What this is
- The increasing interest in psychedelics necessitates guidance for safe use, particularly for first-time users.
- This study crowdsourced recommendations from the psychedelic community to create a resource.
- Participants shared insights on preferred substances, combinations, and practices to enhance safety and positive experiences.
Essence
- Community-sourced recommendations emphasize psilocybin for first-time psychedelic experiences, with caution against more intense substances. Embracing practices can enhance safety and outcomes.
Key takeaways
- Psilocybin was recommended by 73.7% of participants for first-time use, favored for its moderate intensity and manageable effects.
- Participants advised against using ayahuasca and DMT due to their intensity and associated risks, highlighting the importance of choosing safer options.
- practices, such as preparation and setting intentions, were emphasized as crucial for enhancing the safety and positive outcomes of psychedelic experiences.
Caveats
- The study's sample may not represent the broader population of psychedelic users, limiting the generalizability of the findings.
- Recommendations may vary significantly based on individual experiences and cultural contexts, necessitating further research for more comprehensive guidance.
Definitions
- Harm reduction: Strategies aimed at minimizing the negative consequences associated with drug use while respecting individual autonomy.
Simplified
Background
Psychedelic substances are serotonergic hallucinogens, some of which have been used for millennia in various cultural and religious contexts worldwide 1. During the mid-twentieth century, psychedelic research flourished, demonstrating substantial potential for treating conditions such as depression and substance addiction 2. However, promising research programs were discontinued during the culture wars of the late 1960s when psychedelics were criminalized with the initiation of the War on Drugs and the accompanying moral panic around these substances [,]. Despite this, there continued to be considerable levels of illicit psychedelic use and underground research 3. Par13
How to Change Your Mind There has recently been a resurgence of interest in psychedelics, with both classic psychedelics (5-HT2A agonists, e.g., psilocybin, Lysergic acid diethylamide (LSD)) and non-classic psychedelics (psychoactive substances with other neuropharmacological mechanisms; e.g., MDMA, ketamine, ibogaine) being studied for potential mental health benefits, particularly when paired with psychotherapy [,]. Pharmaceutical companies and venture capitalists are investing billions of dollars in clinical trials 5. As of January 2025, there were at least 73 registered clinical trials studying the potential therapeutic efficacy of psilocybin alone 6. Reports in respected news outlets and popular books like Michael Pollan's7 have raised public awareness of these substances and their potential benefits. Legislative changes have liberalized psychedelic access for personal use 8 and institutional health care 9. Not surprisingly, levels of psychedelic use are increasing in the general population and may be at all-time highs [,]. Par14
Although psychedelic-assisted psychotherapy is becoming increasingly accessible, most classic psychedelic use continues to happen outside of a regulated context. Rather than waiting for legal medical access to become available, many individuals are choosing to use psychedelics by other means [,]. Decriminalization (or de-prioritization by law enforcement) may increase accessibility but does not guarantee oversight. Two U.S. states have legalized psychedelic therapy, though individual sessions at licensed psilocybin centers in Oregon range from $1,500 to $3,200 14, and a full course of therapy is estimated to cost between $7,638 and $9,532 15. There is no health insurance coverage for these services, which limits access to those with sufficient resources to pay out of pocket. Optimistic expectations were tempered by the Food and Drug Administration's (FDA) recent decision to reject Lykos Therapeutics' New Drug Application for MDMA combined with psychotherapy to treat posttraumatic stress disorder. There will be a longer wait for broader legal access to psychedelics, which may happen eventually, given that Lykos Therapeutics is initiating another Phase 3 clinical trial to address FDA concerns and there are hundreds of other active clinical trials. There is considerable media attention to the therapeutic clinical trials intended to facilitate the approval for the prescription of new pharmaceutical products. Recreational psychedelic use has been associated with better mood, higher social connectivity, and transcendent experiences 16. Par15
Adverse experiences
