Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 109
Guide XI-109

Kambo (sapo)

Peru–Brazil border
A 31 · L 58 · M 1116 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: no treatment manual exists. Indigenous use is described from published ethnography and scholarship (Lima 2012 on the Katukina/Noke Koĩ; Ribeiro 2021; the 2014 letter in the Journal of Venomous Animals and Toxins including Tropical Diseases). Medical risk is described from case reports and reviews (da Silva et al. 2019; Sacco et al. 2025; Tran et al. 2025). The psychotherapist's own procedures follow the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules as published by the American Psychiatric Association.

What it is. Kambo (also kambô, kampô, or "sapo", Portuguese/Spanish for frog or toad) is the secretion of the giant monkey frog, Phyllomedusa bicolor, an Amazonian tree frog. The word also names the practice in which the secretion is used. [source: Sacco et al. 2025] Scholars report its use among Pano-speaking peoples of the Peru–Brazil border and their neighbours, including the Noke Koĩ (Katukina), Yawanawá, Matsés (Mayoruna) and Huni Kuĩ, mainly as an emetic, tonic and stimulant for hunters. [source: Ribeiro 2021; JVATiTD 2014] Reported Indigenous purposes include hunting success and stamina, strengthening the body, and warding off panema, a state of bad luck in hunting and life. [source: da Silva et al. 2019] One news report dates the earliest known written account to a French missionary in 1925 [uncertain: secondary news source]. [source: Al Jazeera 2026] Rubber tappers in Acre adopted it after colonisation. It then spread to Brazilian cities, the ayahuasca religions Santo Daime and União do Vegetal, alternative-therapy clinics, and wellness markets in Europe, North America and Australia, where it is sold as a "detox" or cleansing ritual. [source: da Silva et al. 2019; Sacco et al. 2025]

This is not a psychotherapy. It is an Indigenous practice that has also become a global, largely unregulated wellness trade. A psychotherapist does not perform, recommend or facilitate kambo. Two quite different clients may present: (a) a member of an Amazonian Indigenous community, for whom kambo belongs to a living body of knowledge with its own holders; (b) a client, often non-Indigenous, who has attended a commercial or neoshamanic kambo session, frequently alongside ayahuasca. [source: Ribeiro 2021; Sacco et al. 2025] The guide is about the psychotherapist's own work with either: cultural assessment, medical and psychiatric risk recognition, routing to medical care, collaboration where the client wishes, integration of experiences, and safeguarding. For psychedelic-assisted therapy and psychedelic integration, see Domain VII.

How change happens, as the different parties describe it. In Indigenous accounts the secretion acts on the body and on luck (for example against panema) and supports hunting. [source: da Silva et al. 2019; Ribeiro 2021] Western advocates describe the purge as cleansing, detoxification and transformation, and some value the ordeal itself. [source: Swinburne 2023] Clinical authors state that efficacy is unproven, that reported benefits are hard to separate from belief and expectation, and that the peptides cause vomiting, falls in blood pressure, rapid heart rate and opioid-like effects. [source: Sacco et al. 2025; JVATiTD 2014; Swinburne 2023] In the psychotherapist's own work, change comes from understanding what the client seeks from kambo, addressing that need within safe care, and keeping the client connected to medical care. [synthesis]

Who holds authority. No single body speaks for kambo. Authority over the knowledge rests with the Indigenous peoples who hold it. Scholars describe it as shared by more than a dozen peoples, which complicates questions of ownership and benefit-sharing. [source: Ribeiro 2021] In 2003 the Noke Koĩ wrote to Brazil's Ministry of Environment asking for protection of their traditional knowledge. A government "Kambô Project" followed but, according to Ribeiro, never came to fruition. [source: Ribeiro 2021] Lima's long fieldwork with the Katukina examines internal and external conflicts over urban use and over kambo's value as a genetic resource. [source: Lima 2012] A Yawanawá leader (the report spells it "Yamanawa") has criticised online sales and warned that use without Indigenous preparation or permission puts people at risk. [source: Al Jazeera 2026] Indigenous people are also reported to be concerned that new practitioners may misapply kambo or substitute secretions from other species. [source: da Silva et al. 2019] The International Association of Kambo Practitioners (IAKP) runs trainings for urban applicators. It is a self-governing practitioner association, not an Indigenous cultural authority, and one legal guide states that its certifications are not medical credentials. [source: Ribeiro 2021; The Psychedelic Journal 2026]

Legal status, as sources state.

