Ayahuasca and Public Health: Health Status, Psychosocial Well-Being, Lifestyle, and Coping Strategies in a Large Sample of Ritual Ayahuasca Users

Ayahuasca is a traditional Amazonian decoction typically combining Banisteriopsis caapi with plants that contain N,N-dimethyltryptamine (DMT); its use has spread from indigenous and Brazilian religious settings into diverse international contexts. Earlier research has examined clinical trials of serotonergic psychedelics and population-level survey data, and some naturalistic comparisons of ritual users versus non-users have suggested better outcomes on certain neuropsychological and psychopathological measures. However, there has been little work using public-health indicators to assess the broader bio-psychosocial status of long-term ritual ayahuasca users outside clinical trials. Ona and colleagues set out to address that gap by conducting a face-to-face assessment of long-term ritual ayahuasca users in Spain using a self-administered questionnaire built from standard psychometric instruments and public-health survey indicators. The aim was to describe health status, psychosocial well-being, lifestyle, coping strategies, and personal values in this population and to compare key indicators with Spanish normative data, while also exploring associations with frequency of ayahuasca use, type of ceremony, and gender.

This was a cross-sectional, naturalistic assessment conducted over a six-month period in locations across Spain where ayahuasca ceremonies occurred. Inclusion required at least six months' ritual communitarian ayahuasca use; exclusion criteria were age under 18 and clinical suspicion of a neurocognitive disorder. The investigators collaborated with ICEERS to engage ceremony leaders and approached participants who planned to attend Santo Daime or neo‑shamanic rituals. Data collection involved a bespoke questionnaire assembled from items drawn from established psychometric scales and health surveys. The instrument covered eight dimensions: General Health (self-perceived health, BMI, chronic disease, physical limitation, sleep, cholesterol/blood pressure, medical/psychology visits, prescription-drug use), Lifestyle (physical activity, transport mode, diet), Positive Mental Health (e.g. meditation/yoga, feeling loved, vital goals, autonomy, happiness), Adjustment (selected items from the Bell Adjustment Inventory), Coping Strategies (items from the CSI and COPE), Cultural Activities and Reading, Social Support (number of close friends/family, availability of companions for medical visits and emotional sharing), and Personal Values (Engaged Living Scale with Valued Living and Life Fulfilment subscales). The General Health Questionnaire-12 (GHQ-12) was also administered as an independent mental-health measure. Questionnaires were completed face-to-face, prior to ceremonies, with trained psychologists or anthropologists obtaining informed consent; procedures received approval from the Universidad Autónoma de Madrid ethics committee. For analysis, descriptive statistics were presented and selected indicators were compared with Spanish normative data from recent health surveys. The multivariate General Linear Model (GLM) tested differences by number of ayahuasca uses, ceremony type (Santo Daime vs neo‑shamanic), and gender, with effect sizes (Cohen's d) calculated. A stepwise linear regression examined predictors of GHQ-12 scores. Significance was set at p < .05 with Bonferroni correction; IBM SPSS v21.0 and an online effect-size calculator were used.

