulated that the effects of ayahuasca may target traumatic memories and provide healing in PTSD patients.

The author behind this study states that DMT, one of the alkaloids found in ayahuasca, activates sigma 1 receptors (SIGMAR1), which is a multi-faceted stress-responsive receptor that promotes cell survival, neuroprotection, neuroplasticity, and neuroimmunomodulation. As MAOIs prevent the degradation of DMT, this appears to allow PTSD patients to retrieve repressed memories, making them easier to identify and process.

Read: What is Changa? The Truth About Smokeable Ayahuasca

As per usual with psychedelics, more research is needed to understand the full extent of how ayahuasca interacts with the sigma 1 and other receptors. It’s important to note that ayahuasca shouldn’t be treated as a cure-all, but rather a specialized tool among others such as therapy and other healing modalities.   

“A lot of the time, people with depression or PTSD are not necessarily going to get a miracle cure from the ayahuasca ceremony,” says the director of the plant medicine program at Posada, who wished to withhold their name. “It has to really be put in proper context that ayahuasca can be something that can be enormously beneficial, but it works best when it’s in combination with other support.”

Ayahuasca for Depression and Anxiety

Early scientific evidence appears to back the belief that ayahuasca could be a useful experience for those living with depression. 

A small study published in March 2019 suggests that ayahuasca may help with treatment-resistant depression. The double-blind randomized trial involved 29 patients, some of whom were given a single dose of ayahuasca and others a placebo. The results showed that ayahuasca produced significant antidepressant effects compared to the placebo. 

Other research has examined ayahuasca’s ability to modulate levels of cortisol, a hormone involved in stress responses that is produced by the adrenal glands. Cortisol levels are thought to play a major role in the onset of depression, and properly regulating it has become a critical aspect of treatment. Recent findings suggest that ayahuasca could modulate salivary cortisol levels, once again showcasing its potential value to those with depression.    

In another study observing 57 ayahuasca ceremony attendees in the Netherlands and Colombia found that ratings of depression and stress dramatically dropped after the ceremony and persisted for four weeks. Interestingly, the researchers found a correlation between the magnitude of ego dissolution (sometimes called ego death, when the ego disappears completely) and the individual’s level of life satisfaction, mindfulness, and overall changes.

Ayahuasca’s Effect on the Brain

There is also some scientific insight showing that certain components of ayahuasca may offer neuroprotective and neurorestorative properties to the brain. We’ve already noted how DMT appears to activate sigma 1 receptors (SIGMAR1) and enhance cell survival, neuroprotection, neuroplasticity, and neuroimmunomodulation. Similarly, in a test-tube study observing the effects of DMT on human brain cells, the DMT increased cell survival and protected the brain cells from damage that occurs due to lack of oxygen.  

It’s not just the DMT from ayahuasca that seems to foster brain health, but also the alkaloids in the main ingredient Banisteriopsis caapi. A 2017 animal study showed that the main alkaloids found in this vine stimulated neural stem cell proliferation, migration, and differentiation in the brains of adult mice. The modulation of brain plasticity could contribute to the apparent antidepressant effects of ayahuasca. 

Furthermore, the natural β-carboline alkaloid harmine, which is bountiful in Banisteriopsis caapi, has been looked at in preclinical studies for its neuroprotective and cognitive-enhancing effects. It also improved memory and learning capabilities in different animal models. All in all, researchers have called for harmine to be further evaluated in additional studies.  

Ayahuasca for Spirituality and Mindfulness

Ayahuasca ceremony participants may also experience immense benefits relating to a sense of elevated well-being. This could be especially helpful for people suffering from conditions like cancer. In a 2018 comparison study, four weekly ayahuasca sessions appeared to increase mindfulness and acceptance more than an eight-week mindfulness training program.  

On a soulful level, ayahuasca has been lauded for its ability to magnify existential and spiritual awareness. According to Caldarelli, people have come away from Posada Natura prepared to leave behind unsatisfying careers or ready to change other aspects of their lives. 

“I think that ayahuasca can be very illuminating in giving somebody a perspective on their spiritual life just as a whole no matter what tradition the person is in or not in a tradition at all,” Caldarelli says. “It can be very illuminating in finding one’s own path, in finding one’s own sense of direction, one’s own sense of relationship of what’s important in that sector of their life.”

