The DEA report on ayahuasca risks: “Science”
in service of prohibition?
Journal of Psychedelic
Studies
DOI:
10.1556/2054.2023.00279
© 2023 The Author(s)
COMMENTARY
†
Shared first authorship.
p
Corresponding author.
E-mail: sidartaribeiro@neuro.ufrn.br
BEATRIZ LABATE1,2†, ANNA O. ERMAKOVA1†,
JORDAN SLOSHOWER3, NICOLE GALVÃO-COELHO4,
FERNANDA PALHANO-FONTES5,
HENRIQUE FERNANDES ANTUNES1,
GLAUBER LOURES DE ASSIS1, CLANCY CAVNAR1,
DRAULIO DE ARAÚJO5 and SIDARTA RIBEIRO5,6p
1
Chacruna Institute for Psychedelic Plant Medicines, USA
2
Naropa University, USA
3
Department of Psychiatry, Yale University School of Medicine, West Rock Wellness, New Haven,
CT, USA
4
Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
5
Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil
6
Center for Strategic Studies, FIOCRUZ, Rio de Janeiro, Brazil
Received: April 25, 2023 • Accepted: May 3, 2023
ABSTRACT
On February 2023, the Drug Enforcement Administration (DEA) released a document to the legal
team representing the Church of the Eagle and the Condor (“CEC”). This disclosure came two
years after the church, in conjunction with Chacruna Institute, submitted two FOIA requests to the
DEA and the Department of Justice requesting all records pertaining to ayahuasca. This report,
titled “Ayahuasca: Risks to Public Health and Safety,” was issued in July 2020. In the present article,
we challenge a number of claims made in the DEA report and highlight significant factual
omissions, theoretical biases, and misinterpretations of existing data. We will demonstrate that the
DEA report severely downplays the safety profile and therapeutic potential of ayahuasca and
overemphasizes the risks. It also fails to include current research on ayahuasca demonstrating its
potential benefits.
KEYWORDS
ayahuasca, Drug Enforcement Administration, report, critique
INTRODUCTION
Ayahuasca is a traditional Amazonian beverage most commonly prepared by a decoction of
two plants from the Amazon region (McKenna et al., 1984): Psychotria viridis, containing the
psychoactive alkaloid N,N-dimethyltryptamine (DMT), and Banisteriopsis caapi, which
contains reversible monoamine oxidase inhibitors (MAOi), such as harmine, harmaline, and
tetrahydroharmine (Riba et al., 2003). Ayahuasca has been used by Indigenous peoples in the
Amazon for centuries (Bianchi 2005; Miller, 2017) and, additionally, is a sacrament in several
ayahuasca religions that originated in Brazil and have spread all over the world. Recently,
ayahuasca (or its main psychoactive component, DMT) has been investigated as a potential
therapeutic for various mental disorders; notably, treatment-resistant depression and
addiction. Early-phase trials are promising, both in terms of safety and efficacy (Nunes et al.,
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2 Journal of Psychedelic Studies
2016; Osório et al., 2015; Palhano-Fontes et al., 2019;
Sanches et al., 2016). Nonetheless, DMT remains a Schedule
I substance in the United States.
Recently, in the USA, there has been a flurry of
ayahuasca seizures and attempts to criminalize patients,
sitters, and Indigenous shamans involved with ayahuasca
(see, Council for the protection of Sacred Plants, 2020;
Heffernan, 2021). On February 13, 2023, the DEA released a
single document to the legal team representing the Church
of the Eagle and the Condor (“CEC”). This sole disclosure
comes two years after the Church, in conjunction with
Chacruna Institute, submitted two FOIA requests to the
DEA and the Department of Justice requesting all records
pertaining to ayahuasca—requests that went ignored and
unanswered in violation of the Freedom of Information Act.
This document, titled “Ayahuasca: Risks to Public Health
and Safety,” was issued in July 2020 (Chacruna Insti-
tute, 2023).
