Ayahuasca and Public Health : Health Status, Psychosocial Well-Being, Lifestyle, and Coping Strategies in a Large Sample of Ritual Ayahuasca Users
Genís Ona, Maja Kohek, Tomàs Massaguer, Alfred Gomariz, Daniel F. Jiménez, Rafael G. Dos Santos, Jaime E. C. Hallak, Miguel Ángel Alcázar- Córcoles & José Carlos Bouso
Journal of Psychoactive Drugs, 2019,
Assessing the health status of ayahuasca users has been challenging due to the limitations involved in randomized clinical trials and psychometric approaches. The main objective of this study is the implementation of an approach based on public health indicators. We developed a self-administered questionnaire that was administered to long-term ayahuasca users around Spain. The questionnaire was administrated face-to-face to participants (n = 380) in places where ayahuasca ceremonies were occurring. Public health indicators were compared with Spanish normative data, and intergroup analyses were conducted. Long-term ayahuasca use was associated with higher positive perception of health or with a healthy lifestyle, among other outcomes. Fifty-six percent of the sample reported reducing their use of prescription drugs due to ayahuasca use. Participants who used ayahuasca more than 100 times scored higher in personal values measures. The main conclusion of this study is that a respectful and controlled use of hallucinogenic/psychedelic drugs taken in communitarian settings can be incorporated into modern society with benefits for public health. This new approach, based on the use of health
indicators that were not used in previous ayahuasca studies, offers relevant information about the impact of long-term exposure to ayahuasca on public health.
KEYWORDS : Ayahuasca; hallucinogens; lifestyle; psychedelics; psychological well-being; public health
Ayahuasca is the Quechua term for the decoction of the Amazonian vine Banisteriopsis caapi (Shultes 1967). It is used in traditional contexts as a medicine, for spiritual purposes, and in communitarian ceremonies to strengthen social bonds (Andritzky 1989). B. caapi contains inhibitors of the monoamine oxidase (MAOI compounds), such as harmine, harmaline, and tetrahidroharmine, which prevent the endogenous breakdown of compounds from the plants that are added to ayahuasca, thereby enhancing their biological effects (McKenna, Towers, and Abbott 1984).
The most common presentation of ayahuasca is the combination of B. caapi with P. viridis, or with the vine Diplopterys cabrerana, which contains the hallucinogenic compound N,N-Dimetyltryptamine (DMT). The expansion of ayahuasca from the jungle into urban Brazil (Grob et al. 1996; Labate 2004; Luna 2011; McKenna 2004) and then internationally (Sánchez and Bouso 2015) has led to its being used in multiple eclectic and syncretic ways throughout the world. The international expansion of the use of ayahuasca is occurring in a context wherein serotonergic psychedelic research and therapy are gaining new recognition in the field of biomedicine, a phenomenon that several authors refer to as a “psychedelic renaissance” (Kotler 2010; Sessa 2018; Tupper and Labate 2014). Psilocybin, lysergic acid diethylamide (LSD), ibogaine, and MDMA (3,4-Methylenedioxymethamphetamine) are being studied for the treatment of addictions, major depression, cluster headache, obsessive-compulsive disorder, posttraumatic stress disorder (PTSD), anxiety and depression associated with life-threatening diseases, and social anxiety among individuals with autism (Danforth et al. 2018; dos Santos et al. 2018; dos Santos, Bouso, and Hallak 2016; Mithoefer, Grob, and Brewerton 2016).
At the same time, contemporary psychedelic research is occurring in a particular moment when biomedicine is being questioned as the main source of evidence for public health decisions (Jones and Wilsdon 2018). In the field of psychopharmacology (focusing on psychiatric and neurological drugs), some authors suggest that it is in a state of crisis (Fibiger 2012; Insel et al. 2013), while others claim that psychedelic drugs may offer a solution for overcoming such a crisis (Mithoefer, Grob, and
Brewerton 2016; Ona and Bouso 2019).
Alongside evidence from clinical trials, some study populations that use data from national epidemiologic surveys also conclude that psychedelics can offer beneficial outcomes with regards to mental health (Hendricks et al. 2015; Johansen and Krebs 2015; Krebs and Johansen 2013). Additionally, studies comparing ritualistic peyote (a mescaline-containing cacti) users (Halpern et al. 2005) and ritualistic ayahuasca users (Barbosa et al. 2016; Bouso et al. 2012, 2015; Fábregas et al. 2010; Grob et al. 1996) with non-users have indicated that the former performed better regarding some neuropsychological and psychopathological variables, including showing less use of alcohol and illegal drugs and reporting remission from anxiety and mood disorders. Although psychedelics can also trigger psychopathological crises (dos Santos, Bouso, and Hallak 2017), their occurrence seems to be limited and preventable when doing proper screenings (Johnson, Richards, and Griffiths 2008).
Despite the growing interest in biomedicine regarding psychedelics as potential tools for the treatment of mental conditions, there are no studies based on public health indicators that assess the potential benefits of psychedelics when they are used in communitarian contexts. With the globalization of some traditional medicines like ayahuasca and peyote, a growing number of people from outside of the traditional territories are attending ceremonies with the purpose of generally improving their health, curing specific medical and/or psychopathological conditions, or simply for personal growth (Franquesa et al. 2018; Horák, Hasíková, and Verter 2018; Malcolm and Lee 2018; Prat et al. 2012). Contemporary use of ayahuasca is generally in the context of a social setting (Apud and Romaní 2017; MacRae 1998; Talin and Sanabria 2017), thus strengthening social bonds (Andritzky 1989; Cavnar 2014; Kavenská and Simonová 2015; Prat et al. 2012), an aspect that is particularly important for the maintenance of a positive mental health status (Berkman 1995; Ozbay et al. 2007; Wang et al. 2018). Thus, it is now possible to assess in the real world, from a public health perspective, the consequences of the integration of psychedelics into society.
In this article, we present the results of a face-to-face assessment of health and psychosocial well-being, lifestyle, and coping strategies among a large sample of Spanish ritualistic ayahuasca users, using public-health -based indicators.