Purging to Cleanse: A Qualitative Study of Ayahuasca Healing at a Drug Treatment Center in Peru.

OBJECTIVE: Ayahuasca, an entheogen from the Amazon rainforest, has garnered growing interest for treating substance dependence. To date, there is little research concerning the act of ayahuasca-related purging (mainly vomiting), which is considered to be central to healing during ayahuasca rituals. This study explored practitioner perspectives on purging during ayahuasca rituals at the Takiwasi Center in Peru. METHOD: We conducted in-depth interviews with curanderos (healers), plant preparers, and psychotherapists (N = 11) at the Takiwasi Center between August and October 2021. Interviews were conducted and transcribed in Spanish. Interviews were analyzed using a thematic analysis approach. RESULTS: Participants described purging as a fluid concept that went beyond the act of vomiting. Participant narratives around purging were organized into three central themes or accounts: spiritual-oriented, which highlighted the relationship between purging and spiritual development; Amazonian-oriented, which emphasized purging as a cathartic expulsion of embodied cargas (loads) that are perceived to lead to sickness; and clinical-oriented, which stressed that purging generates a range of empirically observable therapeutic benefits. All of these explanatory models emphasized the pivotal interconnection between purging and healing during ayahuasca-assisted treatment for substance dependence at Takiwasi. CONCLUSIONS: This study highlights practitioner perspectives on purging at the Takiwasi Center, who offer three main explanatory models for this aspect of healing during ayahuasca-assisted therapy for substance dependence. This research contributes to the limited literature on the role of purging in ayahuasca-related healing, which may inform further investigation into differential understandings of the role of purging for therapeutic benefits.

Administration of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) among high school students in the Peruvian Amazon.

This article reports on results of the administration of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to 500 high school students (aged 16-19) in the Peruvian Amazon. Results indicate 68.6% of the sample reported consumption of alcohol in the past three months. One out of four students reported high risk involvement with at least one substance while 1 out of 3 reported moderate risk. This is one of the few instances in which ASSIST was administered to adolescents and offers possibilities for further reflection on drug use at early ages.

Traditional Use of Banisteriopsis caapi Alone and Its Application in a Context of Drug Addiction Therapy.

Takiwasi is a therapeutic community for the treatment of Substance Use Disorders (SUDs) that combines traditional Amazonian medicine (TAM) with modern psychotherapy. One of the plant medicines from TAM used in this protocol is purgahuasca. It is a decoction of the vine Banisteriopsis caapi alone, whose use is traditional among the Awajún and other ethnic groups in Peru. The research began with a field trip to Awajún territory to explore the indigenous use of purgahuasca as an initiation rite. Then, analysis of its application was conducted in the clinical context of Takiwasi. Open-ended and semi-structured interviews with Awajún informants and Takiwasi's therapeutic staff were performed and analyzed following the narrative methodological approach. Further clinical data on the ingestion of purgahuasca by Takiwasi's SUD patients were obtained from the internal repository. These indicate that 359 (92.1%) patients reported having had the so-called mareación (dizziness), 299 (76.7%) experienced physical sensations, and 208 (53.3%) had visions. These effects can be related to the psychoactivity of ß-Carbolines alkaloids from B. caapi, a medicinal plant that seems to have potential benefits also for SUD, especially giving a key contribution to the patients' therapeutic process of becoming aware of the personal reasons behind addictive behaviors.

Implementation of Nagoya Protocol on access and benefit-sharing in Peru: Implications for researchers.

ETHNOPHARMACOLOGICAL RELEVANCE: The Peruvian Amazon holds more than 1000 plant species with commercial potential and the national sales of natural products derived from medicinal and aromatic plants have exceeded $ 400 million per year. Research and development activities carried out on the genetic and biochemical composition of Peruvian flora have to abide by national and international regulations, such as the Nagoya Protocol (NP). AIM OF THE STUDY: The aim of this paper is to describe the implications of the current implementation of the NP in Peru for performing research on national genetic resources. MATERIALS AND METHODS: A review of the current legal framework and status of the NP in Peru was performed accompanied by first-hand experience undertaken by submitting a request for access to genetic resources related to wild continental species. RESULTS: So far, Peru has issued 16 Internationally Recognized Certificates of Compliance (IRCCs) through 2 of the identified National Authorities. Some of the difficulties and challenges observed have to do with the degree of effective implementation of the Access and Benefit-Sharing (ABS) system, the fact that the application process is not sufficiently clear, and the wide gap between this formal system and what occurs informally outside of it. In response to this, training and implementation projects have been launched and a new law on the access to genetic resources has been proposed. CONCLUSIONS: The difficulties observed still represent an obstacle to scientific research and the development of new commercial products based on Peruvian traditional knowledge and genetic resources. Although improvements have been made to the ABS framework, there remain major challenges to encouraging and ascertaining the equitable and sustainable use of Peru's biodiversity.

