Originally published on Psyche.co:

https://psyche.co/guides/how-to-have-a-safe-psychedelic-trip


How to have a safe psychedelic trip

A psychedelic experience can be deeply rewarding, but also carries real risks. Here’s how to avoid a bad trip

Humans have consumed substances with consciousness-altering properties for millennia. Traditional societies used them in healing rituals, initiation ceremonies and to make contact with the gods and the dead, among other practices. Today they are known as psychedelics, and include the naturally occurring compounds psilocybin (found in ‘magic mushrooms’), DMT and mescaline; the hallucinogenic tea Ayahuasca, used by indigenous peoples in the Amazon basin; and the hallucinogenic shrub iboga, found in West Africa.

Synthetic hallucinogenic compounds, most famously LSD, emerged in the 20th century. The synthetic ‘party drugs’ MDMA (also known as ecstasy) and ketamine (used in medicine as an anaesthetic) are not technically classified as psychedelics, but they also produce consciousness-altering effects and are often considered under the same broad umbrella as the classic psychedelics.

In the industrialised West, psychedelic substances, especially LSD and magic mushrooms, burst on to the scene in the 1950s and ’60s with intense research interest in their therapeutic potential. However, an establishment backlash began in the late-1960s as the drugs became associated with the counterculture movement and opposition to the Vietnam War. Fermenting the eventual clampdown, the psychedelics-researcher-turned-evangelist Timothy Leary exhorted American youth to ‘turn on, tune in, drop out’. Tales spread of ‘bad trips’ and associated suicides, and the field of psychedelic research fell silent for decades.

We are now living through what’s been described as a ‘psychedelic renaissance’ that began in the 1990s. Research groups around the world, notably at Imperial College London and Johns Hopkins University in Baltimore, have been pumping out studies uncovering the neural basis of the drugs’ effects and exploring their apparent therapeutic benefits, especially when used as an adjunct to psychotherapy.

Research trials suggest that, when used as part of psychotherapy, the benefits of psychedelics include, but are not limited to, alleviating depression and anxiety (including for people who have not benefited from other forms of therapy or drug treatment), tackling longstanding symptoms of post-traumatic stress disorder, treating addiction, and calming existential distress in people with terminal illnesses.

Superior trial outcomes correlate with participants’ reports of having a mystical or transcendent experience during their psychedelic session. In fact, many people who take a psychedelic drug describe the experience as among the most personally meaningful of their lives. Many are changed by their trip, displaying greater open-mindedness, humility and feelings of connectedness with humanity and the wider world.

Although they can lead to subjectively similar experiences, different psychedelic drugs exert their effects in the brain via different mechanisms. For instance, psilocybin, mescaline and LSD act principally via the 5-HT2A receptor system (5-HT, also known as serotonin, is a neurotransmitter involved in mood and perception), whereas DMT acts on the 5-HT2A system and sigma-1 receptors involved in neuronal signalling. Meanwhile, ketamine interacts with another brain chemical called glutamate by blocking the NMDA receptors that this neurotransmitter usually binds with.

At a global level, psychedelic drugs have in common that they increase levels of entropy in the brain by allowing for communication between neural regions that don’t usually interact, and reducing the activity of a group of neural areas known collectively as the ‘default mode network’, which is involved in self-conscious thought. It’s believed that these neural changes lead to ‘ego dissolution’ and facilitate the mystical feelings of oneness and transcendence that are common to many trips.

The upsurge in research interest in psychedelic drugs and reports of their transcendent, life-changing effects have led to a steady flow of newspaper stories documenting their potential, and the publication of a spate of popular books about psychedelics. As curiosity about these drugs and their beneficial effects continues to grow, it raises the question of whether it’s possible for individuals to take these substances safely – and, if so, how?

Safety and legality issues

There are certain physical and mental health conditions that make it inadvisable to experiment with psychedelics, including heart problems and a history of psychosis or bipolar disorder. Antidepressant or antipsychotic medication could also interact unpredictably with the psychedelic. ‘Chronically, SSRIs [a form of antidepressant] may reduce the effect of psychedelics while other antidepressants may have other effects. But at this point there’s just not enough known about the effect of other psychoactive drugs on psychedelics,’ explains Sandeep Nayak, a psychiatrist at Johns Hopkins who has trained as a facilitator in psychedelic research studies.