  • Brazil: ANVISA Resolution RE No. 8 of 29 April 2004 suspended all advertising of the therapy, citing no scientific evidence of quality, safety or efficacy. [source: da Silva et al. 2019; Ribeiro 2021] A 2005 legal-news report likewise describes ANVISA's measure as suspending all advertising of kambô's therapeutic and medicinal properties, with the agency's concern directed at use outside Indigenous communities and penalties under Law 6.437/77. [source: ConJur 2005] A 2020 review describes RE No. 8 more broadly, as prohibiting any use, trade, distribution or advertising of kambô as a medicine outside the villages. [source: Haddad Junior & Martins 2020] One news report describes a ban on sale and marketing since 2004, while one review dates the sale and marketing ban to 2016. The exact scope of the 2004 measure and of any later measure is [uncertain: sources conflict; resolution text not cited]. [source: Al Jazeera 2026; Sacco et al. 2025]
  • Australia: the Therapeutic Goods Administration listed kambo in Schedule 10 of the Poisons Standard in 2021, the schedule for substances so dangerous that sale, supply and use are prohibited. [source: Swinburne 2023; Sacco et al. 2025] In New South Wales, state reforms prohibit the manufacture, supply or use of kambo unless a person is expressly authorised, as reported in coverage of the NSW State Coroner's findings. [source: AAP coroner report]
  • United States: sources conflict. One review says it is not explicitly banned but strictly regulated. A legal guide says it is not a federally scheduled controlled substance, is not FDA-approved, and has been restricted by some state or local actions (unnamed). A news report calls it illegal. [uncertain: sources conflict] [source: Sacco et al. 2025; The Psychedelic Journal 2026; Al Jazeera 2026]
  • Others: Chile is reported to prohibit importing the secretion. In the UK it is reported as legal to buy but not licensed as a medicine. New Zealand's Medsafe is reported to warn that it is not an approved medicine. [uncertain: secondary sources only] [source: Al Jazeera 2026; The Psychedelic Journal 2026]

2. Framework

Kambo has no therapy phases. The framework below is the psychotherapist's own work with a client who uses, has used or plans to use kambo. The phase structure is [synthesis]; its components come from the CFI and from the clinical recommendations in the case literature.

Phase 0: Immediate safety (any session, minutes). Goal: recognise a medical emergency. Kambo toxicity reports include severe headache, repeated vomiting, confusion, drowsiness, seizures and collapse, and a fatal case progressed over hours after the session. [source: Tran et al. 2025; Sacco et al. 2025] If a client describes or shows these signs after a recent session, call emergency services first. No psychological work happens until medical care is in place. Move on when there is no acute risk or medical care has taken over.

Phase 1: Engagement and cultural assessment (1–2 sessions). Goal: understand the client's own account of the problem, what kambo means to them, and which community or market they encountered it in. Tools: the core CFI (16 questions, four domains), adding the Explanatory Model; Spirituality, Religion and Moral Traditions; Coping and Help-Seeking; and Cultural Identity modules as needed. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] Time: none of the APA forms gives a duration. The field trial found later interviews took less time, and a figure of about 15–20 minutes for the core CFI is [uncertain]. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/] Move on when you can state the client's explanatory model in their own words and they agree with your summary.

Phase 2: Risk review and medical liaison (1 session, then ongoing). Goal: document what was taken, when and in what setting (no technique detail is needed); identify medical conditions, pregnancy, medicines and co-use of ayahuasca or other substances; identify psychiatric symptoms; and, with consent, link the client to their physician or prescriber. Move on when risks are documented, a medical contact is in place or offered, and any psychiatric presentation is assessed.

Phase 3: Formulation and shared plan (1–2 sessions). Goal: a cultural formulation and a plan that respects the client's values and keeps them safe. Where the client is Indigenous and wishes it, this includes collaboration with knowledge holders in their own community. Where the client used a commercial provider, it includes the needs (health, meaning, belonging, relief) that drew them to it. Move on when the client agrees to the plan.

Phase 4: Integration, treatment and follow-up (variable). Goal: help the client make sense of the experience, treat any disorder with ordinary evidence-based care, and review risk if they plan further sessions. Repeat CFI modules as needed, since APA states they can be used later in care or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] End when the presenting problem is resolved or the client is stably held in other care.

Format: individual sessions. Add a family member or friend with the CFI Informant Version (17 questions) when the client consents or lacks capacity. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf] Use an interpreter for Portuguese, Spanish or Indigenous-language speakers.

