Ozone therapy · Atlas

1. Introduction

Version followed: the method as its proponent bodies describe it: the International Scientific Committee of Ozone Therapy (ISCO3) Madrid Declaration (2nd ed., 2015) as summarised by an ISCO3 officer (Schwartz 2016), the Italian Society for Oxygen-Ozone Therapy (SIOOT) as its members describe it (Loprete et al. 2019) and proponent researchers (Bocci et al. 2009); regulatory and safety status from the US FDA regulation 21 CFR 801.415, the Malaysian Ministry of Health HTA brief (2017), courts, the US Department of Justice and the FTC. The psychotherapist works with the client's decision-making, meaning and risk; the psychotherapist never performs, sells, prescribes or recommends ozone therapy.

What it is, as proponents describe it. Ozone therapy ("oxygen-ozone therapy", "ozonotherapy") is the use of a mixture of medical oxygen and ozone gas applied to the body by several routes. Proponents name, among others: major autohaemotherapy (MAH), in which some of the person's own blood is taken, exposed to the ozone-oxygen mixture outside the body and returned to the vein; infusion of ozonated saline; injections into muscle, joints or discs; and extracorporeal blood oxygenation-ozonation (EBOO) [source: Schwartz 2016; Bocci et al. 2009]. The Malaysian HTA describes autohaemotherapy plainly as an autologous blood transfusion combined with ozone [source: HTA Malaysia 2017]. Some US businesses also sold "ozone steam saunas" and "oxidative therapy with intravenous ozone" [source: DOJ 2020; FTC 2020].

Core idea of how change happens (attributed). Proponents hold that a controlled oxidative stimulus acts as a signal: ozone reacts with blood components to form short-lived messengers (e.g. hydrogen peroxide, lipid oxidation products) that switch on the body's own antioxidant defences (the Nrf2 pathway is cited), and that it improves oxygen delivery and microcirculation, modulates immunity and inflammation, and disinfects against bacteria, viruses, fungi and parasites [source: Schwartz 2016; Loprete et al. 2019]. These are the method's own claims. Evidence status in one line: an HTA review found no high-level evidence for cancer, heart disease, stroke or HIV and only very limited low-quality evidence elsewhere, and did not recommend it for medical treatment [source: HTA Malaysia 2017]. The US FDA regulation states that ozone is "a toxic gas with no known useful medical application" [source: 21 CFR 801.415]. Nothing in this guide presents ozone therapy as a treatment for cancer, infection or any physical disease.

The psychotherapist's change model alongside it [synthesis]. Clients rarely need the therapist's opinion of ozone; they need a place to think. Change happens when the client (a) can speak openly about what they are using or considering, (b) understands their own hopes and fears driving the choice, (c) has accurate, sourced information about regulatory status and documented risks, and (d) makes a decision that fits their values while staying connected to medical care.

2. Framework

How the method is delivered (as proponents and regulators describe it; no technique given).

Setting: physicians' private clinics, some integrative or naturopathic practices, and, in documented harm cases, out-of-scope or unlicensed practitioners working in clinics, homes or hotel rooms [source: Robins v Rosa 2024; Asian Pacific Post 2006].
Format: usually a course of repeated sessions; the procedure involves a needle in a vein (MAH, ozonated saline) or an injection into tissue. Proponents state that blood withdrawal follows SIOOT guidance submitted to the Italian Ministry of Health [source: Loprete et al. 2019]. Session numbers and parameters are deliberately not given here.
Who practises it: physicians who take proponent-society courses; in some US states naturopathic doctors (California's naturopathic committee proposed requiring extra training for ozone injection and prohibiting direct injection of ozone gas into the vascular system) [source: California Naturopathic Medicine Committee 2020, proposed text; uncertain: final adopted wording not verified].

Regulation and licensing, one line each.

