RISK & HARM REDUCTION

While the potential benefits of psychedelics are increasingly acknowledged, like with any activity or substance that affects perception, they come with risks and may be inappropriate or even dangerous for some people and in particular contexts. 

Educating yourself on the risks for psychedelics will help reduce the risk of harm and increase the likelihood for a beneficial experience.

General Points for Consideration

If you’re considering using psychedelics, it’s vital to educate yourself on responsible use as knowing the potential risks makes it easier to avoid them and to reduce their harmful effects. 

Psychedelic education can also help increase the safety of the overall community as it can inform you how to respond to somebody else who may be having a challenging time on psychedelics, or can help you best advise somebody who may be trying them for the first time. 

We’ve gone into more detail about these points below but some overall important consideration points for safe psychedelic use are:

  • The psychedelic experience is highly influenced by your mental landscape and physical environment (set and setting). Psychedelics are best taken in a positive headspace and comforting environment.

  • Having the support or guidance of a close friend or family member who has experience with psychedelics (a “trip-sitter”) during an experience can be of great benefit, especially for first-time users.

  • Integration from psychedelics is key to helping people better make sense of and learn from their experiences.

  • Though population studies show no associations between psychotic disorders and psychedelic use, the link between psychedelics and psychosis remains unclear. For this reason, people with or predisposed to psychosis are cautioned against using psychedelics.

  • Buying psychedelic substances illegally increases the risk of these substances being adulterated or mis-sold. If you’re able to access testing kits we strongly recommend testing the purity for all drugs before taking them (testing kits can be found: https://www.reagent-tests.uk/)

  • Serotonin syndrome, or serotonin toxicity, is a drug-induced condition caused by too much of the chemical messenger serotonin in the nervous system. Because certain psychedelics, including ayahuasca, MDMA, and the 2C family, significantly increase serotonin action, avoid mixing them with other serotonin-increasing drugs, such as antidepressants.

General risks of risks from psychedelics can include:

  • Psychedelic crisis

  • Psychosis and other related long-term mental health issues

  • Hallucinogenic perception persistence disorder (HPPD)

  • Psychological addiction

  • Harmful drug interactions

  • Dangerous behaviors and engaging in dangerous situations during a trip

Follow the links below to learn more about specific substances, or read on for general harm reduction and key emergency response advice on psychedelics. 

These psychedelics harm-reduction guidelines are relevant to the majority of commonly used substances. Click the icons below to skip to the relevant section.


Follow the links below to learn more about specific substances, or read on for general harm reduction and key emergency response advice on psychedelics.

Our Harm Reduction Resources are split over overall guidance to risks and harm reduction, as well as specific information on each of the most common psychedelic substances. We recommend reviewing general guidance first. Click the icons below to skip to the relevant section.

 WHAT IS A
PSYCHEDELIC CRISIS?

A psychedelic crisis also referred to as a “bad trip”, can manifest itself in different ways. But some of the most common occurrences tend to be:

  • Unpleasant, or scary hallucinations

  • Remembering suppressed traumatic events

  • Feeling extremely confused and disoriented

  • Experiencing thought and time loops

  • Distressing emotions

  • Extreme panic

Typically these occurrences wear off once the drug has worn off. However, unpleasant psychedelic experiences can have long-lasting consequences. 

In early psychedelic research, well-known figures in the field, such as psychiatrist Stanislav Grof, recognized how psychedelics have the ability to bring up memories stored in a person’s subconscious memory. 

This capacity makes psychedelics particularly harmful when taken in an uncontrolled setting, such as a festival or party environment, because of the overwhelming amount of distraction preventing a psychedelic user from processing or making sense of any memories that may have surfaced. 

Furthermore, the extreme difference in somebody’s immediate sense of reality psychedelics can induce, and loss of sense of time from its usual sense can be extremely disorientating leading to fear and panic. 

However, if dealt with well, and if the experience is properly integrated afterward, then the re-surfacing of psychological material and changes in perspective that may occur during a psychedelic experience can provide an opportunity for personal transformation. 