3. Guiding principles

  • Work alongside, never inside, the practice. You do not administer, source, time, prepare or recommend kambo, and you do not give "safer use" instructions. Practically: if asked how to do it safely, explain that this is outside your role and route medical questions to a physician. [synthesis]
  • Knowledge belongs to its holders. Kambo knowledge is held by Indigenous peoples, who have sought its protection and criticised outsiders' sales. [source: Ribeiro 2021; Al Jazeera 2026] Practically: never present a commercial applicator or a practitioner certificate as Indigenous authority, and never steer a client towards a provider.
  • Neither endorse nor dismiss. Concepts such as panema, cleansing and spiritual protection are described as the client's tradition or provider holds them. [synthesis] Practically: ask what these terms mean to the client, and do not call them false or medically validated.
  • Distinguish the contexts. Use within an Indigenous community differs from a commercial "detox" session in authority, setting and risk profile. [source: da Silva et al. 2019; Ribeiro 2021] Practically: early in assessment, establish where, with whom and under whose authority the client took part.
  • Medical risk is real and sometimes fatal. Case reports document hyponatraemia, SIADH, cerebral oedema, hepatitis, oesophageal rupture, psychosis and deaths. [source: Sacco et al. 2025; Tran et al. 2025] Practically: treat any recent use with physical symptoms as a medical question first.
  • Never advise on medicines. Practically: questions about stopping, starting or combining prescribed medicines go to the prescriber, documented. [synthesis]
  • No health claims. Clinical authors state there is no adequate evidence of benefit for conditions such as cancer, diabetes or depression. [source: da Silva et al. 2019; Sacco et al. 2025] Practically: if a client is using kambo instead of treatment for a physical illness, gently support continued medical care. [synthesis]
  • The CFI is an aid, not a verdict. APA states it supports clinical understanding and is not the sole basis for diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] Practically: combine it with ordinary psychiatric assessment.
  • Neither pathologise nor miss illness. Unusual experiences during a purge or ceremony may be expected within that setting. New or persisting psychotic symptoms need psychiatric assessment. [source: Sacco et al. 2025] Practically: assess onset, course, function and the views of people who share the client's tradition.
  • Consent and confidentiality. Practically: any contact with physicians, family or community members happens only with the client's informed consent, except where safeguarding duties apply. [synthesis]
  • Safeguarding overrides cultural deference. Practically: risk to children or pregnant people, coercion, or a provider who keeps a person away from emergency care triggers your usual safeguarding and reporting duties. [synthesis]
  • Cultural humility. Practically: notice your own assumptions about Indigenous medicine, wellness culture and "detox", and seek consultation when unsure. [synthesis]

4. Intervention inventory

These are the psychotherapist's own interventions. None involves taking part in, preparing or giving kambo. Kambo-specific adaptations are [synthesis] unless a source is given.

4.1 Cultural humility and self-examination

  • Purpose / when: before and throughout work with any client who mentions kambo, so that neither romanticism about Indigenous medicine nor contempt for wellness culture shapes the work. [synthesis]
  • Steps: (1) Note your own reactions: alarm, fascination, dismissiveness, or curiosity about trying it. (2) Separate what you know from published sources (Sections 1 and 6) from assumptions. (3) Note whether the client is Indigenous, Brazilian or Peruvian, a wellness consumer, or a member of an ayahuasca church, and how your reactions might differ for each. (4) Take uncertain cases to supervision or cultural consultation.
  • Example language (illustrative): to yourself or in supervision: "Am I reacting to the danger, to the unfamiliarity, or to my views about the wellness industry?"
  • Watch for: lecturing; avoiding the topic; over-identifying with the client's enthusiasm. It is working when the client describes the experience freely and returns to the topic unprompted.

4.2 Asking about kambo and other healing practices without judgement

  • Purpose / when: at intake and whenever a client mentions detox, retreats, plant medicine, purging, "frog medicine" or ayahuasca. Clients may not volunteer it, and clinical authors advise that kambo exposure be considered in unexplained acute illness. [source: Tran et al. 2025] This follows the CFI's past help-seeking question (Domain 3). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Steps: (1) Normalise: many people use many kinds of healing. (2) Ask openly about all sources of help, including ceremonies and retreats. (3) If kambo is named, ask when, where, with whom, and whether other substances were involved. Do not ask about preparation or technique, since they are not needed. (4) Ask how it went and how they have been since. (5) Thank the client for telling you.
  • Example language (illustrative): "Some people I work with have tried things like detox retreats, plant medicines or kambo. Have you used anything like that? I ask so I can understand you, not to judge."
  • Watch for: shame or defensiveness, especially if a provider told the client to keep it private; symptoms since the session (headache, vomiting, confusion, weakness, yellowing skin, chest pain, low mood, unusual beliefs). It is working when the client gives a clear timeline.