United States: FDA regulation states ozone has no known useful medical application; devices used to generate ozone for such purposes are treated as adulterated and/or misbranded [source: 21 CFR 801.415]. Advertising health claims require "competent and reliable scientific evidence"; the FTC sent warning letters to ozone marketers in 2020, and a federal court entered a permanent injunction against a Dallas wellness centre claiming ozone prevented COVID-19 [source: FTC 2020; DOJ 2020]. Who may perform injections is set by state licensing boards [source: California Naturopathic Medicine Committee 2020; Robins v Rosa 2024].
Spain: Catalonia (2012) and Madrid (2016) classified major autohaemotherapy as a blood-transfusion procedure under Royal Decree 1088/2005, requiring direction by a haematology specialist; this is reported by a proponent who opposes it [source: Schwartz 2016].
Italy: practised by physicians, many in proponent societies (SIOOT, FIO), which publish their own guidelines. A Ministry of Health circular of 31 December 2002 restricted trial use of oxygen-ozone therapy to hospital settings; parliamentary questions in early 2003 asked for it to be extended to private medical offices, argued it did not bind private practitioners, and asked for rules to keep it out of beauty centres [source: Camera dei Deputati 2003, questions 4-05184 and 4-05284]. A Tuscany regional health technical committee (2018) cites a later Ministry circular of 20 January 2005 and regional rules, requires informed consent, and confines intravenous use of a related preparation ("liquid polyatomic oxygen") to authorised facilities within ethics-approved trials [source: Regione Toscana CTS Decision 20/2018]. Current national legal status beyond these documents [uncertain: content of the 2005 circular unconfirmed].
Russia and Ukraine: a proponent reports ministry approval of ozonated saline (Russia, early 1980s; Ukraine, 2001) [source: Schwartz 2016; uncertain: proponent report only].
Malaysia: national HTA did not recommend it for medical treatment [source: HTA Malaysia 2017].
Brazil: the Brazilian Society of Infectology (2023) states the literature does not support it as effective and safe for hepatitis B, C or cirrhosis; legal status [uncertain: not verified] [source: SBI 2023].
UK, Canada, Australia: [uncertain: not verified].

The psychotherapist's framework [synthesis]. Not a separate therapy course; it is woven into ongoing therapy, with follow-up.

Phase A, Ask and record: complementary use is asked about routinely; goal: an honest, non-judgemental picture. Move on when you know what, who, where, why, and cost.
Phase B, Understand: meaning, hopes, explanatory model, social context. Move on when the client can state in their own words what they hope ozone will do and what they fear if they do not try it.
Phase C, Decide: values-based weighing with accurate information; coordination with the client's doctor with consent. Move on when the client has made (or deferred) a decision they own.
Phase D, Monitor and respond: watch for risk signals, emergencies, financial harm, safeguarding, regret or harm; reporting where needed. Continues throughout.
Fast track: any acute warning symptom after an intravenous procedure (chest pain, collapse, seizure, sudden neurological or visual change) overrides all phases: emergency services first (see 4.6).

3. Guiding principles

All principles are [synthesis] unless a source is given.

Curiosity before information. Ask what draws the client before saying anything about ozone; information lands only once they feel understood.
The therapist is not the prescriber or the seller. Never perform, sell, refer to, recommend or advise against a specific procedure as if prescribing; route medical questions to the doctor or pharmacist.
Attribute, do not adjudicate. Describe proponents' claims as theirs and regulators' findings as theirs (e.g. "the FDA's regulation describes ozone as a toxic gas") [source: 21 CFR 801.415].
Autonomy with accurate information. The client decides; your job is that the decision is informed, uncoerced and consistent with their values.
Stay connected to medical care. The central risk is substitution or delay of effective treatment; protect the client's link to their doctor.
Physical safety outranks rapport. Embolic events, infection and blood-borne disease exposure are documented risks of intravenous ozone procedures [source: Wong et al. 2025; HTA Malaysia 2017; Robins v Rosa 2024]; acute symptoms mean emergency care now.
Notice who is doing the procedure and where. Documented deaths involved out-of-scope or unlicensed practitioners and non-clinical settings [source: Robins v Rosa 2024; Asian Pacific Post 2006].
Watch the money. High fees, packages and claims of cure are red flags for exploitation [source: Asian Pacific Post 2006; FTC 2020].
Protect children. Claims that ozone is "safe even for children" were part of a case ending in an injunction [source: DOJ 2020]; children trigger safeguarding thinking.
No conflicts of interest. Never earn from, or promote, complementary products or providers to your clients.
Respect grief and regret. When harm has happened, avoid "I told you so" framing; the client's shame is clinical material.
Document. Record what the client uses, what was discussed, information given, consent for coordination, and risk actions.

