What's the story with MAPS and finally getting real clinical research on psychedelic substances?

The Not-So TL;DR:

Our first responder and psychedelic harm reduction friends have reported a recent, noticeable uptick in calls involving people who read a glowing article or watched How To Change Your Mind, took psychedelics with no idea what they were doing, and ended up in an unexpectedly difficult, traumatic, or dangerous situation.

We’re here to help you avoid being that person.

For context, the psychedelic research studies you've heard about are conducted on extensively screened subjects. Pharmaceutically pure compounds made in licensed labs are used. The sessions themselves are conducted by trained professionals in tightly controlled environments with lots of preparation and aftercare for the subjects. Medical professionals are standing by in the next room the whole time in case they're needed.

This is in many ways the exact opposite of how people take psychedelics in the real world.

When you’re taking psychedelics in an unsupervised, uncontrolled environment like a festival, party, or event at home, the number of risk vectors you have to anticipate, track, and manage on your own goes way up.

We learned about the importance of psychedelic safety while coming of age working as staff, performers, and first responders at festivals, which are arguably one of the most (if not THE most) complex, uncontrolled environments where people regularly take psychedelics.

Over the years, we have seen a small but painfully consistent percentage of people overdose, have terrifying experiences, injure themselves, experience psychotic episodes, and rarely (but heartbreakingly) even die in situations involving psychedelics. Many of these incidents involved friends and people we cared about, so we got real nerdy with an interdisciplinary team of psychedelic safety experts to figure out how to take care of our communities.

We’ve now been working together for seven years to create a comprehensive video masterclass for people who use psychedelics outside of supervised medical, therapeutic, and ritual contexts. Having recently completed and launched the masterclass, we’re now able to help answer a wide range of psychedelic safety questions, including:

- Avoiding dangerous drug combinations

- Safer dosing practices

- Determining whether your mindset and environment (“set and setting”), and the people you're with are conducive for a safe, beneficial experience

- How to test your drugs for purity and screen for harmful adulterants like fentanyl- Medical and mental health conditions which are contraindicated with various psychedelics

- Where to find quality, no-BS information about drugs on the internet

- How to triage and respond in a crisis if something goes sideways and you need to get help

- Strategies for supporting someone having a difficult trip

- Consent around psychedelics

- How to make sense of psychedelic experiences and integrate them into your life

A COUPLE NOTES:

- This AMA is intended for informational and harm reduction purposes and should not be taken as medical advice. We’re not doctors and we don’t play them on the internet, but we also know that most medical professionals don’t receive comprehensive training about psychedelics. Thus, we encourage you to do your own research and will be happy to direct you to legit sources of online drug information.

- The word “psychedelics” is an umbrella term which refers to a wide array of compounds from many different classes of drugs. Drugs from different classes have different effects, work differently in your body, and have different safety profiles, which makes general questions about “psychedelics” hard to answer. Asking us questions about specific drugs will get you better answers.

- We don’t know everything about psychedelic safety and won’t pretend to. There’s just too much to know. We teamed up because our complimentary knowledge bases allow us to cover a lot more ground than most people in this space, but new research is coming out all the time, there are hundreds of new drugs being created every year, and there are always edge cases. If we don’t know the answer to a legit question, we’ll tell you so and will try to direct you somewhere or to someone who might.

- There is no such thing as taking psychedelics risk-free. If you take enough drugs at high enough doses over a long enough period of time, something will inevitably go sideways. Part of the point of all this safety stuff is to minimize the impact when it does. That said, there are also always going to be a small percentage of people who react poorly to psychedelics due to genetic factors or predispositions which could not have been known or anticipated in advance.

Okay, that’s all the additional stuff.

Now, should you feel so inclined…Ask Us Anything!

What public safety concerns is the public going to run up against with increased uneducated use of psychedelics?

It's a very long story indeed and far longer than a single comment could encompass! MAPS, and several other incredible organizations, have been working for decades to push psychedelic research through the steep financial and regulatory requirements involved in the onerous clinical research process. The primary compounds being studied are MDMA, LSD, psilocybin, and ketamine, for a wide variety of different clinical applications varying from treating PTSD to depression to OCD to end-of-life anxiety. We've been keen observers as this research has evolved and excited for the implications for so many that are suffering... but also have watched the enthusiasm for these treatments spill over into people trying out less-than-safe DIY applications in home and other unlicensed environments.

We're a big fan of Michael Pollan's book, "How To Change Your Mind", for a deep dive into the history of use of these compounds and how regulation and clinical research has evolved over the last century. From his website: https://michaelpollan.com/books/how-to-change-your-mind/ Amazon purchase link: https://amzn.to/3swCUEW

If you're not looking for a whole book, but would rather like to stay up to date on the clinical research as it emerges, Lucid News has as great weekly newsletter that sums up the headlines with the latest and greatest in clinical research developments: https://www.lucid.news/

Does it piss you off that the 'War on Drugs' has led to the suppression of the clinical study of these drugs and a loss of knowledge over the last century as a result (not to mention the untold damage that has been done due to the ignorance of said drug policy) ?

YES. If all the time and energy that has been spent battling often malicious regulatory environments had instead been spent on finessing clinically-sound treatment protocols using these compounds, we believe the world would be a much safer and happier place. But, here we are, and despite the War on Drugs, the scientific community is more vibrant than ever when it comes to exploring the therapeutic potential of these substances.

Thank you!

You're welcome!

There are a couple.

A major one is the increasing prevalence of harmful adulterants like fentanyl in the underground drug supply. Though fentanyl specifically still doesn't show up in psychedelics sold in underground markets *that* often, there have been some reports of it showing up in ketamine, and given the way fentanyl has crept into many other drugs (heroin, methamphetamine, cocaine), we have concerns that this could continue further into the psychedelic market as well.

- Another issue is people not knowing how to dose themselves correctly, which is one of the things we cover exhaustively in our new masterclass. Being too high to drive or safely navigate public space carries a safety risk both to yourself and to others

- A very small but reliable percentage of people who take psychedelics will experience some kind of psychotic episode or become erratic, which can lead to unpredictable and risky behaviors that can affect their health and safety, as well as that of those around them. (As another example, one of us had a friend in college who was triggered into a major bipolar episode resulting from psychedelic use who impulsively decided to take a late-night bike ride to another state and was hit by a car.)

- There's also a possibility that more people experiencing psycho-emotional crises on psychedelics could check themselves into emergency rooms when they don't need medical attention, taking staff resources away from people in more urgent medical need.

How likely are these things? Hard to say. What we do know is that all of these things happen a little bit already and are statistically likely to happen to more people as more people start taking psychedelics without proper safety education.

Where can people learn more about the different psychedelics and the medical benefits? For instance DMT came up in recent years but there isn’t a lot of information on it from a scientific stand point

What are some examples of deaths from taking psychedelics?

I don’t really trip anymore (maybe some mushrooms once in a blue moon), but they helped me a lot in understanding and accepting myself. How can I help the cause legally?

For more AMAs on this topic, subscribe to r/IAmA_Nonprofit, and check out our other topic-specific AMA subreddits here.

An example: there was a notable headline-generating incident recently in which an individual who had taken psilocybin-containing mushrooms assaulted several individuals on a plane. While rare, taking high doses of psychedelics in the wrong set and setting can be immensely disruptive and sometimes dangerous for those around you. While certainly not the majority of use cases, when situations like these end up in the headlines, it certainly makes it harder for activists to make the case for decriminalization or legalization on the basis of there being little public safety risk. https://www.washingtonpost.com/travel/2022/10/10/psychedelic-mushrooms-united-flight/

Connecting with Decriminalize Nature to start an initiative to decriminalize plant-based psychedelics in your city or state is one option.

