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Joshua Wickerham is the founder of the Ethnobotanical Stewardship Council, a nonprofit organization dedicated to assuring the sustainable and safe use of traditional plants, and enriching the communities who work with them. Ellen Percival is research and outreach coordinator for the Ethnobotanical Stewardship Council.

Ayahuasca continues to gain media attention—some positive, some negative—with negative reports often focusing on the rare occasions when people come to harm. Ayahuasca is in fact broadly safe, and the long history of its ritual use, along with a growing wealth of scientific evidence, attests to this. Nevertheless, accidents do happen. Increasing and freely sharing knowledge is perhaps the most powerful way to prevent them.

The Ethnobotanical Stewardship Council is a nonprofit committed to assuring the sustainability and safe use of traditional plants like ayahuasca. We work in dialogue with communities to help develop and recognize best practices for people who work with plants.

For the last year, we have been engaging with healers, cultivators, ayahuasca center owners, policy makers and many others around the world and across the Amazon as part of a project we call the Ayahuasca Dialogues. The goal of the Ayahuasca Dialogues is to build relationships and consensus around safe use and sustainability practices for ayahuasca. The consensus around these practices will eventually be known as the Ayahuasca Agreement, which farms, forests, centers and communities can use as the foundation for globally-recognized best practice standards.

Because ensuring safer ayahuasca use is absolutely crucial to the future acceptance of this medicine, the ESC launched the Ayahuasca Health Guide in late September this year, in partnership with organizations such as ICEERS (International Center for Ethnobotanical Education, Research and Service), Plantaforma and others. Built on existing good practice documents, we’re hosting the draft guide at AyahuascaHealthGuide.com for public feedback. You can leave comments or edit the actual text of the document there. This Health Guide will always be an open source resource, where you can find all the facts about ayahuasca in one place, up to date and free.

We’ve gotten lots of feedback. The Guide is currently in its fourth iteration (Version 0.4). We’ll be launching Version 0.5 for comments in January. The comment period for Version 0.4 ends on December 3rd, 2014.

Here is a step-by-step guide to staying safe with ayahuasca in South America and beyond:

• Know your health profile and research risks associated with any pre-existing conditions and/or prescription drugs you may be taking.

• Be careful with antidepressants, especially SSRIs (selective serotonin reuptake inhibitors); it is thought that there could be a risk of serotonin syndrome if you drink ayahuasca while you are taking them. It’s also important to remember that some antidepressants can’t be discontinued abruptly, so you may need to weigh the potential benefits of taking ayahuasca against the difficulties of withdrawing. Nevertheless, there are some ceremony leaders who will admit people who are taking antidepressants, and who will provide a lower dose of the medicine. This practice is common in some Brazilian ayahuasca churches, for instance.

• Play it safe when taking herbal or pharmaceutical medications. A number of medications (both short and long term, pharmaceutical and herbal) may be risky in combination with ayahuasca, so it is important to do some personal research or ask a doctor, to see if there could be side effects. Known examples include: St. John’s Wort, ginseng, and medicines to treat cardiovascular, neurological, mood and liver dysfunctions.

• No major heart conditions. Scientific studies have suggested that if you have serious cardiovascular issues you should not take ayahuasca, as it raises both blood pressure and heart rate.

• Psychological: If you have a personal or family history of psychosis it is thought that taking ayahuasca could involve a high risk, especially if your disorder is active. A personal or family history of personality disorders or bipolar disorder are also seen as risk factors, although many people experiencing symptoms of these have done well after taking ayahuasca. Again, it is very important to weigh the possible positive benefits against the risk of a psychotic reaction or the re-emergence of symptoms. It is also vitally important to inform those who will be looking after you of your personal and family history. Depending on the risk factors, they may or may not admit you. Nevertheless, the important thing is not whether you are being admitted, but making sure any admission is made with conscious responsibility and getting the assurance that, whatever happens, you will be taken good care of, prior to, during, and after the ceremony.

• Read about diets and avoid certain foods that contain high levels of tyramine, such as aged cheeses, soy sauce, beer, wine and certain meats and nuts. Although it is unlikely that these would cause a hypertensive crisis, there are anecdotal reports that eating them before or after a ceremony can lead to severe headaches and an increased risk of panic attacks. There are many important parallels between a low-tyramine diet and the dietas (diets) followed in the Northwestern Amazon as preparation for ayahuasca sessions.

• Optional: Make your own decision about whether you want to follow what’s become known as the “ayahuasca diet” and go without sex, salt, pork, and other things before and after the experience.

• Research ceremony centers: Ask your friends, read about centers, find the ones that resonate with you. Don’t arrive blind at the airport and take your driver’s advice. You can check out ceremony center references and reviews online. One good resource is openmindtrips.com. By early 2016, expect to see the first ESC-recognized centers and communities offering safer and more sustainable ayahuasca experiences, following the Ayahuasca Agreement. (This will always be completely voluntary. The ESC’s role is only to point the way to good practices with support and feedback from the ayahuasca community.)

• Research the area you are visiting in order to be culturally aware and appropriate, and to increase your understanding of its history and peoples’ worldviews.

• Travel with friends or loved ones: Taking ayahuasca could be one of the most profound experiences of your life. If you have any doubts during ceremonies, have your friend stay sober and observe. When traveling in South America, someone in your group should probably have at least passable Spanish, Portuguese, or other local languages, or you should find someone to translate for you. A second-best option is to make friends along the way.

• Be clear about your intentions: Why are you drinking ayahuasca and what do you hope to gain from the experience?

• Understand potential safety hazards present on site, and the steps that have been taken to reduce the associated risks. For example, does the center have basic first aid equipment?

• Have an exit plan: Know how to leave if you need to, for personal or medical reasons.

• Know your brew (medicine): Understand the contents and origins of the brew. Try to understand the dosage as best you can and talk to the facilitator about this. Since many brews are proprietary (and many argue that healers have a right to their secret formulas), try to find out if there is a history of safe use at this center with these practitioners. Brews should not contain high levels of toé (Brugmansia sp.) or other substances which may to lead to incapacitation.

• Know your shaman or practitioner: Discuss appropriate touching, or what the ceremony will be like, including potential chuperia (sucking). You have the right to know and talk to the healer (including being provided with translation if necessary). There are many different classes of practitioners advertising ceremonies, from indigenous and mestizo curanderos who have followed traditional initiation and rituals; those whose work is mostly focused on ayahuasca, known as ayahuasqueros; neoshamanic practitioners who may not follow traditional ceremonial methods; as well as those who have very little training by comparison. Traditionally, healers are judged based on the recency, frequency, and length of dietas, or plant diets, as this is what gives them direct experience of the plants themselves, and how to use them. Based on ESC research, the general consensus is that one must train for 4 to 5 years, minimum, in order to master ayahuasca, thus becoming an ayahuasquero. Further training is required in order to work with a wider variety of plant medicines. Ask about your healer’s training and background, prior to sitting in ceremony with them.

• Know the rules of the ceremony: Every responsible ayahuasca center and/or practitioner should inform participants of the rules, conduct and safety precautions for the ceremony before it begins. If the practitioner or center does not provide this information, then this may well be an early sign of a lack of safety. Staying until the closure of ceremony is a fundamental element in safety –– unless a medical emergency happens –– both due to its psychological importance and to ensure physical safety. Participants may experience strong journeys that involve temporary changes in consciousness. At times this can cause difficulties in performing certain physical tasks, which could result in them hurting themselves if they leave in the middle of a ceremony. Traditionally the closure of the ceremony is also considered to be important because it seals the energy field and helps to prevent bad spirits from entering participants’ bodies.