For purposes of safety and clarity participants in sessions with ayahuasca are required to sign the following consent form, describing the rights and responsibilities of participant and organizers. Ayahuasca is brewed from a combination of substances (containing amongst others a small amount of DMT, a Class A Scheduled psychotropic substance.) Traditionally prepared ayahuasca is not illegal under international law (see declaration of the INCB1) although France has Scheduled all its constituent plants. Because of this legal status those participating in this ceremony or a 1 on 1 session must be aware of the following important safety precautions:


Ingredients:


Ayahuasca contains two main ingredients, N, N- dimethyltryptamine (DMT) a psychoactive substance, Harmines and Harmalines, which have an effect on the way the human body absorbs DMT. Mono-amine oxydase inhibitors (MAOi's) increase the activity of the hallucinogen DMT, by preventing its digestion by stomach enzymes. In the combinations that we use for this ceremony they have no lasting effect. These enzymes are in the body for an important reason, since they break down other substances that can be harmful to the body, so please read the following section carefully. The materials that we use are derived from natural plant substances, according to traditional Native-American recipes. In the case of Jurema, the source material is the root bark of the mimosa hostilis (source of DMT) combined with harmines and harmalines derived from the seeds of peganum harmala (Syrian rue, an MAO inhibitor) In the case of ayahuasca we work with harmalines from the South-American plant banisteriopsis caapi, and the leaves of psychotria viridis, or diplopterys cabrerana (for DMT) There is ample information on these substances and plants all over the internet and we recommend running a search for them, on the Google search engine. MAOi's have a very subtle effect on the mind (on their own they do not produce visual effects).


Download list of MAOi interactions:


Dietary precautions:


As a dietary precaution, abstention from the following substances for three days prior, and three days after a ritual involving ayahuasca or ayahuasca analogues is mandatory:

  1. alcohol in any form

  2. blue cheeses or any fermented substances containing moulds

  3. drugs such as Ecstasy, MDMA, 2CB, Cocaine, Heroine, Amphetamines, Methadone, etc.

  4. medication such as Antibiotics

  5. Anyone who has used psychiatric medication such as anti-depressants, anti-psychotics etc., is expressly prohibited from participation, unless he is able to establish his mental health and stability, and to prove convincingly that he/she no longer uses psychiatric medication. There are dangerous contraindications for many psychiatric medications in combination with ayahuasca. Please do not fool around!


Health warning:


You are expressly forbidden to participate if there is any illness, physical or mental, without consulting the organizers of the ayahuasca ceremony. If in doubt we recommend you abstain (this does not apply to headaches common colds and menstrual cramps) Please keep in mind that ayahuasca remains active for a short while after the ceremony has been closed, we recommend that you stay the night and sleeping accommodation will be available, so that you do not have to drive, or make your way home alone.


I have read the above and agree with it: (sign)


The ayahuasca ceremony that we will perform is believed to have a powerful and therapeutic effect, therefore it is possible to have a strong reaction to the substance. We regard ayahuasca as a catalyst for this reaction, not the cause of it. ayahuasca catalyses psychic and physical material from our own biography and memories. For this reason its effect is unpredictable: some will have ecstatic experiences while others may have frightening or emotional experiences, and these effects may vary from ritual to ritual. Frightening or painful experiences are considered to be a part of the therapeutic effect, as material from the subconscious is revealed. Each participant must be aware of this possibility. The ayahuasca ceremony offers a safe environment with lots of support (setting) in which emotions may be expressed freely, and participants receive and give each other support. In order to protect both organizers and participants we wish to emphasize this agreement between organizers and participants:


Statement of intent:


I am participating voluntarily and of my own free will, in this ritual, in which ayahuasca (a known psychoactive substance) is being used. I have read the terms of this agreement, and agree to its terms. I release the organizers from any responsibility for damage to my person following the use of the substances described above, or my participation in the ceremony. I am fully responsible for the consequences of my participation, before, during and after the ceremony. I will acquaint myself with the guidelines for behavior, that will be explained to me personally, prior to my participation in the ceremony. I participate voluntarily without pressure from anyone. I understand that my payment is towards the cost of the organization of the ceremony itself, and not for the provision of any substance.

Participant:                                           Date:                                  


Place:                                                   Date of birth:                              


Address:                                               Telephone nr:


E-mail:                                                   Fee:



1  "No plants (natural materials) containing DMT are at present controlled under the 1971 Convention on Psychotropic Substances. Consequently, preparations (e.g.decoctions) made of these plants, including ayahuasca are not under international control and, therefore, not subject to any of the articles of the 1971 Convention." Herbert Schaepe, Appendix 1, letter September 13, 2001 of, Secretary of the Board. In 2004 the working group concluded that the opinion expressed by the Secretariat in 2001 on the issue should remain as it is (appendix 2, letter of May 25, 2005 of Mr. R Lousberg, member of the INCB, with appendix).

     


                 
 

Consent form:                      Download