Supporting any such existing campaigns in your city or state is another.

If you're a college student, starting or joining a chapter of Students for Sensible Drug Policy is a good move.

You can also support the Drug Policy Alliance, which is the major national organization pushing for drug policy reform.

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There are two major categories of deaths associated with psychedelics....

The first category has to do with the physiological impact that the psychedelic has on the body - in short, an overdose. These are extremely rare for most psychedelics, given that they have such a high LD50 (the "lethal dose" amount of a material which causes the death of 50% of subjects) compared to other psychoactive compounds such as alcohol. A famous example is the legendarily high dose of LSD that had to be given to an elephant to result in its death: https://www.illinoisscience.org/2016/06/lsd-and-the-elephant/

But other compounds may cause death through other physiological mechanisms - especially psychedelics with a strong impact on cardiac systems, such as ibogaine or MDMA. Each compound presents its own unique challenges, and should be researched carefully with respect to contraindications with other drugs - another potential source of fatal effects - and underlying conditions that may not place nice with your psychedelics.

The biggest risk we see is how psychedelics change behavior, and in particular awareness of the environment. People on psychedelics much more in danger from the world around them - from perhaps not checking both ways before crossing the street while on bicycle day ride, from accidentally drowning in a DIY float tanks in their home bathtubs while K-holed, from losing their balance and falling while giddily climbing tall structures at festivals - all situations ourselves and/or our first responder community members have had to deal with. Ketamine seems to be a particularly common factor in deaths of this nature.

This is why we strongly recommend folks not only take preventative steps to make sure they are taking the appropriate substance in an appropriate dose for their individual biology, but also use substances in community so that they have people that can help them not accidentally harm themselves while on their cosmic voyage. We've got a safe(r) psychonaut dosing protocol we put together for community here to minimize risk: https://www.psychedelicsafetyalliance.org/f/safer-psychonaut-dosing-protocol

Due to the freeze on psychedelic research that hit in the late 60's, there's still a ton of research to be done on various psychedelics, especially more esoteric ones like DMT. So if you're looking for peer-reviewed research on medical benefits, in many instances, you just have to wait until the research has been funded and conducted in the first place.

That said, if you want to see what does exist in the medical literature, PubMed or Google Scholar are our go-to databases for published research findings. Many of the studies you'll find in there are pretty jargon-heavy and not meant for the general public, but you can easily go in there and do a keyword search for the compound you're curious about and you'll get a list of things folks have published. Some studies have methodological issues that only research geeks can pick apart and it's still not always possible to say definitively that the findings of a single study are conclusive, but it's a start.

A better option for laypeople can be databases like Erowid or PsychonautWiki, which, though they don't list much in the way of medical research findings, can give you a more accessible glance at the experiences other people have had on a wide variety of psychedelics through the Experience Reports they collect. You can also occasionally find research cited on Wikipedia, though you'll want to follow up with those to make sure they're legit.

There are tons of groups that are lobbying for drug policy reform in the United States; expanding clinical research and treatment options is just one of many. Many of the nonprofits and businesses that have been funding clinical research are also very involved in pushing for regulatory reform, most notably in the US MAPS. There are plenty of groups with a more international scope, such as Beckley Foundation.

There's excellent sociological science that's been produced that has examined the negative impact of the War on Drugs on marginalized populations that has in turn led to social justice-oriented reform initiatives by the ACLU, Drug Policy Alliance, and others. While the focus of organization efforts varies by local chapter, SSDP also does excellent work on the activism front as well.

I'm so glad to see a real psychedelic researcher promote EROWID. This has been one of the best resources for me to get the basics of various drugs and people's personal experiences with the substances.

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Where would one get psychedlics if they wanted to try them?

I'm in Canada.

Erowid kicks ass.

To be clear, we're not conducting our own academic research, but we do study and aggregate a bunch of academic research for a lay audience. Many of the researchers we've spoken with have told us that science has an information dissemination problem, so we view part of our role as filling that gap.

It's also worth noting that many emergency medical professionals like Erowid, as they don't receive much education about psychedelics during their training and can be asked to care for patients experiencing some kind of medical issue that could be due to a substance that they've never heard of before.

Though Erowid doesn't always have information on *every* drug out there (especially very new ones), it's the most encyclopedic database we know of, has been around the longest, and was a major starting point for both of us in our journeys to understand WTF was up with drugs generally, psychedelics specifically, and how to keep people safe.

Thanks! Doing our best.

Legality varies greatly by jurisdiction and individual psychedelic compound in question, so we're hesitant to provide sourcing information in a public forum. We'd recommend checking the legal status of the compounds that you are interested in in your given city/province. For example, many jurisdictions have licensed ketamine-assisted psychotherapy clinics, so you can have a safe, supervised experience if you are seeking psychedelics for purposes of clinical treatment.

For most folks, however, psychedelic access is largely restricted to either growing/making your own (complex and again, legally fraught) or accessing black/gray market sources. We created a brief harm reduction guide for Dealing With Your Dealer to minimize the likelihood of getting something other than what you were looking for (and maybe causing harm to yourself or community members as a result): https://www.psychedelicsafetyalliance.org/f/dealingwithyourdealer

I’ve had a few great experiences on psychedelics, from MDMA, mushrooms, and LSD, which leads me to want to take them again. But how long should one wait in between uses? Or does that depend on a whole array of different factors?

I've bookmarked your AMA because I think it helps to answer some serious questions regarding access to and use of psychedelics.

Where is your masterclass accessible from?

Do you think the US will ever actually accept and not just decriminalize, but legalize, the use of these compounds as a viable treatment option?

Is there a resource of providers of psychedelic-assisted counseling per state? And if so, is it accessible by a layman?

Okay I see! Maybe not conducting your own research but consolidating the research that is already out there. Really appreciate any effort anyone puts in to spread harm reduction for recreational users.

We should also add here that there are two kinds of crises one can experience while on psychedelics: Medical Crisis and Psycho-Emotional Crisis.

People experiencing an acute medical crisis sometimes need hospitalization, as a medical crisis can be fatal in some instances. Getting people in this camp medical attention can often keep them alive or prevent things from getting worse.

People experiencing a psycho-emotional crisis can often present as being in bad shape and really scared, possibility to a legitimately traumatic level, even to the the point where they think they're dying, but actually are not dying. Getting people in this camp to a hospital can often subject them to environments and situations which can make things more scary or traumatic.

To help some festival first responders in our network determine the difference between the two types of psychedelic crises, we made this nifty Crisis Laminate, which you can download for free, print out, and take with you when you're out in the world.

Your instinct is right here in yes - it DOES depend on a whole array of different factors!

MDMA in particular has some unique properties that make it potentially harmful to take frequently, especially in higher doses. While there are some steps you can take to minimize the harm that MDMA has on your brainpan (we wrote up a guide on the science behind neuron-saving supplementation here: https://www.psychedelicsafetyalliance.org/f/mdma-harm-reduction) MDMA is not something that is appropriate to take more than once every few months, at least if you value your ability to consistently use your dopamine and serotonin receptors.