Most classic psychedelics are generally considered to have fewer physiological adverse effects compared to legal recreational and pharmaceutical drugs [,]. However, adverse experiences including suicidality, psychotic disorder, manic symptoms, cardiovascular events, and hallucinogen persisting perception disorder have been documented in clinical or research administrations of psychedelics 4, and some researchers have noted that risks are somewhat understudied in the face of increasing hype around psychedelic benefits 19. These include psychological adverse events and serotonin syndrome when certain psychedelics are taken by those using specific antidepressant classes 20. The enthusiasm for the potential therapeutic applications of psychedelics may have led both researchers and patients to downplay adverse effects 21, an important area which is currently understudied 22. Concerns about inadequate assessment of adverse events were highlighted in the Institute for Clinical and Economic Review report regarding the Lykos application 23. Recently, there has been increasing attention among psychedelic researchers to better characterize the risks and potential adverse effects of psychedelics 18. In a large survey of people who have used ayahuasca, most reported adverse physical and mental health effects 23. Vomiting was the most frequent adverse physical effect, with some respondents experiencing headaches, abdominal pain, and breathing difficulties; about 2% sought medical treatment after their experience 24. Adverse mental health effects included feelings of loneliness, nightmares, anxiety, uncontrollable worrying, and derealization; around 12% sought professional support afterward 25. Most individuals who have experienced a broad range of psychedelics report adverse experiences such as fear, sadness, body tremors, and loneliness 25. About half reported experiencing panic, despair, and fearing that their current state would last forever 25. Smaller but substantial proportions reported feeling as if they were dead or dying, fearing they would lose their mind, and paranoia 26. Those who consume psychedelics at musical parties or festivals have experienced hallucinations (e.g., hearing voices), disorientation, and derealization 26. Adverse experiences such as anxiety and fear, existential struggle, social disconnection, depersonalization, and derealization can persist after psychedelic experiences, sometimes for over a year 26. Without the availability of a legal and regulated option for therapeutic use, risks are increased for those who seek to use psychedelics therapeutically but are unsure of how to do so safely 27. Par16
Psychedelics and harm reduction
The widespread interest in and use of psychedelics outside of regulated environments, combined with the potential for adverse experiences and events, necessitate a harm reduction approach. U.S. drug policy has historically focused on reducing drug use and making drugs less available, though in the 1990s public health researchers argued for a shift towards reducing the harms to society [,]. The Mersey Harm Reduction Model, created in Liverpool, England in the mid-1980s in response to the emergence of HIV/AIDS 29, shifted the focus from exclusively reducing drug use to reducing the risk of harms from drug use 30, with goals of reducing overdose rates and limiting the spread of infectious diseases 30. Harm reduction is now recognized as a critical evidence-based approach for engaging with those who use drugs by the Substance Abuse and Mental Health Services Administration 30 and is also a key aspect in the U.S. Department of Health and Human Services' Overdose Prevention Strategy 31. Par17
Harm reduction is broadly relevant to all personal use of any substance, acknowledging personal autonomy and reducing risk and maximizing benefits from personal choices 14. Harm reduction programs do not increase drug use 33. Some argue that because the potential benefits of psychedelics compare favorably to the potential harms in comparison to other psychoactive substances, a harm reduction approach may not only focus on safety but also facilitate the potential benefits of psychedelics [,]. Drug testing is one form of harm reduction, though these services are prohibited in some countries 14. Guidelines and recommendations have been created for carefully controlled psychedelic research and clinical settings [,,]. Par18
The use of psychedelic harm reduction practices is positively associated with emotional breakthroughs 15, a key mediator of longer-term positive psychological changes 37, and is negatively associated with challenging experiences 15. Notably, individuals use fewer harm reduction practices in their first experiences, employing more and a wider range of harm reduction practices as they gain experience 15. These practices include ensuring a comfortable setting, setting a purpose, obtaining the drug from a reputable source, measuring the dose, and arranging a time to take the drug 15. Par19
The Psychedelic Experience Tibetan Book of the Dead The Great Liberation upon Hearing in the Intermediate State Psychedelic use outside of carefully controlled environments with therapeutic support may increase the risk of difficult or adverse experiences 15, though even therapeutic environments can have adverse events such as inappropriate sexual contact 38. Harm reduction advice for psychedelic use outside of regulated environments largely consists of catchphrases that may resonate with those who have experienced psychedelics but may perplex the uninitiated. "Turn off your mind, relax, and float downstream…surrender to the void," sang the Beatles 39, paraphrasing Leary, Metzner, and Alpert's, 40 adapted from the, 41 a Western interpretation of. The original Tibetan Buddhist texts were meant to be read aloud to the deceased to help guide their consciousness to a favorable next life 2. Phrases such as "surrender to the void" 39 may be loaded with meaning for the psychedelic community, though even with elaboration people may not have a concrete idea of what exactly they should plan or do. Par20