‘If you have underlying mental health concerns or are experiencing depression, anxiety, or any medical issues, talk to a psychedelic-friendly therapist or doctor before taking substances,’ advises Sara Gael, director of harm reduction at the Multidisciplinary Association for Psychedelic Studies (MAPS) in the United States.

Even if you are fully fit and healthy, experts unanimously say that it’s a bad idea to take a psychedelic drug on your own, especially if it’s your first time. Ben Sessa is a psychiatrist, based in the United Kingdom, who has been researching the therapeutic effects of psychedelics for more than 15 years. He rejects the framing of the question in terms of whether it is possible to have a safe trip. ‘It’s like: “Is a knife safe or dangerous?”, it’s a ridiculous question. It’s about risk/benefit analysis.’ But he, like others, warns against journeying solo.

‘There are more risk factors [on your own] because there isn’t somebody there to manage your feelings or your behaviour,’ he says. ‘More importantly, you could be disorientated, and try to get in your car and drive away. Anything from the most benign behaviour – going online and buying 200 kg of avocados – to much more dangerous, there’s nobody who is not high who is able to temper your behaviour and make sure things are okay.’ Psychedelics have a pround effect on cognition, perception and coordination and you should take care to be in a physically safe, controlled environment. You should not plan to be driving, walking in traffic, be in high places or other dangerous environments which require you to be alert and coordinated.

Ideally you should identify an experienced and trusted guide or therapist to work with you before, during and after your psychedelic experience. Many cities in the US, Europe and elsewhere have psychedelics societies and these can be a good place to begin your search for a guide. At a minimum, make sure you are with a trusted and competent friend to keep you as safe as possible for the duration of the drug’s effects (consider, for instance, that the mind-altering effects of LSD can typically last up to 12 hours).

Another glaring practical issue is that, in most jurisdictions around the world, psychedelic drugs are illegal and if you are caught in possession, you will face criminal charges. This also has important implications for sourcing drugs safely. Françoise Bourzat, who has worked as a psychedelics guide in California for decades and is the author of the book Consciousness Medicine (2019), says that to source the drugs you will have little option other than to rely on word of mouth. ‘Always test your drugs,’ adds Gael. ‘Test kits are available on the DanceSafe website.’

If you decide to go ahead and it’s your first time, it’s sensible to start out with a weaker dose and, as mentioned, to pay due attention to the duration of the drug’s effects. The PsychonautWiki community encyclopaedia has information on dosing, duration and other practical issues.

However, even if you take these practical precautions, other experts urge an even more cautious stance. ‘I can’t and don’t endorse the use of psychedelics outside of research settings,’ says Nayak.

Fortunately, the physiological risks from the classic psychedelics are low to zero. ‘LSD and psilocybin are virtually inert physically – they have very low physical toxicity profiles so there are minimal physical risks,’ says Sessa. ‘They’re also not moreish,’ he explains. ‘You can see this in animal trials, they won’t repeatedly self-administer psychedelic drugs, they’ll take a single dose and then just largely ignore options to redose. So, the risk of addiction to psychedelics is low. Taking MDMA repeatedly long-term can be more harmful, but studies show that the physical risks go down after stopping.’

The main risks are psychological, and this is why preparation is so important. As safety guidelines for psychedelics trials from Johns Hopkins University put it: ‘The most likely risk associated with hallucinogen administration is commonly known as a “bad trip” and is characterised by anxiety, fear/panic, dysphoria, and/or paranoia.’

What to do

The most effective way to minimise the risk of a bad trip occurring is to prepare well. The Johns Hopkins advice is for guides and therapists to discuss the broad range of psychological effects that can be experienced under the influence of a psychedelic, including out-of-body sensations, the evocation of powerful memories, distortions to time and space, and feelings of oneness with the world, to name but a few. It’s also important to pay due attention to what Leary called ‘set and setting’. Most relevant to the preparation phase, ‘set’ describes the mindset and intention you bring to the psychedelic journey, and an experienced guide will work on this with you. The ‘setting’ refers to the physical, social and cultural environment in which the user takes a psychedelic drug.

