Evidence of health and safety in American members of a religion who use a hallucinogenic sacrament

Halpern and colleagues situate their study in the ethnobotanical and legal context of ayahuasca, a traditional South American sacramental tea containing DMT and reversible MAO inhibitors. Earlier research characterises the pharmacology and acute subjective effects of ayahuasca and reports relatively few harms when used in ritual settings; however, most published samples have been Brazilian and little systematic data exist about American members of ayahuasca religions. The authors note relevant legal developments in the United States, including an Oregon exemption and a 2006 U.S. Supreme Court ruling permitting religious importation for a related church, which together raise public-health questions about the safety and longer-term consequences of sacramental ayahuasca use in American congregations. This study therefore set out to perform an initial health and safety evaluation of active members of one Santo Daime community in the United States. The investigators aimed to collect demographic, medical, psychiatric and substance-use data, plus self-reported benefits and harms attributed to church participation, using standardised psychiatric interviews and rating scales. The study is presented as a pilot assessment intended to inform further, more definitive research rather than to establish causal claims about ayahuasca use in the wider population.

The study recruited the entire membership of an Oregon branch of the Santo Daime Church (approximately 40 people); church leadership encouraged participation. Over one week in July 2006 a research psychiatrist (JHH) assisted by a postdoctoral fellow conducted semi-structured interviews with 34 members after obtaining informed consent. Two relatively new members with minimal ceremony exposure (5 and 1 ceremonies) were excluded from analysis, leaving 32 subjects. Interviews lasted about two hours and combined a timeline-based lifetime drug-use history with a Structured Clinical Interview for DSM-IV Disorders (SCID). Standardised instruments administered included the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Symptom Checklist-90-Revised (SCL-90R), the Uplifts, Hassles, Stresses and Cognitive Failures questionnaire (UHSCF), the Wender Utah Rating Scale (WURS) for childhood ADHD symptoms, and a conduct-disorder checklist modelled on SCID-II items. A neurology-focused physical examination was also performed. Participants were asked about extent of church participation, perceived benefits and harms of ayahuasca, and what they liked least and most about the practice. Demographic information was not collected for non-participants. Statistical details reported in the extracted text are limited. The authors converted SCL-90R raw scores to T scores using normative data and used single-sample t-tests to compare participant means to population norms for the SCL-90R. Other analyses relied on descriptive reporting of diagnoses, remission status and self-reported outcomes. The study protocol received approval from the Colorado Multiple Institutional Review Board.

Thirty-two established Santo Daime members were included in the analysed sample. The group is described as a mature, generally well-educated cohort who typically joined in their early 40s and usually attend at least one prayer service per week. Nearly half were married, all but one were employed (two retired), and the physical examinations revealed no notable medical illness across the sample. When asked about perceived effects of church participation and sacramental ayahuasca, members commonly reported improvements in psychological and social domains. Tabulated counts (out of N=32) included improved general physical health (12), increased mental clarity (11), improved relationships (9), improved outlook on life (7), increased sense of purpose (6), greater spirituality (6), increased happiness/ wellbeing (5), greater self-confidence (5), calmer mood (5) and more compassion/empathy (4). Some individuals attributed improvements in chronic medical conditions to ayahuasca: three reported reduction or cessation of migraine, four reported weight loss of 20 pounds or more, and one reported resolution of asthma. Psychiatric assessment found lifetime diagnoses in 19 subjects, but current active psychiatric disorder was uncommon: only two members reported an active disorder. Specific lifetime diagnoses included single-episode major depression (5), recurrent major depression (6, four in remission, two in partial remission), simple phobia (4, two in remission, two partial remission), bulimia nervosa (3, all in remission), and post-traumatic stress disorder or panic disorder (6, all in full remission). Eight individuals reported that their remission had been induced through church participation. On rating scales, HAM-A scores did not indicate clinical anxiety and HAM-D scores were non-clinical for all but one individual (HAM-D = 19), who met SCID criteria for bipolar I disorder in partial remission and reported clinical benefit from church participation. WURS did not suggest childhood ADHD and the conduct-disorder checklist revealed no childhood conduct disorders. UHSCF responses indicated high uplift scores and low hassles/stress/cognitive-failure scores compared with referenced controls. For the SCL-90R, participants’ T scores were significantly lower than nonpatient population norms on most symptom dimensions, indicating lower self-reported symptomatology overall; the paper states two dimensions did not differ significantly. Substance-use histories were heterogeneous. Eight participants reported minimal lifetime drug exposure; the other 24 reported histories of multiple substances but, according to the authors, none described reactivation or worsening of pathological drug use since joining the church. Lifetime substance-use diagnoses among these 24 were reported as: alcohol abuse (8), alcohol dependence (5), marijuana abuse (4), marijuana dependence (3), hallucinogen abuse (3), sedative-hypnotic dependence (1), cocaine abuse (1), and stimulant abuse (1). Of these, 22 of 24 were described as being in full sustained remission; one person had marijuana dependence in partial remission and one had ongoing marijuana abuse. All five subjects with prior alcohol dependence and one with alcohol abuse characterised church participation as the turning point in their recovery. Adverse effects reported were mostly acute and transient: nausea, vomiting and unpleasant taste during ingestion, and tiredness lasting a day or two afterwards. The authors report no evidence in their data of persistent medical or psychiatric harms attributable to sacramental ayahuasca within this sample.

Halpern and colleagues interpret their findings as preliminary evidence that active members of this American Santo Daime community are physically healthy, generally mentally well, and report subjective physical and psychological benefits associated with church participation. They highlight the prominence of improved interpersonal relationships, mental clarity, life purpose and reports of recovery from prior substance problems in members’ accounts. Low anxiety and symptom scores on standardised measures are seen as possibly consistent with prior reports of acute anxiolytic effects during ceremonies and suggest these benefits might persist beyond the immediate setting. The authors situate their results within the legal and comparative-religious context, noting that ritualised sacramental use in a structured community has parallels with peyote use in the Native American Church and arguing that, in this sample, ayahuasca use in the church context met the authors’ conception of a ‘‘non-drug, sacramental use’’. They also cite prior reports of abstinence among former alcoholics in related religions to argue that structured ritual settings may merit further study as treatment adjuncts for substance problems. Several limitations are acknowledged. The sample is small, drawn from one U.S. community, and possibly affected by selection bias: about 80% participation was achieved but no data on non-participants or former members were collected. The absence of a matched control group, lack of blinded raters, and absence of prospective pre/post measures limit causal inference. The authors note the possibility that those harmed by the practice may have left the community and therefore were not captured by this study. They also suggest that a more extensive neuropsychological battery could identify deficits not apparent in their brief exam, although they reference existing evidence that ritual long-term hallucinogen use does not necessarily impair neurocognition. For future research the investigators recommend prospective designs that follow new joiners, inclusion of matched non-member controls, blinded assessments, and broader cognitive testing to address the present study’s limitations and to better evaluate claims of benefit or harm.

The authors conclude that, for this community of active Santo Daime members who agreed to be interviewed, sacramental ayahuasca use within the organised church context was associated with self-reported health and psychosocial benefits and with low levels of current psychiatric morbidity. They urge continued, collaborative research with Santo Daime congregations to provide data useful to policymakers, clinicians and prospective members. The paper emphasises that DMT’s Schedule I status in the United States was not founded on specific evidence of harm from DMT itself and suggests that structured religious settings may offer a safe context in which to learn more about potential pharmacologic benefits of such substances.