Current study
Given the widespread interest in psychedelics, limited options for legal access, and lack of systematic education, it is critical to inform the public of practices which minimize the risk of harms of psychedelic use. We believe that minimizing the risk of harm from psychedelic use will also help to promote the benefits of psychedelic use, though the relationship between risk minimization and benefit maximization may be complex and is an important question for future research. The knowledge and experiences of those who already use psychedelics may be a valuable resource, though it is difficult to access this information without personal connections. There is a need to investigate harm reduction beliefs and practices in psychedelic using populations 34 and to communicate effective practices to those using psychedelics for the first time 15. In the current project, our objective was to crowdsource practical recommendations for first psychedelic experiences from people currently using psychedelics, creating a practical and legitimate resource for first-time psychedelic experiences. We recruited individuals who have knowledge regarding harm reduction practices derived from personal experiences with psychedelics and recruited through professional networks to include individuals with both personal experience and professional roles related to psychedelics (e.g., therapist, sitter, researcher). We hypothesized that participants would emphasize preparing for the substance use, using substances that were considered less psychologically and physically dangerous, and including practical tips like substance testing and starting with low doses. Par21
Methods
We employed a community-based approach [–] to conduct a survey assessing various aspects of psychedelic use in a multi-component survey. Our team, comprising academic researchers, psychedelic therapists, and community leaders, collaboratively designed survey items to gather recommendations for first-time psychedelic experiences from the psychedelic community. We recognize that the "psychedelic community" is not a unified entity, though the aggregation of advice across many individuals and roles regarding psychedelics will reveal important patterns and trends. We conducted a large-scale survey following the principles of community-based collaborative research [–]. This approach included the involvement of members of the psychedelic advocacy community in every stage of the project and consensus decision making. A collaborative research environment where community members actively participate can produce academically rigorous work that is also socially responsive and beneficial to the communities involved. The active involvement of psychedelic community members may enhance the quality of research and increase public trust in the results. Par22
Participants were recruited in person at Entheofest, a psychedelic advocacy event in Ann Arbor, MI, on September 17, 2023, and via psychedelic-related email listservs, newsletters, and social media platforms (e.g., Reddit, Facebook) from September 17 to October 31, 2023. The "Prevent Ballot Box Stuffing" setting in Qualtrics was used to prevent duplicate responses. Adults aged 18 years and older who had taken a psychedelic substance and had not previously completed the survey were eligible to participate.
Survey design
is The survey included seven questions regarding recommendations for people experiencing psychedelics for the first-time. Participants were first asked "Are there psychedelic(s) you would recommend for a first experience? (Select all that apply)" and were provided with a list of 20 substances or classes of substances, e.g., "Synthetic tryptamines (AL-LAD, ETH-LAD, 4-HO-MET, 5-MeO-MiPT, etc.)" Participants were also provided with a "No/None" option and a "Other:" option with an open-ended text box. We included "classic" psychedelics such as LSD and psilocybin, which are 5HT2A agonists, non-classic psychedelics such as MDMA and Ketamine, and substances which are often grouped with non-classic psychedelics such as cannabis (THC) 46. Wittgenstein argued that a term's useits meaning 47, and researchers have incorporated this approach into psychedelic realms, acknowledging that how people actually use these terms in naturalistic language may be more important than pharmacological definitions in some contexts 48. We took a similar inclusive approach, as cannabis was considered to be a psychedelic by over a third of respondents in a recent international survey of over 8000 individuals experienced with psychedelics 49. Par24
Those who selected any psychedelic substance or class of psychedelic substances were asked, "Why would you recommend this/these for a first experience?" Subsequently, participants were asked "Are there psychedelic(s) you would NOT recommend for a first experience? (Select all that apply)" with the same response options and a parallel follow-up question, "Why would you NOT recommend this/these for a first experience?" These items were followed by open-ended text items, "Are there psychedelics that you recommend taking together? (or other substances to take with psychedelics?)"; "Are there psychedelics that you DO NOT recommend taking together? (or other substances NOT to take with psychedelics?)," and "What other recommendations do you have for someone using psychedelics for the first time?".
