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Ayahuasca, a plant-based brew that gives people a psychedelic experience, can be fatal, especially when mixed with other drugs. Jairo Galvis Henao/flickr, CC BY-NC-ND

Weekly Dose: ayahuasca, a cautionary tale for tourists eager to try this shamanic brew

Last night’s ABC Foreign Correspondent highlighted how Australians have been travelling to South America to seek the mystical experiences and healing properties of the plant brew ayahuasca.

Spiritual leaders known as shaman have been using this brew for hundreds of years for healing and religious purposes. It’s prepared by boiling plants from the Amazon and reducing the brew. Either the shaman or the person who wants to be healed (or both) can drink it.

But the program shows the dangers of using such a powerful drug while overseas where there is little regulation over the retreats that offer it.

What is ayahuasca?

Ayahuasca has two main ingredients, both of which are needed for the drug to have its psychoactive effects.

One is a plant containing dimethyltryptamine (DMT), the same compound found in many plants, including Australia’s national floral emblem, the wattle. Usually, if you eat or drink dimethyltryptamine, an enzyme in your stomach called monoamine oxidase quickly metabolises it into non-psychoactive chemicals. So, on its own, dimethyltryptamine has almost no psychoactive effect.

But among the millions of plants in the Amazon, shaman somehow realised mixing two plants could create a brew to provide a mystical experience and powerful visions. This second plant contains chemicals known as reversible monoamine oxidase inhibitors, which “neutralise” monoamine oxidase. So, dimethyltryptamine is free to be absorbed into the body, unaltered.

Dimethyltryptamine then activates the same receptors in the brain activated by psychedelic drugs like LSD (lysergic acid diethylamide) and psilocybin (found in some mushrooms).

What are its effects and risks?

When you drink ayahuasca, the acute effects last about four hours. These include powerful perceptual changes users have reported can change a person’s view on life.

But sometimes a person might feel they are dying or losing control of their mind. Common acute side-effects include vomiting and diarrhoea, which Amazonian shaman view as spiritual purging. Ayahuasca is hardly a “recreational drug”.

For a few hours after the acute effects wear off, people report being sedated, thanks to the various monoamine oxidase inhibitors in the brew; there are few documented cases of longer lasting negative side effects.

But if people with a serious mental illness such as schizophrenia or bipolar disorder use ayahuasca, their symptoms may worsen. So, it’s recommended people with such a pre-existing condition, or a predisposition to one, avoid it.

While there is a low chance of overdosing from ayahuasca due to its pungent flavour, high doses are linked with having strong changes in perception, which can be distressing.

Ayahuasca, however, carries with it a physiological risk. Monoamine oxidases have an important protective role in the body in defending the circulation from substances in the gut, either food or drugs. So, turning off these protective enzymes exposes the body to a variety of possible toxicological effects, like seizures, delirium, coma and collapse of the circulatory system. These effects, particularly in the context of other drugs, either illicit or medical, have the potential to be fatal.

As a consequence, there are substantial numbers of drugs that could have significant, even potentially lethal consequences if taken with ayahuasca, including medications for depression, high blood pressure, some complementary medicines, and illicit drugs, including cocaine and amphetamines.

Foods to avoid for similar reasons include those that are aged, preserved, dried, fermented, pickled, cured (meats), rancid, old, out of date, overripe, or even slightly spoiled.

But the death reported by Foreign Correspondent did not involve ayahuasca; it involved a brew of tobacco mixture touted as a body cleanse. In fact, most deaths associated with ayahuasca have been due to various plants, like tobacco or brugmansia, added to the brew.

Are there benefits?

When drunk in a safe setting with the right intention, ayahuasca can have beneficial effects, with potential therapeutic effects attracting much research attention.

Early research found people who drank ayahuasca at a Brazilian church had decreased levels of depression compared to a matched control group. This was thought to be related to increased levels of serotonin, which researchers found among regular ayahuasca drinkers.

Meanwhile, a recent systematic review found it helped anxiety and depression. There is also research suggesting ayahuasca could treat addictive behaviours.

Ayahuasca tourism

Travelling overseas to drink ayahuasca is not new, with the Australian media reporting on ayahuasca tourism as early as 2013. And in 2014, it was featured in Hamish and Andy’s Gap Year South America.

Hamish and Andy’s Gap Year South America showed the effects of ayahuasca.

Australia’s Department of Foreign Affairs and Trade website warns about ayahuasca tourism being a burgeoning industry in parts of Ecuador and Peru and while not illegal, there is no way to thoroughly vet ayahuasca tour operators. There have been reports of assaults and people being robbed, rape and murder linked with it.

Ayahuasca in Australia

We don’t know how many people use ayahuasca in Australia, but a story on SBS in 2016 featured an interview with a local facilitator of ayahuasca ceremonies.

Although the active ingredient dimethyltryptamine is found in many Australian acacias, it remains an illegal drug in all states and territories. Drinking ayahuasca is therefore considered illegal. This perhaps explains why many Australians drink it overseas rather than in Australia.

An application to Australia’s drug regulator, the Therapeutic Goods Administration, last year to grant Australian members of some faiths the right to legally make and drink ayahuasca was denied, citing concerns about managing safety risks.

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