Kambo (drug)

{{short description|Pseudoscientific use of tree frog secretions}} {{about|the traditional medicine|the frog|Phyllomedusa bicolor|other uses|Kambo (disambiguation)}}

{{Undue weight|date=July 2023}} {{Infobox alternative intervention | image = Applying Kambo.jpg | caption = A kambo ceremony: the frog secretion is being applied to the burnt skin. | pronunciation = | claims = It is claimed that kambo will help with a number of issues, including depression, anxiety, addiction, fertility, fever, mental clarity, negative energy as well as provide the cleansing of the body | classification =  | school = | risks = | legality = | MeshID = | other codes = |name=Kambo|Synonyms={{Hlist| vacina-do-sapo | sapo}}|NCCIH=None}}

'''Kambo''', also known as '''sapo''' (from {{Langx|pt|sapo|lit=toad}}) or '''vacina-do-sapo''', is substance derived from the natural secretions of an amphibian belonging to the Phyllomedusa family. Commonly the dried skin secretions of the giant leaf frog, known as the ''kambô'' in Portuguese, a species of frog, are used for ritualistic purposes with a strong religious and spiritual components. Less commonly it is used as a transdermal medicine, however, evidence for its effectiveness is limited.

Kambo is usually used in a group setting, called a '''kambo circle''' or '''kambo ceremony'''. Some of the effects on humans include tachycardia, hypotension, nausea, as well as vomiting and sometimes bowel movements owing to smooth-muscle contractions. A meta-review of 50 studies in which 11 cases of acute intoxication were examined found that extreme cases have included psychosis (occasionally severe), SIADH, kidney damage (including acute renal failure), pancreas damage, liver damage including toxic hepatitis, dermatomyositis, esophageal rupture, and seizures, in some cases leading to death{{R|SaccoZibettiBonetta2022}}{{R|JVATITD2014}}{{R|DalyCaceres1992}}, although such incidents are limited in number and some evidence suggests precipitation by medical contraindications.{{R|ForensicScience2019}}

Kambo, which originated as a folk medicine practice among some indigenous peoples in the Amazon basin, is also administered as a complementary medicine and alternative medicine treatment in the West, often as a pseudoscientific cleanse or detox. The ceremony involves burning an arm or leg and applying the kambo secretion directly to the burn. Promoters claim that kambo helps with several illnesses or injuries. There is no scientific evidence that it is an effective treatment{{R|Derma2019}}{{R|TheGuardian2021}}{{R|ABCNewsMay2023}}{{efn|name=longnote}} and causal evidence is limited.{{citation needed|date=May 2024}}

It seems to be particularly dangerous to take kambo with large quantities of water. Doing that is associated with SIADH and severe electrolyte imbalances: changes in plasma and urine osmolarity, hypokalemia, hypomagnesemia and hypophosphatemia. Controlling water intake is therefore an important safety measure. Naloxone is under study as a possible antidote; hospital treatment also includes medicines to protect organs from damage and restore electrolyte function.{{R|SaccoZibettiBonetta2022}}

== Terminology == [[File:Phyllomedusa bicolor01a.jpg|thumb|left|''Phyllomedusa bicolor'' – Giant leaf frog]] * '''Kampo pae''', a name used by the Noke Kuin (formerly Katukina){{R|Lima2000-01}} * '''Dow kiet''', a word used by the Matses{{R|Erspamer1993}} * '''Sapo''', '''kampô''', '''kampu''', '''vacina de sapo''', or '''vacina da floresta''', in Brazilian Portuguese{{R|Lima2008}}

"Kambô" is a common name of ''Phyllomedusa bicolor'', an Amazonian tree frog, also known as the blue-and-yellow frog, bicolored tree-frog, giant monkey frog, giant leaf frog, or waxy-monkey tree frog. "Sapo" means "toad" in Spanish and Portuguese.{{R|JVATITD2014}} The frog is an anuran amphibian that inhabits the Amazon and Orinoco basins in South America.{{R|AmphibiaWeb2015}}

== History == [[File:Aldeia Caxinauá no Acre.jpg|thumb|Caxinauá village in Acre]]

Natives who practice kambo are Panoan-speaking indigenous groups in the southeast Amazon rainforest, such as the Matsés, Marubo, Amahuaca, Kashinawa, Katukina, Yawanawá, and Kaxinawá.{{r|DalyCaceres1992}}{{R|LimaLabate2007}}{{R|Derma2019}} There are ethnographic studies on the use of kambo in traditional Noke Kuin medicine in the region of the state of Acre, in the Brazilian Amazon.{{R|tellus2014}}

Since the mid-20th century, kambo has also been practiced in urban regions of Brazil.{{R|SilvaMonteiro2019}}{{R|LimaLabate2007}} In 2004, Brazil banned the sale and marketing of kambo.{{R|BBCMundo2016}} Import is illegal in Chile.{{R|LaNancion2019}} Outside of South America, it first became known as an alternative therapy in the late 2010s.{{R|SBSnov2019}}

In 2021, the Therapeutic Goods Administration (TGA) of Australia banned the use of kambo in Australia and classified it as a schedule-10 poison. It is listed in the category for "substances of such danger to health as to warrant prohibition of sale, supply and use".{{R|TheGuardian2021}}{{efn|name=longnote}}

