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As interest in psychedelics undergoes a cultural revival, accompanied by a rise in clinical research and development and potential FDA approval of certain psychedelic compounds, college students may be coming across media that seems to promote the use of these substances. In some instances, media coverage of psychedelics portrays them as a panacea or cure-all, often glossing over real concerns regarding safety and tolerability. It’s also likely that they have seen consumer-ready psychedelic products. The purpose of this student’s guide to psychedelic harm reduction is to educate students about the potential risks and critical factors associated with psychedelic use to minimize or avoid harm and more safely navigate challenging experiences. We have gathered a range of resources that offer contact with trained support-line staff who are skilled in handling crises related to psychedelics and providing help with integrating these experiences.

When talking about psychedelics, it’s paramount to prioritize safety and preparedness, especially considering these substances’ profound and often unpredictable nature. Harm reduction begins with thorough education: understanding the contraindications, effects, risks, appropriate dosing, and legal aspects of various psychedelics is crucial.

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What are psychedelics?

Psychedelics, also known as hallucinogens, are a class of psychoactive substances that produce profound alterations in perception, mood, and cognitive processes. Anecdotally, these substances can induce experiences often described as transcendent, including sensations of unity, altered time perception, and vivid visual hallucinations. However, some users also report having serious, adverse reactions to psychedelics. Most often, these are what is known as a “bad trip”: an event where someone has a negative experience that may cause serious psychological distress. Common types of classical psychedelics include lysergic acid diethylamide (LSD), psilocybin (found in magic mushrooms), dimethyltryptamine (DMT), and mescaline (derived from the peyote and San Pedro cacti). Other non-classical psychedelics include ketamine and 3,4-Methyl​enedioxy​methamphetamine (MDMA).⁽¹⁾

How Do Psychedelics Work?

The primary mechanism through which classical psychedelics exert their effects is by interacting with serotonin receptors in the brain. Other drugs, such as ketamine and MDMA, affect different receptor pathways. This interaction changes chemical messaging in the brain, leading to the altered states of consciousness characteristic of psychedelic experiences. This mechanism is responsible for changes in perception and emotion brought on by psilocybin and other classical psychedelics.⁽¹⁾

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Therapeutic Potential of Psychedelics

Recent research has renewed interest in the potential therapeutic uses of psychedelics. Studies have shown promising results in treating various mental health disorders, including depression, post-traumatic stress disorder (PTSD), and anxiety, including anxiety in terminally ill patients. Some research has suggested that psilocybin, for instance, may produce significant and lasting reductions in depression and anxiety in clinical trials. These findings have led to a reevaluation of the therapeutic potential of these substances. However, their use remains controversial and heavily regulated due to their potent effects and potential for adverse psychological events (aka a bad trip).⁽³⁾

Typical Trip Timelines & Subjective Experience Trajectory for Classical Psychedelics, Ketamine, and MDMA

Each psychedelic compound has a distinct pharmacological profile, leading to unique experiences. Classical psychedelics like LSD, psilocybin, and DMT are known for their strong hallucinogenic properties. MDMA, though often grouped with psychedelics, primarily enhances mood, empathy, and social connection. Ketamine, a powerful dissociative anesthetic (a type of drug that makes you feel detached from yourself and your surroundings), also has hallucinogenic properties in high doses.^(4, 5, 6)

LSD (Lysergic Acid Diethylamide)⁽⁷⁾

0 MINS

Ingestion

60 – 90 MINS

On Set

2 – 3 HR

Come-up

4 – 6 HR

Peak

6 – 12 HR

Comedown

10 – 12 HR

Return to Baseline

Psilocybin (Magic Mushrooms)⁽⁹⁾

0 MINS

Ingestion

60 – 90 MINS

On Set

2 – 3 HR

Come-up

4 – 6 HR

Peak

6 – 12 HR

Comedown

10 – 12 HR

Return to Baseline

DMT (Dimethyltryptamine)⁽¹⁰⁾

0 MINS

Ingestion

60 – 90 MINS

On Set

2 – 3 HR

Come-up

4 – 6 HR

Peak

6 – 12 HR

Comedown

10 – 12 HR

Return to Baseline

Ketamine⁽¹¹⁾

0 MINS

Ingestion

60 – 90 MINS

On Set

2 – 3 HR

Come-up

4 – 6 HR

Peak

6 – 12 HR

Comedown

10 – 12 HR

Return to Baseline

MDMA (3,4-Methylenedioxymethamphetamine)⁽¹²⁾

0 MINS

Ingestion

60 – 90 MINS

On Set

2 – 3 HR

Come-up

4 – 6 HR

Peak

6 – 12 HR

Comedown

10 – 12 HR

Return to Baseline

Each substance has a unique profile affecting perception, emotion, and cognition. The subjective experiences are deeply personal and can vary widely among individuals. Additionally, factors like the environment (setting) and the individual’s mental state (set) play crucial roles in shaping the psychedelic experience.

