David Londoño began thinking about safety years ago, while working in Peru. There, he witnessed numerous ayahuasca sessions that provided participants with tremendous therapeutic value. However, he also witnessed cases of people getting hurt: falls, overwhelming experiences, or individuals who arrived seeking relief from a problem and ended up with an even bigger one. That tension — between the medicine’s potential and the real risks of working with it — is the starting point for the AyaSafe documents, a set of seven resources that ICEERS is now making available to the community free of charge.
Jerónimo Mazarrasa, the project’s promoter and co-author alongside David, identifies the specific catalyst as a pattern they detected while working on a previous document commissioned by the Generalitat de Catalunya. “We realized that there is a life cycle in working with ayahuasca in non-native contexts that ranges from the process of providing information to new participants beforehand to their follow-up after the session,” he explains. “For example, first-time participants sometimes arrive with very superficial ideas or unrealistic expectations. In these cases, facilitators have to provide a lot of basic information — an introduction that, to be comprehensive, must be quite lengthy, is repeated over and over again, and is always very similar. The result is that this constant repetition of a large amount of material comes at a cost. Facilitators, sometimes in the interest of efficiency, ended up taking certain shortcuts. The result was incomplete information that sometimes left participants in situations for which they were unprepared. A fairly comprehensive document was needed that participants could read at their own pace.”
The solution they found is inspired by a model outside the ceremonial world: informed consent, as used in scientific studies involving human subjects. “First, participants are given a very comprehensive document containing all the necessary information, possible effects, and so on. Some time later, there is an interview where participants can ask questions and voice their concerns,” Jerónimo summarizes, “and after these two steps — the comprehensive document and the interview to address concerns—the person is considered to be properly informed and can then sign a consent form, which is now an informed consent.”
From the first question to integration
The AyaSafe 1 through 7 documents — available for free download under a Creative Commons license — guide participants and facilitators through the entire session, organized into three stages: before, during, and after the session.
Before the session, AyaSafe 1: Guide for New Participants provides the basic information that anyone should know to be well-informed before taking ayahuasca for the first time, and AyaSafe 2: Health Questionnaire collects the medical history needed to identify potential contraindications. This questionnaire was developed with the guidance of Dr. Rosa Giove from the Takiwasi Center and Spanish psychiatrist Jesús León, who collaborated to create a document tailored to the project’s needs. Designing this questionnaire required a constant process of editing, David recalls: “There are very comprehensive questionnaires that end up having too many questions. The problem with a multi-page document is that some people decide not to read it. They simply click ‘OK’ on everything and sign […] This defeats the purpose.” The team opted for a health questionnaire optimized to the fullest extent possible, one that respected participants’ time and privacy by removing questions that did not provide real value in terms of identifying contraindications.
With the health questionnaire already completed, the next document, AyaSafe 3: Pre-Interview Guide, helps facilitators — who do not necessarily have clinical training — to conduct a preliminary assessment and screening through an interview. “Not everyone can or should take ayahuasca. The combination of the medical questionnaire and the pre-ceremony interview should help the facilitator determine whether the participant is suitable to take ayahuasca at that time. The better the screening, the greater the safety,” summarizes Londoño, who identifies this as one of the project’s key lessons: the more time spent screening participants, the lower the chances that people with contraindications will attend the ceremony.
When a person is deemed eligible, the corresponding resource is AyaSafe 4: Personal Pact and Legal Pact. This is an innovative resource that combines two very different types of documents: an informed consent form — legally valid in Spain and drafted by lawyers — and an innovative “pact of honor.” This second document arose from a discomfort the team itself detected in the first. “The informed consent form — this document, so necessary and legally flawless — was, in spirit, quite far removed from the plants and the kind of relationships established in ceremonial circles,” Jerónimo acknowledges. Hence the need for a supplement, AyaSafe 5: The Pact of Honor — a document with no legal standing but strong symbolic value — which establishes the commitments and responsibilities of facilitators and participants. For example, in the pact, participants commit to not lying on the questionnaires, while facilitators agree to support participants as long as they need it and not to cross ethical boundaries.