4. Intervention inventory

These are the psychotherapist's own interventions alongside ozone therapy. They are general practice for complementary-therapy conversations, adapted here; all steps are [synthesis] unless a source is cited. None involves performing, recommending or selling ozone therapy.

4.1 Routine, non-judgemental inquiry and recording

Purpose / when: at intake and at reviews, and whenever a client mentions "IVs", "oxygen", "detox", "ozone", "blood cleansing" or a wellness clinic. Many clients do not volunteer complementary use unless asked neutrally.
Steps: (1) Normalise: say that many people use complementary approaches and that you ask everyone. (2) Ask open questions: what, since when, where, who performs it, what they were told it does, cost. (3) Ask specifically whether anything involves needles, blood being taken and returned, or a drip. (4) Ask whether their doctor knows. (5) Record it factually in the notes (procedure as the client names it, provider type, setting, cost, whether the doctor knows) without evaluative language.
Example language (illustrative): "Lots of people I work with use treatments outside standard medicine, so I ask everyone. Is there anything like that you're using or thinking about, such as drips, injections, saunas or supplements?" / "When you go for the ozone sessions, what actually happens? Is any blood taken, or is something put into a vein?"
Watch for: defensiveness (slow down, reaffirm no judgement); intravenous routes or non-clinical settings (move to 4.6); out-of-scope practitioners. Working: the client names their use spontaneously at later sessions.

4.2 Exploring meaning, hopes, expectations and explanatory model

Purpose / when: once use or interest is known; before any information-giving.
Steps: (1) Ask what first drew them to ozone (a friend, social media, a practitioner, an illness). (2) Elicit their explanatory model: how they understand their illness and how ozone is meant to help (proponents' language such as "oxygenating", "detox", "boosting immunity" or "killing viruses" [source: Loprete et al. 2019; DOJ 2020] is worth reflecting back in the client's own words). (3) Explore the functions it serves: control, hope, distrust or past hurt in medicine, identity ("natural" person), belonging to a community, wish to leave no stone unturned. (4) Ask about expectations: what would count as it working, how they would know if it isn't. (5) Summarise without correcting.
Example language (illustrative): "What do you hope ozone will do for you that your other treatment isn't doing?" / "It sounds like trying this gives you back some control after months of feeling things were done to you." / "If six months from now it had worked, what would be different?"
Watch for: hope that is the client's main defence against despair (go gently; this links to grief work); medical distrust rooted in real past harm (validate the harm, not the conclusion); signs of a high-control group or a practitioner discouraging contact with doctors. Working: the client articulates their own reasons and begins to separate the hope from the procedure.

4.3 Giving accurate, attributed information on request

Purpose / when: when the client asks what you know, or after asking permission to share. Not as a lecture.
Steps: (1) Ask permission. (2) Ask what they already know. (3) Share short, sourced facts, attributed: what the FDA regulation states [source: 21 CFR 801.415]; that a health-technology review did not recommend autohaemotherapy for medical treatment and noted the risk of blood-borne disease [source: HTA Malaysia 2017]; that published case reports describe embolic strokes and a death after intravenous ozone [source: Wong et al. 2025; Robins v Rosa 2024]; that proponent researchers themselves warn against direct injection of gas into a vein [source: Bocci et al. 2009]. (4) Ask what they make of it. (5) Offer to help them write questions for their doctor or the provider.
Example language (illustrative): "Would it be useful if I shared what I know about how regulators view this? You can take it or leave it." / "The US FDA's regulation describes ozone as a toxic gas without a known medical use. Practitioners see it differently. What do you make of that gap?"
Watch for: the client feeling judged (return to 4.2); information overload; your own urge to persuade. Never give technique, dosing or provider advice. Working: the client asks follow-up questions or plans to check with their doctor.