==Indigenous use== thumb|left|The kambo ritual. A) ''Phyllomedusa bicolor''. B) Collecting the frog's secretions. C) Applying kambo to burns on the skin. D) Closeup of skin marks.{{r|SilvaMonteiro2019}} To collect the secretions from the frog's body, first, the frog has to be caught. A practitioner will tie the frog to four sticks placed in the ground with its limbs stretched. This causes the frog to become stressed enough to activate its defense mechanism and secrete a substance containing peptides from its skin.{{R|ABCnewsmarch2017}} After these secretions are obtained, the frog is released back into the wild. The secretions are then left to dry.{{R|ABCnewsmarch2017}} Small burns are created on the skin, and a small dose of the frog secretions is applied to the open wounds.{{R|ABCnewsmarch2017}} In native practice, the secretions are removed from the wounds after 15 to 20 minutes, ending the acute symptoms.{{R|Derma2019}}

Traditional practitioners claim that it aids fertility, cleanses the body and soul, increases strength, and brings good luck to hunts, though there is no scientific evidence for these claims.{{r|SilvaMonteiro2019}}{{R|MontrealGazettesept2019}} It is used by natives to who attempt to expel "panema" (bad spirit) and to induce abortions.{{R|Derma2019}} The secretions are also commonly used in people who suffer from laziness, a condition perceived as unfavorable by the Noke Kuin as the person stops participating socially.{{R|Lima2000-02}}

Joaquim Luz, a Yamanawa leader, criticized internet sales and kambo's use without the preparation or permission of indigenous peoples, saying that such users are at risk, even of death. {{R|BBCMundo2016}} Other native groups have also expressed concerns.{{R|SilvaMonteiro2019}}{{R|LimaLabate2007}}

==Non-indigenous use== Outside South America, a kambo ceremony can involve just two people: the practitioner and the participant, or many participants at once, which is known as a kambo circle. Participants are encouraged to bring plenty of water, a towel, and a bucket.{{R|SBSnov2019}} There are usually yoga mats on the floor and the ceremony room, which is often the practitioner's living room, is heavily incensed.{{R|SBSnov2019}}

During the ceremony, the participant's skin is deliberately burnt multiple times, usually on the upper arm or leg, by the practitioner using a smoldering stick or vine.{{R|ABCnewsmarch2017}} The practitioner uses saliva or water to reconstitute the secretions and place it on top of the burnt skin.{{R|ABCnewsmarch2017}} Participants may be encouraged to shout ''"Viva"'' whenever one of them vomits into their bucket.{{R|ABCNewssept2018}} Short-term effects include violent nausea, vomiting, diarrhea, edema (swelling) of the face, headaches, and tachycardia. The secretions seem to be vasoactive (affecting the circulation), explaining why they are absorbed rapidly.{{R|Derma2019}}

Intoxication may occur immediately or within hours.{{R|SaccoZibettiBonetta2022}}

===Medical claims=== Non-indigenous users and practitioners of kambo claim it helps with a wide variety of issues and conditions. These claims include treating addiction, depression, and chronic pain,{{R|SBSnov2019}}{{R|ABCNewssept2018}}{{R|SBSnov2019-2}} reducing fevers,{{R|SBSnov2019}} increasing fertility,{{R|SBSnov2019}} boosting energy and physical strength,{{R|MontrealGazettesept2019}}{{R|ABCNewssept2018}} and improving mental clarity.{{R|ABCNewssept2018}} It is also claimed that kambo removes negative energy.{{R|SBSnov2019}}{{R|MontrealGazettesept2019}} There is currently no scientific evidence to support positive health effect claims.{{R|Derma2019}}{{R|TheGuardian2021}}{{efn|name=longnote}}.

There is no high-quality medical evidence on the safety and efficacy of the kambo practise: while studies of some of the individual peptides exist, no clinical trials have evaluated the practise itself on humans, {{as of|lc=yes|November 2019}}.{{R|Derma2019}} Reports of adverse effects are numerous, including for use with experienced guidance.{{R|Derma2019}}

Kym Jenkins of the Royal Australian and New Zealand College of Psychiatrists, in a ''Sydney Morning Herald'' article, said "people with mental illness are a more vulnerable group anyway for a variety of reasons. If you're feeling very anxious or very depressed, you're automatically more vulnerable, and you could be more susceptible to people advertising or marketing a quick fix. I do have concerns that people can be preyed upon when they are more vulnerable."{{R|SydneyMorningHeraldmay2019}}

The Australian Medical Association (AMA) supports the TGA's ban on the sale, supply, and use of kambo, saying it considers kambo to be a "significant health risk".{{R|TheGuardian2021}}{{efn|name=longnote}}

===Marketing=== In non-indigenous use, the frog secretion is described and marketed as a "detox" treatment, cleanse,{{R|ABCnewsmarch2017}}{{R|NYT2021}} purge,{{R|SBSnov2019}} and as a "vaccine" that is "good for everything".{{R|Biotemas2011}} Kambo has been marketed both as a "scientific" remedy, emphasizing the biochemistry, and as a "spiritual" remedy, emphasizing its Indigenous origins.{{R|LimaLabate2007}} Purging (deliberate vomiting) has been a popular treatment since the 1800s.{{R|ABCnewsmarch2017}} "Detox" has been described by Edzard Ernst, emeritus professor of complementary medicine, as a term for conventional medical treatments for addiction, which has been "hijacked by entrepreneurs, quacks, and charlatans to sell a bogus treatment."{{R|TheGuardian2014}}