As a general rule of them with psychedelics, especially ones like LSD and psilocybin that don't build as much of a tolerance, we like to advise folks wait until they have fully integrated their last experience before moving on to the next one. Have you really absorbed whatever teachings your experience had to give? Has your body fully recovered and your mind returned to baseline? What benefit would you get out of doing it again that you can't achieve by doing something less risky? What's the minimum effective dose and frequency to get you what you want? Some people find that a regular microdose protocol gives them much of the benefits with less of the hassle of a regular macrodose, for example. Psychedelics are incredible tools, but you want to make sure you're applying them with intention and care.

Happy to help! That's why we came back for another round - there are just so many questions, especially as psychedelics have been moving more into the mainstream.

Our masterclass is available on our website, which we update quarterly with new research and resources: https://www.psychedelicsafetyalliance.org/courses

We've also got an email list we regularly send out resources to: https://www.psychedelicsafetyalliance.org/f/psychedelic-safety-resources

Regarding legalization, it is our sincere hope that our country will continue to move in that direction. The recent announcement by the Biden administration formally announcing the failure of the policies around marijuana was an exciting step in the right direction: https://www.whitehouse.gov/briefing-room/statements-releases/2022/10/06/statement-from-president-biden-on-marijuana-reform/

The FDA's incremental progress in approving MDMA and psilocybin therapies has also taken some promising steps forward in recent months: https://theintercept.com/2022/07/26/mdma-psilocybin-fda-ptsd/

It's been the work of countless activists and researchers over decades, but I think, as a community, we're getting there!

Psychedelic-assisted psychotherapy is still illegal in the US, with the exception of ketamine therapy in some places.

Finding ketamine therapy in your area can be a simple as a Google search. Bigger cities are more likely to have ketamine clinics if they're legal in your state.

Until psychedelic-assisted therapy becomes legal, the next-best option which many people use is to use psychedelics on their own, and work with a psychedelic integration therapist to plan their journey beforehand and make sense of what came up during their journey afterwards. The Multidisciplinary Association of Psychedelic Studies has a list of integration therapists HERE.

Mental health professional who works with psychedelics will tell you that it's usually not what comes up during the session that leads to healing, but rather, what you do with it afterwards that has the lasting benefit, so this option is actually pretty good for a lot of people.

If being our geeky selves can be of service to the community, bring it on.

What are your opinions on using psychedelics to treat substance use disorders, specifically opiates?

The major issue here with this last method is that you still have to source your own psychedelics through unregulated underground markets, which can lead to all kinds of issues with adulteration and misrepresentation. This isn't really an issue for whole psilocybin-containing mushrooms, but when you get into the realm of pressed pills or bags of off-white powders, things get more risky.

To help people navigate underground markets as safely as possible, we made a resource called Dealing With Your Dealer which you can download for free.

We also recommend testing your drugs using chemical reagents and fentanyl strips.

These methods used together are fairly accessible for most people, but they can't catch all adulterants, so if you have $100-150 to spend in the name of safety, we also recommend using a laboratory service like DrugsData.org , energycontrol-international.org , or GetYourDrugsTested.com (depending on where you live). This is the only way to guarantee you know what you have and can make an informed choice about whether you want to take it.

How do you feel about the numerous trip guidance providers that are popping up in countries where this is not regulated, such as Canada and The Netherlands? They do not provide licensed therapy but advertise and profile themselves as able to assist with various anxieties, fobia, addictions, and self exploration. How does this impact legitimate clinical studies and future therapeutic professionals?

Early psychedelic researchers in the 1950's and 60's found LSD helpful in the treatment of alcoholism, and Bill Wilson (founder of Alcoholics Anonymous) had his own experiences with psychedelics which led him to the opinion that they were helpful in treating addiction.

Many mental health professionals today view addiction through the lens of trauma, which often an underlying factor in substance use disorders, and using psychedelics in a therapeutic setting can help treat some of these underlying issues.

For treating opioid addiction specifically, a psychedelic called ibogaine has shown a lot of promise. We know a couple people who have maintained long-term recovery after ibogaine treatment. Ibogaine has to be taken under medical supervision and is thus not cheap, but it seems to be the "magic bullet" for some people.

Is ibogaine treatments legal in the US and if so do you have any resources on finding someplace that offers it?

I'm currently experimenting with psilocybin microdosing to treat depression and anhedonia.

When I started this, there seemed to be early results that supported the idea. Small samples, a lot of anecdotal information. Not much peer reviewed material, but very encouraging all the same.

Since then, I've seen other reports that any beneficial effect might just be the placebo or expectancy effects at work.

So, what's the current understanding in the scientific community? Has it reached a consensus either way?

It's mixed. We feel many ways about this.

On the one hand, everyone and their mom wants psychedelic therapy right now, but capacity in clinical trials is low, which means many people who could benefit from psychedelic-assisted treatment or the therapeutic support of a clinical trial can't get it. In this situation, taking psychedelics on your own and working with an integration coach could be the best option that's available for people who are going to do it no matter what, and can theoretically be beneficial. That said, we've also heard stories of this route going poorly for people, so it's not the best option by far and really comes down to the individual providing the service.

On the other hand, a lack of regulation isn't great when we're talking about the hearts and minds of people who are suffering. If you're gonna look for someone to do psychedelic integration work with, we'd recommend going through a licensed therapist who at least has *some* training and experience working with clients, whether or not that training covered psychedelics.

It should also be noted that some licensed mental health providers are offering psychedelic-assisted psychotherapy under the table, which is not great given that many of them have no training in this whatsoever. Even those who have received training in underground psychedelic therapy programs often have no idea how to source safely, as this horror story can attest.

Hi ! Has their been much research into psychedelics and the negative medication combinations? I’ve experienced rather negative trips whilst on lithium, unfortunately their wasn’t much or any information on this matter before I experienced it for my self. What exactly is happening to my brain whilst on lithium and taking psychedelics?

We've seen some of the reports you mention, and to our understanding, the research is still too new and ongoing to be conclusive.

Microdosing exploded in popularity during COVID lockdown and there are more people doing it than ever before, so we're very curious to see if this could ultimately lead to larger sample sizes for microdosing research and/or more people who'd be willing to take place in microdosing studies, should the funding and interest become available to do more investigation.

Friend years ago got Hawaiian baby Woodrow seeds off the internet to try LSA. Pretty sure that’s the right name. We had to burn the hairs off them or something like that and eat them. Never been so sick but obviously survived. What did we do wrong and just how stupid were we?

Ibogaine is unfortunately classified as a schedule 1 substance in the US, despite its promising clinical applications. Wikipedia has a great chart showing its status by country: https://en.wikipedia.org/wiki/Legal_status_of_ibogaine_by_country

Two cautionary notes when seeking ibogaine: it is one of the riskier psychedelics to take, especially if there are underlying cardiac conditions - though the clinical research is not as robust yet as with some other compounds. We recommend that it is only done with careful consultation with your physician and a clear-eyed view of the personal health risks.

We would also recommend confirming that the sourcing of the iboga is done in an environmentally sustainable way, as increasing mainstream demand for ibogaine has resulted in unfettered deforestation that threatens the long term viability of ibogaine as a treatment option. More on conservation efforts here: https://chacruna.net/iboga_conservation/

There hasn't been anywhere near as much as research into this as there should be. This is a bummer, as many people are interested in taking psychedelics to alleviate mental health issues which they currently take psychiatric medications for.

The task of studying contraindications between psychedelics and mental health conditions is mind-bogglingly complex given the number of combinations possible, and we've yet to find a truly definitive guide to what we know thus far.

Here's one table we've found about combining antidepressants with psychedelics, though it doesn't include lithium specifically.