4.4 Supporting an informed, values-based decision without coercion

Purpose / when: when the client is deciding whether to start, continue or stop. No published decision aid specific to ozone therapy is cited here [uncertain: not verified]; use general shared-decision principles [synthesis].
Steps: (1) Clarify the decision (start / continue / stop / delay). (2) List options, including keeping standard medical care alongside. (3) For each, the client names benefits hoped for, risks they know of, costs (money, time, travel), and what matters most to them. (4) Identify gaps in information and who could fill them (doctor, pharmacist, licensing board). (5) Ask: "Is anyone pressuring you either way?" (6) Let the client decide or defer; record the decision and reasoning.
Example language (illustrative): "Let's put the options side by side. What matters most to you here: safety, cost, feeling you've done everything?" / "Whatever you decide, I'll still be here, and I won't think less of you."
Watch for: decisions to stop or delay effective treatment (cancer, infection, hepatitis, COVID-19 care), which are the highest-risk outcome (move to 4.6 and 4.8); pressure from family or practitioner. Working: the client can state the decision and their reasons, and it is consistent with their values.

4.5 Coordination with the client's doctor or pharmacist (with consent)

Purpose / when: whenever the client is having or planning a procedure that involves blood, injections or intravenous lines, has a serious illness, takes medicines (especially those affecting clotting), or is pregnant.
Steps: (1) Explain why coordination helps (safety, joined-up care). (2) Obtain explicit, documented consent for what you share and with whom. (3) Encourage the client to tell their doctor directly first; offer to help them rehearse. (4) If consented, write briefly and factually: what the client reports using, your role, no recommendation. (5) Route all medicine questions (starting, stopping, interactions) to the prescriber or pharmacist; proponent literature itself mentions coagulation concerns with intravenous routes [source: Bocci et al. 2009, citing Ikonomidis et al. 2005].
Example language (illustrative): "Your doctor needs to know about anything going into your bloodstream. Would you like to tell them yourself, or shall we draft a short note together?" / "That's a question for your pharmacist; I'd hate to guess about your medicines."
Watch for: refusal of consent (respect it unless a safeguarding or imminent-risk threshold is met); doctors who dismiss the client harshly (help the client stay engaged anyway). Working: the doctor is informed and the client remains in medical care.

4.6 Recognising and responding to physical risk and emergencies

Purpose / when: any client who has had, or is about to have, an intravenous or injected ozone procedure.
Steps: (1) Know the documented warning picture: after intravenous ozone, a previously healthy woman developed chest pain, fainting and a seizure, with multiple embolic-pattern strokes, needed intensive care and was left with lasting cognitive impairment [source: Wong et al. 2025]; a patient died after an intravenous injection of ozone-oxygen gas [source: Robins v Rosa 2024]; proponent authors describe fatal gas embolism, sudden low blood pressure, slow heart rate, fainting and temporary blindness with some routes [source: Bocci et al. 2009]. (2) If the client reports, during or after a session, chest pain, breathlessness, collapse, seizure, confusion, weakness, speech or vision changes: tell them to call emergency services now, or call for them; do not wait for the next session. (3) Ask about infection signs after procedures (fever, redness at the injection site) and route to their doctor; the HTA notes exposure to blood-borne disease [source: HTA Malaysia 2017]. (4) Record what happened and actions taken.
Example language (illustrative): "Chest pain and fainting after something went into your vein needs an ambulance now, not tomorrow. I'm going to stay on the line while you call."
Watch for: minimisation ("it's a healing crisis", a framing some practitioners may use [uncertain: not verified in sources]); clients reluctant to tell emergency staff what was done (reassure them it is essential and not a moral judgement). Working: the client knows the warning signs and has agreed what they would do.

