DEA exaggerates risks of ayahuasca – 03/05/2023 – Psychedelic Turn

Giving a text the appearance of secure knowledge, based on scientific studies, is a powerful rhetorical device, even when a government body produces an internal document to justify a retrograde public policy. It would not be different with the US anti-drug agency, as seen in the DEA report on ayahuasca made public by the Chacruna Institute, in San Francisco, on Friday (3).

The 33-page document, obtained by the NGO based on the US Freedom of Information Act (FOIA), was titled “Ayahuasca: Risks to Public Health and Safety”. It dates from July 2020, but its existence only became known in an April 2021 communication to Chacruna and the Church of the Eagle and the Condor (CEC), or Church of the Eagle and the Condor, co-author of the request for access to the information.

In the US, religions such as the União do Vegetal (UDV) saw the Supreme Court recognize, in 2006, the right to consecrate ayahuasca, based on the constitutional precept of religious freedom. The CEC, however, faces barriers to using the sacrament, and biases in the DEA’s report on the health and safety of the drink contribute to continued discrimination.

As soon as they became aware of the existence of the report, Chacruna and CEC included it in the FOIA request. They had to wait almost two years to gain access to the document. And this in a country that prides itself as a beacon of democracy and the rule of law (“rule of law”).

“The language of evaluation [da DEA] does not take into account the benefits of ayahuasca and probably overestimates the risks of using ayahuasca, particularly in a controlled, religious or spiritual context, with adequate screening procedures and informed consent”, states the Chacruna page where the facsimile of the report is introduced.

The tone of the DEA’s text is alarmist, as can be read on p. 10: “…despite claims that ayahuasca is safe, ayahuasca use has been associated with moderate cardiotoxicity, neurotoxicity, psychopathology, transient disorientation, anxiety, coma and death”.

Many of the risks pointed out are based on studies with dimethyltryptamine (DMT), which is just one of the psychoactive compounds present in ayahuasca. Although it is generally identified as triggering the visions (“mirações”) provided by tea, DMT acts in conjunction with a complex mixture of plant substances –chacrona and cipó-mariri– used in the preparation.

On the same p. 10 the American Association of Poison Control Centers (AAPCC) is said to record 538 cases of ayahuasca-related attendances in one decade (2005-2015). Of these, there were 150 cases of hospitalization in the ICU or semi-ICU, with 28 people intubated, 7 respiratory arrests and 4 cardiac arrests. In ten years, it’s good to repeat.

On p. 11, it is reported that data requested by the DEA from the AAPCC for the period 2012-2017 indicated 341 consultations on ayahuasca and 122 on DMT. With regard to ayahuasca, the episodes involved cardiotoxicity (tachycardia and hypertension); 6 respiratory and 3 cardiac arrests; 33 intubations or ventilations. The DEA itself points out that 43% of the consultations involved the associated use of one or more substances, so there would be no way to attribute serious adverse effects directly to ayahuasca.

On p. 13, the report highlights the clinical case of a 36-year-old man with a history of psychosis related to cannabis abuse. On p. 14, turns to journalistic reports: 9 cases of death in or after rituals. But, again, the DEA recognizes that the available elements do not allow us to state that the deaths occurred as a result of ayahuasca.

These caveats give the official document an appearance of scientific impartiality. On p. 15, however, the negative bias against ayahuasca is explicit: despite citing studies saying that it would be necessary to multiply 15 to 50 times the amount ingested in rituals to arrive at the lethal dose, the DEA resorts to the allegation that the method of preparation varies a lot for maintain that a considerable risk would persist:

“Thus, the use of ayahuasca in religious ceremony or for recreational purposes may result in amounts of DMT approaching the LD dose₅₀ and, consequently, can lead to DMT intoxication and/or extreme psychoactive effects”. (LD₅₀ is a standardized measure for the amount of any chemical compound capable of causing the death of 50% of the rodents used in the toxicological test.)

On pp. 17-18, after citing pharmacological literature showing that DMT does not generate tolerance, which would require ever-increasing subsequent doses, the DEA resorts again to a theoretical possibility to assert that there is indeed a probability of causing chemical dependence: there is evidence of changes structural changes in the brain with long-term ayahuasca use, and these changes could be in the direction of addiction.

The risk overestimation strategy continues on pp. 19-20. The DEA cites only four clinical cases of psychotic breaks after ayahuasca use, but concludes (p. 19): “Although the occurrence of ayahuasca psychosis is low, the consequences or health outcomes of psychosis can be severe.”

On p. 20, when dealing with mortality reported in the medical literature, the report begins by mentioning a single death, of a young man who had taken a high dose of 5-MeO-DMT in a drink that he thought was ayahuasca, although that amount could not have come from natural sources, only of a synthetic compound… 5-MeO-DMT is a compound related to dimethyltryptamine found naturally in the venom of some toads.

When it comes to talking about potential health benefits, the DEA reverses the pattern: the existing studies would be very limited, with fragile conclusions confounded by several factors. That is, any beneficial effects could, in theory, be attributed to other conditions of the psychedelic experience under the effect of ayahuasca, such as the feeling of welcome in a religious ceremony with chants.