For example, sometimes people can have profound realizations during a psychedelic experience that changes their attitudes afterward towards certain relationships with others, or their relationship to their health, or to their work life.

It’s often during the integration phase that people are able to make meaningful lessons from challenging experiences. We will discuss more on the process of integration below.

HOW TO REDUCE THE RISK OF A PSYCHEDELIC CRISIS

Preparing for A Trip

Knowing your substance and dose

It’s important to be aware of what drug you’re taking and what kind of effects to expect. In this way, you won’t be shocked by unexpected effects, and can better prepare for the particular psychedelic you’re working with. 

It’s also essential to be aware of what doses you may require for the particular substance you taking.

To learn more about the specific effects and dosing guidelines for different psychedelic substances check out our substance profiles, above.

Set and Setting

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The risk of a psychedelic crisis can be decreased by taking psychedelics in the right set and setting. 

Set refers to your mood, recent experiences, and intentions prior to going into the trip. If you are feeling anxious or in a low mood then taking psychedelics may not be a good idea as there may be a chance these emotions could be amplified to an unpleasant degree. 

Setting refers to the physical environment in which the drug is taken.  This should be a quiet, safe, and familiar environment that doesn’t have negative associations. 

It is also important to plan ahead for things you may want during the course of your experience. This may include food, creative activities, a place to lay down, music, and access to the bathroom. 

Whilst some people do have positive experiences of using psychedelics in highly stimulating environments, like festivals, these environments are much less predictable and controllable. In taking psychedelics in party and festival environments, it would be advisable to have prior experience, to use a low dose, and test the drug’s purity before consumption if this is an available option.

Intention-setting

As well as paying attention to set and setting, another important step in preparing for a psychedelic experience is creating an intention you’d like from the experience. 

Perhaps you are looking to use the experience as a way to help improve your life in some way or another, for example trying to become more empathic, or better control your experience. Or perhaps you are simply curious about what effects the substance may have on your brain. 

Whatever your intention is, it’s good to reflect on your goals before the experience. In this way, whatever the trip brings, you can return to your pre-set goals and review whatever is happening in the context of your intention. 

 

 

Having a Trip Sitter

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Taking psychedelics with other people can be a positive experience. However, taking psychedelics with strangers or people you feel uncomfortable around can increase the risk of experiencing anxiety or a psychedelic crisis. 

It can be best practice to have a “trip-sitter” present, especially for first-timers and high-doses. The trip sitter is somebody who you feel comfortable around who has previously used and is knowledgeable of the drug the user is taking but remains sober throughout the trip. Their role is to provide a stable reference point and to keep the user safe whilst avoiding “guiding” the psychedelic experience. 

More information on the role of a trip-sitter can be found on Trip Sitters https://www.tripsitters.org/tripsit


Navigating a Psychedelic Crisis

If and when a psychedelic crisis occurs - there are certain tips that may help you navigate the situation. 

Letting go

During psychedelic clinical trials and psychedelic ceremonies, therapists and healers often encourage people to surrender to the experience. They encourage people to meet whatever challenges arise with acceptance, knowing that the drug effects will eventually wear off and that these challenges can also be opportunities for self-growth. 

Returning to the breath/ mantra

Sometimes people may become overwhelmed and enter a state of panic during a psychedelic experience. In this instance, you can help bring yourself out of the panic by focusing your mind on a particular mantra and this helps re-focus your thoughts away from whatever may be causing you fear and anxiety. This mantra could be something meaningful like “Everything is the way it is meant to be”, or “I accept life’s challenges as opportunities to learn and grow”.

 

Healthy mind and body 

As mentioned before, your baseline mental state plays a huge role in how a psychedelic experience might unfold. Therefore, it’s important to look after your mental well-being in the days leading up to a trip, trying to avoid creating any unnecessary mental stress for yourself. Before ingesting a substance you may also want to practice meditation, yoga, or other practices that help calm the mind.

Because physical health plays a huge role in mental wellbeing, you may also want to eat well, get plenty of fresh air, and exercise in the days leading up to the psychedelic experience.