In the present article, we challenge a number of claims
made in the DEA report, and highlight significant factual
omissions, theoretical biases, and misinterpretations of
existing data.
LACK OF SYSTEMATIC REVIEW OF THE
RELEVANT LITERATURE
First, the DEA report did not conduct a comprehensive re-
view of the literature; rather, it selected studies that exaggerate
dangers and ignored or, at best, made cursory mention of
studies that demonstrate safety or positive effects. Notably,
the report has not been updated since it was written in 2020,
and does not include several recent pertinent studies in
humans and in animal models. Given the influence that the
DEA report may have on government policy related to
ayahuasca, it must be dynamic and updated regularly, e.g.
yearly, in much the same way as Investigator’s Brochures, to
reflect the most current evidence.
Moreover, there seems to be a kind of circular argument
in the report, wherein being part of the Schedule I list is
proof in and of itself that these substances are dangerous and
problematic. The Controlled Substance Act (CSA) is evoked
as an authoritative argument that attests to the danger of
ayahuasca to public health. But the CSA needs to be seen as
a political document that is subject to change and ques-
tioning. The recent discussions about psilocybin, MDMA,
and other psychedelics make it clear how it is a document
that can be updated, and that it cannot in any way be taken
as scientific evidence that ayahuasca causes risks to public
health and safety.
MISSING EVIDENCE FOR SAFETY AND
BENEFITS OF AYAHUASCA IN HUMANS
A comprehensive assessment of the state of the art in
ayahuasca research could not have ignored numerous recent
original clinical trials indicating antidepressant and anti-in-
flammatory effects of ayahuasca, as well as that ayahuasca
promotes an elevation of a blood biomarker of neuroplasticity
(de Almeida et al., 2019; Galvão-Coelho et al., 2020; Leite,
2023; Osório et al., 2015; Palhano-Fontes et al., 2019).
Several comprehensive reviews and a global survey on
ayahuasca’s therapeutic potential indicate consistently
mounting evidence of potential benefit in psychiatric ill-
nesses, such as depression, anxiety, and substance use dis-
order (Domínguez-Clavé et al., 2016; Dos Santos, Balthazar,
Bouso, & Hallak, 2016; Hamill, Hallak, Dursun, & Baker,
2019; Perkins et al., 2022; Sarris et al., 2021); and, poten-
tially, in other illnesses, such as neurodegenerative disorders
and end-of-life distress (Maia, Daldegan-Bueno, Wießner,
Araujo, & Tófoli, 2023).
In addition, multiple cross-sectional, case-control, and
longitudinal studies of ayahuasca in religious or retreat
settings indicate positive effects of ayahuasca (see review by
Maia et al., 2023). Turning a blind eye to so many sound
studies is highly problematic and anti-scientific. It raises
suspicion that the author[s] of the report had an a priori
negative bias, possibly related to a political agenda or ideo-
logical position.
MISSING DATA ON THE SAFETY AND
POTENTIAL BENEFITS OF AYAHUASCA FROM
PRE-CLINICAL RESEARCH
Likewise missing is a large body of pre-clinical evidence
of ayahuasca’s therapeutic potential. Rodent and primate
studies indicate the antidepressant and anti-addictive po-
tential of ayahuasca (see reviews by Cameron & Olson, 2018;
Dos Santos, Osório, Crippa, & Hallak, 2016; Ferraz et al.,
2019; da Silva et al., 2019). Some new evidence indicates that
ayahuasca seems to have prophylactic action, buffering the
emergence of depressive-like behaviors and cortisol changes
in a non-human primate animal model of depression (de
Meiroz Grilo et al., 2022). Moreover, there is evidence that
DMT regulates adult neurogenesis, both in vivo and in vitro
(Ly et al., 2018; Morales-Garcia, 2020), as well as modulating
immune response (see review by Inserra et al., 2021).