‘Are you entering the experience with a certain need in your life? Do you want to explore something? Do you need healing? Do you have an emotional relationship that is problematic, burdened by childhood issues?’ asks Bourzat. ‘Do you want to be connected more with spirits or explore your relationship with nature? You don’t have to have a pathology to have an experience, but it’s a good idea to know why you’re doing it. What are you looking for in the journey? That’s the preparation.’ Other basic aspects of preparation, she adds, include writing a journal and preparing the body by fasting and avoiding alcohol.

The journey

Researchers have known about the importance of the ‘setting’ in the psychedelic experience for decades. In a series of studies published in 1960, Robert Hyde, a doctor at Boston Psychopathic Hospital, spent three years observing how the effects of LSD varied in different contexts. For instance, in the second year of his research, volunteers were treated as ‘research objects’ and given structured tasks to complete, whereas in the final year, the experience involved more chance for relaxation and personal support from and rapport with the researchers. Needless to say, the final year was generally associated with positive psychedelic experiences whereas the second year led to more unpleasant outcomes.

If you take a hallucinogenic drug at a party, even the attitude – the ‘set’ – of your friends could influence the ‘setting’ and thereby make a difference to your own experience. A field study in 2002 found that, on the rare occasions when people taking MDMA/ecstasy at parties reported bad experiences, this usually coincided with the user’s friends having pessimistic expectations or concerns about the trip. ‘A sense that another user, particularly a friend or acquaintance who is part of the collective, is not having a pleasant experience may have a deleterious effect on the group as a whole,’ the researchers said.

When it comes to a more formal, guided psychedelic journey, Bourzat explains that the setting is literally where the journey is happening: ‘What is the location? Who is sitting with you? Who is helping? What is the expertise and style of the guide? It also includes the length of time … What is guiding the work? Is it nature? Is it someone singing for you? Is there music playing? Is it quiet? All these different elements create the setting.’

She adds that commonsense steps to take include ensuring that the room is comfortable with soft furnishings and that any music is conducive to a pleasant experience. ‘I wouldn’t play rock and roll or house music. It should be expansive, not just classical but also more contemporary, or new age or tribal, African, Tibetan – anything ambient that’s conducive to introspection,’ says Bourzat.

If you have any frightening experiences or difficult overwhelming emotions, the usual advice is to surrender to these rather than trying to suppress them or run away from them. ‘Whether the disturbance consists of frightening illusions or internal imagery, difficult thoughts and feelings about some past or present personal issue, or anxiety related to a radical change in sense of self (eg, temporary loss of self-identity), the volunteer is encouraged to mentally surrender to the experience, trusting that her or his usual state of consciousness will return when the drug effects resolve,’ state the safety guidelines from Johns Hopkins University.

Integration

Following your psychedelic journey, it’s critical that you process the meaning of your experience with a guide or therapist. This ‘integration’ should take place during the two to three months after your experience. ‘When people take drugs recreationally, like just go to a festival and take LSD and then go home, that’s where they tend to run into problems because there’s a lack of integration of the experience,’ says Sessa.

One of the key aims of integration, Bourzat explains, is to carry the beneficial aspects of the psychedelic journey into everyday life. ‘If someone had a beautiful experience of nature, and in the journey they experienced beautiful birds, a meadow, then I would say you actually need to do that in your life. You need to cultivate that experience, and maintain that goodness that you connected with in the journey,’ she says. ‘Or say someone connected with a loved one they had lost, and felt love and tenderness and dealt with unfinished business in the journey, then I would suggest some ritual in real life – writing to the deceased person or beginning a journal and making that part of their life.’

Gael notes that integration therapists have different approaches and backgrounds. It’s important to find a guide or therapist whom you trust and who is nonjudgmental. ‘One helpful resource for finding integration support is the Psychedelic Support [network],’ she says.