In Brazil, given the growth in the consumption of kambo in urban centers, there has been criticism by indigenous people, academics and communicators regarding the cultural appropriation of indigenous knowledge, the process of extracting the secretion of the ''Phyllomedusa bicolor'' frog, the form of transmission of wisdom, and the price charged by the ritual and the mystification of the origin of the frog.{{R|LimaLabate2007}}

There is also concern about pharmacological patents on the peptides identified in kambo (see biopiracy), the commercialization of the kambo outside its place of origin, and the unknown impact on frog populations, since many more are now removed from their natural habitats.{{R|Biotemas2011}}

In light of the chemical complexity of the frog toxins, and their complex and potentially fatal effects, the authors of a 2022 review on the diagnosis and treatment of kambo cases said they urged "strict surveillance of the websites that encourage the use of this substance and [we] urge greater control of e-commerce or illicit trafficking of animals and secretions, including through the dark web".{{R|SaccoZibettiBonetta2022}}

== Environmental impact == The effect of the increased use of kambo rituals, and trafficking of the frogs and their secretions, may have an effect on the population of ''Phyllomedusa bicolor'' in its natural habitats: the forests of Bolivia, Peru, Brazil, the Guianas, Colombia, and Venezuela.{{R|SilvaMonteiro2019}} ''Phyllomedusa bicolor'' is not considered an endangered species by the IUCN.{{R|IUCN}} Besides ''Phyllomedusa bicolor'', other threatened endemic frog species of South America's neotropical regions have been poached and smuggled on the black market.

<gallery mode="packed" caption="Species used{{citation needed|date=April 2021}}"> File:Waxy Monkey Tree Frog Phyllomedusa sauvagii.jpg|''Phyllomedusa sauvagii'' File:Rã arborícola face.jpg|Tree frog, Caetité, Bahia, Brazil File:Phyllomedusa hypochondrialis.jpg|''Phyllomedusa hypochondrialis'' File:Phyllomedusa burmeisteri01b.jpg|''Phyllomedusa burmeisteri'' File:Phyllomedusa iheringii01.jpg| ''Phyllomedusa theringii'' File:Phyllomedusa trinitatis.jpg|''Phyllomedusa trinitatis'' File:Phyllomedusa distincta01.jpg|''Phyllomedusa distincta'' File:Phyllomedusa boliviana - Bolivianischer Makifrosch.jpg|Bolivian Phyllomedusa File:Phyllomedusa azurea.jpg|''Phyllomedusa azurea'' </gallery>

=== Parasitology ===  Smuggling amphibians such as ''Phyllomedusa bicolor'' can spread parasites.{{R|ParasitologyResearch2020}} Zoos keep frogs for conservation purposes, and there are many parasites present in these animals that naturally occur only in the native habitats.{{R|ParasitologyResearch2020}} It is recommended for imported amphibians to go through a quarantine process to verify they are not spreading parasites that could damage other ecosystems.{{R|ParasitologyResearch2020}} Parasite infection rates in frogs is 51%, while in salamanders it is 13%.{{R|ParasitologyResearch2020}} Individuals who want to have them as pets are obligated and encouraged to get them examined to detect gastrointestinal parasites that could potentially be harmful.{{R|ParasitologyResearch2020}} ''Neocosmocercella fisherae'' is the first nematode species found parasitising ''Phyllomedusa bicolor'' from the Brazilian Amazon region.{{R|SystematicParasitology2017}}

== Notable deaths ==

A 40-year-old businessman was charged in Brazil in 2008 with the illegal exercise of medicine and felony murder after administering kambo toxins to a business colleague who died; the deceased's son, who said his father had pressured him into participating, suffered more minor effects.{{R|Estadao2008}}{{R|SilvaMonteiro2019}} In Chile, in 2009, Daniel Lara Aguilar, who suffered from chronic lumbar disc disease, died immediately after taking kambo administered by a local shaman in a mass healing ceremony; the autopsy was inconclusive due to pre-existing conditions.{{R|BBCMundo2016}}{{R|BioChile2009}} Medical literature reported a 2018 case in Italy of a man with obesity and ventricular hypertrophy, who, according to autopsy reports, died of cardiac arrhythmia while under the effects of kambo use.{{R|Forensic2018}}{{R|SilvaMonteiro2019}} In March 2019, kambo practitioner Natasha Lechner suffered a cardiac arrest and died while receiving kambo.{{R|SBSnov2019}}{{R|ABCNewsmarch2019}}{{R|ABCNewsMay2023}} In April 2019, a homicide investigation was opened into the death by "severe cerebral edema" of a young person who had taken kambo toxins in Chile; the import of the frog and its secretions is illegal in Chile.{{R|LaNancion2019}}{{R|Infocatolica2019}} In October 2021, Australian man Jarred Antonovich died at a festival in New South Wales from a perforated esophagus suspected to be caused by excessive vomiting after being administered kambo and ''N'',''N''-dimethyltriptamine. After a car accident in 1997 from which he had to learn to walk and talk again, he was left with lasting impediments, the inquest heard, which may have contributed to the esophageal rupture.<ref>{{cite news | url=https://www.abc.net.au/news/2023-05-08/inquest-jarred-antonovich-death-ayahuasca-kambo-frog-poison/102318674 | title=Paramedics not told about dying man's use of powerful psychedelic and Kambo frog poison | newspaper=ABC News | date=8 May 2023 }}</ref>

