Ayahuasca retreats

Safety facts, with sources

What published research, regulators and harm-reduction services say about ayahuasca. These are the questions to put to any centre. Nothing here makes any centre safe, and none of it is medical advice.

• Serotonin syndrome with SSRIs and other serotonergic drugsSerious risk

  The MAO-inhibiting harmala alkaloids in ayahuasca combined with SSRI antidepressants may induce a serotonin syndrome with a potentially grave outcome. ICEERS states that combining MAOIs with SSRIs or other serotonergic medications is contraindicated. (Journal of Psychoactive Drugs, 1998; ICEERS, 2026)

• Why MAOI-containing brews carry more interaction riskSerious risk

  A review of serotonin toxicity notes that true serotonin toxicity typically occurs with overdose or when a drug that increases synaptic serotonin is combined with an MAOI; serotonergic drugs without MAOIs are low risk with psychedelics that also lack MAOIs. Warning signs needing immediate medical attention include myoclonus, extreme or fluctuating vital signs, agitation or coma, muscle rigidity, high fever and seizures. (Psychopharmacology (Berl), 2022)

• Other contraindicated medicines and supplementsSerious risk

  ICEERS lists antidepressants and other psychotropic medications, drugs metabolised by certain cytochrome enzymes, and any medication that interacts with MAO (including MAO inhibitors) as potentially contraindicated, and names St John's wort and Ginkgo biloba as contraindicated herbal supplements. It advises avoiding alcohol, stimulants, opioids and other drugs in the days or weeks before a session. (ICEERS, 2018)

• Stopping medication before a ceremonySerious risk

  ICEERS says contraindicated medications such as certain antidepressants may need to be stopped at least two weeks before a session, but only under strict medical supervision because abruptly stopping psychiatric medication can be dangerous. It also warns that stopping medication for a chronic illness to take ayahuasca can itself be dangerous. (ICEERS, 2018)

• Psychosis and personal or family psychiatric historySerious risk

  A systematic review found case reports of psychotic episodes after ayahuasca or DMT, several in people with a personal or possibly family history of psychosis or mania, and concluded that people with a personal or family history of any psychotic illness or non-psychotic mania should avoid hallucinogens. ICEERS describes ayahuasca as contraindicated for people with severe psychiatric disorders, particularly those prone to psychosis. (Therapeutic Advances in Psychopharmacology, 2017; ICEERS, 2026; ICEERS, 2018)

• Deaths linked to ayahuasca often involved other substancesSerious risk

  An ICEERS review of 58 deaths that media attributed to ayahuasca between 2010 and 2022 states that no autopsy attributed death to acute intoxication with the traditional brew; in 4 cases tobacco seems to have been the direct cause, one death was from scopolamine (a Brugmansia admixture was suspected in two others) and one US death seems to have followed an overdose of synthetic 5-MeO-DMT taken hours after ayahuasca. ICEERS is an ayahuasca advocacy and harm-reduction organisation, and it notes 16 cases where the cause could not be determined. (ICEERS, 2023)

• Tobacco purge teaSerious risk

  CBC News reported that Canadian Jennifer Logan, 32, died at a retreat near Puerto Maldonado, Peru, in January 2015 after drinking a mapacho 'tobacco purge tea' in a ceremony; she died of pulmonary edema and her family believed the tea played a role. (CBC News, 2015; ICEERS, 2023)

• Ayahuasca combined with 5-MeO-DMTSerious risk

  A published autopsy case describes a 25-year-old man found dead after taking herbal extracts containing beta-carbolines and tryptamines; heart blood contained 5-MeO-DMT (1.88 mg/L) plus DMT, harmine, harmaline and tetrahydroharmine, and the medical examiner ruled the cause hallucinogenic amine intoxication. (Journal of Analytical Toxicology, 2005)

• Tyramine and diet: evidence strengthWorth knowing

  ICEERS says combining ayahuasca with large amounts of tyramine (aged cheese, soy sauce, wine, beer, some meats and nuts) can in rare cases cause a hypertensive crisis, but that the MAO inhibitors in ayahuasca are eliminated relatively quickly, making poisoning unlikely if tyramine-rich foods are eaten before or after the session. Harmine and harmaline inhibit MAO-A reversibly; none of the sources cited here report controlled studies of tyramine interactions with ayahuasca, so strict ayahuasca diets rest more on tradition and caution than on measured risk. (ICEERS, 2018; Journal of Ethnopharmacology, 1999)