MISSING EVIDENCE FROM EPIDEMIOLOGICAL
STUDIES OF POPULATIONS REGULARLY
USING AYAHUASCA
The DEA report fails to discuss epidemiological studies
suggesting that long-term ayahuasca use is not associated
with psychological and physical impairments but, rather,
improved quality of life and well-being (Barbosa, Mizumoto,
Bogenschutz, & Strassman, 2012; Grob et al., 1996; Kohek
et al., 2022; Ona et al., 2019). The level of collective health
and quality of life of certain ayahuasca communities may
actually be more positive than that of non-ayahuasca-using
social groups living in the same region, as is the case for
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Journal of Psychedelic Studies
some Santo Daime communities in the Amazon region
(Grob et al., 1996; MacRae, 1992).
Moreover, the report does not consider Indigenous
peoples who use ayahuasca as relevant actors whose
traditions and ceremonies need to be considered and
respected. The report leaves aside all the rich anthropolog-
ical and sociological literature on the uses of ayahuasca
(Anderson et al., 2012; Labate & Araújo, 2004; Labate et al.,
2008), and on ayahuasca and health (Labate et al., 2013).
It also ignores all the hundreds of accounts of ayahuasca
benefits present in the oral history of traditional ayahuasca
use and, instead, cherry-picks negative anecdotal cases.
NO MENTION OF THE LEGAL STATUS OF
AYAHUASCA ELSEWHERE IN THE WORLD
The DEA report fails to reflect on the legal status and
policies around ayahuasca in South American countries, nor
on the case of the UDV victory in the US Supreme Court.
The safety profile of ayahuasca use among the exempted
groups is not analyzed.
It is important to highlight the Brazilian case. Contrary to
the constrained stance of the DEA, the Brazilian government
has shown a much more mindful and comprehensive attitude
regarding the use of ayahuasca. Shortly after the ban of
ayahuasca by the Brazilian regulatory agency on drugs in
1985, the Federal Council of Narcotics (CONFEN) issued a
resolution that established the creation of a working group
(WG) to examine the use of ayahuasca in Brazil. The WG was
comprised of members of the council and experts in various
fields. After two years of intensive research, in which the
members of the WG visited a number of ayahuasca churches
in the Amazon and in the southeast of Brazil, interviewed
their members and leaders, examined their practices, and did
a thorough literature survey, the WG published a Final Report
(Federal Council of Narcotics CONFEN, 1987). The report
stated that ayahuasca religions had moral and ethical stan-
dards of behavior similar to the rest of Brazilian society, and
sometimes even stricter. As for the ceremonies, they
emphasized the role of the religious environment as a whole,
including the role of music and dancing. In addition, they
highlighted that, after the ceremonies were over, everyone
returned to their homes in an orderly fashion. In general, the
report described its members as peaceful and happy people,
highlighting that some of them attributed several positive
changes to the religious use of ayahuasca, such as the
constructive reorganization of family life, a renewed interest
in the work environment, and the encounter with oneself and
with God (Federal Council of Narcotics CONFEN, 1987 p. 7).
The WG also pointed out that the preparation of
ayahuasca is quite difficult and prolonged and performed
within a ritual, meaning that a significant increase in pro-
duction levels capable of providing a supply for “abuse” and
for recreational use would be unlikely. Finally, the WG
stressed that the ritual use of ayahuasca has been documented
for many decades and that they did not find any evidence of
3
health or social harm caused by the use of ayahuasca in the
religious communities examined. The report concluded that
the use of the tea did not have any adverse consequences on
the social life of its followers; on the contrary, it stated that
ayahuasca is likely to orient them toward the search for social
happiness within an orderly and productive context (Federal
Council of Narcotics CONFEN, 1987, p. 29).
We must highlight the innovative approach of CONFEN.
Instead of reducing ayahuasca to its chemical compounds
and focusing solely on their effects, the Brazilian drug agency
had the cultural and anthropological sensibility to under-
stand the historical and socio-cultural context of the religious
use of ayahuasca, giving credit to the accumulated knowledge
on the matter and witnessing firsthand the practices of
ayahuasca religions, which began in 1930s (Labate, 2012).
