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By Sarah Abedi, MD

Ayahuasca is a hallucinogenic tea that has been used by Amazonian cultures for centuries as a central element of healing ceremonies. In the native Quechua language spoken by indigenous peoples in the Peruvian Andes, aya means ancestors, souls or dead persons and wasca (huasca) means rope or vine with the compound word ayahuasca translating roughly to “vine of the soul”.¹ Indigenous populations have used ayahuasca as a medicine to treat physical ailments, mental problems as well as to help guide social issues. In Peruvian tradition this plant is regarded as one of the “teacher plants” that conveys spiritual knowledge to humans.²

The main psychoactive compound of ayahuasca is known as N, N-Dimethyltryptamine, abbreviated as DMT, which originates from the plant Psychotria viridis. DMT also occurs as the primary psychoactive alkaloid in several other plants and is found as a minor alkaloid in bark, pods, and beans of the Anadenanthera peregrina and Anadenanthera colubrina trees used to make Yopo and Vilca snuff. Some indigenous peoples of the Orinoco basin in Colombia, Venezuela and possibly in the southern part of the Brazilian Amazon make use of yopo snuff for spiritual healing. Psilocin and its precursor psilocybin, an active chemical in many psilocybin mushrooms, are structurally similar to DMT.³

When administered by itself, DMT is rapidly metabolized and does not produce hallucinogenic effects unless the dose exceeds the body’s metabolizing capacity. However, when this plant is mixed with a second plant Banisteriopsis caapi, an enzyme contained in the Banisteriopsis plant (monoamine oxidase inhibitor, MAOI) prevents the body from breaking it down. The combination of these two plants creates ayahuasca. Other plant combinations can also create similar psychoactive brews. The compound DMT is widely found naturally in both plants and mammals with studies suggesting its presence in the human brain, blood and cerebrospinal fluid⁴ as well as in the pineal gland of rats.⁵ The function of this endogenous DMT is not known, but one may speculate that it plays a role in spontaneous hallucinations, or otherworldly spiritual experiences.

The neurophysiologic mechanism of ayahuasca remains a mystery. Ayahuasca’s role in addiction therapy may come from its effects on dopamine and serotonin release on the brain’s mesolimbic pathways as well as balancing the neurotransmitters associated with withdrawal and reinforcement of addiction.⁶ It is also thought that ayahuasca may alter the synaptic connections of neurons, a phenomenon known as neuroplasticity. These neuroplastic changes may help facilitate the rewiring of the brain’s reward pathway.⁷

DMT naturally occurs in many plant species. Ayahuasca gained popularity in Western culture with the Beat writers of the 1960s. Most notably, William Burroughs chronicles his experiences with the ancient medicine in his book The Yage Letters. Recently, there has been an increasing popularity drawing people from around the world to the Amazon to partake in ayahuasca rituals for therapeutic and spiritual purposes.⁸ People report seeking such a medicine for personal growth, emotional healing, improved insight as well as contact with the sacred. Ayahuasca allows for an introspective, ethereal experience that can be autobiographical in nature and allow for innate inner healing.

Brazilian syncretic churches of União do Vegetal and Santa Daime have been using ayahuasca within the context of religious practice since 1987. Studies show that adolescents who voluntarily consumed ayahuasca in a ceremonial capacity with their parents showed less anxiety with more self-confidence, optimism and emotional maturity than their peers. Individuals also appear to respond with less anxiety in panic-inducing environments.⁹ It should be noted that the prolonged social contact in ayahuasca based treatments form a social support that is integral for healing. It is important to note that a social support is necessary for integration after to help manage daily stress and allow for a long-lasting sense of belonging that encourages meaningful change.

There is growing scientific interest in therapeutic uses of ayahuasca for the treatment of addiction. Therapists who use ayahuasca suggest the medicine allows for processing of previously suppressed emotions while supporting introspection to allow for the awareness and impact of the addiction.¹⁰ It is thought that this medicine allows for blunting of the internal ego defenses allowing unconscious material to enter consciousness making them available for integration. Victims of abuse and addiction report ayahuasca allows for a recovery of inaccessible memories of trauma that they can subsequently work through, allowing for catharsis.¹¹ It is thought that addiction may be a coping mechanism for unresolved and unprocessed trauma. Ayahuasca is thought to catalyze the healing of the underlying trauma and resolve the addiction coping mechanism.¹² Many participants taking ayahuasca for addiction treatment note ayahuasca produces visions of one dying as a consequence of drug use which then motivate radical change in behavior and lifestyle.¹³