Data analyses
Frequencies were computed for psychedelics recommended and not recommended for a first experience. A table of all possible binary combinations of psychedelics was used to document recommendations for and against psychedelic combinations, with a numeric code for each combination. Recommendations not to mix psychedelics were coded with a list of substances (e.g., alcohol).
An experienced qualitative researcher (DJK) and two qualitative coders (GM, AS) analyzed responses to open-ended items. The content was reviewed and discussed to generate themes and sub-themes for each item. Coders independently coded a subset of responses for each item, and the team collectively revised the coding scheme based on coder feedback. Coders independently coded responses to each item using the final coding scheme. Coders indicated all applicable codes for each response. Discrepancies were discussed and resolved, resulting in a consensus set of codes used for analyses. The overall coding discrepancy rate was 4.2% (825/19425); all discrepancies were successfully resolved.
Recommendations and other content that was outside of the scope of an item's content (e.g., "be with people you love and trust" in response to "Why would you recommend this/these for a first experience?") were combined with the responses to "What other recommendations do you have for someone using psychedelics for the first time?" for each participant. Thus, these recommendations were documented per participant, regardless of where in the survey the participant entered the advice. Similarly, those who explicitly advised against combining psychedelics in response to "Are there psychedelics that you recommend taking together?" were included in the proportion of participants computed for "Do not mix any psychedelics" in "Recommended to not combine." Participants who responded "No," "Not really," were coded as "No recommendation." Those who indicated a lack of knowledge or experience (e.g., "Not enough experience to comment.") were coded as "Unsure, do not know." Participants who did not provide a response were not included in these proportions. Some participants gave responses without specific content, e.g., "Have fun, man," "You covered them well. Good prep for the journey," these responses were not coded. There were no responses containing any suggestions deemed to be harmful advice.
Chi-squares tested whether those having experiences with specific substances were more likely to recommend them for a first psychedelic experience or recommend not to use them for a first psychedelic experience. These analyses were conducted for the top five psychedelics recommended and not recommended for a first experience. We calculated the total number of unique pieces of advice given by each participant. We did not include the number of psychedelics recommended or not recommended in these totals, though we did include the reasons given for making these recommendations. We did not include responses indicating that the participant was unsure or did not have enough knowledge or experience to provide advice. We conducted a stepwise regression analysis predicting the total number of unique pieces of advice given. Candidate predictors included age in years, education level in years, income in USD, White versus Non-White ethnicity, whether participants identified as a woman, whether participants identified as gender diverse (non-binary, transgender, etc.), frequency of psychedelic use in the past five years, number of different psychedelics used (lifetime), and whether participants had experienced full doses of psychedelics or only microdoses.
Results
Participant characteristics
Participants most frequently reported using psilocybin mushrooms or truffles (91.9%), lysergic acid diethylamide (LSD, acid; 43.9%), MDMA/MDA (Ecstasy, Molly; 40.4%), and Ketamine (28.1%). Most (85.4%) had taken full doses of psychedelics (effects are clearly or strongly felt), whereas 14.6% had only taken microdoses of psychedelics (effects are sub-perceptual; these definitions were provided to participants). Most participants (80.8%) had experienced at least two different psychedelics. Additionally, 86.4% had taken psychedelics in the past year, 75.2% had taken psychedelics at least twice in the past year, and 4.5% had taken psychedelics but not in the past five years.