As to what's happening to your brain on lithium and psychedelics, it comes down to the specific psychedelic and your specific brain, which even a trained expert would not be able to fully determine or predict.

That said, if you have had negative experiences taking psychedelics on lithium, it's probably a good idea to avoid doing so in the future: your brain could be trying to send you a message, and it's a good idea to listen when that happens.

There’s a lack of research on psychedelics and mental illness, and even less understanding of their interactions with drugs like SSRIs etc.

But there’s a vested interested in psych use to improve mental health, thus how do you provide advice while also being cautious of the potential for aggravation of any mental illness? Or do you caution against trying them at all?

I have dabbled in the mixing of psychs with SSRIs, more for curiosity, and haven’t had issues. I was lucky to have experienced friends that offered what they knew, but it’s still always a gamble.

We know one or two who have also used Hawaiian baby woodrose seeds to get high on LSA, but we don't know anything about the preparation thereof.

How stupid were you? Certainly enough to make yourselves sick off some seeds from the internet.

Thank you.

FWIW; I think I'm seeing a small improvement in certain specific symptoms of depression, but no effect on the anhedonia.

Hey, if it works for you, suppose that's better than nothing. While we cannot speak to your individual biology, your anhedonia might respond better to different microdosing protocols, which are easy to find online

Hey, thanks for pointing out the difference in these two kinds of emergencies. I think having some sort of "field guide" is a very good idea, but I can't help finding the version you have provided very unclear and hard to navigate. There's a couple of things that I didn't get straightaway, and I'm sober at home and not out on a festival with someone on a bad trip near freaking me out.

On page one, you say: "Check for basics. Are they 10-20 breaths per minute."
That's not only very weird grammar, it's especially useless because you don't even tell me what to do with the info that "they are 20 breaths". Also, what are "arousal techniques"? You are talking to festival goers I assume, not medical professionals (because then you would not explain that regular breath is a vital sign)?

I think it would be helpful to say something like "First of all, make sure that people are physically safe. If one of these conditions is not met, you may have a medical emergency on hand, and you should get help". Give clear guidance.

Also, the drawing of a person in recovery position is not under the paragraph mentioning the recovery position, but under the CPR paragraph. That's just bad layout, and hard to navigate.

The second page suffers from some serious layout issues, too. Example: "Sitting, not guiding. You are the anchor..." should be one bullet point, not two. Press Shift-Enter for line breaks without starting a new list item.

The text could be more explanatory. Be not attached to the outcome. What is that supposed to mean? A short headline with a short instruction would be more helpful than some shorthand. For example:
"Talk through, not down.
A bad trip lasts as long as it does, you can't 'talk somebody down' or 'steer them in the right way'. Be supportive, be their anchor rather than trying to be their steering wheel"

"Breathing" on its own is also super unhelpful...

And lastly, the font you chose is fairly hard to read.

Sorry to rip your flyer apart like that, but I think it can be super helpful to people out their to have good information, hope the feedback can help in some way.

Keep up the good work!!

At a physiological baseline, it takes half a week for your tolerance to LSD and mushrooms to fully reset after a single dose, so that's another factor to consider.

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I know. Right now I am doing 200 mg every other day. I plan on staying at that level for at least 6 months before making changes.

My big concern right now is on potency and varying chemistries. I know cannabis can have very different effects depending on the exact strain. I assume that shrooms are similar to that.

Plus, it's my understanding that there is a lot of variation in potency within a strain or even with the same batch

Where I am, I can't consistently get the same strain and there's no chance of having an assay done to gauge potency.

These are all real issues. Damn you, prohibition! You make sensible science so difficult sometimes!

I agree with Dr. Carl Hart in his feeling that we need to move on from the term "harm reduction".

A quote from his extraordinary book Drug use for Grownups: "I reflected on the idea of harm reduction. It doesn’t capture the complexity associated with grown-up activities such as love or war or drug use. Instead, it preoccupies us with drug-related harms. And the connection between harms and drug use is reinforced repeatedly through our speech. This connection in turn narrows our associations, conversations, feelings, memories and perceptions about drugs and those who partake. Perhaps even worse, it relegates drug users to an inferior status.

What are you thoughts?

Though honestly, if you're at the 200mg level, variations in potency are unlikely to make a microdose *too strong*, so if you get a bunch of one batch at one time, grind them all up in a coffee grinder to minimize any variability in potency between stems and caps, and store the powder in a sealed mason jar in the fridge, you should be able to get consistent potency for awhile.

Absolutely. While it absolutely makes sense that the clinical trials are proceeding cautiously, with very strict parameters on who they treat and how they treat them and only changing a few variables at a time, there is a lot of eagerness by the innumerable folks who have not found relief through traditional psychiatry to DIY these protocols now. It's hard not to want to jump in when you've been experiencing so much unrelieved suffering, and you're seeing all these exciting headlines in mainstream news outlets.

For the interactions with SSRIs, there's this handy chart that summarizes some of the (known) issues, along with relevant citations. If you are able to identify a psychedelic-friendly psychiatrist in your area, it's worth it to talk through contraindications and any proposed change or taper to your medications with them. It could prevent further exacerbation of whatever mental health challenges you may have, such as triggering (potentially fatal) Serotonin Storm Syndrome.

As a general rule of thumb, we encourage anyone who is seeking treatment to seek as much professional assistance as they can find while on this path. It's a bit of a wild west out there right now in terms of identifying competent integration specialists who can truly help you on your path - not all of them are adhering to safe sourcing or testing strategies (here's a recent horror story about someone being given meth instead of MDMA for their underground therapy session). Having a professional, licensed person to guide you on your path in preparing and integrating the experience can help you identify any potential issues that may be difficult to identify without that outside set of eyes. We always advise, regardless of known underlying mental health conditions, to start with a low dose, and go slow, with any doses, and slowly titrate up to the desired dose to match your intention over the course of many sessions. This takes time, but will help you carefully evaluate your body's response and find a dose that minimizes negative effects while maximizing benefits. We've got our Safer Psychonaut Dosing Protocol here to minimize risk, and a set & setting checklist to help people create as safe a container as they can for their experience.

And finally: for folks with a genetic predisposition to schizophrenia-type disorders, there is a small but nonzero risk of triggering psychotic episodes, especially at higher doses. We encourage folks with this predisposition to have especial caution when thinking about LSD, psilocybin, and their analogues.

So how do you change a personality trait with them? For instance stage fright or something simple. How would u use them to achieve a specific goal?

And while there does seem to be some variation in effects between different mushroom strains, we've not seen anything indicating the difference is so major that it's going to make your microdoses markedly differently.

I am curious about psychedelic use and its benefits for those with mental illnesses. I have previously recreationally a tiny amount of mushrooms and loved how I felt. There were no visuals or anything during these times. I am currently on SSRIs and tried a higher dose of mushrooms with a guide, worked up to 2 grams and felt nothing. I later learned SSRI could inhibit the ability of the mushrooms and/or can cause serotonin syndrome.

Are there other supplements like GABA or pharmaceuticals that can either boost or inhibit psilocybin?

So, I have had a interesting life, mainly a lot of trauma. I live in Oregon and if understand correctly it is legal here for medical use. I have tried conventional therapy, and a slew of ssri medication. I do not do well with SSRIs and I'm currently weening myself off of them. My question is, how should I go about telling my doctor that I'm interested in psychedelic therapy? I know there is a stigma with these drugs and in the past I was labeled as a drug seeker by a former doctor. I can't express how bad that made me feel to be labeled as that and pretty much denied treatment. Thank you for the research you have done.