There is, however, a serious omission from the biomedical literature in the bibliography used by DEA experts: although the document is dated July 2020, it did not include the first clinical trial of a psychedelic (ayahuasca, in this case) to treat group-controlled depression. placebo, with 29 volunteers, carried out by the group of Dráulio de Araújo at the Federal University of Rio Grande do Norte-UFRN (Palhano-Fontes et al., 2019).

With so many biases, it is not surprising that the DEA concludes against ceremonial tea: “Although ayahuasca is claimed to have beneficial psychological effects, there are not enough well-controlled studies to support this claim. More well-controlled clinical studies are needed to evaluate its full potential. treatment and to increase and diversify the studied population”, says the text.

“Further studies are also needed to relate the positive or negative findings specifically to ayahuasca rather than the context in which ayahuasca was used, and to assess the long-term or persistent effects of ayahuasca and its components on mental health. Until these studies are completed and the results analyzed, it cannot be said that ayahuasca is safe.”

It is also not surprising that the DEA was slow to give access to the report, which seems to be tailored to reinforce the prohibitionist doctrine of the police force, even in the face of growing scientific evidence in favor of ayahuasca. And not only scientific, but also from safe ritual use by indigenous peoples of the Amazon for centuries, if not millennia, and for almost a century by urban ayahuasca religions in Brazil, such as Santo Daime, Barquinha and UDV.

Anyone who wants to find out about ayahuasca in a more balanced way will find plenty of material in the academic literature. One of the most recent papers came out in the journal European Neuropsychopharmacology. Signed by a quintet of authors active in Brazil, Lucas Maia, Dimitri Daldegan-Bueno, Isabel Wießner, Dráulio de Araújo and Luís Fernando Tófoli, its title is “Therapeutic Potential of Ayahuasca: What We Know and What We Don’t Know”.

The systematic survey of the literature indicates, according to this group of researchers of psychedelics for depression (ayahuasca and inhaled DMT), that the evidence of ayahuasca’s therapeutic effect is stronger in the case of depression and substance abuse (chemical dependence).

Another comprehensive review of tea, also called daime, was published just over a year ago by Edward James, Joachim Keppler, Thomas Robertshaw and Ben Sessa. It is in the journal Human Psychopharmacology, with the title “N,N-dimethyltryptamine and the Ayahuasca Plant Medicine of the Amazon”.

Sessa is the author of a good introductory book on the topic, “The Psychedelic Renaissance – Reassessing the Role of Psychedelic Drugs in 21st Century Psychiatry and Society”. Out in 2012 by Muswell Hill Press.

His recent article with James, Keppler and Robertshaw offers a good example of how a positive bias, or at least unrelated to the prohibitionist paradigm, can result in a much more generous appreciation of the potential of ayahuasca, as well as everything that is still unknown about it and its effects. effects.

Citing largely the same literature surveyed by the DEA, they conclude rather more benignly: “A shift in framing [retirando a substância] of Schedule 1, recognizing potential medical applications of DMT, is justifiable at that time, and such a change in framework would facilitate further medical study.” Schedule 1 is the list of prohibited substances in the US.

At no point does Sessa and her co-authors minimize the risks involved in ingesting ayahuasca, but neither do they lose sight, as the DEA does, that its use is demonstrably safe in a community ritual context. The UDV alone, for example, has 22,000 fans drinking the tea regularly, every fortnight, with very rare serious adverse effects.

After citing some of the same cases and reports overrated by the DEA, the review states: “These examples demonstrate the need for sufficient screening and preparation before ayahuasca sessions, as some people with underlying health conditions, including a personal or family history of psychosis , face greater risk”.

“However, regular use in healthy individuals has not been associated with deterioration in mental health or cognitive function, and the reported incidence of psychosis in ayahuasca users indicates that it occurs in less than 0.1% of users.”

The article points out that ayahuasca is generally used in a group setting and that the supportive community environment likely plays an important role in the effectiveness of ayahuasca as a medicine. And he argues that this should serve as an inspiration for biomedicine, should the drink be included among the authorized therapies.

“If ayahuasca is to be fully integrated into international medical systems, facilitators outside the Amazon should be trained physicians, psychiatrists and psychologists, who could specialize and receive additional training in the Amazon”, recommend the authors.

They cite as possible mentors for European and North American health professionals none other than Shipibo-Conibo, Tukano, Kamsa and Huitoto, some of the many peoples of the Amazon who traditionally use the drink “and have been designated the Amazonian equivalents of institutions such as Oxford, Cambridge and Harvard”.

It seems highly unlikely that the DEA will include this review in its next internal report on ayahuasca’s public health and safety risks. The recognition and homage due to traditional knowledge do not fit within the narrow scope of instrumentalizing science as a weapon in its failed War on Drugs.

– – – – – – – – – –

NOTICE TO NAVIGATORS – Psychedelics are still experimental therapies and certainly do not constitute a panacea for all psychic disorders, nor should they be the object of self-medication. Speak with your therapist or doctor before venturing into the area.

To learn more about the history and new developments of science in this area, including in Brazil, look for my book “Psiconautas – Viagens com a Ciência Psychedelica Brasileira”.

On the tendency to legalize the therapeutic and adult use of psychedelics in the US, see the article “Cogumelos Livres” in the December 2022 issue of Piauí magazine.

Be sure to also see the articles in the series “A Ressurreição da Jurema” in Folha: