Safety above all: Medical contraindications and the ethics of ceremonies

Working with expanded states of consciousness through deep immersion into the experience provided by Ayahuasca requires from organizers and participants a level of responsibility comparable to aviation safety or high-tech medicine. In the context of the premium SACRUNA retreat, safety ceases to be merely a formal requirement and becomes the foundation of trust. For a person accustomed to controlling their life and business processes, transferring this control into the hands of facilitators is possible only in the presence of impeccable risk-minimization protocols. This material is intended to examine in detail the medical and ethical aspects that distinguish a professional approach from amateurism.

Biological Foundation: Pharmacology and Physiology

Ayahuasca is not merely a plant; it is an extremely complex biochemical cocktail. Its primary mechanism of action is based on the interaction of the alkaloids harmine, harmaline, and tetrahydroharmine, which are monoamine oxidase inhibitors (MAOIs), and dimethyltryptamine (DMT). Monoamine oxidase is an enzyme in our body that breaks down certain neurotransmitters and tyramine. When this enzyme is inhibited, DMT gains the ability to enter the bloodstream and cross the blood-brain barrier.

From a medical perspective, this process causes temporary but significant changes in the functioning of the body. Blood pressure increases, heart rate accelerates, and deep brain structures become activated. For this reason, the first and primary stage at SACRUNA is medical screening.

Cardiovascular System

Any serious heart condition is an absolute contraindication. Severe-stage hypertension, a history of stroke, structural heart defects, or arrhythmia may lead to critical complications at the moment of peak physiological load during the ceremony. We consider each case individually, but priority is always given to the preservation of life and health rather than to obtaining the experience at any cost.

Pharmacological Incompatibility

This is a critical section in which there is no room for compromise. The most dangerous risk is associated with serotonin syndrome—a potentially lethal condition that arises when Ayahuasca is combined with antidepressants from the SSRI group (selective serotonin reuptake inhibitors). Since Ayahuasca itself sharply increases serotonin levels, additional external stimulation leads to receptor overload, resulting in seizures, hyperthermia, and multi-organ failure.

The list of incompatible medications includes:

Antidepressants of all types. Medications for ADHD and amphetamine-based stimulants. Certain cough and cold remedies containing dextromethorphan. Weight-loss and appetite-suppressant drugs. A number of antipsychotics and sedative-hypnotics.

Such medications must be fully discontinued several weeks prior to the retreat and strictly under the supervision of the prescribing physician. Concealing the fact of medication use constitutes a gross violation of ethics and a direct threat to participant safety.

Mental Health: The Limits of Admissibility

Ayahuasca has a unique capacity to bring repressed material from the subconscious to the surface. For a healthy psyche, this is a therapeutic process leading to catharsis. However, for individuals predisposed to psychotic states, it may act as a trigger for irreversible changes.

Psychiatric Contraindications

Individuals suffering from schizophrenia, bipolar affective disorder (in the manic phase), or borderline personality disorder are in a high-risk category. Deep immersion may provoke prolonged psychosis, from which it is extremely difficult to emerge without pharmacological intervention. At SACRUNA, we adhere to a conservative approach: if there is a risk of psychological destabilization, we decline participation. True assistance in such cases lies not in offering Ayahuasca, but in referring the individual to specialized professionals.

Psychological Readiness and Personality Structure

Safety is not only the absence of illness, but also the presence of sufficient internal resources to process the experience. We assess the psychological stability of each guest. If a person is in a state of acute grief or deep clinical depression, the group retreat format may be premature. We seek a balance between the necessity of transformation and the psyche’s capacity to withstand that transformation.

The Ethics of the Facilitator: Power and Responsibility

A ceremony is a space of extreme vulnerability. The participant temporarily loses habitual defense mechanisms, and at that moment the facilitator’s personality becomes the sole guarantor of safety. At SACRUNA, the facilitator’s ethical code is based on several fundamental principles.

Absence of Sexualization and Physical Boundaries

Any sexual undertones, flirtation, or violation of personal boundaries during the retreat constitute a gross breach of professional ethics. The facilitator is not a guru, not a deity, and not an object of desire. They are the technical and spiritual guardian of the process. We maintain strict boundaries, providing support through presence, music, and only minimal physical contact when assistance is required.

The Problem of Spiritual Ego

One of the shadow aspects of working with Ayahuasca is the development of spiritual narcissism among facilitators. When a person observes others undergoing transformation in their presence, there is a temptation to attribute this power to oneself. At SACRUNA, we cultivate an approach in which the facilitator remains merely an instrument. We do not impose interpretations of guests’ visions, do not construct personality cults, and do not use manipulative persuasion techniques. We respect the autonomy of each participant.

Confidentiality as the Highest Priority

For entrepreneurs and public figures, the risk of reputational damage may be as significant as physical risk. SACRUNA’s ethical standards guarantee that everything that occurs within the ceremonial space remains within that space. We do not use personal guest stories for marketing purposes without explicit consent and ensure maximum privacy at all stages of their stay in Spain.

Diet as a Tool of Safety

Many mistakenly perceive the pre-retreat diet as a religious fast or a ritual cleansing of karma. In reality, the diet is pure biology. The exclusion of tyramine-rich foods (aged cheeses, red wine, smoked meats, fermented products) is necessary due to the previously mentioned inhibition of the MAO enzyme. Excess tyramine when MAO is inactive causes a sharp spike in blood pressure and severe headache, turning a spiritual journey into physical suffering.

We also insist on the exclusion of alcohol and psychoactive substances for at least two weeks prior to the retreat. This is necessary so that the nervous system returns to equilibrium and is prepared to perceive the subtle signals provided by Ayahuasca. Receptor clarity directly influences the quality and depth of the experience obtained.

Integration as the Final Stage of Safety

Safety does not end at the moment the ceremony is closed. The most vulnerable period is the first few days after returning to the familiar social environment. The psyche remains open, emotions are heightened, and old behavioral patterns may begin to feel alien.

It is the ethical duty of the organizers to provide support during this period. We do not leave the guest alone with their insights. At SACRUNA, integration sessions are provided, during which we help translate the metaphorical experience of Ayahuasca into the language of concrete life decisions. This prevents the emergence of an existential crisis and helps avoid impulsive actions in an altered state.

Criteria for Choosing a Safe Space

For those seeking an encounter with Ayahuasca, we recommend paying attention to the following markers of safety and ethics:

The presence of a detailed medical questionnaire. If you are not asked about medications and cardiac condition—leave. Team transparency. You must know who will conduct the ceremony, what experience these individuals have, and what ethical principles they follow. Facilitator-to-participant ratio. A safe format assumes no more than 4–5 guests per facilitator. Absence of pressure. If you are being told that Ayahuasca is necessary for everyone without exception, this is a sign of commercial interest rather than concern for well-being.

Our Approach

At SACRUNA, we have chosen the path of maximum transparency and strictness in matters of safety. We believe that only in a space where all risks are calculated and boundaries are clearly defined can a person truly relax and allow deep transformation. The premium nature of our retreat lies, first and foremost, in the level of responsibility we assume for every life entrusted to us along this path.