Mapacho is considered very sacred by Amazonian shamans and is employed alone (by tabaqueros) or in combination with other plants in shamanic practices. Some shamans drink the juice of tobacco leaves alone as a source of visions. Mapacho is used extensively in healing practices and is considered a medicine, not a health hazard, when used properly.

The principal active biochemicals are nicotine, nornicotine and anabasine. The proportion of each varies greatly among the species and varieties. As many as eight other pyridine alkaloids occur in lower concentrations.

A perenial shrub characterized by large fleshy leaves and numerous sticky hairs, Tobacco is smoked on rare occasions, except in ceremonies and curative rituals of the medicine men who blow smoke over the patient or inhale the smoke, all with appropriate incantations and ritual. Recreational smoking amongst the Indians of the northwest Amazon is not common, and cigarettes are rarely smoked except in areas where tribal customs are breaking down due to acculturation and the availability of commercial cigarettes.

The mestizo ayahuasqueros of Perú use mapacho as an admixture to the sacred brew and usually smoke large cigarettes during ayahuasca ceremonies, both inhaling the smoke and also blowing the smoke over patients, a process called 'soplaying.'