4.3 Medical red-flag recognition and routing (not treatment)

  • Purpose / when: whenever use is recent or planned. Documented harms include hyponatraemia, SIADH, seizures, cerebral oedema, rhabdomyolysis, toxic hepatitis, oesophageal rupture, cardiac events and death. [source: Sacco et al. 2025; Tran et al. 2025; da Silva et al. 2019] The psychotherapist's task is to recognise and route, not to manage medically.
  • Steps: (1) If use was within the last day or so and the client has severe headache, persistent vomiting, confusion, drowsiness, weakness, seizure, chest pain or breathlessness, call emergency services. Tell them that a frog-secretion (kambo) ritual and any large water intake may be involved, since the case report authors urge clinicians to consider kambo exposure and to check electrolytes. [source: Tran et al. 2025] (2) For use without acute symptoms, encourage the client to inform their physician and, with consent, write to them. (3) Record known medical conditions, pregnancy or recent birth, and heart disease, which clinical authors flag as risk factors. [source: Sacco et al. 2025; da Silva et al. 2019] (4) For questions about prescribed medicines, refer to the prescriber. Do not advise. (5) Document.
  • Example language (illustrative): "What you're describing (the headache, the vomiting that won't stop, feeling muddled) can be a sign of a dangerous drop in blood salt after kambo. I'm calling for medical help now." / "Would you be willing for me to let your doctor know you've been to kambo sessions, so they can check anything that needs checking?"
  • Watch for: the client minimising symptoms because the provider called them "part of the cleanse"; delay of emergency care. It is working when the client accepts medical contact.

4.4 The core Cultural Formulation Interview, focused on kambo

  • Purpose / when: Phase 1, with any client for whom kambo is part of the story. APA describes the CFI as designed for any clinician, any individual and any care setting. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
  • Steps: use the official APA form, which clinicians may reproduce for use with their patients without permission (modification or translation needs APA permission). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] Cover its four domains in order: (1) cultural definition of the problem (Q1–3); (2) cultural perceptions of cause, context and support (Q4–10), including cultural identity; (3) self-coping and past help seeking, and barriers (Q11–13), where kambo usually appears; (4) current help seeking: preferences and the clinician–patient relationship (Q14–16). Then summarise back.
  • Example language (illustrative): "In your own words, what is the problem that brought you here?" … "What have you already tried for it, including ceremonies or treatments outside regular medicine?" … "Is there anything about me, or about services like this one, that makes it harder for you to talk about these things?"
  • Watch for: Q16 is where mistrust of mainstream medicine, which often draws people to "detox" practices, or experiences of racism and colonial history for Indigenous clients, may surface. It is working when the client corrects or adds to your summary.

4.5 Supplementary CFI modules

  • Purpose / when: to deepen the core CFI. APA states they can be used as add-ons or standalone, at first evaluation, later in care or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] Most relevant here: Explanatory Model (what the client thinks kambo does and what their problem is); Spirituality, Religion and Moral Traditions (cleansing, protection, panema, membership of an ayahuasca church); Coping and Help-Seeking (the full pathway of providers, retreats and clinicians); Cultural Identity (Indigenous, Brazilian or other belonging); Immigrants and Refugees where relevant; Psychosocial Stressors and Social Network (who introduced them to kambo, group pressure). The 12 modules also include Level of Functioning, Patient–Clinician Relationship, School-Age Children and Adolescents, Older Adults, and Caregivers.
  • Steps: (1) Choose modules from the core CFI answers. (2) Explain why you are asking more. (3) Use the official forms, without rewording items. (4) Integrate the answers into the formulation.
  • Example language (illustrative): "You mentioned the kambo felt like a cleansing of more than your body. Could I ask some more about the spiritual side of what you were looking for?"
  • Watch for: interview fatigue, so spread modules across sessions. It is working when themes link up, for example a search for purification after a loss.

4.6 Exploring the explanatory model (Kleinman)

  • Purpose / when: whenever the client's understanding of their problem, or of kambo, differs from biomedical framing. Source: Kleinman, Eisenberg and Good (1978), Annals of Internal Medicine 88:251–258. [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
  • Steps: cover, in your own words, the eight areas: what the client calls the problem; its cause; why it began when it did; what it does and how it works; how severe it is and how long it will last; what treatment they think they should get; the main problems it has caused; and what they fear most. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] Ask the same questions about kambo itself: what it is supposed to do, how, and what they fear about it. Then compare their model with yours and negotiate a shared plan. [synthesis]
  • Example language (illustrative): "What do you think the kambo was clearing out of you?" / "What worries you most if this low mood doesn't lift?"
  • Watch for: a model in which vomiting or illness after use is proof of benefit ("it was the toxins leaving"), which can delay medical care. Hold your concern alongside respect for their meaning. It is working when the client can hold both views.