• Blood pressure and heart conditionsWorth knowing

  In a placebo-controlled trial, diastolic blood pressure rose significantly at the high ayahuasca dose (9 mm Hg at 75 minutes), while systolic pressure and heart rate rose moderately and non-significantly. ICEERS advises that people with serious cardiovascular conditions should not take ayahuasca. (Journal of Pharmacology and Experimental Therapeutics, 2003; ICEERS, 2018)

• Adverse effects in the Global Ayahuasca SurveyWorth knowing

  In the Global Ayahuasca Survey (n = 10,836, collected 2017 to 2019), 69.9% reported acute physical adverse effects (primarily vomiting) and 2.3% reported needing subsequent medical attention. 55.9% reported adverse mental health effects in the following weeks or months, around 88% of whom saw them as part of a positive growth process, and around 12% sought professional support. (PLOS Global Public Health, 2022)

• Who is more likely to have adverse effectsWorth knowing

  In the same survey, physical adverse effects were linked to older age at first use, having a physical health condition, more frequent use, a previous substance use disorder diagnosis and taking ayahuasca in a non-supervised context. Mental health adverse effects were linked to anxiety disorders, physical health conditions and a stronger acute spiritual experience. (PLOS Global Public Health, 2022)

• Vomiting, fluids and low blood sodiumWorth knowing

  Dutch clinicians reported a 36-year-old woman who developed severe hyponatremia (low blood sodium) after an ayahuasca ceremony. ICEERS reports that one ceremony death (Brandon Begley) was due to hyponatremia from overhydration, so drinking large volumes of water during purging is not harmless. (Nederlands Tijdschrift voor Geneeskunde, 2020; ICEERS, 2023)

• Combination with ayahuasca can be fatalSerious risk

  A published autopsy case attributed a death to hallucinogenic amine intoxication after 5-MeO-DMT was taken together with harmala alkaloids, and ICEERS reports a US death that seems to have followed an overdose of synthetic 5-MeO-DMT taken hours after ayahuasca. Retreats that offer toad medicine alongside ayahuasca therefore raise interaction concerns. (Journal of Analytical Toxicology, 2005; ICEERS, 2023)

• Limited clinical safety dataWorth knowing

  A 2022 narrative review notes that clinical studies of 5-MeO-DMT in humans were lacking and recommended the same precautions as with other classic psychedelics. In a 2018 survey of 515 users, 1% reported medical and 1% psychiatric problems related to use. (Journal of Psychopharmacology, 2022; Journal of Psychopharmacology, 2018)

• Sexual abuse by healers and facilitatorsSerious risk

  Chacruna's community guide warns that ceremonies or healing sessions alone with a healer have been a common context for sexual abuse, that practices such as sopladas and plant baths do not involve touching private parts or require nudity, and that sexual contact between healer and participant during or directly after ceremonies is not acceptable in ayahuasca traditions. (Chacruna Institute for Psychedelic Plant Medicines, 2018)

• Monitoring gaps in unregulated ibogaine careSerious risk

  The New Zealand Health and Disability Commissioner case shows a death where a clinic departed from its own protocol, did not obtain written consent and left an 'iboga assistant' solely responsible for monitoring a patient after ibogaine; the assistant was also found in breach for failing to monitor adequately. (New Zealand Health and Disability Commissioner, 2015)

• Unsupervised use raises riskWorth knowing

  In the Global Ayahuasca Survey, taking ayahuasca in a non-supervised context was associated with physical adverse effects, and consumption in religious settings was associated with fewer mental health adverse effects. (PLOS Global Public Health, 2022)

• No external quality controlWorth knowing

  The Dutch Trimbos Institute notes that no one checks whether ceremony guidance is in order, including intake, aftercare or the number of sober people present. (DRUGSinfo (Drugs Infolijn), Trimbos-instituut)

• Violence at retreatsWorth knowing

  CBC News reported in December 2015 that a Canadian man killed a British man, Unais Gomes, 26, at an ayahuasca retreat near Iquitos, Peru; witnesses told police it was in self-defence after Gomes attacked him with a knife during a ceremony. (CBC News, 2015)

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