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Contraindications for Classical Psychedelics, Ketamine, and MDMA

Classic psychedelics, ketamine, and MDMA, while having potential therapeutic benefits, also come with significant contraindications. Understanding the risks of psychedelic use is crucial for safety, especially considering the powerful psychological and physiological effects these drugs can induce.⁽¹²⁾

Classic Psychedelics (LSD, Psilocybin, DMT) Contraindications⁽¹³⁾

Ketamine Contraindications⁽⁶⁾

MDMA Contraindications⁽¹⁴⁾

It’s important to note that while research into psychedelics and MDMA is growing, there is still much to learn about their long-term effects and interactions. Individuals considering these substances, especially for therapeutic purposes, should consult healthcare professionals and consider existing mental and physical health conditions. The legal status of these substances also varies by region, and they are often subject to strict regulatory controls.^{(12, 6, 13)}

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Understanding Psychedelic-Assisted Therapy vs. Recreational Use

Psychedelic-assisted therapy and the recreational use of psychedelics are two fundamentally different approaches to how someone may use these substances, each with its own context, intentions, and implications.^(14, 15)

In psychedelic-assisted therapy, the use of substances like psilocybin or MDMA is integrated into a therapeutic process under the guidance of trained professionals. This therapy typically occurs in a controlled, clinical setting designed to provide safety and support. The focus is on mental health treatment, and psychedelics serve as a tool to enhance or facilitate the therapeutic process. Therapists are present throughout the session, providing guidance and support. The dosage is carefully controlled, and the entire process is often part of a larger treatment plan that includes preparatory sessions and post-session integration therapy (the practice of utilizing talk therapy and other techniques to intentionally integrate the psychedelic experience into your daily life and routine).^(14, 15)

Furthermore, psychedelic-assisted therapy, within a harm reduction framework, has the potential to be pivotal for individuals transitioning from hard drug and alcohol use. This approach prioritizes informed decision-making, focusing on educating patients about the risks and benefits of psychedelics, without advocating for or against their use. It emphasizes the importance of understanding interactions between psychedelics and other medications, under the guidance of medical professionals. Additionally, this method acknowledges the potential positive impacts of psychedelics, framing their use within a growth-oriented lifestyle. Through this balanced focus on safety and beneficial outcomes, psychedelic-assisted therapy offers a nuanced and potentially transformative option for substance use treatment.⁽¹⁶⁾

Conversely, recreational use of psychedelics occurs outside of a clinical or therapeutic setting. This type of use lacks a structured environment and professional oversight in therapeutic settings. Recreational use can vary widely in terms of setting, dosage, and the purity of the substances used, leading to unpredictable and potentially risky experiences. The absence of professional guidance and a supportive setting can increase the risk of negative reactions, such as anxiety, panic attacks, or even long-term psychological issues.

Some of the key distinctions are as follows:^{(14, 15, 16)}

Psychedelic Use in a Therapeutic Setting:

Psychedelic Use in a Recreational Setting:

One of the most important and potentially impactful aspects of psychedelic use is integration. Integration is the practice of taking lessons and experiences learned during a psychedelic trip, and integrating them into your daily life. When taken outside of a therapeutic setting, you may not have the necessary support and experience needed to fully integrate the things you learned while under the effects of classic psychedelics or other compounds like MDMA, and ketamine. This can make the recovery process much longer, and you may lose some of the most critical aspects of the psychedelic experience. 

Understanding these differences is crucial for anyone considering the use of psychedelics, whether for therapeutic purposes or recreational exploration. The therapeutic use of psychedelics is a growing field of research, showing promise for treating various mental health conditions, while recreational use remains a complex and often legally ambiguous activity.^{(14, 15, 16)}

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What is Set and Setting

The concepts of “set” and “setting” are fundamental in understanding the experiences and effects of psychedelic substances. These terms were popularized in the field of psychedelic research to emphasize the importance of psychological and environmental factors in shaping the experience of a psychedelic journey.^{(16, 17, 18)}

Set: This refers to the mindset or psychological state of an individual before consuming a psychedelic substance. “Set” encompasses a person’s expectations, mood, and mental health during the experience. This can include their intentions, emotional state, and pre-existing mental conditions. The “set” plays a crucial role in influencing the nature of the psychedelic experience. A positive mindset can lead to profound, insightful experiences, while a negative or anxious mindset may increase the likelihood of a challenging or unpleasant trip.

Setting: This denotes the physical and social environment in which the psychedelic experience occurs. “Setting” includes factors like the location, the presence or absence of other people, the level of comfort and safety, and the general ambiance (including lighting, music, and overall atmosphere). A supportive and secure setting can foster a positive experience, whereas an uncomfortable or over-stimulating environment may lead to disorientation or distress during the psychedelic journey.