4.7 Indigenous idioms and cultural concepts of distress

  • Purpose / when: when an Indigenous client, or a client from Amazonian riverine or Brazilian communities, frames their problem in local terms. Panema (misfortune, especially in hunting) is reported as one condition kambo is used against. [source: da Silva et al. 2019] It is not one of the DSM-5-TR cultural concepts of distress. DSM-5-TR describes such concepts as including idioms, explanations or perceived causes, and syndromes. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] Concepts listed in DSM-5-TR training material include nervios and ataque de nervios, which may be relevant for Spanish- or Portuguese-speaking clients. [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]
  • Steps: (1) Ask the client to explain the term and how it shows itself. (2) Ask who in their community recognises and deals with it. (3) Treat the idiom as meaningful, and screen separately for any DSM disorder. (4) Record the idiom in the client's words.
  • Example language (illustrative): "When you say you had panema, what does that mean for you, and how would people at home know?"
  • Watch for: translating the idiom straight into a diagnosis, or ignoring a mood disorder because it is framed as bad luck. It is working when the client feels understood and a symptom picture still emerges.

4.8 Distinguishing expected ritual experiences from psychiatric disorder

  • Purpose / when: when a client reports altered states, visions, voices or a sense of spiritual influence during or after kambo, often in sessions that also involved ayahuasca. Psychosis is reported after kambo, including in a woman after frequent sessions. [source: Sacco et al. 2025; da Silva et al. 2019] Diagnostic anchors: DSM criteria for dissociative identity disorder exclude disturbance that is a normal part of broadly accepted cultural or religious practice, and dissociative trance is excluded when it is a normal part of collective cultural or religious practice. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] (The exact DSM-5-TR wording is [uncertain].) ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require the state to be involuntary and unwanted and not part of accepted cultural or religious practice. [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
  • Steps: (1) Establish timing: during the session only, or persisting after. (2) Ask whether the experience fits what the client's tradition or group expects. (3) Assess course, insight, function, sleep, mood and risk. (4) If unsure, consult, with consent, a person from the client's own community or church who can say what is expected there (a cultural broker), and a psychiatrist. (5) Refer urgently if psychotic or manic symptoms persist or risk is present.
  • Example language (illustrative): "During the ceremony, what you saw made sense to you. Since then, have the voices or ideas continued when you're on your own, at work, at night?"
  • Watch for: two errors: labelling expected ceremonial experience as illness, and accepting a provider's framing of persisting psychosis as "spiritual opening". It is working when the picture is clear enough to decide on referral.

4.9 Psychiatric risk assessment and co-use

  • Purpose / when: at intake and after any new session. Kambo is often linked with ayahuasca and with syncretic religions. [source: Sacco et al. 2025] Risks of combinations and of interactions with prescribed medicines are medical questions.
  • Steps: (1) Ask what else was taken around the same time, and whether the client takes prescribed medicines. (2) Assess mood, suicidality, psychotic and manic symptoms and re-traumatisation using standard risk-assessment practice. (3) Pass medicine and interaction questions to the prescriber with consent. Do not advise on any change. (4) For psychedelic integration see Domain VII.
  • Example language (illustrative): "Your doctor needs to know about the kambo and the ayahuasca alongside your antidepressant. Could we contact them together?"
  • Watch for: the client stopping prescribed medicine on a provider's advice. Route to the prescriber at once. It is working when the prescriber is informed.

4.10 Exploring what the client is seeking

  • Purpose / when: with clients who used or plan to use commercial kambo. Sources report it is marketed for conditions from anxiety to cancer, that Western users include people with cancer seeking alternatives, and that advocates value cleansing, transformation and the ordeal. [source: Al Jazeera 2026; Sacco et al. 2025; Swinburne 2023]
  • Steps: (1) Ask what problem or hope led them to it. (2) Ask what they expected and what happened. (3) Identify the underlying need, such as relief, control over illness, belonging, purification after shame, or a turning point. (4) Explore other ways to meet that need within safe care. (5) If they are delaying treatment for physical illness, encourage medical review and do not argue the belief. [synthesis]
  • Example language (illustrative): "What were you hoping would be different after the kambo?" / "That wish to feel clean and start over matters. Can we look at what else might help with it?"
  • Watch for: shame after a harmful experience; group or partner pressure. It is working when the client names the need behind the practice.

4.11 Collaboration and referral with community knowledge holders

  • Purpose / when: only for clients from communities that hold kambo knowledge who wish their own healers or elders involved. Authority sits with those communities. [source: Ribeiro 2021; Lima 2012] There is no published kambo-specific collaboration programme for clinicians [uncertain]. Evidence for clinician–healer collaboration comes from other settings. In the COSIMPO cluster trial in Nigeria and Ghana (Gureje et al., The Lancet 2020), collaborative care between traditional or faith healers and primary-care workers reduced psychotic symptoms more than usual care, and harmful practices fell. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839] In a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric medication reduced symptoms, but days in chains were not significantly reduced. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial] The second trial shows that collaboration does not by itself end harmful practices.
  • Steps: (1) Ask whether the client wants anyone from their community involved, and whom. (2) Obtain written consent stating what will be shared. (3) Contact through the client or a community organisation, never by seeking out a commercial applicator. (4) Agree roles: you provide psychological care and medical liaison, and the community provides its own guidance. (5) Keep safety limits explicit. (6) Review with the client.
  • Example language (illustrative): "Is there someone at home whose view on this matters to you, and would you like them part of the conversation?"
  • Watch for: a commercial practitioner presented as an Indigenous authority; pressure from either side; confidentiality in small communities. It is working when the client feels their two worlds are not in conflict.