4.7 Recognising delay of medical care, children, pregnancy, financial and group pressure

Purpose / when: throughout, especially with serious illness.
Steps: (1) Ask whether ozone is being used instead of, or alongside, treatment recommended by their doctor. (2) Note claims of cure for cancer, COVID-19, hepatitis or HIV; regulators and courts have acted against such claims [source: DOJ 2020; FTC 2020; SBI 2023]. (3) Ask about cost, packages, travel abroad and debt; a practitioner abroad charged tens of thousands of dollars for intravenous "liquid ozone" for cancer [source: Asian Pacific Post 2006]. (4) Ask whether children in the household are being given ozone procedures (move to safeguarding, 4.10). (5) Ask about pregnancy and route to the obstetric team. (6) Ask about group dynamics: a practitioner or community discouraging medical contact, testimonials, shaming of doubt.
Example language (illustrative): "Is the ozone instead of the treatment your oncologist suggested, or alongside it?" / "How are you managing the cost? Some people end up borrowing for this kind of thing."
Watch for: secrecy, escalating spending, isolation from doctors or family. Working: the client stays in medical care and spending is a conscious decision.

4.8 Psycho-oncology and serious illness conversations

Purpose / when: clients with cancer or other serious illness considering ozone as a treatment.
Steps: (1) Respect the wish to fight and to hope; name it. (2) Separate hope for cure from hope for time, comfort and connection. (3) Encourage open discussion with the oncology team; offer to help prepare. (4) Raise palliative-care referral as a source of support, not giving up. (5) Address family conflict: help family members voice fear without ultimatums. (6) If the client has already chosen alternatives and is deteriorating, attend to grief, regret and family conflict without blame (see 4.12). Cross-reference 172 (integrative oncology) for complementary-alongside framing.
Example language (illustrative): "Part of you is looking for anything that might help. Can we also think about what helps you live as well as possible right now, whatever else you try?"
Watch for: ultimatums in families; despair hidden behind certainty. Working: the client discusses the option openly with their oncologist and family.

4.9 Health anxiety and somatic symptom presentations

Purpose / when: a client pursuing repeated "detox" or "oxygenating" procedures for diffuse symptoms, fear of toxins or infection, or idiopathic environmental intolerance.
Steps: (1) Assess for health anxiety or somatic symptom disorder using established approaches (Domain II). (2) Formulate the cycle: symptom, threat appraisal, checking or procedure-seeking, short-term relief, renewed doubt. (3) Use CBT for health anxiety or somatic symptoms per Domain II (attention, reassurance-seeking, safety behaviours). (4) Treat procedure-seeking as a possible safety behaviour without banning it; build the client's own experiments. (5) Keep medical review with one consistent doctor.
Example language (illustrative): "After each session you feel relief for a while, then the worry comes back. Shall we look at that pattern together?"
Watch for: escalation to riskier routes; comorbid depression or eating restriction. Working: reduced reassurance-seeking and procedure-seeking, better functioning.

4.10 Safeguarding children and adults at risk

Purpose / when: a child (or an adult lacking capacity) is given ozone procedures, or is deprived of medical care. A business claimed ozone was "safe even for children" before a court injunction [source: DOJ 2020].
Steps: (1) Gather facts calmly: what, how often, who performs it, any medical care withheld. (2) Consider the child's assent and parental consent, and whether medical neglect is involved. (3) Consult your safeguarding lead or supervisor. (4) Follow local child-protection procedures and make a referral where thresholds are met. (5) Document. Never name the child outside the clinical record.
Example language (illustrative): "I need to understand a bit more about what your son is having done, because keeping children safe is part of my job."
Watch for: injections or intravenous procedures in children; refusal of needed medical treatment. Working: the child's medical care is secured.