The CONFEN report understood, as is well known in
anthropological studies regarding psychedelic substances,
that these cannot be examined isolated from the context of
use, and that the practices of established religious commu-
nities play a central role in the use of ayahuasca, making it
not only a safe practice but a tradition that is in tune with the
family-centered values most dear to Brazilian society.
In the 2000s, the National Council on Drug Policy (CONAD)
reaffirmed the right of ayahuasca groups to practice the religious
use of ayahuasca, based on the principle of religious freedom and
the constitutional commitment to protect and safeguard Indig-
enous and Afro-Brazilian traditions. Furthermore, CONAD
sponsored a pioneering initiative of organizing a Multidisci-
plinary Working Group (MWG) to establish guidelines for the
use of ayahuasca in Brazil. Understanding that this could not be
done without acknowledging the accumulated data on the sub-
ject, CONAD invited a number of scholars from various fields
and representatives of the main Brazilian ayahuasca religions to
be part of the MWG. Together, they published a report in 2006
that established a number of recommendations for the respon-
sible use of ayahuasca (National Council on Drug Policy
CONAD, 2006). In 2010, the Brazilian government established a
resolution to implement the recommendations of the MGW
report, recognizing the importance of the cultural and religious
value of ayahuasca traditions in the country (National Council on
Drug Policy CONAD, 2010).
The Brazilian case is a successful example of an inclusive
public policy developed through a partnership with promi-
nent academic specialists in the country and members of
ayahuasca religions, proving that the religious use of
ayahuasca can safely be accommodated in society if there is
an open channel for dialogue and collaboration. Hopefully,
the DEA can learn from the Brazilian experience and look
for ways to regulate the religious use of ayahuasca in the US.
FALSE CLAIMS REGARDING AYAHUASCA
PREPARATION AND DANGEROUS
ADMIXTURES
A central point in the DEA argumentation is the statement
about ayahuasca that “there is no unified or standardized
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4 Journal of Psychedelic Studies
formula for its preparation.” This point appears in the first
paragraph and continues to be stated more than 10 times
throughout the document.
Like all botanical preparations, no two ayahuasca prepa-
rations are exactly the same, and different ayahuasca-using
communities have different methods for preparation. How-
ever, this process among ayahuasca-using communities is far
from random; rather, the traditional uses of ayahuasca are
historically built on formulas that follow strict procedures,
deep cosmologies, and a know-how that are far from random
and are usually quite rigorous. In fact, ayahuasca is a central
part of several Indigenous medical systems, and is frequently
found among mestizo and urban settings throughout the
globe (Dobkin de Rios, 1972; Luna, 1986).
The fact that ayahuasca is not a “controllable” synthetic
compound is not, in and of itself, a risk to public health. The
traditional use of whole plants as medicines has millennia of
cultural experience, while purified compounds, especially
psychoactive ones, have only recently started to be investi-
gated (Ribeiro, 2018). By falsely asserting the dangers of
botanical preparations that lack a single method of prepa-
ration, the report leads readers to believe that people are
taking the risk of drinking lethal doses of ayahuasca. The
vast anthropological bibliography about the traditional and
urban uses of ayahuasca shows that, in practice, such doses
are never consumed (Labate, 2004). Additionally, the report
overemphasizes the prevalence of admixtures, suggesting
that substances such as cocaine or plants containing tropane
alkaloids are commonly used in the preparation of
ayahuasca, and can therefore cause overdose or toxicity.
Kaasik et al. (2021) analyzed 102 samples of brews from
ayahuasca-using communities. They found higher and more
variable concentrations of DMT in neoshamanic ayahuasca
samples compared to Indigenous samples or samples from
ayahuasca churches. The analysis revealed the average
(minimal – maximal) concentrations (mg L 1) of DMT 764
(88–2687), THH 995 (32–3875), harmine 1318 (141–4440),
and harmaline 85 (4–387). In this study, other psychoactive
components, such as moclobemide, psilocin, and yurem-
amine were only found in analogues of ayahuasca (Peganum
harmala, Mimosa tenuiflora), but not in ayahuasca itself.
