Dr Daniel Perkins is an Honorary Research Fellow at the University of Melbourne, where he is leading the development of a multidisciplinary ayahuasca research project (www.globalayahuascaproject.org), and a Senior Policy Adviser in the Department of Health and Human Service. He has completed a PhD through the Centre of Public Policy (Politics) at the University of Melbourne, as well as a Master of Commerce (Hons) degree, and Graduate Diploma in Social Theory, from the same institution. Daniel has over 15 years experience leading health, social policy, and labour market focused research and policy work that has included partnerships with universities, NGOs, business and all levels of government. TITLE: Ayahuasca use across contexts: understanding difference and supporting safe practice Abstract: Research to date indicates that short and long-term ayahuasca drinking is not associated with adverse mental or physical health outcomes, with some possible benefits. However, it is unclear the extent to which such outcomes may vary by context of consumption. In traditional settings the use of the tea takes place within carefully structured ceremonies under the guidance of experienced leaders, ensuring that set and setting are optimally managed to maximise positive effects and minimise risks. The ayahuasca churches have similarly developed a high degree of structure and process likely to support safe practice. In Western countries neo-shamanic ceremonies, rapidly growing in popularity, typically replicate elements of traditional ceremonies using music and ritual, however the structure and process as well as experience of leaders vary widely, suggesting that outcomes may be more variable. Likewise, in South American countries some tourist focused centres may employ staff with limited knowledge and experience. The paper discusses the unique public health challenges that ayahuasca ceremonies and consumption present and outlines a new global survey of ayahuasca drinking that is collecting detailed data on safety and risk associated with consumption in a wide range of settings. Health and drug policy options to respond to these challenges are discussed.