Focusing on the breath is also a useful tool to help return the mind to a calm and focused state. You may also choose to work with certain breathing techniques that help activate the parasympathetic nervous system (the branch of your nervous system which activates when your body is in a state of calm). For example, you could try:

  • Counting the number of seconds for the inhale and exhale, with the number of seconds of the exhale larger than the inhale e.g. inhale for three seconds -> exhale for five

  • Box breath: breathing in, holding the breath at the top of the inhalation, breathing out, holding the breath at the bottom of exhalation for an equalized amount of time e.g. three seconds in -> three seconds hold -> three seconds out -> three seconds hold

  • Alternative nostril breathing (Nadi Shodhana): breathing in through the left nostril, holding at the top of the inhalation then breathing out through the right nostril. Then repeating but beginning breathing in through the right nostril

INTEGRATION

Integration is what happens after a psychedelic experience, and is the process of bringing insights from a psychedelic experience into the context of our lives at large.

In the context of a psychedelic crisis, integration is especially important. Sometimes it can be difficult to re-emerge into the everyday after a shift in perspective of reality. People may feel alone not knowing who to talk to about their experience in the fear that “nobody will understand.” 

Furthermore, sometimes painful or confusing memories can arise during a psychedelic experience which, if remain unaddressed, can leave us feeling distressed. 

Personal integration techniques include things like:

  • Journaling about the experience

  • Spending time alone in nature

  • Contemplating the difficult aspects of your experience and asking yourself whether you’ve learnt anything or may learn anything as a result

  • Creating art, such as painting and poetry, about your experience

If you feel you’ve been traumatized by a psychedelic experience our first recommendation would be to see if it’s possible to access the support of a psychedelic integration therapist. You can find a list of integration therapists via websites such as the Institute of Psychedelic Therapy (UK based), International Spiritual Emergence Network (global). 

Peer support is also incredibly helpful for integrating challenging experiences. You may choose to attend a psychedelic integration circle which is an intimate closed space for people to share their experiences on psychedelics. 

At the psychedelic society, we offer a members-only online integration circle facilitated by psychedelic integration therapists Ashleigh Murphy-Beiner, Michelle Baker Jones, and Natasha Moscovici. You can find out more on our Dandelion upcoming events page under the Harm-Reduction & Psychedelic Integration activity. 

For more information about integration check out our integration webpage


HELPING OTHERS DURING A PSYCHEDELIC CRISIS

There are several instances where we may come across other people going through difficult psychedelic experiences. These may be close friends we are tripping together with or people we’ve never met that we see at a music festival. 

Knowing how to help somebody navigate a psychedelic crisis can be hugely beneficial in helping redeem the chance of the person becoming traumatized from the experience. 

However, we only recommend intervention if you have been through training in crisis intervention, have had experience working with mental health, or have thoroughly researched, or have been trained in psychedelic support. 

To get clued up on how you might help support another going through a psychedelic crisis, we recommend reading the manual of psychedelic support

This manual is a comprehensive guide to helping those experiencing psychedelic difficulties. Although specifically aimed at those struggling from psychedelic experiences at music festivals and events, it can be applied to individuals taking psychedelics in all settings. 

Guidance: The Manual of Psychedelic Support

For more information on managing a psychedelic crisis, the manual of psychedelic support is a comprehensive guide to helping those experiencing psychedelic difficulties. The guide is specifically aimed at music festivals and events but can be applied to individuals taking psychedelics in all settings.

This video provided by MAPS is also a useful resource.

 LONG-TERM
MENTAL HEALTH RISKS

Psychedelics and Psychosis

We don’t know too much about the long-term mental health implications of psychedelic use because most of the studies have examined short-term health implications.

Although rare, psychedelic substances have the potential to exacerbate or onset mental health disorders. In particular, people with a pre-existing or underlying condition where psychosis is a symptom, such as schizophrenia or bipolar disorder, are at risk.

Imperial College published a paper investigating this link between psychedelics and psychosis. They explained that psychedelics induce “magical thinking” -a  state where reality is easily swayed and that in this state, people are more vulnerable to paranoid delusions, which could become ongoing once the drug has worn off. 