=== Contraindications ===

Kambo has been associated with serious adverse events in some individuals, and trained practitioners commonly screen for contraindications prior to administration. A history of esophageal rupture or conditions that may increase risk of esophageal injury are often regarded as contraindications due to the expected vomiting that results from the smooth-muscle contractions.<ref>{{cite journal |last1=Aquino |first1=Marina |last2=de Souza |first2=Alessandra |title=Kambo and Acute Medical Complications: A Case Report and Literature Review |journal=Case Reports in Emergency Medicine |year=2020 |volume=12 |issue=9 |article-number=e10677 |doi=10.7759/cureus.10677 |doi-access=free |pmid=33133843 |pmc=7592631}}</ref> Recent chemotherapy or radiotherapy treatment, commonly within the previous 4 to 6 weeks, is also frequently listed as a contraindication by practitioners.<ref>{{cite journal |last1=Roy |first1=M. |last2=others |title=The Application of Kambo in Cancer Supportive Care: A Scoping Review |journal=Journal of Integrative and Complementary Medicine |year=2022 |volume=20 |doi=10.1177/1534735421999106 |pmid=33719640 |pmc=8743964}}</ref> Some practitioners additionally advise avoiding kambo for several weeks following use of Bufo 5-MeO-DMT, although this precaution is based primarily on practitioner guidelines rather than established clinical evidence.<ref>{{cite web |title=Contraindications |url=https://iakp.org/contraindications/ |website=International Association of Kambo Practitioners}}</ref>

== Pharmacology ==

[[File:Dermorphin.svg|thumb|Chemical structure of dermorphin]]

The frog secretes a range of small chemical compounds of a type called peptides, which have several different effects.{{R|ChangPorreca2003}} Peptides found in the frog secretions include the opioid peptides dermorphin and deltorphin, the vasodilator sauvagine, and dermaseptin, which exhibits antimicrobial properties ''in vitro''.{{R|Derma2019}} Various other substances such as phyllomedusin, phyllokinin, caerulein, and adrenoregulin are also present.{{R|ChangPorreca2003}} There is active medical research into the peptides found in the skin secretions of ''Phyllomedusa bicolor'', focusing on discovering their biological effects. There have been some preclinical trials in mice and rats, but no phase-1 tests or clinical trials of safety in humans, {{as of|November 2019|lc=yes}}.{{R|Derma2019}}

Most of the kambo-related bioactive peptides so far characterized have displayed potential applications in medicine, such as phyllocaeruleins with hypotensive properties, tachykinins and phyllokinins as vasodilators, dermorphins and deltorphins with opiate-like properties, and adenoregulins with antibiotic properties.<ref name="Nogueira et al">{{cite journal |last1=Nogueira |first1=Thais A. C. |last2=Kaefer |first2=Igor Luis |last3=Sartim |first3=Marco A. |last4=Pucca |first4=Manuela B. |last5=Sachett |first5=Jacqueline |last6=Barros |first6=André L. |last7=Júnior |first7=Moysés B. A. |last8=Baía-da-Silva |first8=Djane C. |last9=Bernarde |first9=Paulo S. |last10=Koolen |first10=Hector H. F. |last11=Monteiro |first11=Wuelton M. |title=The Amazonian kambô frog Phyllomedusa bicolor (Amphibia: Phyllomedusidae): Current knowledge on biology, phylogeography, toxinology, ethnopharmacology and medical aspects |journal=Frontiers in Pharmacology |date=2022 |volume=13 |article-number=997318 |doi=10.3389/fphar.2022.997318 |pmid=36278168 |pmc=9582840 |issn=1663-9812 |doi-access=free }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref>

In a clinical trial of a randomized, placebo-controlled study in postoperative pain, dermorphin administered via the intrathecal route was "impressively superior" over the placebo and the reference compound morphine."<ref>{{cite journal |last1=Hesselink |first1=Jan M. Keppel |last2=Schatman |first2=Michael E. |title=Rediscovery of old drugs: the forgotten case of dermorphin for postoperative pain and palliation |journal=Journal of Pain Research |date=23 November 2018 |volume=11 |pages=2991–2995 |doi=10.2147/JPR.S186082 |pmid=30538538 |pmc=6260176 |language=English |doi-access=free }}</ref> Due to the numerous biological activities of these substances and the similarities with the amino acid sequences related to mammalian neuropeptides and hormones, many have aroused the interest from a medical and pharmacological perspective, such as in the production of new drugs.<ref name="Nogueira et al"/>