Importantly, no ayahuasca analogues were found in any
samples from Brazil or ayahuasca used in Santo Daime
ceremonies in Europe.
PROBLEMATIC COMPARISONS WITH ANIMAL
TOXICOLOGY
The DEA report cited an animal toxicology extrapolation
model estimating that the LD50 for oral DMT in humans
would be 8 mg kg 1, which is more than 20 times the dose of
oral DMT (approximately 27 mg) typically consumed from
ayahuasca (Gable, 2007). However, the report also omitted
the researcher’s explanation that “simple extrapolation of
DMT lethality data from mice to humans is obviously un-
tenable” due to differences in metabolism, physiology, and
even serotonin receptor distribution and that “the depen-
dence potential of oral DMT and the risk of sustained
psychological disturbance are minimal” (Gable, 2007).
A more recent review of animal data on ayahuasca/DMT,
which was not mentioned in the DEA report, indicates that
ayahuasca is toxicologically safe in ceremonial-comparable
doses (Daldegan-Bueno, Simionato, Favaro, & Maia, 2023).
The LD50 in rodents is approximately 30 times higher than
the therapeutic/ceremonial doses (even taking into account
variability across samples) (Brito-da-Costa, Dias-da-Silva,
Gomes, Dinis-Oliveira, & Madureira-Carvalho, 2020; Simão
et al., 2019).
Another article omitted from the DEA report estimated
that an extrapolated oral DMT “usual lethal dose” in
humans would be 2 g, which is about 75 times greater than
the typical 27 mg DMT dose taken in ayahuasca, and that
the oral ayahuasca “usual effective dose” to “usual lethal
dose” safety ratio of 50 was substantially higher than several
commonly used substances, such as alcohol (10), dextro-
methorphan (10), and codeine (20), which demonstrated a
favorable safety profile for DMT (Gable, 2004).
A further point that should be highlighted is that the
authors of the report equate the use (and associated risks) of
ayahuasca with that of isolated DMT and beta-carbolines,
which is a mistake for several reasons. DMT and ayahuasca
have very different pharmacokinetic and pharmacodynamic
profiles and are used via different routes of administration
and in different contexts. DMT has a much shorter onset
time and duration of effects, a higher intensity, and a
different phenomenology (James, Keppler, L Robertshaw, &
Sessa, 2022; Strassman, Qualls, Uhlenhuth, & Kellner, 1994).
The synergy between plants containing DMT and plants
containing beta-carbolines in the report is reduced to
“additional risks leading to potential toxic consequences.”
To support this claim, they cite studies that have shown
beta-carboline toxicity, where these substances were isolated
and analyzed alone. Paradoxically, studies indicating that
isolated beta-carbolines are neuroprotective and anti-
inflammatory were omitted from the report (Katchborian-
Neto et al., 2020; Santos, Moreira, Borges, & Caldas, 2022).
CONFLATION OF AYAHUASCA EFFECTS WITH
ADVERSE HEALTH EFFECTS
The DEA report views all subjective and consciousness-altering
effects of ayahuasca through a negative lens, as if they are all
harmful or undesirable “side effects.” This is in stark contrast to
Indigenous understandings of phenomena such as vomiting,
which is seen as a cleansing opportunity (purging) (Politi et al.,
2022), and ignores emerging scientific evidence that psyche-
delic-induced mystical-type experiences are correlated with
therapeutic benefit (Yaden and Griffiths, 2020). The choice to
view all effects of “drug intoxication” as negative follows a long
demonizing tradition at the core of Prohibition, based on moral
and religious dogmas that starts by using language with nega-
tive bias. There is a section called “Adverse Effects of
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Journal of Psychedelic Studies
Ayahuasca Reported in the Media.” This kind of reference
should be viewed with great caution, as these stories are often
sensationalist and garbled (Sinclair, 2017).