In general, psychedelic practitioners recommend that if you have a diagnosis for schizophrenia, bipolar, or any other psychotic disorder, or if you have a family history of people with any of these conditions, then you should avoid using psychedelics.

If this is the case for you but you are still interested in exploring altered states, perhaps you may choose to explore breathwork, guided hypnosis, or other non-drug-induced experiences that can evoke changes in consciousness. 

Depression and Anxiety

Distressing psychedelic experiences can be traumatic and the isolation and confusion which may emerge following such a traumatic psychedelic experience could evoke a mild to severe depression and/ or anxiety.

If the trauma from the experience remains unprocessed, these mental health consequences could last anywhere from weeks up to years following the trip.

Hallucinogenic perception persistence disorder (HPPD)

HPPD is a rare occurrence where effects of hallucinogenic drugs, mainly the visual hallucinations, remain for a long period of time (from a couple of weeks up to several months, in very rare situations some people even report the effects persisting for years) once the drug has worn off. This can be unpleasant and make people feel detached from reality.

We have a full webpage where you can learn more about HPPD

Whatever it is, the way you tell your story online can make all the difference.

ADDICTION

Psychological vs. Physical Addiction

Physical addiction is when more of a drug is needed to feel the same effects (tolerance) and when physical withdrawal symptoms occur when people try and stop taking the drug (dependence). Psychological addiction is when somebody has a mental or emotional attachment to a drug and so are strongly driven to find and use this drug. 

Although research seems to suggest that physically, classical psychedelics such as LSD and psilocybin are not addictive, people may still feel attached to the experience and so may find themselves becoming psychologically addicted. 

Furthermore, evidence has demonstrated that some of the non-classical psychedelics such as MDMA and ketamine can cause tolerance, and therefore pose a risk for physical, as well as psychological, addiction.

If you feel like you or somebody else has developed psychological addiction to psychedelics or any other drug, helplines are available. A list of free UK helplines can be found at: https://www.lifeworkscommunity.com/addiction-treatment/guide-to-uk-free-addiction-helplines.

DECREASING MENTAL HEALTH RISKS OF PSYCHEDELICS

Long-term negative impacts on mental health are much more likely to occur following distressing psychedelic experiences. Following the guidelines in our “How to Reduce the Risk of a Psychedelic Crisis” section will therefore help decrease the likelihood of long-term mental health impacts. 

Furthermore, integration support can help prevent a psychedelic experience from having long-term negative impacts on mental health. However, in the case where mental health has been severely impacted by a psychedelic experience, we recommend seeking specialist support not just from a psychedelic integration therapist, but also from your GP, and/or a clinical mental health support team.

Another way to reduce the risk is by having pure and properly dosed substances, as this reduces the risk of unwanted psychological reactions due to unexpected effects from contaminated or highly potent drugs. 

For UK citizens, you can buy testing kits to determine the purity of your substances online at https://www.reagent-tests.uk/.

 DRUG INTERACTIONS

You can find out more about drug interactions for specific substances in our substance profile pages. However, here is some general drug interaction information.

Psychedelics and Antidepressants

Mixing psychedelics, particularly phenethylamines and stimulants like MDMA,  and antidepressants can increase the risk of serotonin syndrome (see below). 

The risk of this is greatest when an individual begins taking a course of antidepressants as this is before their serotonin receptors have been downregulated. 

Some people report that after they begin taking certain antidepressant drugs, they feel a reduction in the effects of psychoactive drugs which affect serotonin (predominantly MDMA and classical psychedelics). In some instances, certain people are no longer able to feel the effects of these drugs at all once they’ve been taking their antidepressants for a long time. 

In general, it’s unclear exactly how antidepressants and psychedelics mix because there is a wide range of both antidepressant and psychedelics pharmacology. In general, it is best to avoid mixing drugs as the effects and risks are unpredictable. 