More rigorous scientific research is required to further understand ayahuasca. Pharmaceutical companies cannot patent the natural form of these plant medicines, and therefore do not have any financial incentive to study them. There are no doubt significant therapeutic possibilities with ayahuasca. Evidence-based medicine not only looks at research studies but also the myriad of clinical expertise and best available clinical evidence to aid an individual- all of which suggest a great potential in healing with this medicine when administered by experienced therapists and healers. When we look at the significant suffering and mortality associated with addiction, we must look at all potential avenues of treatment including ayahuasca. Scientific studies are important but not the only element required to unlock the potential benefits of this psychedelic medicine- public policy, education and our mindsets will need to expand to allow for this potential paradigm shift.

References

1. Luna L. E. (2011). “Indigenous and mestizo use of ayahuasca: an overview,” in The Ethnopharmacology of Ayahuasca ed. dos Santos R. G. (Kerala: Transworld Research Network; 1–21.
2. Luna L. E. (1986). Vegetalismo: Shamanism Among the Mestizo Population of the Peruvian Amazon. Stockholm: Almqvist and Wiksell International
3. Ott. J. Psychoactive Drugs 33:273-281, 2001
4. Endogenous hallucinogens as ligands of the trace amine receptors: a possible role in sensory perception.Wallach JV Med Hypotheses. 2009 Jan; 72(1):91-4.
5. LC/MS/MS analysis of the endogenous dimethyltryptamine hallucinogens, their precursors, and major metabolites in rat pineal gland microdialysate. Barker SA, Borjigin J, Lomnicka I, Strassman R Biomed Chromatogr. 2013 Dec; 27(12):1690-700.
6. Effects of ayahuasca on the development of ethanol-induced behavioral sensitization and on a post-sensitization treatment in mice. Oliveira-Lima AJ, Santos R, Hollais AW, Gerardi-Junior CA, Baldaia MA, Wuo-Silva R, Yokoyama TS, Costa JL, Malpezzi-Marinho EL, Ribeiro-Barbosa PC, Berro LF, Frussa-Filho R, Marinho EA Physiol Behav. 2015 Apr 1; 142():28-36.
7. Prickett J., Liester M. (2014). “Hypotheses regarding ayahuasca’s potential mechanisms of action in the treatment of addiction,” in The Therapeutic Use of Ayahuasca eds Labate B., Cavnar C. (Berlin, Germany: Springer-Verlag; ) 111–132.
8. Drug tourism or spiritual healing? Ayahuasca seekers in Amazonia. Winkelman M J Psychoactive Drugs. 2005 Jun; 37(2):209-18.
9. Ayahuasca in adolescence: a preliminary psychiatric assessment. Da Silveira DX, Grob CS, de Rios MD, Lopez E, Alonso LK, Tacla C, Doering-Silveira E J Psychoactive Drugs. 2005 Jun; 37(2):129-33.
10. Exploring the therapeutic potential of Ayahuasca: acute intake increases mindfulness-related capacities. Soler J, Elices M, Franquesa A, Barker S, Friedlander P, Feilding A, Pascual JC, Riba J Psychopharmacology (Berl). 2016 Mar; 233(5):823-9.
11. Loizaga-Velder A., Pazzi L. A. (2014). “Therapist and patient perspectives on ayahuasca-assisted treatment for substance dependence,” in The Therapeutic Use of Ayahuasca eds Labate B., Cavnar C. (Berlin: Springer-Verlag; ) 133–152.
12. Therapeutic effects of ritual ayahuasca use in the treatment of substance dependence–qualitative results. Loizaga-Velder A, Verres R J Psychoactive Drugs. 2014 Jan-Mar; 46(1):63-72.
13. Mabit J. (2007). “Ayahuasca in the treatment of addictions,” Psychedelic Medicine New Evidence for Hallucinogenic Substances as Treatments Vol. 2 eds Winkelman M. J., Roberts T. B. (Westport, CT: Praeger Publishers; ) 87–103.

Sarah Abedi, MD is an emergency medicine doctor practicing in Southern California. She completed her medical school at UC Irvine and finished her emergency medicine residency at Harbor UCLA. Her medical interests lie in the science of disease prevention which motivated her to create The Hidden Body Podcast.