It is more informative to look at comprehensive survey
data, such as the online Global Ayahuasca Survey, which ran
between 2017 and 2019, and collected information about
“ayahuasca side-effects” in participants (n 5 10,836) from
more than 50 countries. Acute physical health adverse effects
(primarily vomiting) were reported by 69.9% of the sample,
with only 2.3% reporting the need for subsequent medical
attention. Adverse physical effects were related to older age
at initial use of ayahuasca, having a physical health condi-
tion, having a previous or family history of psychotic
symptoms, having a previous substance use disorder diag-
nosis, and taking ayahuasca in a non-supervised context.
Adverse mental health effects in the weeks or months
following consumption were reported by 55.9% of the
sample; however, around 88% considered such mental
health effects as part of a positive process of growth or
integration. Around 12% sought professional support for
these effects. The occurrence of adverse mental health effects
was positively correlated with pre-existing anxiety disorders,
physical health conditions, and the strength of the acute
spiritual experience, and negatively associated with con-
sumption in religious settings (Bouso et al., 2022).
Below we provide necessary nuances to some of the
“adverse effects” discussed in the report:
Hallucinations
The DEA report cites hallucinations as a side-effect of
ayahuasca. In fact, they are one of the most sought-after
effects of a psychedelic experience. Altered states of con-
sciousness induced by psychedelics, and resulting “mystical”
or “peak” experiences, are reported as some of the most
meaningful experiences (Griffiths et al., 2011), correlating
positively with therapeutic outcomes in depression, anxiety,
and nicotine addiction (Yaden and Griffiths, 2020),
including in ayahuasca randomly-controlled trials (RTCs)
(Palhano-Fontes et al., 2019).
Hallucinations—particularly visions of autobiographical
or transpersonal nature, but even more abstract geometric
hallucinations—are thought to catalyze mystical experiences,
emotional breakthroughs, insights, and experiences of awe
induced by psychedelics, which are all related to therapeutic
effectiveness (Aqil & Roseman, 2022). In fact, recent evi-
dence suggests that the neurophysiological mechanisms
involved with these visions are related to a dream-like state,
rather than a pathological hallucination (de Arujo
et al., 2012).
Vomiting
In shamanic contexts, purging is an essential and
intrinsic aspect of ayahuasca’s medicinal value. Although
purging as a healing method is not recognized in Western
medicine, new studies on the gut-brain axis may add
knowledge about it in the near future. For instance, it has
been suggested that purging has potential benefits for
gastrointestinal function and microbiota balance, modu-
lating the gut-brain axis in a positive way (Fotiou et al., 2019;
Politi, Tresca, Menghini, & Ferrante, 2022). Rather than a
5
side effect, the emetic effects of ayahuasca should be regar-
ded as a safety point, since the emetic dose is similar to the
psychoactive one.
Hypertension and tachycardia
In the DEA report, the authors refer to hypertension
(high blood pressure) and tachycardia (increased heart rate),
as “cardiotoxicity” (bottom of page 11). For a cardiologist,
however, cardiotoxicity refers to the occurrence of heart
dysfunction as electric or muscle damage, resulting in heart
toxicity, as occurs sometimes after chemotherapy. Acute
high blood pressure and tachycardia do not indicate damage
to the heart, or “cardiotoxicity.” Elevated blood pressure and
heart rate normally happen transiently in most humans,
including those with no measurable damage to their hearts.
Gable (2007) analyzed several studies to compare changes in
heart rate and blood pressure brought on by various psy-
choactive substances and concluded that the hemodynamic
effects of ayahuasca appear less hazardous than alcohol.
Other adverse effects
Chronic ayahuasca users (n 5 22) show no change in
biochemical parameters related to hepatic damage (Mello
et al., 2019).