4.12 Interpreters and cultural brokers

  • Purpose / when: language barriers (Portuguese, Spanish, Indigenous languages) or unfamiliar cultural frames. The CFI's Q16 covers language barriers. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Steps: (1) Use a trained interpreter, not family, for assessment. (2) Brief them on the topics and on confidentiality. (3) Check whether they and the client share a community, and offer an alternative if so. (4) Debrief afterwards on terms and cultural meanings. [synthesis]
  • Example language (illustrative): to the interpreter: "If a word like panema has no English equivalent, please keep the word and tell me that you have."
  • Watch for: the interpreter editing content they find shameful. It is working when key terms come through intact.

4.13 Working with family and informants

  • Purpose / when: when family are worried, the client lacks capacity, or relatives were present. Use the CFI Informant Version. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Steps: (1) Obtain consent. (2) Ask the informant's relationship and view of the problem. (3) Explore family views on kambo, which may differ across generations or between Indigenous and urban relatives. (4) Agree how the family will recognise a medical emergency and respond. [synthesis]
  • Example language (illustrative): "How do you understand what has been happening to your brother since the retreat?"
  • Watch for: blame, or family conflict about the practice. It is working when family and client share a safety plan.

4.14 Integration of the experience

  • Purpose / when: after a session, whether felt as helpful, frightening or harmful. [synthesis]
  • Steps: (1) Invite an account in the client's own words. (2) Separate bodily events, emotions and meanings. (3) Link meanings to the client's values and goals. (4) For frightening or harmful experiences, assess for trauma symptoms and treat with standard care. (5) If the client plans further sessions, review risks with them (4.15). For psychedelic integration practice see Domain VII.
  • Example language (illustrative): "What has stayed with you from it, in your body and in how you see things?"
  • Watch for: grandiosity, persistent dissociation, intrusive memories, or medical after-effects (refer). It is working when the experience is part of the client's story rather than a source of distress or compulsion.

4.15 Conversation with a client who plans to attend

  • Purpose / when: when a client says they intend to take part. You do not advise on how to take part. You can share what clinical sources report and support an informed decision. [synthesis]
  • Steps: (1) Explore motives (4.10). (2) With permission, share published risk information: case reports describe serious and fatal harms, case authors link heavy pre-session water drinking to fatal hyponatraemia, and clinical authors advise medical consultation beforehand, especially with heart disease or pregnancy. [source: Tran et al. 2025; Sacco et al. 2025; da Silva et al. 2019] (3) Note the legal position where the client lives (Section 1). (4) Encourage a physician consultation and that someone knows how to call for help. (5) Respect the client's decision, record the discussion, and keep the door open.
  • Example language (illustrative): "It's your decision. I'd be letting you down if I didn't mention that doctors have reported serious reactions, including dangerous drops in blood salt. Would you talk to your GP first?"
  • Watch for: pressure from a provider to drink large amounts of water or to ignore symptoms; pregnancy; heart disease. It is working when the client consults a physician or reconsiders.

4.16 Safeguarding and reporting

  • Purpose / when: children or pregnant people involved; coercion; a provider who discourages emergency care; serious harm. Sources list pregnancy, children and people with low body mass among those at risk, and report use to induce abortion. [source: Sacco et al. 2025; da Silva et al. 2019]
  • Steps: (1) Apply local safeguarding procedures for children and adults at risk. (2) In an emergency call emergency services. (3) Where a regulator governs the substance (for example the TGA in Australia), or a death or serious injury has occurred, consider your reporting routes and seek advice. (4) Document. [synthesis]
  • Example language (illustrative): "Because a child was given this, I have a duty to share my concern. I'll tell you what I'm doing and why."
  • Watch for: confusing cultural respect with silence. It is working when risk is reduced and the client stays engaged.

5. Handling problems

The sources do not address psychotherapy problems with kambo. All responses below are [synthesis], drawing on the risks reported in the sources cited.