Once these documents are signed, the person may participate in the ceremony, and this is where AyaSafe 5: Emergency Protocol comes into play — based on the work of Dr. Jesús León and reviewed by Rosa Giove, as well as nursing professionals with experience in ayahuasca ceremonies. It outlines the most likely physical and psychological emergencies during a ceremony and includes guidelines on how to call an ambulance if necessary, as well as a document to help emergency medical personnel understand the specific characteristics of ayahuasca.
When the session is over, the final two documents come into play: AyaSafe 6: Guide to Managing Talking Circles provides guidance on how to facilitate the sharing circles that are typically held the following day, and AyaSafe 7: Pitfalls of Integration closes the cycle with a document designed for people who accompany ayahuasca integration processes and who do not necessarily have psychological training.
Dangers rather than prescriptions
This latest document clearly illustrates the philosophy behind the entire model. In its early versions, AyaSafe 7 was a “best practices” guide for integration, but as the team iterated, they realized that this concept was misleading: “We didn’t want to create a standard for good work or best practices, because we don’t think that’s possible in a single document,” explains Mazarrasa. “What we really wanted — and that does seem possible — is to define minimum security standards.” That’s why the document doesn’t list what to do, but rather what to avoid: the most common integration mistakes, not best practices.
That same approach — focusing on what to avoid, not what to prescribe — lies behind one of the risk patterns that most concerns David: the belief that a high dose, without preparation, produces better results. “It’s like running a marathon when you haven’t gone for a run in years,” he compares. And he adds, regarding the idea — which he says is very widespread — that more quantity or more intensity equals greater healing: “That’s not true, that’s not true.”
That same spirit led to another, less intuitive adjustment. Following standard clinical practice, an informed consent form must list all possible adverse effects. With psychedelics, as the facilitators themselves warned the team, that list can have a paradoxical effect, especially on first-time and suggestible participants: describing a negative effect can actually induce it, particularly when the plant’s effects have not yet manifested in full intensity. The first version of the legal agreement, written entirely from a legal perspective, suffered from this problem: “The result was a somewhat terrifying document: everything bad that could happen to you if you take ayahuasca, and although this is 100% necessary,” Jerónimo admits, “it also creates potential new dangers.” The solution was to add, alongside the list of adverse effects — which remained intact — a parallel list of “desired” or sought-after effects, “so that the person would, in fact, be signing a genuine informed consent form, and not just a deterrent document.”
A seed, not a standard
The AyaSafe documents are part of the Dandelion model, whose name captures the project’s ambition. Mazarrasa explains the metaphor: it refers to a plant that, after blooming, releases seeds that the wind carries far away to very different types of terrain, where they germinate once again. “We wanted to create a series of resources that would be like seeds scattered to reach other places and grow there,” he summarizes. That is why the documents do not aim to establish a standard for best practices — something both authors agree is impossible to define given the diversity of contexts and traditions surrounding ayahuasca — but rather a series of starting points or basic templates with minimum requirements that each facilitator adapts to their own reality, adding or removing elements as appropriate.
From a broader perspective, Londoño clarifies that many of the risks the model seeks to prevent are specific to the non-indigenous context in which the ceremonial use of ayahuasca has become globalized. In indigenous communities where this practice is carried out in the traditional manner, he notes, the type of problem being addressed — often communal, tied to the territory or subsistence — and the type of risk being managed — primarily energetic and spiritual — differ from the challenges and needs that arise in non-Amazonian contexts and among Western participants marked by trauma, anxiety, or isolation. In his words, this involves “a different type of patient and a different type of context,” which requires resources and a different kind of support.
A model under constant update
The model, first published several years ago, has not remained static. Before its launch, it underwent a six- to eight-month validation process with a group of eight to ten facilitators, led by Londoño, who reviewed it together with doctors and ayahuasca practitioners. Today it is in its second version — with adjustments ranging from language (the term “guide” was replaced with “facilitator” in several documents) to more precise medical questions in the health questionnaire — and the team is already working on a third, more rigorous and comprehensive version.
The documents, which are provided in the online course on safety in ayahuasca ceremonies for facilitators in non-native contexts, are available for download and free modification under a Creative Commons license.
Those interested can download the seven documents of the Dandelion model for free after filling out the following form.