Evaluating herbal medicine preparation from a traditional perspective: insights from an ethnopharmaceutical survey in the Peruvian Amazon.

The field of medical ethnobotany has historically contributed to the advancement of modern pharmaceutical and biomedical science through bringing discoveries from the field into the laboratory. In ethnopharmacology, a sub-field of ethnobotany, there is a concerning lack of ethnographic methods reported in the literature. The ethnographic approach is essential for detailing traditional methods of preparation and administration of plant medicines, yet pharmaceutical researchers overemphasize western epistemologies of medicinal discovery and production. In the present work, we propose an ethnopharmaceutical survey as a model to investigate the culturally recognized standards necessary for the formulation of herbal medicines. Fieldwork based on participant observation and semi-structured interviews examined the modes of preparation employed by traditional healers in the Amazonian region of San Martín, Peru. The authors draw on anthropological insight into plural epistemological encounters and propose an ethnopharmaceutical approach that takes seriously the Amazonian methods and perceptions for the preparation of traditional plant medicines.

Uso de tecnologías de la información en la gestión de un centro de medicina integrativa especializado en adicciones / Use of information technologies in the management of an integrative medicine center specialized in drug-addiction

Objetivo. Describir el perfil de usuarios, pacientes atendidos y tratamientos brindados en el Centro Takiwasi por medio del sistema de información PPLUS, entre los años 2013-2018. Materiales y métodos. Estudio descriptivo. De acuerdo con los objetivos bajo los cuales el sistema PPLUS ha sido concebido, se recolectó información sobre la cantidad de registros, número de usuarios del sistema, áreas involucradas, modalidad de egreso de la comunidad terapéutica, prácticas de medicina tradicional amazónica, uso de los módulos del sistema, y perfiles de usuarios por fines de investigación. Resultados. Se encontró una tendencia irregular de registros de información, siendo registrado el pico máximo en el año 2016. Ciento ochenta y ocho pacientes egresaron de la comunidad terapéutica, de los cuales el 45,2% (85) recibió alta médica. Entre el 54,8% de los pacientes de Takiwasi que no terminaron el tratamiento, un 33,5% no lo hicieron por solicitar retiro voluntario, en su mayoría durante el primer mes de tratamiento. Se registraron 19 620 prácticas de medicina tradicional amazónica, de las cuales las sesiones de ayahuasca representaron el 36,1% y las sesiones de purga, el 39,1%. Se observó que el 46,5% de perfiles de investigación correspondieron a practicantes de psicología, mientras que el 29,8% (34) fueron investigadores externos. Conclusiones. La implementación y uso del sistema PPLUS en el Centro Takiwasi, durante los años 2013 a 2018, ha sido gradual, pero no lineal; sin embargo, la información obtenida y la capacitación del personal en su uso hacen que se convierta en una herramienta tecnológica con potencial para la investigación y desarrollo a corto plazo.

Objective. To describe the profile of users, patients treated, and treatments provided at the Takiwasi Center, through the PPLUS information system, between the years 2013-2018. Materials and methods. A descriptive study. According to the objectives under which the PPLUS system has been conceived, information was collected on the number of registries, system users, areas involved, modality of clinical discharge, practices of traditional Amazonian medicine, use of system modules, and user profiles for research purposes. Results. An irregular trend of information registers was found, with the maximum peak recorded in 2016. 188 patients were discharged from the therapeutic community, of which 45.2% of them (85) received medical discharge. Among 54.8% of Takiwasi patients who did not complete the treatment, 33.5% requested voluntary withdrawal, mostly during the first month of treatment. 19620 practices of traditional Amazonian medicine have been recorded, of which ayahuasca sessions represented 36.1% and purge sessions, 39.1%. It was observed that 46,5% of research profiles corresponded to psychology practitioners, while 29.8% (34) were external researchers. Conclusions. The implementation and use of the PPLUS system at the Takiwasi Center, during the years 2013 to 2018, has been gradual but not linear; However, the information obtained and the training of personnel in its use make it a technological tool with potential for short-term research and development.