4.11 Reporting routes

Purpose / when: documented harm, false claims, unlicensed or out-of-scope practice.
Steps: (1) With the client's consent (or under a duty that overrides it), identify the route. (2) United States: false health claims to the FTC (the FTC site links a fraud-reporting page, reportfraud.ftc.gov) [source: FTC 2020]; product or device problems to the FDA (MedWatch) [uncertain: not verified]; out-of-scope or negligent practice to the relevant state licensing board (a state disciplinary office investigated a practitioner after a death) [source: Robins v Rosa 2024]; deaths and serious injury to police or the medical examiner where relevant. (3) Other jurisdictions: the national medicines and devices regulator (e.g. UK MHRA, Australian TGA, Health Canada), advertising regulators and professional boards [uncertain: routes not verified]. (4) Safeguarding referrals as in 4.10. (5) Document what was reported and when.
Example language (illustrative): "What happened to you may also happen to others. Would you like help reporting it? You decide, unless someone is at immediate risk."
Watch for: fear of retaliation or shame. Working: the client feels in control of the reporting decision.

4.12 Working with clients after harm, regret or financial loss

Purpose / when: after an injury, a lost medical opportunity, a bereavement, or financial loss linked to ozone therapy.
Steps: (1) Ensure medical follow-up (e.g. neurological rehabilitation after embolic stroke [source: Wong et al. 2025]). (2) Assess trauma symptoms, depression, suicidality (standard risk assessment). (3) Work with shame and self-blame; distinguish responsibility from blame. (4) Grief work for bereaved families, including regret about choices the person made. (5) Practical help: financial counselling, legal advice, reporting (4.11).
Example language (illustrative): "You made the best decision you could with what you were told. We can be angry about what you were told."
Watch for: suicidal thinking, family scapegoating. Working: reduced self-blame, re-engagement with care.

4.13 Managing the therapist's own role and conflicts of interest

Purpose / when: always.
Steps: (1) Never sell, refer to, promote or take payment linked to ozone providers. (2) Notice your own reactions (alarm, contempt, enthusiasm) and take them to supervision. (3) Stay within scope: no medical opinions. (4) Follow your professional ethics code on conflicts of interest [synthesis: code not cited here].
Example language (illustrative): "I don't have any stake in what you choose. My job is to help you think it through."
Watch for: colleagues in your service offering or promoting ozone; dual relationships. Working: clients experience you as neutral and safe.

5. Handling problems

Sources do not address psychotherapeutic problem-handling for ozone therapy; all responses below are [synthesis], with safety facts sourced where stated.

Client becomes defensive or feels judged. Stop giving information; return to 4.2. Say: "I'm not here to talk you out of anything (illustrative)." Repair explicitly if you pushed.
Client insists ozone has cured them and wants you to agree. Reflect their experience without endorsing the claim: "You feel much better, and that matters to you (illustrative)." Keep the focus on their health and their link to medical care.
Stuck between hope and fear, cannot decide. Narrow the decision (e.g. "tell my doctor" before "start or not"); use 4.4; allow deferral.
Non-adherence to medical treatment in favour of ozone. Explore what medical treatment means to them (side effects, past hurt, cost); support a frank conversation with the doctor; for serious illness, use 4.8; consider whether capacity or safeguarding questions arise.
Rupture after you raised risk. Name it, own your part, reaffirm the client's autonomy, and ask how they want such information in future.
Overwhelm after learning of risks or after harm. Ground first; slow pacing; small next steps; screen for trauma symptoms.
Client refuses consent to contact their doctor. Respect it; keep encouraging direct disclosure; break confidentiality only where law and imminent-risk or safeguarding thresholds require.
Acute symptoms reported mid-session or by message. Emergency services now (4.6). Embolic events after intravenous ozone are documented [source: Wong et al. 2025; Robins v Rosa 2024].
Practitioner pressure or group pressure. Map the influence (who, what is said, cost, contact with family); explore high-control dynamics; support the client to set limits.
Financial exploitation. Help the client total actual spending; involve financial advice; consider reporting false claims (4.11).
Family conflict over the choice. Family sessions with a focus on fear and love behind positions; no ultimatums.
Client wants your recommendation of a provider or a "safer" protocol. Decline clearly and kindly; route to the doctor; note that regulation and lawful practitioners differ by jurisdiction (section 2).
Your own strong reaction (alarm or contempt). Supervision; avoid letting it leak into persuasion.
Colleague in your service offers ozone or promotes it. Raise with the service lead; review conflict-of-interest policies; consider professional-board reporting if out of scope or harmful.