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If you're on an SSRI and you don't respond to mushrooms on them, we're not aware of anything you can take to change that, short of doing a controlled taper off your SSRIS and being off them for a little while (which, to be clear, we are not recommending and should be done under the supervision of a medical professional).

SSSRIs are the main pharmacological agent we're aware of that will inhibit your response to psilocybin, but that doesn't mean they're not out there.

As far as boosting the effects of psilocybin, the one thing we know of is thelemon tek method, which you can also do a quick, jankey version of by just throwing some lemon into your mushoom tea.

However, as far as we know, taking SSRIs with psilocybin does not cause serotonin syndrome. Taking way too much MDMA does, as can taking the supplement 5-HTP while on MDMA.

We'd strongly advise anyone seeking a deliberate, significant change in their cognitive function to seek out a licensed professional therapist to develop a targeted treatment selecting the appropriate modalit(ies) that will address the underlying issue (which is rarely as "simple" as it may appear): there is no "one size fits all" approach. Everyone's brain chemistry is unique, and therefore presents unique challenges: and creating a customized treatment plan with the help of a professional is essential. For one person, perhaps a therapist with somatic training is appropriate; for another, perhaps family systems therapist; for another, maybe it's just combining classic CBT with the psychedelic experience.

Do you recommend that someone with experience with various psychedelics, including psilocybin, still build a tolerance to the same before taking a “heroic dose”? Where can we find information about this kind of “tapering on”?

"Harm reduction" is a good term if you're trying to get often-fickle public funding to help people who suffer from acute, negative impacts from taking drugs. People who suffer from overdose due to adulterated drugs or disease spread by dirty needles are definitely experiencing harm and need those harms to be reduced.

But Dr. Hart is right: drug use is a lot more complex than just harm reduction. One of the things that the professional drug people in our network sometimes talk about is the the positive counterpart to many "harm reduction" practices is that they maximize the benefits people get from using drugs.

A lot of social media platforms will kick you off if you say anything about benefit optimization being the result of many of the things we study and teach (a Facebook Ads expert recommended we use the word Safety in the name of our org for this reason), so in the name of not getting our accounts deleted, we've opted to be verrrrry careful about the language we use and made peace with this sub-optimal compromise.

I heard some talk that microdosing can be bad for the heart in the mid to long term. Can you speak to that?

If we're gonna get technical (and we will, we're nerds), the term "tolerance" refers to your body's lowered response to a drug after taking it, so we're going to address what it seems you're getting at here, which is building a base of experience in working up to higher doses.

We don't like the term "heroic" for high doses because that term has some Epic Badass Connotations to it, which we feel is misplaced given that higher doses are more likely to lead to difficult trips, not being able to navigate you environment safely, unearthing major trauma you weren't prepared to deal with, and seems to anecdotally increase the risk of lingering negative consequences like psychotic episodes and HPPD.

That said, working your way up to higher doses over many sessions can give you a better idea as to what's par for the course and what's not. This can help you determine what kind of help/support you need in a given moment (a trusted friend on the phone vs. a hospital, for instance). Also, if you happen to be one of those rare people who reacts poorly to a given drug due to some genetic factor, health condition, or mental health condition, it's often less bad to learn that at a lower dose.

It's always better to be cautious than totally fucked.

So, the legal framework in Oregon for psilocybin-assisted psychotherapy is actually still in development (and is experiencing some significant issues) - unfortunately, you can't count on having safe, legal access to professional resources there quite yet. Ketamine clinics have been cropping up in Oregon, however, which may be a useful treatment to consider in discussion with your mental health providers - many folks have found some relief from the symptoms of trauma, freeing up the capacity to work on the underlying issues in the long term.
We're very sorry to hear that you've been labeled as "drug seeking" by folks you've worked with in the past. That type of stigmatizing treatment by mental health professionals gives the rest of us a bad name, and we know you are not the only one who has not sought out treatment because of fear of the people who are supposed to be there to help them. Plenty of psychiatrists and others working in the behavioral healthcare field have not been exposed to all the excellent research that has been happening in this field in recent years, let alone received training that would enable them to have an even-handed, nonjudgmental conversation about their use. We would advise coming in prepared with your research before speaking with your doctor. If they are not prepared to treat your interest in exploring these other treatment modalities in a nonjudgmental, professional manner, that may mean identifying someone who has received more education and training on these subjects in your area.

Ah, I understand that approach. Thanks for the AMA. Godspeed!

Thank you so much for taking the time to respond to me with such a message. I actually was watching a pbs Nova special on this topic when I seen your AMA. Thank you for the work you do for people like myself, and I wish you well.

Totally. We've also heard the term "risk reduction" or "risk management" used, which are probably a little better and would likely still be tolerated by major social media platforms. This has given us some good stuff to think on in regards to how we present what we do online, so thanks for jogging our brains on this.

Thanks for the reply.

I think Terrence McKenna coined the term heroic because of old tales about journeys that people would take which you likely will mentally with that size dose. I don’t think it was meant to be macho in a traditional sense

Word. We're familiar with McKenna and don't think it was meant to be macho in a traditional sense either, which is why it's a bummer that it's sometimes taken that way out of context.

This is a good example of bad science followed by bad science journalism creating a speculative nonissue out of nowhere. While it hasn't been demonstrably proven that microdosing doesn't cause cardiac issues, the original article with that assertion also doesn't do a great job of proving that it does. Here's a great write up of some of the methodological issues with the original article from Third Wave. To summarize: Dr Ketan has no real-world data to back up his theory; they rely on an assumption of frequency of microdosing that does not match the most commonly used protocols; and finally, he actually extrapolates his hypothesis using some data from MDMA, which has a completely different structure and dosing protocol. That's not to say that there aren't issues and we can definitely say that this is absolutely safe, since the research out there is scant and there is tons we don't know... but this particular assertion is a theoretical stretch and needs some data before it can be given serious attention.

tl;dr, reading beyond the headline and into the methodological details of what smart-sounding people are saying is important.

I’ve recently started using shrooms. What is a good frequency and dose to use them for and for what purposes?

As far as information about "tapering on" specifically, we're not aware of much in the way of dedicated research or anecdotal data on how to do it. One strategy informed by Alexander Shulgin's approach could be to raise your dose at small, consistent increments (indexed to the dosage range of the particular substance in question) over successive sessions.

For instance, many drug databases like Erowid or PsychonautWiki list a range of dosages from "threshold" to "heavy." You could start at the low end of a "threshold" dose, then do something on the higher end of a threshold dose. Then something on the low end of a "light" dose, then something on the high end of a light dose, and so on.

You're welcome! Well wishes for you on your journey.

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This crisis laminate thing was made as a shorthand addendum to a longer training offered to festival first responders. formatted to fit into little laminates you can wear around your neck and is meant to jog someone's memory in a crisis without missing critical indicators of safety or being so dense as to be illegible at night.

We've mentioned it here because it's the best free thing we have right now for crisis response, but it's certainly imperfect for anyone who hasn't taken that training. When we're able to get around to making one in long form that's better suited for folks without first responder training, your feedback will be super helpful, so thanks for that.

Right now the only place we offer comprehensive crisis response triage and training to people who aren't first responders is our psychedelic safety masterclass.

Deciding on the frequency and dosage depends entirely on you and your own unique biology and intentions - we can't really advise a one-size-fits-all approach. I'd suggest starting with establishing what you are hoping to get out of your experience. Depending on the intention, a micro or a macro dose may be more effective; and, if it's something that intersects with trauma or other mental health challenges, creating a treatment structure with the assistance of a professional, licensed psychedelic therapist may be the safest way to go.