  • Client minimises a medical warning ("the vomiting is the toxins leaving"). Acknowledge their meaning, state your concern plainly, and name the specific danger signs (4.3). If acute signs are present, call for help regardless. Document.
  • Client asks you how to do it safely, or for a provider recommendation. Decline clearly and warmly: this is outside your role and competence, and Indigenous knowledge holders and doctors are the relevant authorities. Offer 4.15 instead.
  • Resistance: client fears judgement or reporting. Explain confidentiality and its limits at the start. Separate legal status, which varies by country (Section 1), from your role. Return to the CFI's help-seeking questions.
  • Rupture after you raised risk. Name it: "I think my worry came across as disapproval." Repair by returning to the client's goals. Do not drop the safety point.
  • Overwhelm or trauma after a frightening session. Stabilise and ground first, assess for acute stress and PTSD, and treat with standard trauma-focused care when the client is ready. Check for medical after-effects.
  • Persisting unusual beliefs framed as spiritual awakening. Use 4.8: cultural consultation and psychiatric referral. Avoid both dismissal and collusion.
  • Non-adherence to prescribed treatment because of a provider's advice. Do not argue medication content. Contact the prescriber, with consent or under safeguarding if the risk is serious.
  • Repeated or escalating use, or use for weight or "purging". Assess for compulsive patterns, eating-disorder features and self-harm. Treat the underlying problem with standard care.
  • Indigenous client caught between community expectations and their own wishes. Support the client's own decision. Use 4.11 only if they want community involvement. Be aware of internal community disagreement over urban use and commercialisation. [source: Lima 2012]
  • Stuck: the client finds nothing helpful except kambo. Revisit the explanatory model and the need behind the practice (4.6, 4.10). Consider adding a group, social or spiritual resource the client chooses.
  • Group or retreat pressure, including a partner who runs sessions. Explore coercion and power. Assess adult-safeguarding needs and intimate-partner abuse.
  • Your own discomfort, or interest in trying it. Take it to supervision. Do not join a client's group or ceremonies.

Harm account

What was actually done

  • Commercial and neoshamanic sessions. Kambo moved from Indigenous and riverine use into neoshamanic, New Age and holistic therapy settings. A practitioner association trains urban "applicators", and European websites sell the secretion directly. [source: Ribeiro 2021] Dried secretion is sold as "kambô sticks" in markets and online. [source: JVATiTD 2014] Inexperienced practitioners are reported to use secretions from other species, such as the cane toad (Rhinella marina). [source: Sacco et al. 2025; da Silva et al. 2019] Sessions are marketed as detox or cleansing for conditions from anxiety and arthritis to cancer, diabetes and HIV/AIDS, often combined with ayahuasca. [source: Al Jazeera 2026; Sacco et al. 2025] Western sessions often add songs, incense and prayers that are not part of traditional use. [source: Swinburne 2023]
  • Water loading. In a 2025 US case, a 35-year-old woman six months postpartum drank large volumes of water beforehand as part of the facilitator's "prehydration protocol". About five hours after the session she developed severe headache and repeated vomiting, then confusion. [source: Tran et al. 2025] In an earlier Slovenian case (Leban et al. 2016, as summarised by Tran et al.), a woman drank a very large volume of water during a session. [source: Tran et al. 2025] People are reported to be routinely advised to drink large amounts of water beforehand. [source: Al Jazeera 2026]
  • Expected effects presented as cleansing. Vomiting, diarrhoea, sweating, racing heart, dizziness, facial flushing and swelling, and abdominal pain are expected during sessions. Symptoms usually last 15–30 minutes but sometimes hours. [source: Swinburne 2023; Sacco et al. 2025] Vomiting is framed as cleansing. [source: Sacco et al. 2025]
  • Retreat deaths and litigation. In 2018 a man died after an ayahuasca-and-kambo retreat run by Soul Quest in Florida. In May 2024 a jury awarded his family $15 million, and the company closed in August 2024. [source: The Psychedelic Journal 2026]