Harm account

What was actually done

Direct intravenous injection of ozone-oxygen gas. Proponent researchers write that direct intravenous gas injection was used in patients with HIV in the 1990s and caused fatal oxygen embolism, and that the route was prohibited (they give 1984 [uncertain: dates as given in the source are inconsistent]) [source: Bocci et al. 2009]; a Tuscany regional committee also states that the proponent societies have banned direct intravenous administration since 1984 [source: Regione Toscana CTS Decision 20/2018]. The same proponent authors state that larger gas volumes injected under the skin caused three deaths in Italy; they cite no case report or official record for this [uncertain: proponent statement only, numbers and circumstances unverified]. An Italian parliamentary question of January 2003 says a "tragic event" prompted the Ministry of Health's December 2002 circular restricting the therapy, without giving details [source: Camera dei Deputati 2003, question 4-05184].
New York (death; court and medical examiner findings). A New York-licensed podiatrist used ozone therapy for ailments unrelated to podiatry. A patient died shortly after treatment; the New York City Office of Chief Medical Examiner found the death was caused by an intravenous injection of ozone-oxygen gas and ruled it a homicide due to extreme medical negligence, a finding later upheld in court. The state's Office of Professional Discipline opened a misconduct investigation in 2020 [source: Robins v Rosa 2024]. Outcome of discipline [uncertain: not verified].
Thailand, 2006 (cancer patients; unlicensed practice). A practitioner without a licence, dubbed "Dr Ozone" by the media, treated cancer patients in hotel rooms in Chiang Mai, supervising unidentified "nurses" who injected what he called "liquid ozone" into patients' veins, for a fee reported at about US$22,000. A patient with ovarian cancer died after severe bleeding; another lost consciousness after an injection. He was charged with commercial fraud and practising without a licence; he had earlier lost medical licences in several US states and was linked by Australian police to deaths after cesium chloride therapy [source: Asian Pacific Post 2006]. Verdict [uncertain: not verified].
Intravenous ozone, 2025 case report. A previously healthy 36-year-old woman had intravenous ozone therapy, then chest pain, fainting and a generalised seizure; imaging showed multiple strokes consistent with embolism; she needed intensive care and was left with lasting cognitive impairment [source: Wong et al. 2025].
Autohaemotherapy and blood-borne infection. A health-technology review reported one study with a high incidence of hepatitis infection with the therapy and noted exposure to blood-borne disease [source: HTA Malaysia 2017]. Reports specifically attributing infections to reused equipment [uncertain: not verified].
COVID-19 marketing, 2020. A Dallas wellness centre promoted ozone, including an "ozone steam sauna", as the "only prevention" for COVID-19, safe even for children, and also claimed it combated cancer, SARS and Ebola; it agreed to a permanent injunction [source: DOJ 2020]. The FTC sent warning letters including to a clinic promoting ozone therapy and a "cancer institute" promoting "oxidative therapy with intravenous ozone" against COVID-19 [source: FTC 2020].