We made this Safer Psychonaut Dosing Protocol a while ago to help people think through these issues methodically with respect to any one experience. Minimally, we recommend taking it slowly and cautiously in increasing dosage and frequency, and ensuring that the prior experience has been fully integrated before proceeding to the next one. Take your time - and lots of notes to reflect on each experience afterwards!

For dosage info, here's the Erowid vault for psilocybin mushrooms

Decriminalize Nature is rife with gross and messy approaches to advancing their agenda, lend themselves to silencing indigenous folk, and are just not particularly well versed on anything outside of legalizing “”””plant medicine””””. Chacruna, EntheoNation, and Visionaries Gathering are much, much better resources to start with, from someone that tried very hard to find common ground with Decrim Nature.

Great, thanks for your input! We've heard of Chacruna but are not familiar with the other organizations you've mentioned (we're much more on the science/harm reduction side than the policy side), but will avoid recommending Decriminalize Nature in the future if they suck.

How can I figure out which psychedelics are safe to take with my antidepressant/anti-anxiety medications, and in what amounts?

I’ve gathered some medications dull the effect of psychedelics, some enhance it, and maybe some are potentially deadly? Info online always seems to range from “you will get serotonin syndrome and die” to “if you need psychiatric medication you should not be tripping.” But my friends and I have had enough positive experiences to know that it isn’t categorically dangerous. Where can I get good harm-reduction info about this?

For sure! Hart suggests "health and happiness" as an alternative term which is definitely good but is a little too far on the other end of that spectrum maybe. I think "risk management" is an excellent middle ground.

Can you speak to the harm inflicted on indigenous populations by the increase of whitewashed ayahuasca ceremonies and retreats, the quintessential colonial poaching and endangering of bufo toads, and over-harvesting of peyote off lands cared for by people who have been stigmatized and criminalized for their relationship with the same plant?

I did a large amount of psychedelics (everything across the board from basics like LSD and psilocybin to MXE and other designer chemicals) when I was in my teens and now am suffering from a pretty hefty case of Hallucinogen Persisting Perception Disorder (HPPD). I stopped my hallucinogenic intake when the symptoms started getting bad, but it's persisted for the last few years since. Is there any way you have researched that can mitigate the effects of HPPD/facilitate a return to feeling normal again? I know the effects may well be permanent, but I would love any information you might have.

Thank you for your advice!

What specific interventions has your research determined to be most likely to help someone who seems to be experiencing a challenging psychedelic experience? I have sort of trial and error’ed my way into a few steps but would love to have as many effective tools in my arsenal as possible so that I might be able to help someone around me if they need it.

There's not enough research on this and not enough of it is centralized, which sucks given that this is a common question.

It's a really complicated thing to try and study given how many psychedelics and psychiatric medications there are.

Here's a table we found about combinations between various psychedelics and antidepressants.

We don't know of anything relevant to contraindications with anti-anxiety meds and many psychedelics, but because ketamine is a legal medicine, you can at least find contraindications between ketamine and various psych meds using the Drugs.com Interaction Checker.

There's some research you can do on Google by typing "__name of psychedelic___" and "__name of psychiatric medication__", then adding the words "interaction," "combination" and "contraindications" to that in three successive searches. Much of what you'll find through this method is not medical research and thus should be treated as for informational purposes only.

If you know anyone with a lot of money who'd like to fund a psychedelic safety organization to wrangle a bunch of experts to do a literature review on this topic and compile an at-a-glance resource for folks with this question, we might know some people they'd want to talk to. ;)

There's a whole field of psychedelic harm reduction dedicated to just this thing, and they have hella best practices to share.

During a challenging psychedelic experience, one of the easiest things you can do is call the free hotline offered by the Fireside Project, where someone trained to hold space for your difficult time can monitor you and help you through it over the phone.

For general theory on what to do, the Manual of Psychedelic Support is one of the texts a lot of people point to.

What do you know, and/or what are your thoughts on the various folks that having success using psychedelics to treat cluster headaches and migraines?

How to go about trying it? Anyone?

Firstly, we're sorry to hear that you're experiencing such long term negative effects - and unfortunately far from the first we've heard. HPPD is not well understood (especially when start of symptoms is when the brain is still developing as a young adult); consequently, the clinical treatment options are scarce and inadequately studied.

To start on simply keeping it from getting worse: you're definitely on the right track with ceasing use of hallucinogens. Anyone with lasting detrimental side effects from taking psychedelics should probably not take those psychedelics in the future. There is some anecdata indicating the other stimulants, such as common ones like caffeine and nicotine, may also exacerbate symptoms.

There are a few case studies out there in the clinical research indicating off label treatment using Lamotrigine has been successful. It might be worth seeking out a psychiatrist who has worked with HPPD specifically in the past to tailor a treatment protocol for you. Treatment of any co-occuring anxiety or other mental health issues has also been indicated to reduce severity of symptoms.

You already said it. Harming and criminalizing indigenous communities sucks, as does endangering any plant or animal species. There are plenty of other ways to get the benefits of psychedelics.

Chacruna is a psychedelic justice organization that does work around this for anyone who wants to know more.

Tim Ferriss also put out a piece about this not too long ago.

Easy: Buy some sketchy black market drugs from an untrained person you don't know, don't test them, take a large, unmeasured dose in a chaotic environment with people you feel unsafe with, throw a bunch of other drugs in the mix without checking for potential interactions, and see what happens!

Just kidding. We've seen people do all those things and it rarely goes well.

We made a masterclass to answer this question. It covers all the skills and awareness you need to have if you plan to take psychedelics outside of a supervised medical, therapeutic, or ritual environment and want be as safe as possible.

We still don't recommend that anyone take psychedelics without professional supervision, but if you're gonna do it anyways, you might as well know all the ways people accidentally fuck themselves up so you can avoid same.

It's very promising! We're excited to see all the research starting to come out on this subject, which has validated reports of people successfully self medicating. Here's a fun preprint study that just came out a few months ago.

Amazing work, I am very excited to learn more about your organization! Will you have a presence at Psychedelic Science 2023 in Denver?

Our application is currently pending! If it's accepted, all you'll need to do is look for the most fabulous people in the room.

One category of psychiatric medication that's contraindicated with a ton of other drugs is the MAOI's, which one could argue might fit under the "categorically dangerous" header.

Word.

Do you promote erowid.org as a quality site for information? Perhaps along side your own? A lot of safety should be managing expectations and preparing both mentally and physically.

Hopefully, one day everyone will be able to explore the possibilities in peace. GL

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I've logged over 250 trips with various plant medicines and lab created psychedelics over my lifetime.

Started off as an avid microdoser and then one day took way too much of an unknown paper containing LSD-25. Then I became a macrodoser and never looked back.

I'm always a big fan of overdosing in terms of having enough of the chemical to shortcircuit the brain and allow the ego to dissolve, if only for a few hours. I very much appreciate Terence McKenna's attitude to take 5g of mushrooms in complete darkness and silence. Also the native Americans would take a large does of Peyote and venture off into the wilderness solo.

Now it's not always sugar and spice when it comes to dropping in at heroic doses, but I truly believe we are always being taken care of. I never trip with anyone else, in many years. Because someone would call 911 if they saw some of the shit I go through on an average trip. Lol.