== Notes == {{notelist|refs= {{efn|name=longnote|Quoting from the direct statements below{{br}}{{br}}{{cite web|author=[Australian] Therepeutic Goods Administration (TGA)|url=https://www.tga.gov.au/resources/consultation/consultation-proposed-amendments-poisons-standard-acms-accs-and-joint-acmsaccs-meetings-march-2021|title= Consultation: Proposed amendments to the Poisons Standard – ACMS, ACCS and Joint ACMS/ACCS meetings, March 2021}}{{br}}"Kambo use in the absence of medically trained supervision represents a significant health risk, especially for people with cardiovascular disease due to the significant cardiovascular effects.{{br}}Although rare, deaths have also been reported from kambo use.{{br}}{{br}}The significant adverse effects from the topical application of kambo to scarified or burnt areas of skin include:{{br}}{{*}}nausea{{br}}{{*}}vomiting{{br}}{{*}}oesophageal rupture{{br}}{{*}}diarrhoea{{br}}{{*}}stomach pain{{br}}{{*}}liver damage{{br}}{{*}}burning sensation{{br}}{{*}}lowered blood pressure (hypotension){{br}}{{*}}increased heart rate (tachycardia){{br}}These effects are seen as part of the spiritual purification/healing process, however, there is no clinical evidence of kambo having any beneficial medical effect.{{br}}Onset of clinical signs and symptoms is rapid, and there have been reports of altered mental state, agitation, paranoia, delusions and general psychosis. There is insufficient information to characterise the risk from long-term repeated use of kambo."{{br}}{{br}}{{cite web |author=Australian Medical Association|title=Australian Medical Association Submission to the Therapeutic Goods Administration – Proposed amendments to the Poisons Standard |date=March 2021|page=3 |url=https://www.ama.com.au/sites/default/files/2021-02/AMA%20submission%20to%20the%20TGA%20-%20proposed%20amendments%20to%20the%20Poisons%20Standard%20-%20March%202021%20proposals%20-%20FINAL.pdf |archive-url=https://web.archive.org/web/20211006050132/https://www.ama.com.au/sites/default/files/2021-02/AMA%20submission%20to%20the%20TGA%20-%20proposed%20amendments%20to%20the%20Poisons%20Standard%20-%20March%202021%20proposals%20-%20FINAL.pdf |archive-date=2021-10-06}}{{br}}"The AMA supports the proposal to include a new Schedule 9 entry for Kambo. The AMA considers kambo to be a significant health risk for those who use it. In addition to its harmful effects both intended and adverse, the act of blistering the skin and applying kambo to the burnt area risks other health concerns such as infection. There is also a risk that using kambo would prevent a patient from seeing a medical practitioner for their medical condition and delay diagnosis.{{br}}{{br}}Kambo should be regulated under the Poisons Standard as it appears to be used as a therapeutic product by 'kambo practitioners'.<ref name=ABCNewssept2018/> There is currently insufficient evidence for its intended therapeutic effects."}}

}}

== References ==

<references> <ref name=SBSnov2019>{{cite web |last1=Scherer |first1=Jennifer |title=Australians Are Using This Amazonian Frog Poison Aa A Controversial Alternative Medicine |url=https://www.sbs.com.au/news/the-feed/australians-are-using-this-amazonian-frog-poison-as-a-controversial-alternative-medicine |website=SBS |access-date=15 December 2019 |archive-url=https://web.archive.org/web/20191107012338/https://www.sbs.com.au/news/the-feed/australians-are-using-this-amazonian-frog-poison-as-a-controversial-alternative-medicine |archive-date=7 November 2019 |date=7 November 2019}}</ref>

<ref name=ABCnewsmarch2017>{{cite web |last1=Van Zeller |first1=Mariana |last2=Brown |first2=Jasmine |last3=Effron |first3=Lauren |date=29 March 2017 |title=This Amazonian tree frog's poison has become part of the latest supercleanse trend |url=https://abcnews.go.com/International/amazonian-tree-frogs-poison-part-latest-super-cleanse/story?id=46431345 |website=ABC News |access-date=15 December 2019 |archive-url=https://web.archive.org/web/20170329211353/https://abcnews.go.com/International/amazonian-tree-frogs-poison-part-latest-super-cleanse/story?id=46431345 |archive-date=29 March 2017 |url-status=live}}</ref>

<ref name=ABCNewssept2018>{{cite web |last1=Lavoipierre |first1=Angela |title=Tree frog poison being used as an alternative medicine |url=https://www.abc.net.au/news/2018-09-07/kambo-tree-frog-poison-used-as-alternative-medicine/10060126 |website=ABC News |access-date=15 December 2019 |url-status=live |archive-url=https://web.archive.org/web/20180907171022/https://www.abc.net.au/news/2018-09-07/kambo-tree-frog-poison-used-as-alternative-medicine/10060126 |archive-date=7 September 2018 |date=7 September 2018}}</ref>

<ref name=MontrealGazettesept2019>{{cite web |last1=Schwarcz |first1=Joe |author-link=Joseph A. Schwarcz|title=The Right Chemistry: No evidence-based science supports kambo ritual |url=https://montrealgazette.com/opinion/columnists/the-right-chemistry-no-evidence-based-science-supports-kambo-ritual |website=The Montreal Gazette |access-date=16 December 2019 |archive-url=https://web.archive.org/web/20191002050736/https://montrealgazette.com/opinion/columnists/the-right-chemistry-no-evidence-based-science-supports-kambo-ritual |archive-date=2 October 2019 |date=29 September 2019}}</ref>

<ref name=SydneyMorningHeraldmay2019>{{cite web |last1=Hall |first1=Bianca |title=Pedlars of new age cures are 'preying' on mentally ill, doctors warn |url=https://www.smh.com.au/lifestyle/health-and-wellness/pedlars-of-new-age-cures-are-preying-on-mentally-ill-doctors-warn-20190509-p51lle.html |website=The Sydney Morning Herald |access-date=16 December 2019 |archive-url=https://web.archive.org/web/20190517214300/https://www.smh.com.au/lifestyle/health-and-wellness/pedlars-of-new-age-cures-are-preying-on-mentally-ill-doctors-warn-20190509-p51lle.html |archive-date=17 May 2019 |date=17 May 2019}}</ref>