Shelby Bryant is evidence of this existential shift. A media producer from New York City, she returned from Costa Rica yearning to reconnect with nature, which prompted a move to California. She shifted her previous career to focus more on art and healing. She explained that ayahuasca had helped her develop a tighter bond with spirit and changed her overall perception of how psychedelics should be used. 

“Before ayahuasca, I had spiritual tendencies, but this was what really made me feel like I am a very spiritual person,” she said. “It really felt like returning home to [my] true essence.”

What Are the Side Effects and Risks of Ayahuasca?

While the benefits of ayahuasca have been bestowed among more and more people, there are certainly risks that should be taken into consideration. On the bodily level, ayahuasca can induce the following side effects:

• Vomiting
• Diarrhea
• Paranoia, fear, or other psychological distress

Certain medications may also have adverse interactions with ayahuasca, especially those that have a direct impact on the serotonergic system, such as antidepressants. Many ayahuasca retreats will request that participants taper off SSRIs or stop taking other medications. (Note: It is advised to first discuss changes in your medication regimen with your doctor or mental health provider.)

Research has also shown that high doses of ayahuasca could increase heart rate and blood pressure, which could be potentially dangerous for someone with a heart condition. People with a history of schizophrenia or other psychiatric disorders should avoid ingesting ayahuasca, as it could potentially worsen psychiatric symptoms.

Read: The Ayahuasca Privilege

Nonetheless, reports of fatal or life-threatening reactions to ayahuasca appear to be few and far between. That doesn’t mean you should just ingest this plant without proper planning and guidance, however. Danger can arise if the plant facilitator or shaman is untrained or careless when it comes to dosing and guidance. 

As Caldarelli explains it, an ayahuasca session can introduce someone to what are called “hell realms”—but with proper preparation, these so-called hell realms can be incredibly transformative. However, the risk of being unprepared for these potentially frightening experiences is why it’s crucial to attend an ayahuasca ceremony with a highly experienced and trustworthy plant facilitator or shaman. Not only will this help ensure a safer experience, but also a more effective one. 

“I’ve seen so much suffering come out of the medicine,” Caldarelli explains. “But you can experience a hell realm with the proper guidance and it’s actually really therapeutic and healing.”

Risks Associated with Ayahuasca Retreats & Guides

It’s not just the traditional psychedelic motto of “set and setting” that needs to be adhered to when consuming ayahuasca. There seems to be universal agreement that having a seasoned guide is the key to unlocking the full potential of the experience. And moreover, it’s critical to vet your guide with a series of questions, such as those listed here, to ensure that they are experienced and skilled in harm reduction. It’s also important to note that while there exist a number of competent, seasoned guides, there are also a number of phonies with histories of sexual abuse, even during ceremony. Among the primary harm reduction tenets relating to ayahuasca is to ensure your guide is accountable to community guidelines and trusted not to take advantage of ceremony attendees. 

“A skilled medicine person will be able to receive the information from spirit through opening this portal that’s opened in the medicine work, receiving the information that’s needed for each person,” says Caldarelli. “A really good medicine person isn’t the one doing anything, the reason they’re a good medicine person is because they’re able to be as clear of a channel as possible so that the divine can flow through.” 

Is Ayahuasca Legal?

When discussing the legality of ayahuasca, there is often a distinction between the plant materials and the compounds within these plants. For example, the active ingredient of ayahuasca—DMT—is a controlled substance under the U.N. 1971 Convention of Psychotropic Substances, but the plants containing the molecule are not. The International Narcotics Control Board (INCB) noted in 2001 that the preparations like ayahuasca do not fall under the 1971 Convention, though in 2010, the INCB recommended that nations take measures to “control” ayahuasca. 

One reason ayahuasca tourism has become so popular is because the laws surrounding the brew are more relaxed in certain places such as Brazil, Peru, and Costa Rica. In the United States, DMT is a Schedule I controlled substance, though certain religious groups are permitted to use ayahuasca under the Religious Freedom Restoration Act. Individual cities and states have taken steps to unravel this harsh prohibition of entheogens by implementing decriminalization or measures that deprioritize prosecution of their possession.