How it caused harm

  • Hyponatraemia, SIADH and cerebral oedema. Case authors describe a combined mechanism: the peptides cause vomiting, diarrhoea and salivary losses; the peptide sauvagine may drive inappropriate antidiuretic hormone release and impair water excretion; water loading then dilutes sodium further; and the osmotic shift draws water into brain cells, causing oedema and raised intracranial pressure. [source: Tran et al. 2025] In the 2025 case the woman arrived at hospital with GCS 3 and sodium 123 mmol/L, with diffuse cerebral oedema. She was declared brain dead. [source: Tran et al. 2025] The Slovenian case of SIADH recovered after sodium correction. [source: Tran et al. 2025; da Silva et al. 2019] A 2022 review of 11 acute intoxication cases (Sacco et al.) singled out hyponatraemia as the most concerning electrolyte disturbance. [source: Tran et al. 2025]
  • Cardiovascular events and sudden death. Phyllokinin and phyllomedusin cause vasodilation and hypotension, and deltorphin is an opioid-receptor agonist. [source: Sacco et al. 2025] A 42-year-old overweight man with coronary disease died suddenly in Italy (2018). Hypotension, tachycardia and arrhythmia are suggested causes, and deltorphin A was detected in his blood, though causation could not be confirmed. [source: da Silva et al. 2019; Tran et al. 2025] A 52-year-old man died in São Paulo state shortly after a session, and the secretion reportedly came from Acre. [source: da Silva et al. 2019]
  • Oesophageal rupture. Two cases of Boerhaave syndrome followed severe vomiting, one with tension pneumothorax and septic shock. [source: Sacco et al. 2025] A 2021 Australian death involved a suspected perforated oesophagus. [source: Al Jazeera 2026]
  • Liver, muscle and kidney. Reported harms include toxic hepatitis with jaundice; transient hepatitis in Poland; and rhabdomyolysis with renal failure, seizures and mechanical ventilation, followed by full recovery. [source: Sacco et al. 2025; da Silva et al. 2019]
  • Psychiatric harm. Psychosis has been reported in a woman after frequent sessions and in a separate US case. Confusion, short-term memory loss and altered mental status have also been reported. [source: Sacco et al. 2025; da Silva et al. 2019]
  • Other. Reported harms also include dermatomyositis; a systemic inflammatory response in a person with cholangiocarcinoma; and wound infection. [source: Sacco et al. 2025; JVATiTD 2014]
  • Deaths overall. One news report counts at least six deaths: Brazil 2008, Italy 2018, Australia 2019 and 2021, Mexico 2024, and the UK 2026 (a wellness coach after a "cleansing ceremony"). [source: Al Jazeera 2026] Two Australian deaths led to coronial inquests. [source: Swinburne 2023; AAP coroner report] Counts differ across sources. [uncertain]
  • Who is most at risk. People with heart disease or hypotension; pregnant people (use to induce abortion is reported) and, in the fatal case, a postpartum woman; children and people with low body mass; people with pre-existing illness; people who drink large volumes of water; and people buying from unregulated sources. [source: Sacco et al. 2025; da Silva et al. 2019; Tran et al. 2025] Forensic detection is hard because the peptides degrade quickly and reference materials are lacking. [source: Sacco et al. 2025]

Recognising it today

  • Features and phrases: "frog medicine", "sapo", "vacina do sapo", "kambo cleanse", "detox", "reset", "purge"; retreats pairing kambo with ayahuasca; claims to treat anxiety, depression, addiction, cancer, diabetes or HIV; advice to drink large amounts of water beforehand; framing of prolonged vomiting or confusion as "part of the process". [source: Al Jazeera 2026; Sacco et al. 2025; da Silva et al. 2019; Tran et al. 2025]
  • Clinical clues: acute neurological decline, vomiting and low sodium after a ceremony or retreat, especially with characteristic small burn marks on the skin. [source: Tran et al. 2025]
  • Red flags in a provider or colleague: practitioner certificates presented as medical or Indigenous authority (certifications are reported not to be medical credentials); no medical screening; discouraging medical care or prescribed medicines; online sale of secretion; offering kambo where it is prohibited, as in Australia. [source: The Psychedelic Journal 2026; Ribeiro 2021; Swinburne 2023]
  • How Indigenous use differs: it is held by specific peoples and their knowledge holders, who have sought its protection and criticised outsiders' sales and use without their preparation or permission. [source: Ribeiro 2021; Al Jazeera 2026; da Silva et al. 2019] That difference concerns authority and context. It does not make the pharmacological risks disappear, and the clinical sources do not evaluate Indigenous use for safety. [uncertain]

What to do instead and how to help those harmed

  • Instead: for the problems kambo is marketed for, use evidence-based medical and psychological care, chosen with the client's cultural formulation (4.4–4.7). For Indigenous clients who want community involvement, use 4.11. For psychedelic-assisted care and integration, see Domain VII.
  • Acute harm: call emergency services. The clinical recommendations are electrolyte checks, cardiac monitoring and correction of hyponatraemia. These are medical tasks. [source: Tran et al. 2025; Sacco et al. 2025]
  • After harm: assess for PTSD, depression, persisting psychosis and cognitive effects after hyponatraemic or hypoxic injury (refer for neuropsychological assessment). Address shame and self-blame, and anger at providers. Support bereaved families through ordinary grief and trauma care, including during coronial processes. [synthesis]
  • Duties: follow safeguarding procedures for children, pregnant people and adults at risk. Document. Consider reporting serious harm to health authorities, as forensic authors recommend. [source: Sacco et al. 2025] Seek legal and professional-body advice where sale or supply is prohibited (Section 1). Never advise on medicines; route to the prescriber.

Sources

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