Incident report

This was our second full ayahuasca ceremony. We set up outside this time, in a small sheltered area away from the house. Our shaman Rama offered us one of two mixtures of ayahuasca to choose from, one of which was said to be more visual than the other. Most of us chose this one.

The ceremony itself was fairly relaxed. Our shaman Rama sung and played from a variety of acoustic instruments he had brought along, which I found quite interesting to listen to on the ayahuasca – rather interesting spatial audio effects, whereby the perceived precision of the sound’s location would increase, but the sound itself would often be placed in an incorrect location. One of many curious phenomena I will no doubt never find the time to investigate to my satisfaction.

At some point I judged that I was ready to get up and walk from the place outside where we were holding the ceremony, back into the house where the psychophysics experiments were set up. I recall that I suddenly felt quite wobbly and drunk. This was rather unusual, because I typically find that DMT makes my sense of movement feel incredibly precise and well-coordinated.

I sat down at one of the computers and prepared to look through the psychophysics stimuli, but I really did feel that something was off. I had an overwhelming urge to go and lie down somewhere – but I ignored this, and instead I sat down next to Andrés at the kitchen table. I related that I wasn’t feeling so good, and asked if he would help take my blood pressure.

The first reading was really high – 216/152 – and I don’t really remember what happened next. I am told that somebody gave me a hug, and this prompted me to collapse at the table; when my head was raised I was not breathing. I spent under a minute like this before I started breathing again.

When I awoke, I had a pulse oximeter on my left index finger and Andrés had Hunter Meyer – QRI’s Director of Operations – on the phone. I understood that Hunter was in touch with the retreat owner, who had arranged to have a water taxi on standby in case my situation got worse. I will note that Andrés was also on ayahuasca, but he immediately adopted an incredibly professional demeanour – sitting with me from 7 p.m. to 1:30 a.m., monitoring my vital signs until they returned to normal. I asked later if he had any experience with crisis management and I was surprised to find that this was the first time he’d had to deal with anything of this nature – he kept his cool well.

Those around me had noticed that I kept forgetting to breathe and that my blood oxygen levels kept dipping. I asked if someone could find a metronome app on their phone for me to which I could synchronise my breathing, and the sedate tick-tock sound provided a sonic background to the evening.

The DMT was exceptionally kind to me, given the circumstances. I found myself totally unconcerned about what was going on – I had exactly one job to do, which was to keep breathing. I sat upright and incredibly still, and for most of the evening I inhabited a very small and cozy realm populated by simple tiling patterns – periodically interrupted by the process of taking my vital signs.

We remained confused by the initial blood pressure reading, which was extremely high – likely indicating a hypertensive crisis, which we knew to be a primary risk of ayahuasca. However, subsequent readings were quite low, more consistent with fainting. It’s likely that I was simply not holding my arm high enough when that reading was taken. Andrés was later able to replicate such high readings with the same device by holding his arm in an incorrect position while taking a reading.

My vital signs returned to normal over the course of the evening, and some time after we were confident I could breathe unassisted, I retired to my hammock, wearing the pulse oximeter. I woke up in the morning with the sun shining and my blood oxygen reading a solid 98%, and so I went for my morning swim. Later that day I worked through a few pages of my electrodynamics textbook – enough to reassure myself that I did not feel cognitively impaired.

Possible causes

We remain unsure as to what might have caused my adverse reaction to the ayahuasca. I had been diligent about following the low-tyramine diet beforehand, so I don’t think it was related to something I’d eaten. We have considered that it may have been one or all of the following factors:

MAOIs

Our shaman may have mixed a dose of ayahuasca with unusually high MAOI content. We were told that one of the brews was intended to be more visual, which would perhaps suggest a lower MAOI dose; but most participants noted it was not actually that visual – so it’s possible that he mixed up the batches, or just didn’t know what he was doing.

Nicotine

I’m pretty dependent upon nicotine, and I’d chewed nicotine gum during the ceremony so as not to disrupt proceedings by vaping – my preferred method of ingestion. A little while before I got up, I’d swallowed my gum, anticipating that I could soon switch back to using my vape. Perhaps this could have dumped a large quantity of nicotine into my system all at once?

Pregabalin

I am prescribed pregabalin for anxiety, and took my regular 150 mg dose around two hours prior to the ceremony. In hindsight, I think this would have been totally unnecessary; the MAOIs provide ample anxiolytic effects on their own.

Prior to the retreat, the Qualia Research Institute had been quite thorough about asking participants to ensure any medication they were taking would be compatible with ayahuasca. Personally, I’d not been able to find any information about whether or not pregabalin might interact with ayahuasca – but perhaps I’m one of the first to write about it online?

I’d taken my usual dose before the previous sessions and had not noticed any issues. I also do not normally find that pregabalin acts as a respiratory depressant.

Personal risk

I felt we’d done most things right – ramping up dosage slowly, hoping to catch any such reactions early, but I think this caution may have been negated by the fact the shaman changed his recipe on us.

In hindsight it seemed that our shaman was quite young and inexperienced. I think it’s also likely that the process by which he mixed his brew was fairly arbitrary, and that I’d received a significantly higher dose of MAOIs that evening compared to previous ceremonies.

I knew full well beforehand that I was participating in an unproven exercise; but one which carried similar risks to other ayahuasca retreats. Many thousands of people attend such retreats each year, of which around 2.3% have adverse physical health effects requiring medical attention.

After these events, Andrés and Hunter decided that we would not hold any more ayahuasca ceremonies at the house for the remainder of the retreat. One other person elected to pursue a tobacco ceremony outside the house.