Harm reduction
The screening nobody does
Most serious incidents trace back to a question that was never asked, about a medication, a heart, or a family history. Here are the questions, and what the answers mean.
Do not proceed if any of these apply
Contraindications
SSRIs, SNRIs and MAOIs
Ayahuasca contains MAOIs. Combined with an SSRI, SNRI or another MAOI this can produce serotonin syndrome, which can be fatal. Tapering off an antidepressant is itself medically risky and is not something to do alone or on a retreat's timetable.
Lithium
Lithium combined with classic psychedelics has been associated with seizures. This is one of the few interactions where the case reports are unambiguous. Do not combine.
Personal or family history of psychosis
A first-degree relative with schizophrenia or bipolar I meaningfully raises the risk that a psychedelic precipitates a lasting episode. Reputable providers screen for this. Ones that don't are telling you something.
Cardiac conditions, especially with ibogaine
Ibogaine prolongs the QT interval and has caused fatal arrhythmias. It requires ECG screening, electrolyte correction and continuous cardiac monitoring. A centre offering ibogaine without a physician and a monitor is not a centre you should attend.
Pregnancy and breastfeeding
There is no safety data that would justify the risk. Don't.
Fundamentals
What reduces risk
Set and setting
Mindset and physical environment shape the experience more than dose does. Somewhere safe, familiar and unhurried, with someone sober present, changes outcomes more than any other single variable.
A sober sitter
Someone who stays sober, knows what to expect, knows your medical history, and knows when to call for help. Not a participant. Not the facilitator who is also running the ceremony for eleven other people.
Screening before booking
Medications, cardiac history, psychiatric history, family history. If a provider takes your deposit before asking any of it, that is the answer to whether they are safe.
Start lower than you think
Potency varies enormously between batches, brews and species. You can always take more next time; you cannot take less once it's in you.
Check the legal status where you're going and read the relevant substance profile before you commit to anything.