The most prevalent trend is to have a trip sitter. However, it feels more personal to trip alone and let the universe show you what it will. What are your thoughts about solo journeys?

Fuck yeah. Erowid rocks. They're a huge influence for us and our fledgling website doesn't hold a candle to the groundbreaking thing they made.

That said, we've found there's much information on Erowid that it can be overwhelming if you don't know how to synthesize all the info and plug it into a clear, repeatable safety protocol.

So we made one. Here! Have it for free!

Do you get mistaken for Dax J ever? His career is certainly also conducive to psychedelics!

Hey this is great! absolutely a real, good beginners checklist.

You're welcome! We're trying to create the resources we wish we had when we were younger.

Dax here! No, I'm far more handsome than he is.

Ally here: can confirm, much more handsome.

Would you be able to share your thoughts on the difference between Drug Induced Psychosis and ego death? I feel like anyone who takes enough of any drug will experience some sort of psychosis, and it is up to the environment (and biochemistry of the user), whether that experience is good or bad. I for one had an ego death, where my sitter's couldnt keep me under control - and thus the scenario ended up pretty bad. But I cant help feeling like if I was in a different environment, things would have ended differently. General thoughts?

We're safety people, so the main questions we think about with solo journeys are:

"What are the things that could go sideways during a solo trip?"

"How many of those things can I prevent in advance with good technique, preparation and awareness?"

"What are the risks I can't fully prevent, and how do I need to set myself up to access whatever help I might need to address those things in the absence of another person?"

What do you think is the best first step for someone with zero experience but who would be interested in trying mushrooms? (Sorry if this is a poor question.)

Part of having a trip sitter is to have someone who can take care of you if you need it and the intention behind that is solid, so one way to split the difference would be to trip alone somewhere with a friend close by, like in another room in a house.

How much public education do you do on ayuesca and it's immense psychologically healing and purifying properties? That shit has the capacity to heal this planet, likely even the pedos and murderers too.

I used psychedelics and other recreational drugs that were sourced well and tested by myself prior to use. Everything that I used had a relatively green physical safety profile, but I did not follow harm reduction practices very well after I started tiptoeing and then walking over the line with frequency and dosage. Eventually, I had an extremely horrific bad trip that I would probably call a psychosis episode and ended up in the ER. I stopped using recreational drugs completely after that episode (about 5 years ago), however, I still experience occasional but identical episodes that last between 4 and 6 hours. They never involve violence or anything dangerous but they are, by far, the worst thing that has ever happened to me. I would take back every positive drug experience I've ever had to undo that bad trip.

They negatively affect my life in a serious manner and cause me to somewhat subscribe to what most professionals would consider delusional beliefs. I lead a relatively normal and healthy life outside of these episodes - I have a good job and friends that I love.

I'm not sure how to get a grip or understanding of what, if anything, is wrong with me. I've never seen a mental health professional and have what I consider a valid fear of diagnosis and medication. Would you have any suggestions for something I can do by myself to reduce the frequency or intensity of the episodes that I experience?

Another safety thing to consider for solo journeys is only dosing yourself with product you've taken before so you know the potency and aren't going to accidentally get too high to navigate your environment safely. This is especially the case with dissociatives like ketamine.

There are high doses one can calculate that still allow you to find a bathroom or use your phone to call for support or help if needed, and then there are high doses where it's hard to tell if the phone or bathroom even exist at allllll, man....

Microdosing. Safest, easiest way to take mushrooms.

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We don't do much on ayahuasca. Neither of us has taken it, neither of us has been trained on it, and our focus is specifically on providing education to people who take psychedelics outside of a supervised context, which is usually how ayahuasca is used.

If I'm on ssri medication and want to have a psychedelic experience, what's the safest route?

Here's a table that covers answers to your question in regards to the most common psychedelics.

To start with the initial question: Drug-induced psychosis (DIP) refers to a clinical diagnosis. DIP may encompass a few different symptoms that demonstrate a lack of connection to reality, such as hallucinations and feelings of paranoia, and is, by definition, always triggered by use of a drug of some kind. Ego death is a single symptom that some folks may experience, which is not necessarily attached to a psychotic episode (let alone specifically one that is drug-induced.)

To your broader experience: that's unfortunately more common than we'd like to see, and is often preventable with some care taken on the preventative side. We really advise folks take their time to prepare for an experience and really think through all the individual factors that could lead to a difficult time - when you minimize risks, it usually also maximizes potential benefits. We made a checklist of our dosing protocol here, and a more specific one about evaluating set & setting here. Creating a safe container for you to voyage in is absolutely critical, and if you don't have that safe container you're a lot more likely to have a difficult time like what you've experienced.

Thanks for the very thoughtful reply. To digress, it was on a heavy trip that things were very challenging and I confronted my fear of death and suddenly poof, all gone. But up to that point the fear was visceral.

Regardless, I think what you mentioned below is very good safety advice, I think familiarizing oneself with whatever they're taking and dosing lightly for a few times first until they're ready to take a deeper dive is the best practice.

Yeah, the one and only time doing Salvia left me with harsh flashbacks for over a decade. But the dissociation was real. I didn't even know my own name, or what a name even meant. Wouldn't suggest a solo trip for that at all.

I’m wondering how ‘coming out’ publicly as psychedelic enthusiasts has affected your lives/careers? I tend to feel like I need to be very guarded about my experiences so that it doesn’t have a negative impact on my professional life especially. Did you have to kind of dive all-in to this?

Firstly: we're glad to hear you're reaching out after such a series of difficult experiences, and that you've given yourself a pause on further recreational substance usage while you work through this.

What you're describing is rare, but not unheard of, and something one of us (Ally, writing) has seen in clinical settings with some frequency. People sometimes have such a traumatic time on psychedelics - either due to something that happened during the psychedelic experience itself, or a traumatic experience that it unearthed from their memory - that they develop demonstrate symptoms of PTSD. This includes sometimes a reliving of the trauma in flashback episodes. For other individuals, repeated psychotic episodes after a difficult psychedelic experience may be in part influenced by a genetic predisposition to schizophrenia or other related disorders; it could be that family history is a factor here.

Whatever the cause - and again, it could be a few things - there are folks out there who can help you unpack that in a compassionate, nonjudgmental way, who are also quite skeptical of mainstream behavioral healthcare. (That's why so many of us have shifted our focus into psychedelic-assisted psychotherapy, as we are acutely aware of how poorly the establishment has treated so many with mainstream psychiatry.) As difficult as it may be, a good first step would be seeking the right professional assistance on this to tease out a pattern behind the psychotic episodes. Working with someone with a clinical eye to establish what's triggering them - which is sometimes subtle and quite surprising! - can help understand their root cause, and help identify more customized strategies for how you minimize their intensity and reduce their frequency in the long term. If you're not quite up to finding someone to partner with on this, we'd advise starting a journaling practice to try to gather this information for yourself to see if you can pick apart a pattern, and if one of your friends has interest in supporting you in using a co-counseling or similar model.

Also adding: as someone who has operated in clinical environments for much of my career, it's often frustrating that we are pressured by regulatory to create a diagnosis to put on paper to justify insurance billing purposes, or for ease of communication with other providers in such a fast paced environment, when the nuances of an individual case really defy whatever is in the latest already-outdated DSM and can feel dehumanizing. In my experience, a lot of the therapists that specifically work with psychedelics are also skeptical of mainstream diagnostic labeling and mainstream psychiatry for some of the same reasons you are, so you might be best of seeking someone off the MAPS psychedelic integration list. There's some specific nuance to the experience of trauma while on psychedelics that a mainstream behavioral specialist who doesn't have that specialized education just won't get. It's such a uniquely hellacious experience, and I wouldn't wish it on anyone.

