Therapy guide

Ayahuasca therapy

Amazonian N,N-DMT-containing brew; two US religious exemptions, most access abroad.

Frequently asked questions

Is ayahuasca legal in the USA?

Ayahuasca is federally illegal in the United States because its active ingredient, DMT, is a Schedule I controlled substance under the Controlled Substances Act. However, the Religious Freedom Restoration Act (RFRA) creates a narrow pathway: four US religious organizations currently hold confirmed federal DEA exemptions — União do Vegetal (UDV), Santo Daime, the Iowaska Church of Healing, and the Church of Gaia (first granted without litigation, May 2025). Outside these specific organizations, ayahuasca ceremonies operate in a legal grey zone at best, and federal prosecution of operators and participants has occurred.

Is ayahuasca legal in California?

No. Ayahuasca is not legal in California. DMT remains Schedule I at the federal level, and California has not passed any state-level decriminalization or therapeutic access program for ayahuasca or DMT. Several California cities (Oakland, Santa Cruz, San Francisco, Berkeley) have passed entheogen deprioritization resolutions, meaning local police are directed to treat enforcement as low priority — but these are not legal protections and do not bind federal authorities.

Is ayahuasca legal in Colorado?

Partially. Colorado's Natural Medicine Health Act (Prop 122, 2022) includes DMT — the active component of ayahuasca — in its list of natural medicines, and personal-use possession of DMT is decriminalized for adults 21+ under state law. However, regulated ayahuasca healing centers are not yet licensed; the state's Advisory Board is expected to consider adding DMT to the therapeutic program after June 2026. Federal law (Schedule I) still applies.

Is ayahuasca legal in the US? (short answer)

Ayahuasca is federally illegal in the US. DMT, its active ingredient, is Schedule I. The only legal access in the US is through one of the four DEA-exempted religious organizations: UDV, Santo Daime, Iowaska Church of Healing, or the Church of Gaia. No state has fully legalized ayahuasca, though Colorado has decriminalized personal DMT possession.

Is iowosca the same as ayahuasca?

Yes. "Iowosca," "iowaska," and "ayawaska" are common alternate spellings of ayahuasca — the traditional Amazonian brew combining a DMT-containing plant with a Banisteriopsis caapi vine. The spelling "iowaska" also appears in the name of the Iowaska Church of Healing, one of four US religious organizations with a confirmed federal DEA exemption to use the sacrament.

What ayahuasca is

Ayahuasca is a plant preparation, not a molecule. The brew combines two plants that, taken separately, would not produce a psychedelic effect orally:

The MAOIs in the vine prevent the stomach from breaking down the DMT, allowing it to reach the brain via oral dosing. This is pharmacologically distinct from 5-MeO-DMT (a different molecule, vaporized rather than drunk — see 5-MeO-DMT vs ayahuasca) and from psilocybin (which does not require an MAOI).

What a ceremony looks like

Ceremonial ayahuasca is not a clinical procedure. A typical retreat session involves:

Evidence for therapeutic use

Depression

The most-cited trial is Palhano-Fontes et al. (2019), a randomized double-blind placebo-controlled trial in 29 patients with treatment-resistant depression. A single ayahuasca dose produced significantly greater MADRS score reductions than placebo at Day 7.4 The sample was small and the trial was single-site, so this should be read as a promising signal rather than a definitive answer.

Addiction, PTSD, anxiety

Most ayahuasca research is observational — surveys of long-term ceremonial users and small open-label studies — rather than placebo-controlled. These generally report reductions in depressive, anxious, and substance-use symptoms, but the self-selection bias in retreat-goers is severe and the findings should not be interpreted as clinical evidence at the same level as ketamine or psilocybin trials.

Safety & contraindications

Serotonin syndrome. Ayahuasca is a potent MAO-A inhibitor and contains DMT, which is serotonergic. Combining it with SSRIs, SNRIs, tramadol, dextromethorphan, St John’s wort, or other serotonergic agents can cause serotonin syndrome — a potentially fatal condition involving hyperthermia, agitation, tremor, and cardiovascular instability.5 Responsible retreats require full medication disclosure and supervised tapering.

Other important safety issues:

The active ingredient DMT is a Schedule I controlled substance — possession and distribution carry felony penalties. The Religious Freedom Restoration Act (RFRA) creates a narrow path for religious organizations to obtain DEA exemptions. The landmark case was Gonzales v. O Centro Espírita Beneficente União do Vegetal (2006), in which the US Supreme Court ruled unanimously that the UDV could use ayahuasca sacramentally.1

As of 2026, four organizations are confirmed to have federal protection:

  1. União do Vegetal (UDV) — 2006 Supreme Court.
  2. Santo Daime (several US branches) — 2009 federal injunction in Church of the Holy Light of the Queen v. Mukasey.
  3. Iowaska Church of Healing — April 2024 DEA settlement after a long court battle.
  4. Church of Gaia (Spokane, WA) — May 2025 DEA approval; the first ever granted without litigation.
Retreats operating on RFRA claims without DEA approval are in a legal grey zone. The RFRA exemption is organization-specific, not a blanket protection for any group that calls itself a church. Federal agents have prosecuted operators and participants in such settings.

The table below summarizes the most-searched state queries. All states are bound by federal Schedule I status; only state-level carve-outs or city-level deprioritization policies differ. See the full psychedelic legal status by US state tool for real-time detail.