<ref name=ABCNewsmarch2019>{{cite web |last1=MacKenzie |first1=Bruce |title=Frog poison investigated as possible cause of woman's death following kambo ceremony |url=https://www.abc.net.au/news/2019-03-21/frog-toxin-may-be-linked-to-womans-death/10920600 |website=ABC News |access-date=16 December 2019 |archive-url=https://web.archive.org/web/20190321091243/https://www.abc.net.au/news/2019-03-21/frog-toxin-may-be-linked-to-womans-death/10920600 |archive-date=21 March 2019 |date=21 March 2019}}</ref>

<ref name=SBSnov2019-2>{{cite web |last1=Duncan |first1=Elly |title=South Australian Pair Banned Indefinitely From Providing Frog Poison Health Treatment 'Kambo' |url=https://www.sbs.com.au/news/the-feed/south-australian-pair-banned-indefinitely-from-providing-frog-poison-health-treatment-kambo |website=SBS |access-date=16 December 2019 |archive-url=https://web.archive.org/web/20191122092842/https://www.sbs.com.au/news/the-feed/south-australian-pair-banned-indefinitely-from-providing-frog-poison-health-treatment-kambo |archive-date=22 November 2019 |date=22 November 2019}}</ref>

<ref name="SilvaMonteiro2019">{{cite journal|last1=Silva|first1=Francisco Vaniclei Araújo da |last2=Monteiro|first2=Wuelton Marcelo|last3=Bernarde|first3=Paulo Sérgio|title='Kambô' frog (Phyllomedusa bicolor): use in folk medicine and potential health risks|journal=Revista da Sociedade Brasileira de Medicina Tropical|volume=52|article-number=e20180467|year=2019|issn=1678-9849|doi=10.1590/0037-8682-0467-2018|pmid=30942261|doi-access=free|s2cid=92997082 }}</ref>

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<ref name="ChangPorreca2003">{{cite book|author1=Kwen-Jen Chang|author2=Frank Porreca|author3=James Woods|title=The Delta Receptor|url=https://books.google.com/books?id=VtiD88jzb-QC|year=2003|publisher=CRC Press|isbn=978-0-8247-5858-5|page=176|chapter=Chapter 11: Deltorphins}}</ref>

<ref name=tellus2014>{{cite journal |last1=De Lima |first1=Edilene Coffaci |title=Cobras, xamãs e caçadores entre os Katukina (pano) |journal=Tellus |date=25 November 2014 |pages=35–57 |doi=10.20435/tellus.v0i15.161 |doi-access=free }}</ref>

<ref name=Derma2019>{{cite journal|last1=Bartels|first1=Emiel Jacob Henri|last2=Dekker|first2=Douwe|last3=Amiche|first3=Mohamed|date=26 November 2019|title=Dermaseptins, Multifunctional Antimicrobial Peptides: A Review of Their Pharmacology, Effectivity, Mechanism of Action, and Possible Future Directions|journal=Frontiers in Pharmacology|volume=10|article-number=1421|doi=10.3389/fphar.2019.01421|pmc=6901996|pmid=31849670|quote='robust data on pharmacokinetics, efficacy and safety in humans are currently lacking'|doi-access=free}} ''(this is not a reliable medical source; see talk tab)''</ref>

<ref name=BBCMundo2016>{{cite web|last1=Mundo|first1=Leire Ventas|title=Kambó, el polémico veneno que se usa en Sudamérica como medicina para curarlo todo|url=https://www.bbc.com/mundo/noticias/2016/04/160425_salud_kambo_veneno_sapo_amazonico_medicina_polemica_lv|website=BBC News Mundo|date=27 April 2016|language=es}}</ref>

<ref name="LaNancion2019">{{cite news|last1=Vallejos|first1=Ricardo Pérez|title=San Felipe: joven mujer murió tras un ritual de sanación con veneno de rana|language=es-CL|work=La Nación|url=http://lanacion.cl/2019/04/17/san-felipe-joven-mujer-murio-tras-un-ritual-de-sanacion-con-veneno-de-rana/|archive-date=2019-06-03|access-date=2020-02-17|archive-url=https://web.archive.org/web/20190603233343/http://lanacion.cl/2019/04/17/san-felipe-joven-mujer-murio-tras-un-ritual-de-sanacion-con-veneno-de-rana/}}</ref>

<ref name=Lima2000-01>{{cite thesis |last1=Lima |first1=Edilene Coffaci de |title=Com os Olhos da Serpente: Homens, Animais e Espíritos nas Concepções Katukina sobre a Natureza |date=2000 |oclc=55916126 |url=https://labintercult.com.br/download/com-os-olhos-da-serpente-homens-animais-e-espiritos-nas-concepcoes-katukina-sobre-a-natureza/ |page=160 |archive-date=2023-04-05 |access-date=2022-05-17 |archive-url=https://web.archive.org/web/20230405015639/https://labintercult.com.br/download/com-os-olhos-da-serpente-homens-animais-e-espiritos-nas-concepcoes-katukina-sobre-a-natureza/ }}</ref>