How it caused harm

Gas embolism: gas entering the circulation can block vessels in the brain, heart or lungs; documented as stroke with lasting cognitive impairment and as death [source: Wong et al. 2025; Robins v Rosa 2024; Bocci et al. 2009].
Cardiovascular and vasovagal reactions: proponents list sudden low blood pressure, slow heart rate, cardiac arrest, fainting, and temporary blindness after a spinal injection [source: Bocci et al. 2009].
Infection and blood-borne disease: handling blood outside the body and intravenous access expose patients to blood-borne infection; proponents note catheter infection, sepsis, thrombosis and pneumothorax with central lines [source: HTA Malaysia 2017; Bocci et al. 2009].
Toxic gas exposure: the FDA regulation treats ozone as a toxic gas, with devices that let it accumulate in occupied spaces above a set limit considered adulterated or misbranded [source: 21 CFR 801.415].
Delay or replacement of effective care: people with cancer, hepatitis or COVID-19 were offered ozone with claims of cure or prevention [source: DOJ 2020; FTC 2020; SBI 2023; Asian Pacific Post 2006].
Financial harm: very high fees for unproven cancer treatment [source: Asian Pacific Post 2006].
Psychological sequelae [synthesis]: guilt and regret in survivors and families, traumatic stress after emergencies, loss of trust in all care.
Most at risk: people with serious or terminal illness, those seeking cures abroad or from unlicensed or out-of-scope practitioners, children whose parents are persuaded by safety claims [source: Asian Pacific Post 2006; DOJ 2020; Robins v Rosa 2024].

Recognising it today

Phrases and rationales: "oxygenates the blood", "detoxification", "kills bacteria, viruses, fungi and parasites", "boosts immunity", "no side effects", "only prevention", "safe even for children", "liquid ozone", "oxidative therapy" [source: Loprete et al. 2019; DOJ 2020; FTC 2020; Asian Pacific Post 2006].
Rebrandings and formats: major autohaemotherapy (MAH), ozonated saline, EBOO, ozone steam saunas, intravenous ozone drips offered in wellness clinics [source: Schwartz 2016; Bocci et al. 2009; DOJ 2020].
Red flags in a practitioner or service [synthesis, drawing on the cases above]: gas injected directly into a vein; procedures by practitioners outside their licensed scope or unlicensed; non-clinical settings (hotel rooms, homes); claims to treat cancer, HIV, hepatitis or COVID-19; advice to stop or avoid medical treatment; large upfront payments and packages; minimising symptoms after a session; treating children.
How regulated practice differs: some jurisdictions treat autohaemotherapy as a blood-transfusion procedure under specialist direction (Catalonia, Madrid) [source: Schwartz 2016]; a US naturopathic regulator's proposed rules prohibited direct injection of ozone gas into the vascular system and required extra training, sterile technique, emergency equipment and written informed consent [source: California Naturopathic Medicine Committee 2020, proposed]. Regulation is not evidence of benefit; the FDA position and HTA conclusion stand [source: 21 CFR 801.415; HTA Malaysia 2017].

What to do instead and how to help those harmed

Instead: evidence-based medical care for the underlying condition through the client's doctor; for health anxiety or somatic symptoms, established psychological treatments (Domain II); for serious illness, palliative and supportive care alongside standard treatment (cross-ref 172) [synthesis].
Acute harm: emergency services for any embolic or cardiovascular warning signs (4.6).
Assessment of affected clients [synthesis]: neurological and cognitive follow-up via medical teams; screening for PTSD, depression, complicated grief, suicidality; shame and self-blame; financial impact.
Treatment [synthesis]: trauma-focused therapy where indicated; grief and regret work for families; cognitive rehabilitation referral; family work for blame and conflict.
Ethical, reporting and legal duties: report false claims and harmful practice through the routes in 4.11 (FTC, FDA, state boards in the US; national regulators elsewhere [uncertain: not verified]); safeguarding referrals for children (4.10); deaths are matters for medical examiners and police; never perform, sell or recommend the procedure; follow your professional code on conflicts of interest [synthesis].

Sources

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