LACK OF ACCURACY IN NUMBERS OF
HOSPITALIZATIONS AND POISONINGS
The report cites data from the American Association of
Poison Control Centers (AAPCC) that links exposure to
ayahuasca to negative health outcomes, including hospital-
ization. The AAPCC data is based on over 500 cases, some
of which mention serious health issues, such as intubation.
However, there is no comparison of these cases with the
number of people using ayahuasca, so it is impossible to
attest to the overall prevalence of the problem. Moreover,
there were no toxicological exams to confirm the presence of
DMT or other active principles of ayahuasca; thus, we do
not know what, if any, substances were actually consumed,
nor do we know the context in which they were consumed.
Hence, these data are entirely unreliable and exclusively
based on hearsay. Part of the adverse effects report comes
from the article “Ayahuasca Exposure: Descriptive Analysis
of Calls to US Poison Control Centers from 2005 to 2015.”
While this document describes several adverse effects that
are possible due to ayahuasca ingestion, the authors also
assert that “Case reports of adverse outcomes and human
deaths may be not from botanical ayahuasca at all”
(Callaway et al., 2006).
Conversely, the data from studies conducted with
ayahuasca in clinical trials only presented transient and
rapidly resolving side effects, not dissimilar to those of
other classic psychedelics, such as gastrointestinal malaise
and vomiting (but see above about the importance of
vomiting in traditional and religious contexts), headaches,
and mild-to-moderate increases in heart rate and blood
pressure (n 5 108, healthy volunteers and depression
patients in 11 trials). Rarer were reports of anxiety,
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6 Journal of Psychedelic Studies
confusion, emotional distress, depersonalization, and
dysphoric states, although even those were transient and
resolved on their own or with psychological support
provided during the trial (Rossi et al., 2022).
LACK OF AWARENESS REGARDING THE
SETTING AND INFORMAL FORMS OF CONTROL
The DEA does not address any of the cultural and social
dimensions of ayahuasca consumption. The dozens of theses
and dissertations on ayahuasca communities show that they
contain complex social and cultural dynamics. The shamans
and leaders of ayahuasca religions have developed formal
and informal forms of control in order to minimize adverse
effects and to provide a safe environment for the use of
ayahuasca. In fact, organized ayahuasca-using communities
employ a number of strategies to mitigate the majority of
significant risks inherent in using ayahuasca. These include
reliable sourcing of ayahuasca, screening potential ceremony
participants, and consuming ayahuasca within structured
and supervised settings with experienced leaders and guides
who can safely support individuals having difficult experi-
ences or in need of (extremely rare) medical attention. Both
controlled trials as well as prospective data from ayahuasca-
using communities clearly demonstrate the safety profile of
ayahuasca within controlled settings (Barbosa et al., 2012;
Chacruna Institute for Psychedelic Plant Medicines &
Hoots, 2021; MacRae, 2009; Rossi et al., 2022).
In this regard, the literature has shown that the ritual use of
ayahuasca cannot be equated to DMT consumption in a clin-
ical setting. As Hartogsohn (2021, p. 14) states, “the effects of
ayahuasca are profoundly mediated through complex layers of
intentions, expectations, visual, auditory, and symbolic envi-
ronments, social and cultural systems, etc. These various
contextual factors comprise a rich cultural apparatus that serves
to mitigate harms and facilitate social and personal benefits.”
The importance of the setting and the strict informal and
formal means of control established by Indigenous peoples
and ayahuasca religions occupy a central role when it comes
to experiencing ayahuasca. Epidemiological studies that have
demonstrated the lack of harm in ayahuasca-using commu-
nities (Barbosa et al., 2012) are proof of effective harm
reduction practices that cannot be ignored nor minimized.
Moreover, the power of traditional and Indigenous knowledge
should not be underestimated, as is clear from the example of
differentiating different ayahuasca vine varieties that elude
contemporary botanical distinctions (Sheldrake, 2020). By
disregarding the current clinical evidence and research in
Indigenous and religious communities, and not considering
the anthropological literature available on the matter, the
DEA demonstrated a narrow, ethnocentric approach that fails
to truly characterize the potential risks related to ayahuasca.