A total of 380 long-term ritual ayahuasca users completed the questionnaire; 47% were women, mean age was 44 years (SD = 10), and 32.5% reported membership of Santo Daime communities. Lifetime frequency of ayahuasca use varied: 34.2% had used it one to 10 times, and 29.7% reported more than 100 lifetime uses. In the previous six months the modal use was one to two times (38%), with 9.3% reporting more than 20 uses; the mean fell between three and five uses. Regarding subjective impact, 67% described ayahuasca's influence on their life as "very positive," 30.7% as "positive," and 1.7% as "no influence;" no participants reported a negative influence. Nearly half (49.7%) had used drugs other than ayahuasca in the prior six months, most commonly cannabis (31%), followed by MDMA (11%), psilocybin mushrooms (7.1%), and San Pedro cactus (7.1%). On general health indicators, 96.6% rated their health as good, very good, or excellent. Mean BMI was 22.6 (SD = 4.1), within the Spanish normal range. Only 7.4% had been told by a professional they had high cholesterol or blood pressure, a proportion lower than national figures reported by the authors. Nearly half (47.5%) did not visit a doctor in the previous six months and 47% visited one to three times; 81% had not visited a psychologist or psychiatrist in that period. More than half reported reducing use of medical services (53.5%) and mental-health services (57.3%) since using ayahuasca, and 56% reported a reduction in prescription-drug use. Regarding prescription medication in the prior six months, 57.2% reported no use, 39.6% used fewer than five drugs, and 3.2% used more than five. Lifestyle data showed 45.4% considered themselves less physically active than they wished. Modes of transport to work were: private vehicle 36%, walking 32.8%, bicycling 14%, and public transport 12.8%. Sleep problems in recent weeks were reported by 31.2%. Dietary attention was high, with 88.4% attempting healthier eating; 73% consumed one to three daily servings of fruit and 60% consumed one to three daily servings of vegetables. Measures of positive mental health were also high: 86.3% practised meditation or yoga, 98.2% reported having someone who loved them, 97% reported having vital goals, 92.6% reported personal autonomy, and 90.4% reported being quite to immensely happy (43.7% "quite happy," 39.2% "very happy," 7.5% "immensely happy"). On adjustment items the mean score was 3.4 (SD = 0.7) with only 5.3% scoring at levels interpreted as poor adjustment. Coping strategy items yielded a mean of 9.3 (SD = 1.8), with 1.1% scoring five or less and 45% scoring 10 or more. Cultural engagement was reported by 38%–42.5% and 86.2% had read one or more books in the prior six months. Social support indicators were strong: only 2% reported having no close friends or family, 39.4% reported four to six close contacts, and 22% reported 10 or more; 96.3% had someone to accompany them to medical visits, 97% had someone expressing affection, 96.8% could share feelings of joy or sadness, and 96.6% had someone with whom to share private fears and worries. On the Engaged Living Scale, Valued Living mean was 42.6 (SD = 4.6), Life Fulfilment mean was 24.4 (SD = 3), and total engaged-living mean was 67 (SD = 10), with 30% scoring above 70. The GHQ-12 mean was 1.3 (SD = 2.3), and 82.7% scored three or less. Multivariate GLM analyses showed no significant differences by number of lifetime ayahuasca uses overall; those reporting more than 100 uses differed primarily by being older and scoring higher on personal values measures. Participants in Santo Daime ceremonies had fewer mental-health visits in the prior six months than neo‑shamanic participants. Stepwise linear regression identified Valued Living, Engaged Living, and Self-Perceived Health Status as predictors of GHQ-12 scores.

Ona and colleagues interpret these findings as the first large-scale, public-health‑oriented snapshot of long-term ritual ayahuasca users in Spain. The participants overwhelmingly described the ayahuasca experience as positive and, on many indicators, compared favourably with Spanish normative data: high rates of positive self-rated health, normal mean BMI, lower reported high cholesterol and hypertension, lower prevalence of chronic disease and physical limitations, healthier dietary habits, and strong social support measures. The GHQ-12 distribution was similar to national norms overall, although women in this sample reportedly had better mental-health scores than Spanish population norms. The authors note that prevalence of recent use of other psychoactive drugs in their sample was higher than in the general population (except for alcohol), a result they suggest may reflect the inclusion of non-religious ritual participants; earlier studies that found lower concurrent drug use tended to sample members of ayahuasca religions, where doctrine may discourage other drug use. Despite that higher prevalence, the sample's drug use consisted mainly of cannabis and psychedelics, which the authors characterise as generally associated with less social and physical harm than substances such as alcohol or heroin. Regarding associations, sustained high-frequency participation (>100 lifetime uses) was linked to higher scores on personal values and older age, which the authors interpret as possible reinforcement of values through ongoing involvement in communities that endorse those values. Santo Daime members appeared to use mental-health services less often than neo‑shamanic participants, potentially reflecting doctrinal emphasis on spirituality and healing. The regression analysis indicated that Valued Living, Engaged Living, and Self-Perceived Health Status—rather than ayahuasca use per se—predicted GHQ-12 scores, suggesting personal values and perceived health are important correlates of mental-health status in this group. Key limitations are acknowledged: the self-selected sample may over-represent individuals who derive benefit from ayahuasca and therefore could understate risks; no sample-size calculation was performed; the sample was not stratified by gender or region and thus may not be representative (for example, health-sector workers were over-represented and most participants lived in Catalonia); and national prevalence of ayahuasca use is unknown because national drug surveys do not include it. The investigators caution that these cross-sectional data cannot establish causality and that participants might have had similar profiles prior to starting ayahuasca. Their principal conclusion is cautious: ritual, communal use of ayahuasca in respectful and controlled settings is not associated in this sample with adverse adjustment or poor physical or psychological health, and may be compatible with beneficial public-health indicators; they call for further studies with more representative samples using health indicators to clarify these relationships.