The interaction of “set” and “setting” is crucial for the outcome of a psychedelic experience.

Some key considerations include:

Personal Preparation (Set)

Environmental Factors (Setting)

Influence on Experience

Carefully considering both set and setting is recommended for anyone engaging with psychedelics. These elements are key to maximizing the potential benefits and minimizing the risks associated with psychedelic experiences.^{(16, 17, 18)}

Avoid Underestimating the Impact of Set & Setting

The importance of “set” and “setting” in the realm of psychedelic experiences is deeply rooted in how these factors fundamentally influence the nature and quality of the experience.

In essence, set and setting are critical because they can significantly influence not only the immediate experience of the psychedelic journey but also its long-term psychological impact. Good management of set and setting can help in harnessing the therapeutic potential of psychedelics, aiding in personal growth and healing. Conversely, neglecting these aspects can lead to negative experiences, which might include psychological distress or exacerbation of pre-existing mental health issues. ⁽¹⁹⁾

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12 Tips for Navigating a Challenging Psychedelic Experience

When using a psychedelic there is always the risk of having an adverse, or negative psychedelic experience (aka a bad trip). Here are some tips from licensed therapist Brian Hannah, MSW, LCSW, to help you navigate any potential bad trips.

When using a psychedelic there is always the risk of having an adverse, or negative psychedelic experience (aka a bad trip). Here are some tips from licensed therapist Brian Hannah, MSW, LCSW, to help you navigate any potential bad trips.

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Legalities

Under federal law, most psychedelics, including LSD, psilocybin, and MDMA, are classified as Schedule I substances under the Controlled Substances Act. This classification indicates that they are considered to have a high potential for abuse, no currently accepted medical use, and a lack of accepted safety for use under medical supervision.⁽²⁰⁾

Some States and Municipalities with Decriminalization or Legalization Efforts

In recent years a significant shift in public perception of psychedelics, and the underlying science has spurred several states and municipalities to enact significant legal changes regarding civil and criminal penalties for Psychedelic fungi and entheogenic plant medicines. For instance, the city of Oakland has decriminalized the use of some naturally occurring psychedelics such as psilocybin, while others, such as the state of Oregon have legalized the supervised use of magic mushrooms for adults. Often the difference between legalization and decriminalization is not well explained. Legalization means that a substance is fully legal to possess and use with no, or few, criminal consequences (excluding illegal activities such as driving under the influence). Decriminalization on the other hand simply means that something has been moved to the lowest enforcement priority for law enforcement, but it may still carry some civil or criminal penalties for simple use and possession.

These legal changes, particularly in states like Oregon and Colorado, both of which recently legalized entheogenic plants and fungi, indicate a growing acceptance of the potential therapeutic benefits of psychedelics and a shift towards a health-focused approach to drug policy. However, it’s important to note that these changes often only pertain to state laws, and federal law still prohibits the use, possession, and distribution of these substances. This discrepancy can create legal ambiguities and complexities.⁽²⁰⁾

The trend towards decriminalization and legalization, especially for therapeutic uses, is likely to continue as more research emerges supporting the medical benefits of psychedelics. However, anyone considering the use of psychedelics should remain aware of the specific laws in their jurisdiction, as these can vary significantly from place to place.

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Psychedelic Edibles & Consumer-Oriented Products

Psychedelic edibles and consumer-oriented psychedelic products, while gaining popularity, come with significant safety concerns:⁽²¹⁾

Psychedelic edibles introduce an array of safety issues primarily due to their mode of consumption and the unregulated nature of their production. The variability in dosage and potency is a primary concern, as it can lead to either underwhelming or overwhelmingly intense experiences, the latter potentially posing significant risks, especially to inexperienced users. The delayed onset of effects characteristic of edibles often leads to overconsumption, as individuals might ingest more, thinking the initial dose was insufficient, only to find themselves overwhelmed when the effects finally manifest.^(16, 20)

When addressing the safety issues associated with psychedelic edibles, a harm reduction approach emphasizes informed decision-making and education about consumption. This includes understanding the variability in dosage and potency, which is particularly relevant due to the unregulated nature of these products. Consumers need to be made aware of the delayed onset of effects characteristic of edibles to prevent overconsumption. Ensuring quality and purity, alongside legal compliance, is also vital. Support and integration post-consumption are also crucial, much like in therapeutic settings, to help individuals process their experiences effectively and safely.⁽¹⁶⁾