We find it highly problematic that the DEA report did not
exhibit the scientific rigor or anthropological sensitivity to
understand the harm reduction practices and benefits of the
use of ayahuasca in traditional settings.
FALSE CONCLUSIONS ABOUT AYAHUASCA’S
RISK TO PUBLIC HEALTH AND SAFETY
The DEA report asserts that, “Based upon the existing in-
formation, ayahuasca presents a significant risk to public
health and safety.” We do not dispute that there are po-
tential risks inherent in ayahuasca use, including unknown
composition, lack of adequate screening, and lack of psy-
chosocial support leading to untoward experiences, or the
lack of follow-up and integration, which could produce
psychological harm or lead to calls to poison control.
Notwithstanding, the above summary statement is highly
problematic because it asserts that:
a) All ayahuasca use presents a significant risk;
b) All contexts of ayahuasca use are equally likely to cause
problems;
c) Ayahuasca is a risk to public health at large, rather than
to a subset of individuals who choose to drink ayahuasca.
Regarding the first two points, the risk of ayahuasca use
is variable depending on individual user characteristics and,
as discussed above, the context in which ayahuasca is used.
For instance, ayahuasca use among individuals with histories
of psychosis and without social support presents higher
risks. Similarly, ayahuasca use in unstructured and unsu-
pervised settings is riskier than in controlled environments,
such as the ceremonial contexts in which the majority of
ayahuasca use occurs. These principles are similarly true for
nearly all psychoactive compounds, such as alcohol
(e.g., drinking moderate quantities in controlled social
environments vs drinking to excess and driving or drinking
by someone with liver disease vs a healthy adult).
Regarding the third point, the risks of ayahuasca, both to
individual users and to others, are small compared to other
substances, and the vast majority of risks inherent to
ayahuasca use are to the users themselves, and not to others
or to the broader communities in which ayahuasca use takes
place. This is consistent with a variety of expert groups who
rate psychedelic harms low compared to other medical and
recreational drugs, while legal alcohol scores are one of the
highest (van Amsterdam, Nutt, Phillips, & van den Brink,
2015; Bonomo et al., 2019; Nutt, King, & Phillips, 2010).
FINAL REMARKS
In this article, we highlight significant and obvious problems
with the DEA report on ayahuasca, such as overt negative
biases, unacceptable omissions, and obsolete mis-
conceptions, while calling attention to recent scientific
findings that were either not mentioned or mis-interpreted.
In summary, the DEA report severely downplays the safety
profile and therapeutic potential of ayahuasca and over-
emphasizes the risks. It reduces ayahuasca to DMT and
falsely equates the risks of one with the other, while simul-
taneously failing to consider the ways in which context
modulates the risks of use. This is especially harmful when
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Journal of Psychedelic Studies
discussing ayahuasca, given centuries of use among Indige-
nous communities and decades of use in modern religious
contexts. Moreover, the report fails to include current
research on ayahuasca demonstrating its potential benefits.
Thus, when considering the report as a whole, it seems
clear that it was either written by personnel that lacked the
proper knowledge and skillsets to produce a comprehensive
report or was written with a predetermined Prohibitionist-
style political agenda. That being said, we suggest that future
policy related to ayahuasca should be informed by evidence-
based science, including social science and humanities
research on the topic (Labate & Cavnar, 2018; Labate et al.,
2017; Labate & Jungaberle, 2011). Lastly, we advocate for
inclusion of and respect for Indigenous traditions, which is a
challenge for governments, universities, and practitioners.
Since there are no conclusive studies showing that ayahuasca
is harmful to public health, we continue to rely on the im-
memorial traditional uses and their reports on the safety of
ayahuasca, as well as on its key value as a medicine, strongly
supported by a growing number of rigorous clinical studies.
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