Serotonin Syndrome

Serotonin syndrome refers to a spectrum of toxicity caused by too much serotonin in the central nervous system which can lead to various complications. The symptoms of serotonin syndrome include:

  • Autonomic effects- sweating, shivering, increased heart rate (tachycardia), increased body temperature (hyperthermia), nausea

  • Somatic effects- tremor, muscle twitching/stiffness, overactive reflexes (hyperreflexia)

  • Cognitive effects- headache, agitation, hallucinations, confusion, seizures

Hyperthermia is the most dangerous symptom and a body temperature greater than 38oC should be cause for concern. A temperature greater than 40oC is very high risk and should prompt urgent medical attention. When left untreated these symptoms can lead to coma, cardiac arrest, and death, although serious long-term harm is rare when treated promptly.

Combining certain drugs increases the risk of serotonin syndrome and this risk increases as more drugs are combined. 

There is a wide range of drugs that affect serotonin in a range of ways including psychedelics, stimulants, antidepressants, 5-HTP, St. John’s Wort, tramadol, anti-migraine drugs. Particular caution should be paid to herbs containing monoamine oxidase inhibitors including Syrian rue, nutmeg, Yohimbe, as these can have long-lasting pharmacological effects and greatly increase the risk of serotonin syndrome if taken in combination with stimulant drugs like MDMA. 

Avoiding Serotonin Syndrome

Being aware of which drugs increase the risk of serotonin syndrome will decrease the risk. If symptoms of serotonin syndrome appear then it is essential an ambulance is called. 

You can find a list of drugs that pose a risk for serotonin syndrome https://www.uspharmacist.com/article/drug-induced-serotonin-syndrome

Psychedelics and Stimulants 

Psychedelic drugs can increase somebody’s heart rate and blood pressure. This effect is particularly notable for MDMA and 2C-B.

Therefore, if taken in combination with other stimulant drugs,, this combined effect could lead to cardiac complications, including heart attack. However, there have been no reported cases of heart attack from this combination to date. 

Psychedelics and Cannabis

Cannabis and psychedelics can intensify one another so can lead to unpredictable outcomes. Smoking cannabis may bring about visual hallucinations once the psychedelic drug experience is wearing off and coming to an end which can be unpleasant when unplanned.

 LEGAL RISKS

Legal Risks

Although psychedelics are becoming increasingly more popular, in much of the globe these are still scheduled substances meaning being caught picking, possessing, selling, buying or using them all include the risk of being caught breaking the law. 

It is important to be aware of the legal status of any psychoactive substance you plan on using. By being aware of the legal risks associated with being caught you can then make an informed decision whether or not the risk outweighs the benefits. 

For most known psychoactive substances, searching “Legal Status of [drug name]” onto Wikipedia provides a table that contains the legal status of the substance for each country. As Wikipedia is updated, this information source normally contains the most up-to-date laws. However, it must be noted that Wikipedia isn’t always 100% accurate.

Whatever it is, the way you tell your story online can make all the difference.

 

  USEFUL RESOURCES

Support for people going through spiritual emergencies and/or psychedelic trauma

  • Institute of Psychedelic Therapy’s Psychedelic Integration database: A database of UK based counsellors and psychotherapists that offer one to one and group support for integrating psychedelic experiences - https://instituteofpsychedelictherapy.org/psychedelic-integration-database/

  • Spiritual Crisis Network: online and peer group support for people going through or recovering from a spiritual crisis, helping support personal transformation (UK) - https://spiritualcrisisnetwork.uk/about

  • The International Spiritual Emergence Network (ISEN): spiritual emergency support across various countries globally - http://www.spiritualemergencenetwork.org/

  • Emerging Proud: support service and campaigns to reframe mental distress as a catalyst for positive change (UK) - https://emergingproud.com/

  • ICEERS Support Centre: The International Center for Ethnobotanical Education, Research, and Service (ICEERS) is a non-profit organization dedicated to transforming society’s relationship with psychoactive plants. ICEERS Support Center has extensive experience supporting people going through difficult processes with psychoactive plants. https://www.iceers.org/support-center-2/

General Harm Reduction Information

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736944/

Credit to Dr Andrew Gibson for contributing his medical expertise and background in harm-reduction to the process of making this content.