Additionally, the similarity of these products to regular food items raises the risk of accidental ingestion, a particularly concerning issue in households with children. The unregulated market in which many of these products are produced further exacerbates safety concerns, with issues surrounding contamination and lack of quality control. These situations may be compounded by the psychological risks associated with consuming potent psychedelics without adequate preparation, guidance, or understanding of their effects. These factors underscore the need for caution and awareness regarding the use of psychedelic edibles and consumer-oriented psychedelic products.^(20, 21)

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Microdosing Safety & Harm Reduction Tips

Microdosing, the practice of taking very small amounts of psychedelics like LSD or psilocybin, has gained popularity for its potential benefits, such as enhanced creativity, improved mood, and increased focus without the prolonged intoxicating effects of a full dose. However, safety and harm reduction are crucial considerations. It is also important to note that the science is mixed at best, with some studies indicating that microdosing may not be effective, and others suggesting it may have some legitimate benefits. Furthermore, outside of states like Colorado and Oregon or certain municipalities, microdosing with psychedelics is illegal.⁽²²⁾

Some key safety tips include:

Microdosing, like any form of drug use, carries potential risks and benefits. Approaching it cautiously, respecting the substance, and focusing on harm reduction can help minimize risks. Since research on microdosing is still in its early stages, staying informed about the latest studies and recommendations is also advisable.

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Drug Testing and Harm Reduction Services

Accurately determining a substance’s purity and potency may not always be possible. However, testing drugs before use can provide additional information about their contents and allow informed decisions about use and dosing.

Websites and organizations that provide and sell drug testing kits or services include:

Dance Safe →

Dance Safe offers drug testing services:

Substance Drug Checking →

Substance Drug Checking is a service offered in British Columbia, Canada. Individuals can attend in person with a sample or send a sample to the lab for testing.

Test Kit Plus →

Test Kit Plus is based in Canada and ships products worldwide. They offer a range of drug testing kits that can be purchased and delivered, including various drug identification and purity kits.

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Psychedelic Emergencies & Support Hotlines

If you are experiencing a difficult psychedelic event or still need help processing one, call or text 62-FIRESIDE. The Fireside Project offers free emotional support during or after a psychedelic experience. You can also download their app. Their services are completely confidential, and their staff is rigorously trained, compassionate, and knowledgeable regarding psychedelics.

You can contact SAMHSA’s National Helpline at (800) 622-HELP (4357). Their confidential helpline is available 24/7 in English and Spanish for individuals and family members experiencing emotional distress or crisis.

Members of the LGBTQIA+ community may face unique and difficult situations during a challenging psychedelic experience. If you need emotional or crisis support, dial (888) 688-5428 or visit LGBThotline.org. Their hotline is designed for people of all ages and staffed by a dedicated team of highly trained volunteers from all parts of the LGBT+ community. They also offer a dedicated line for LGBT+ seniors that you can reach at (888) 234-7243.

If you are a veteran experiencing a difficult trip or crisis, please contact (800) 273-8255 and Press 1. This will connect you to the Veteran Crisis Line. Their hotline is staffed by experienced personnel, many of whom are also veterans. A trained responder will answer your call 24/7 to help you through a crisis, anxiety, or thoughts of self-harm.

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Support for Integration Post-Challenging Experience

TripSit offers information and support to individuals using psychedelic substances. They have a mobile app and online chat service to provide support and information. They can provide guides or tripsitters for people struggling with a non-ordinary state of consciousness or feeling that they need additional support.

They offer a friendly and supportive network of volunteers who are available 24/7, provide information about harm reduction techniques such as drug testing, and promote discussions around psychedelic use.

The Spiritual Crisis Network is a UK-based organization with trained volunteers who provide email support, community forums, peer support groups, and advice for people experiencing a spiritual crisis or emergency.

Individuals can contact the email support service with information about what is happening to themselves or someone they are supporting and will receive a response from non-judgmental volunteers.

The Spiritual Crisis Network also provides peer-led support groups in England for people who have experienced a spiritual crisis, where they can share their experiences and receive support to understand and integrate these experiences. People who cannot access local groups can also attend online peer-support groups.

The Zendo Project offers online and in-person education to individuals, communities, and organizations to promote psychedelic harm reduction and peer support. They can attend events and festivals to provide training, workshops, and online courses and information. This includes education around:

Never Use Alone is a nonprofit organization providing a crisis hotline for substance use. People calling the hotline can speak to volunteers who have personal experience with substance use.

Volunteers gather information about the individual, including their location and the substance they will use. They remain on the line while the drug is administered to ensure safety and can call emergency services if the individual becomes non-responsive. The goal is to reduce the risk of harm and overdose.

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Emergency Hotlines

If you or a loved one are experiencing a medical emergency and require immediate attention, please dial 911 (USA) immediately.

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Suicide Prevention Hotlines

If you or a loved one are experiencing a medical emergency and require immediate attention, please dial 911 (USA) immediately.