Key points

  • Remember that psychedelic substances are illegal in most jurisdictions.
  • If you have physical or mental health issues, speak to a sympathetic doctor before experimenting with psychedelics. People with a history of psychosis or bipolar disorder are usually not allowed to participate in psychedelic research trials because they face heightened risks.
  • Ensure you are in a physically safe, controlled environment. Always start with a low dose.
  • Don’t take psychedelic drugs on your own. Find an experienced guide or therapist whom you trust.
  • Use word of mouth at psychedelic societies and elsewhere to source psychedelic substances safely, and use online testing kits to ensure their quality. Alternatively, for greater safety, consider signing up to a research trial conducted at a university.
  • Remember the importance of set and setting. Work with a guide who will help you prepare for your psychedelic journey, sit with you during the experience, and conduct integration with you for several weeks or months afterwards.

Learn more

The main safety challenges confronting anyone who wishes to experiment with psychedelics stem from their illegality, meaning that there is no formal regulation of the training of psychedelic guides, nor is there a reliable way to source the drugs safely. Many researchers in the field, including Sessa, have been campaigning for drug-law reforms for decades. ‘The current situation is a total practical folly and extremely dangerous, utterly immoral and totally unpoliceable,’ he says. ‘It’s putting our heads in the sand and not addressing the fact that many people will take these drugs. It’s like the prohibition era in the States but on a much larger scale. The only way to control potentially dangerous drugs is through appropriate regulation. Imagine if scuba diving were outlawed – people would still do it, but now there were would be poor training, poor equipment and loads of people dying.’

Until the laws are changed, and outside of a research environment, the best route to a safe experience lies in finding a suitably trustworthy and experienced guide – someone who is vouched for by others. And it’s key that this guide will work with you before and after your psychedelic journey.

‘There’s lots of underground therapists in this country and elsewhere, these so-called healer/shaman/guru-type people who will quite happily take you down to Totnes and take four grand off you and take you into their yurt and give you a bag of mushrooms, but they won’t give you the other stuff; they won’t do the preparation and they won’t do the integration, so people are left hanging high and dry,’ says Sessa. ‘I always say to people who’ve found a so-called shaman or healer: “Ask this guy if he will see you for three weeks before and three weeks afterwards, and I bet he won’t.” That’s the bit that’s missing, not only from recreational use, but also from underground use.’

Until the laws change, signing up to a research trial is probably the least risky way to experience a psychedelic trip. These are being conducted at various research institutions around the world, principally: the University of Bristol, Imperial College London, Newcastle University and Manchester University in the UK; and at Johns Hopkins University in the US.

Links & books
Erowid is a US-based organisation that provides ‘reliable, nonjudgmental information about psychoactive plants, chemicals, and related issues’.

Bluelight is an ‘international, online, harm-reduction community committed to reducing the harms associated with drug use’.

The Multidisciplinary Association for Psychedelic Studies (MAPS) is a US-based ‘non-profit research and educational organisation that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana’.

DanceSafe is a public health organisation, founded in California, that provides ‘a nonjudgmental perspective to help support people who use drugs in making informed decisions about their health and safety’.

PsychonautWiki is a ‘community-driven online encyclopaedia that aims to document the field of psychonautics in a comprehensive, scientifically grounded manner’.

The Psychedelic Renaissance (2nd ed, 2017) by Ben Sessa is an excellent introductory textbook that describes the cultural history of psychedelics, and is the most up-to-date review of contemporary work in the field.

Consciousness Medicine: Indigenous Wisdom, Entheogens, and Expanded States of Consciousness for Healing and Growth (2019) by Françoise Bourzat with Kristina Hunter is a ‘comprehensive guide to the safe and ethical application of expanded states of consciousness for therapists, healing practitioners, and sincere explorers’.

How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (2018) by Michael Pollan is a ‘brilliant and brave investigation into the medical and scientific revolution taking place around psychedelic drugs ­– and the spellbinding story of his own life-changing psychedelic experiences’.

Disclaimer

The recreational use of LSD, MDMA, DMT, psilocybin and similar substances is currently illegal in most jurisdictions around the world.

Information and support for those affected by substance abuse can be found at the BBC’s addiction page.