Replying to this because I want to highlight that experience in 1 is not experience in another. A friend of mine is very well versed in lsd. I have seen them take what we estimate to be doses of .8 to 1.25mg. (Naturally we can't be certain because it's not well regulated) But whatever the number these were VERY high doses well beyond what people usually take. They're familiar with the substance and can remain "calm" on these herculean doses. They assumed the experience would translate to psilocybin because they are similar. He was very wrong. At 7 grams they had a few hours where they were absolutely convinced they were dying to the point of considering 911. From how they describe it they honestly should have called. To this day they still exhibit PTSD from the event.

I feel like many here are missing the point of this post sadly. Most of the comments here are asking questions in a manner that promotes taking these substances. And although I think we can all agree we need to study this more, the point of this post was to showcase the negative experiences people have using them after reading too much about the positive effects on the internet, in the media, on reddit, on netflix. There are so many positive links and articles surrounding this subject and almost none regarding the dangers, especially here on reddit. We are rapidly changing how people view these substances and we are going to experience some blowback. And thats what these guys are talking about. Sadly I was one of the victims. I took mushrooms 3 years ago and it has completely ruined my life. Im a little better now but there isn't a day that goes by where I'm not negatively affected by it. So my question is, how do you we get people to realise that this can go wrong? Its not all positive nor is risk free. Many people take these substances and are never the same again. I was watching a podcast with Joe Koy who had his genetic testing done. The doctor had told him that he had a gene for schizophrenia that could be triggered by using Marijuana or psychedelics. Luckily he wasn't a big user but he preached the dangers. I imagine many people have these sort of triggers and its important people take caution when diving into this world.

Maybe I'm missing something but how can we find safe psychedelics to use? I did 3.5 grams of shrooms.. blood pressure was sky high the next day

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I greatly appreciate the response. Thank you.

Lithium is highly likely to cause seizures and bad trips. If you haven't already, I'd definitely stop taking any psychedelics with it.

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What are the dangers of MDMA? Is there any truth to the idea that you can permanently damage your brain and never have a proper hormonal balance again?

I don’t trip off of mushrooms anymore. The first few times I’ve had wonderful trips. That last 4-5 times no matter the dosage (from 2.5 grams to 5 grams) eating dry and using lemon tek. I get no noticeable affects. I have friends who’ve eaten the exact same grow and have tripped incredibly hard. I take no medications of any kind and am just curious what might’ve caused this? Also usually have months in between trips for a tolerance break.

Idk about harm reduction and if this would be answered but I'm nearly 4 months off of risperidone and escilatopram something to do with trauma I've tried cubensis on 6-7 grams doesn't really do anything crazy just body high ngl I was expecting some life changing experience.

Tbf it's been hiding in my room for 1 month but it's airtight. And some people are saying cubensis is a weaker shroom so idk about that and they're saying shrooms do lose potency the longer you stock it up.

Rn I'm planning in the future to get panaeolus cyanescens only cost 11 dollars for 5g.

My question is the ssri inhibiting effects permanent from fully experiencing shroom? even though you're months off?

What shroom species did you eat and your friend same or different?

Penis envies, ate the same weighed amount, dried. Three of us. 2 males, 1 female. I was the only one to not feel anything. No visuals, no emotional changes. Nothing.

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Wish I have a friend to trip tho.

I think it's also a Cubensis species?

Like idk if this true but like a larger dude would actually need a larger dose? Or am i wrong?

>Having a professional, licensed person to guide you on your path in preparing and integrating the experience can help you identify any potential issues that may be difficult to identify without that outside set of eyes

A license in what, though? I got my masters at a state university, about to work as an unlicensed therapist eligible for LCSW that I'll have in about 2 years. Within the scope of social work it's pretty much perfectly against ethical standards to suggest treatments that don't have scientific evidence base. Given the unfortunate lack of research in psychedelic tx options I sort of hesitate to suggest just any "licensed" professional. A licensed health coach isn't going to be a super safe option to guide someone utilizing psychedelic drugs to address serious mental health issues, for example. I genuinely want to know, who can? It takes thousands of hours of supervised practice for a genuine clinical mental health license, but none of those professions can act outside the law or outside the scope of existing research without risking said license.

Any supporting evidence for those bold claims or are we expected to simply take your word for it?

There's growing appreciation for psychedelics' potential benefits, especially when used with the right intention. But I see very little mentioning of their potential harm for underdeveloped teen brain (roughly under 25). There's also some dispute on the matter. Any additional information you can shed on it?

Is MDMA considered a psychedelic? I didn't think it usually was...

What dose did you take, may I ask?

Thanks for posting. What dose and how frequently were you tripping, may I ask?

I took 2gs of mushrooms which I was told was a very low dose. Dont know how true that is though.

Aw man I read your comment and held my breath. I currently have some mushrooms ready to take in an attempt to treat my anhedonia and just can't seem to get in the mind set to take them. Part of me thinks if I take it and it doesn't work, I've lost my last hope.

I did read a study recently that claimed that microdosing is actually purely psychosomatic. In blind tests, the only significant result was that if you thought you had been given psilocybin, then you felt positive effects, regardless if you had actually been given any or not.

Have you tried full trips?

I know the feeling of not wanting to use what seems like your last hope.

I haven't tried a full trip. I have a history of what doctors call a paradoxical response to certain psychoactive medications. Basically, anything with a hypnotic effect may instead trigger bad hallucinations and major aggression.

So I hesitate to take a full dose

Start asking. Be aware that it's not a buyers market, and that testing your substances is as simple as ordering a kit from Amazon

Do people still use pillreports for testing purity of substances? Or is there a different service that people use?

Hey! Your comments reminded me of getting ketamine infusions. If you have a risk of bad hallucinations or aggression, a proper medical setting may be helpful. Most clinics also can prescribe nasal spray or lozenges to use at home, basically microdosing ketamine. I was in the LA area and had very good experiences. Anyway, I wish you luck!

>Being too high to drive

Wait are you saying there is any amount of psychedelics to take that is safe to drive on? I have used many psychedelics but that doesn't sound right to me

Micro dosing. Smaller doses = smaller effect. Definitely shouldn't do something as dangerous as driving on it though until you've got your dosages down to a science and know how much for what effects.

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My one issue with erowid is getting pure substance reports can be tedious. Most reports seem to be instances of poly drug use

Yep. Basically Decrim Nature is advocating for peyote legalization without regard for the objections of the Native American Church. Wild Peyote is extremely important for so many American Indians, but it only grows in a somewhat limited range and is becoming scarce for several reasons. The Native American Church basically doesn't want peyote legalized and then have peyote populations decimated by psychedelic tourism. I mean peyote is a huge lifeline for so many American Indians and it's wild to think they'd risk losing access to their sacred plant because of reckless legalization.

https://www.azcentral.com/story/news/local/arizona/2022/09/17/native-religious-leaders-oppose-moves-decriminalize-peyote/10363740002/

https://www.azcentral.com/story/news/local/arizona/2022/09/17/native-religious-leaders-oppose-moves-decriminalize-peyote/10363740002/

https://www.grid.news/story/science/2022/07/19/the-dark-side-of-decriminalizing-peyote-the-tiny-cactus-at-the-center-of-a-fight-between-some-native-americans-and-psychedelic-drug-advocates/