<ref name=Erspamer1993>{{cite journal |last1=Erspamer |first1=Vittorio |last2=Erspamer |first2=Giuliana Falconieri |last3=Severini |first3=Cinzia |last4=Potenza |first4=Rosa Luisa |last5=Barra |first5=Donatella |last6=Mignogna |first6=Giuseppina |last7=Bianchi |first7=Antonio |title=Pharmacological studies of 'sapo' from the frog Phyllomedusa bicolor skin: A drug used by the Peruvian Matses Indians in shamanic hunting practices |journal=Toxicon |date=September 1993 |volume=31 |issue=9 |pages=1099–1111 |doi=10.1016/0041-0101(93)90125-3 |pmid=8266343 |bibcode=1993Txcn...31.1099E }}</ref>

<ref name=Lima2008>{{Versalita|Lima}} (2008): 170.{{full citation needed|date=May 2022}}</ref>

<ref name=Biotemas2011>{{cite journal |last1=Bernarde |first1=Paulo Sérgio |last2=Santos |first2=Rosimeyri Aparecida |title=Utilização medicinal da secreção ('vacina-do-sapo') do anfíbio kambô (Phyllomedusa bicolor) (Anura: Hylidae) por população não-indígena em Espigão do Oeste, Rondônia, Brasil |journal=Biotemas |date=20 June 2011 |volume=22 |issue=3 |pages=213–220 |doi=10.5007/2175-7925.2009v22n3p213 |doi-access=free }}</ref>

<ref name=TheGuardian2014>{{cite news|last1=Mohammadi|first1=Dara|date=5 December 2014|title=You can't detox your body. It's a myth. So how do you get healthy?|work=The Observer|url=https://www.theguardian.com/lifeandstyle/2014/dec/05/detox-myth-health-diet-science-ignorance}}</ref>

<ref name=JVATITD2014>{{cite journal|last1=den Brave|first1=Paul S|last2=Bruins|first2=Eugéne|last3=Bronkhorst|first3=Maarten W G A|year=2014|title=Phyllomedusa bicolor skin secretion and the Kambô ritual|journal=Journal of Venomous Animals and Toxins Including Tropical Diseases|volume=20|issue=1|page=40|doi=10.1186/1678-9199-20-40 |pmc=4582952|pmid=26413084|doi-access=free}}</ref>

<ref name="AmphibiaWeb2015">{{cite web|url=http://amphibiaweb.org/cgi/amphib_query?where-genus=Phyllomedusa&where-species=bicolor&account=amphibiaweb|title=''Phyllomedusa bicolor''|year=2015|work=AmphibiaWeb: Information on amphibian biology and conservation. [web application]|publisher=Berkeley, California: AmphibiaWeb|access-date=15 April 2016}}</ref>

<ref name=Lima2000-02>{{cite thesis |last1=Lima |first1=Edilene Coffaci de |title=Com os Olhos da Serpente: Homens, Animais e Espíritos nas Concepções Katukina sobre a Natureza |date=2000 |oclc=55916126 |url=https://labintercult.com.br/download/com-os-olhos-da-serpente-homens-animais-e-espiritos-nas-concepcoes-katukina-sobre-a-natureza/ |pages=75–76 |archive-date=2023-04-05 |access-date=2022-05-17 |archive-url=https://web.archive.org/web/20230405015639/https://labintercult.com.br/download/com-os-olhos-da-serpente-homens-animais-e-espiritos-nas-concepcoes-katukina-sobre-a-natureza/ }}</ref>

<ref name=LimaLabate2007>{{cite journal |last1=Lima |first1=Edilene Coffaci de |last2=Labate |first2=Beatriz Caiuby |title='Remédio da Ciência' e 'Remédio da Alma': os usos da secreção do kambô (Phyllomedusa bicolor) nas cidades |journal=Campos – Revista de Antropologia Social |date=15 October 2007 |volume=8 |issue=1 |doi=10.5380/cam.v8i1.9553 |doi-access=free }}</ref>

<ref name=IUCN>{{Cite web|last1=Azevedo-Ramos|first1=Claudia|last2=Marca|first2=Enrique La|date=2008-10-30|title=IUCN Red List of Threatened Species: Phyllomedusa bicolor|url=https://www.iucnredlist.org/en|access-date=2020-09-26|website=IUCN Red List of Threatened Species}}</ref>

<ref name=Estadao2008>{{cite web|last1=Menocchi|first1=Simone|date=25 April 2008|title=Investigada morte de homem que tomou 'vacina do sapo' – Geral|url=https://www.estadao.com.br/noticias/geral,investigada-morte-de-homem-que-tomou-vacina-do-sapo,162933|website=Estadão|language=pt-BR}}</ref>

<ref name=BioChile2009>{{cite news|date=22 December 2009|title=Buscan a 'chamanes' por muerte de paciente que recibió veneno de rana|language=es|work=BioBioChile – La Red de Prensa Más Grande de Chile|url=https://www.biobiochile.cl/noticias/2009/12/22/buscan-a-chamanes-por-muerte-de-paciente-que-recibio-veneno-de-rana.shtml}}</ref>