State Status Notes
Colorado Partially decriminalized Prop 122 decriminalizes DMT possession (21+); no licensed ayahuasca centers yet; federal law still applies.
California Illegal No state decrim. Oakland, SF, Santa Cruz, Berkeley have city-level deprioritization (not a legal defense).
Oregon Illegal (enforcement deprioritized) Measure 109 covers psilocybin only; ayahuasca/DMT not included. Some city resolutions.
Washington State Illegal No state decrim. Seattle has a city-level resolution, not a legal protection.
All other states Illegal Federal Schedule I applies with no state-level exception for DMT or ayahuasca.

Decriminalization and Colorado

Several US cities have deprioritized enforcement of entheogens (Denver, Oakland, Santa Cruz, Ann Arbor, Seattle, Washington DC). These measures do not legalize ayahuasca and do not bind federal authorities.

Colorado’s Natural Medicine Health Act (Proposition 122, 2022) defined "natural medicine" to include DMT alongside psilocybin, psilocin, ibogaine, and mescaline. Through June 2026 only psilocybin and psilocin are authorized in the regulated program. The state Natural Medicine Advisory Board may recommend adding DMT (ayahuasca) after that date, though federal illegality would remain.

How to actually access it

Legally, in the US: join one of the four confirmed exempt churches (UDV, Santo Daime branches, Iowaska Church of Healing, Church of Gaia). These are religious communities, not therapeutic retreat centers.

Abroad: Peru has the most developed legal framework — ayahuasca was declared national cultural heritage in 2008 — and centers there range from traditional Shipibo lineage operations to commercial retreats serving Western clients. Costa Rica, Brazil, and the Netherlands also host legal retreats. Quality varies enormously; medical screening, SSRI tapering, and on-site medical support should be considered non-negotiable.

What to avoid. Retreats that don’t require a detailed medical and medication history. Operators making clinical claims (depression cure, PTSD treatment) without any clinical infrastructure. US-based "ceremonies" without a formal DEA exemption.

Ayahuasca's active ingredient, DMT, is scheduled in most countries' drug laws, so the honest answer for the large majority of places is "no, with no exemption" — the same pattern already true across most of the US. The table groups the most-searched countries by actual legal posture rather than repeating "it depends" for each one.

Country / region Status
Peru Most developed legal framework for retreat tourism — declared national cultural heritage in 2008 (see above).
Brazil, Netherlands, Costa Rica Host legal retreats (Brazil via religious-use precedent for Santo Daime/UDV; Netherlands under a "natural plant" carve-out; Costa Rica has no specific ayahuasca ban). Quality and medical screening still vary by operator.
Canada DMT is a Schedule III substance under Canada's Controlled Drugs and Substances Act; no general exemption. Some religious-freedom exemptions have been granted case-by-case (e.g., a Santo Daime-affiliated 2017 exemption), but there is no blanket legal path.
UK, most of continental Europe (France, Germany, Austria, Croatia, Cyprus, Finland, Hungary, Poland, Slovakia, Sweden, Switzerland), Scotland DMT is a controlled substance with no ayahuasca-specific exemption; ceremonies operate in a legal grey zone at best and are prosecutable.
Most of Asia and the Gulf (Japan, Hong Kong, Cambodia, Philippines, UAE) DMT-containing preparations are illegal, frequently with severe penalties (some Gulf and Southeast Asian jurisdictions treat drug offenses as capital or near-capital crimes) — not a tolerant destination for ceremony tourism regardless of what a retreat operator advertises.
Guatemala, Honduras, Bolivia, Ecuador, Colombia, Uruguay, Venezuela, South Africa, Morocco, New Zealand, Panama, Argentina No confirmed, broadly legal framework specific to ayahuasca. Some (notably Colombia and Ecuador, both within ayahuasca's traditional indigenous range) have de facto tolerance for traditional/indigenous ceremonial use, but this is not the same as a codified legal exemption — verify current, country-specific counsel before treating any of these as "legal."

A note on spelling: "iowaska" is a common phonetic misspelling of ayahuasca and refers to the same substance and the same legal analysis above (including for Canada, the most-asked "iowaska" country pairing) — it is unrelated to the US-based Iowaska Church of Healing named earlier on this page, beyond sharing a name.

Does the NFL test for ayahuasca or DMT?

DMT is on the NFL's and most major US sports leagues' banned/ prohibited-substances lists as a Schedule I drug of abuse, the same as it would be under any standard workplace or athletic drug policy — there is no retreat-tourism or religious-ceremony exemption carved out for professional athletes.

Preparation & integration

Ayahuasca experiences are long, visually intense, and frequently bring up unresolved material. Dropping back into ordinary life without therapeutic support is, empirically, where most negative outcomes happen — not during the ceremony itself. A working relationship with a clinician trained in psychedelic integration before and after the retreat is strongly advised.

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Sources

  1. US Supreme Court. Gonzales v. O Centro Espírita Beneficente União do Vegetal, 546 U.S. 418. Decided February 21, 2006, 2006. SCOTUS.
  2. Bejarano M. Soul Quest Ayahuasca Church ordered to pay $15 million in wrongful death case. Orlando Sentinel, 2024. Orlando Sentinel.
  3. Domínguez-Clavé E, Soler J, Elices M, et al.. Ayahuasca: pharmacology, neuroscience and therapeutic potential. Brain Research Bulletin, 2016. PubMed.
  4. Palhano-Fontes F, Barreto D, Onias H, et al.. Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial. Psychological Medicine, 2019. PubMed.
  5. Callaway JC, Grob CS. Ayahuasca preparations and serotonin reuptake inhibitors: a potential combination for severe adverse interactions. Journal of Psychoactive Drugs, 1998. PubMed.