<ref name=Forensic2018>{{cite journal|last1=Aquila|first1=I|last2=Gratteri|first2=S|last3=Sacco|first3=MA|last4=Fineschi|first4=V|last5=Magi|first5=S|last6=Castaldo|first6=P|last7=Viscomi|first7=G|last8=Amoroso|first8=S|last9=Ricci|first9=P|date=May 2018|title=The Biological Effects of Kambo: Is There a Relationship Between its Administration and Sudden Death?|journal=Journal of Forensic Sciences|volume=63|issue=3|pages=965–968|doi=10.1111/1556-4029.13641|pmid=28886207|s2cid=10408804}}</ref>

<ref name=Infocatolica2019>{{cite web|last1=Ries|first1=Secretaría|title=Chile: una joven muere tras un tratamiento ritual con el veneno de la rana kambó|url=http://www.infocatolica.com/blog/infories.php/1904180805-chile-una-joven-muere-tras-un|website=InfoCatólica|language=es}}</ref>

<ref name=ParasitologyResearch2020>{{Cite journal|last1=Hallinger|first1=Malek J.|last2=Taubert|first2=Anja|last3=Hermosilla|first3=Carlos|date=2020-09-22|title=Endoparasites infecting exotic captive amphibian pet and zoo animals (Anura, Caudata) in Germany|journal=Parasitology Research|volume=119|issue=11|pages=3659–3673|language=en|doi=10.1007/s00436-020-06876-0|pmid=32960371|pmc=7578172 |doi-access=free}}</ref>

<ref name=SystematicParasitology2017>{{cite journal |last1=dos Santos |first1=Ana Nunes |last2=de Oliveira Rodrigues |first2=Allan Rodrigo |last3=dos Santos Rocha |first3=Fábio José |last4=dos Santos |first4=Jeannie Nascimento |last5=González |first5=Cynthya Elizabeth |last6=de Vasconcelos Melo |first6=Francisco Tiago |title=Neocosmocercella fisherae n. sp. (Nematoda: Cosmocercidae), a parasite of the large intestine of Phyllomedusa bicolor (Boddaert) (Anura: Phyllomedusidae) from the Brazilian Amazon |journal=Systematic Parasitology |date=March 2018 |volume=95 |issue=2–3 |pages=293–300 |doi=10.1007/s11230-017-9770-0 |pmid=29230677 |s2cid=3516919 |hdl=11336/84100 |hdl-access=free }}</ref>

<ref name=ForensicScience2019>{{cite journal |last1=Byard |first1=Roger W. |title=Is voluntary envenomation from the kambô ritual therapeutic or toxic? |journal=Forensic Science, Medicine and Pathology |date=June 2020 |volume=16 |issue=2 |pages=205–206 |doi=10.1007/s12024-019-00192-5 |pmid=31630322 |s2cid=204786581 |doi-access=free }}</ref>

<ref name=TheGuardian2021>{{cite web |last1=Shepherd |first1=Tory |date=6 October 2021 |title=Kambo, a lethal frog mucous used in shamanic rituals, banned by TGA after reports of deaths |website=The Guardian |url=https://www.theguardian.com/society/2021/oct/06/kambo-a-lethal-frog-mucous-used-in-shamanic-rituals-banned-by-tga-after-reports-of-deaths |access-date=7 October 2021 |archive-date=7 October 2021 |archive-url=https://web.archive.org/web/20211007024353/https://www.theguardian.com/society/2021/oct/06/kambo-a-lethal-frog-mucous-used-in-shamanic-rituals-banned-by-tga-after-reports-of-deaths}}</ref>

<ref name=ABCNewsMay2023>{{cite news |last1=Mackenzie |first1=Bruce |title=Natasha Lechner not told about risk of death from Kambo frog poison vomiting ritual, inquest told |url=https://www.abc.net.au/news/2023-05-04/kambo-ritual-natasha-lechner-inquest/102302834 |website=ABC News |date=4 May 2023 |access-date=4 May 2023 |archive-url=https://web.archive.org/web/20230504230146/https://www.abc.net.au/news/2023-05-04/kambo-ritual-natasha-lechner-inquest/102302834 |archive-date=4 May 2023}}</ref>

<ref name=SaccoZibettiBonetta2022>{{cite journal |last1=Sacco |first1=M. A. |last2=Zibetti |first2=A. |last3=Bonetta |first3=C. F. |last4=Scalise |first4=C. |last5=Abenavoli |first5=L. |last6=Guarna |first6=F. |last7=Gratteri |first7=S. |last8=Ricci |first8=P. |last9=Aquila |first9=I. |title=Kambo: Natural drug or potential toxic agent? A literature review of acute poisoning cases |journal=Toxicology Reports |date=1 January 2022 |volume=9 |pages=905–913 |doi=10.1016/j.toxrep.2022.04.005 |pmid=35515815 |pmc=9061256 |bibcode=2022ToxR....9..905S |quote=The analysis of titles, abstracts and full texts led to the final selection of 11 cases of acute intoxication.}}</ref>

<ref name=NYT2021>{{cite news |last1=Williams |first1=Alex |title=Can You Poison Your Way to Good Health? |url=https://www.nytimes.com/2021/01/01/style/self-care/kambo-tree-frog-detox.html |work=The New York Times |date=1 January 2021}}</ref> </references>

Category:Causes of death Category:Pseudoscience Category:Alternative detoxification Category:Fringe science Category:Scientific skepticism Category:Alternative medicine Category:South American traditional medicine Category:Amphibians and humans