| Descriptive left 2 | |
| Gender | |
| Woman | 50.8% |
| Man | 44.2% |
| Non-binary | 2.9% |
| Trans-Woman | 0.7% |
| Trans-Man | 0.3% |
| Other identity | 0.7% |
| (Missing) | 0.3% |
| Age in years (M, SD, range) | 44, 15, 18–85 |
| Education in years (M, SD, range) | 16, 2, 10–20 |
| High school graduate, GED, or less | 4.3% |
| Some college, technical, or associate's degree | 26.5% |
| Bachelor's Degree | 26.5% |
| Master's, Doctorate or Professional Degree | 42.2% |
| Races/ethnicities (inclusive) | |
| Caucasian/White | 78.7% |
| Hispanic/Latino | 4.6% |
| African American/Black | 3.6% |
| Asian | 3.3% |
| Aboriginal/First Nation/Native American | 3.1% |
| Native Hawaiian/Pacific Islander | 0.2% |
| Other | 1.4% |
| Frequency of psychedelic use in the past five years | |
| Not in the past 5 years | 4.5% |
| Once | 9.1% |
| Once per year | 11.2% |
| Once every 6 months | 15.0% |
| Once every 2–5 months | 27.9% |
| Once every month | 15.8% |
| Once every week | 5.5% |
| More than once per week | 11.0% |
| Roles in relation to psychedelics (inclusive) | |
| User | 57.0% |
| Researcher—Personal | 43.0% |
| Psychonaut | 39.4% |
| Guide/Sitter | 33.2% |
| Activist (involved in specific organizations) | 29.3% |
| Grower/cultivator | 23.8% |
| Therapist | 20.8% |
| Educator | 20.0% |
| Healthcare provider | 16.7% |
| Researcher—Academic | 13.1% |
| Student (in training for psychedelic therapy) | 12.7% |
| Shamanic practitioner | 11.5% |
| Coach | 11.0% |
| Entrepreneur | 10.7% |
| Author | 9.8% |
| Indigenous practitioner (participant) | 8.3% |
| Chemist | 7.1% |
| Indigenous practitioner (facilitator) | 6.0% |
| Journalist | 4.3% |
| Researcher—Industry | 4.3% |
| Trainer | 4.3% |
| Clergy | 2.8% |
| Policymaker | 2.8% |
Substances recommended for first-time psychedelic experiences
| Substance | % Recommending | % Not recommending |
|---|---|---|
| Psilocybin (mushrooms or truffles) | 73.7 | 2.6 |
| Cannabis | 47.8 | 2.1 |
| MDMA/MDA (Ecstasy, Molly) | 30.5 | 6 |
| Lysergic acid diethylamide (LSD, acid) | 17.6 | 17.9 |
| Ketamine | 12.9 | 12.6 |
| Mescaline (Peyote, San Pedro cacti) | 6.2 | 11.7 |
| Psilocybin (synthetic) | 6 | 5.7 |
| Nitrous oxide | 5.7 | 7.9 |
| DMT | 3.3 | 28.2 |
| Synthetic phenethylamines | 2.8 | 15.5 |
| Ayahuasca | 2.6 | 29.3 |
| Lysergic acid amide (LSA, Ergine) | 1.2 | 9.3 |
| Amanita muscaria (fly agaric) left | 1 | 15.5 |
| 5-MeO-DMT | 1 | 19.8 |
| Dextromethorphan (DXM) | 0.9 | 11.2 |
| Kambo | 0.9 | 9.6 |
| Synthetic tryptamines | 0.9 | 14.5 |
| Salvia divinorum or salvinorin A left | 0.7 | 18.8 |
| Bufotenin | 0.5 | 11.4 |
| Iboga/Ibogaine | 0.2 | 15.5 |
| Major themes | % |
|---|---|
| Desirable characteristics of substance | 69.4 |
| Positive effects | 28.9 |
| Existing knowledge on substance | 16.7 |
| Availability/Accessibility* | 15.3 |
| Therapeutic indications* | 12 |
| It depends | 10.5 |
| Desirable characteristics of substance | 69.4 |
| Not too intense | 30.4 |
| Experience is dose dependent and can be dosed precisely | 25.4 |
| Short duration | 13.4 |
| Safe | 8.1 |
| Natural/organic | 7.4 |
| Can be microdosed | 5.6 |
| Unlikely to have a bad experience | 3.5 |
| Lack of negative side effects | 2.3 |
| Reliable purity | 2.1 |
| Predictable trajectory/experience | 1.9 |
| Inability to overdose | 1.7 |
| Powerful | 1.6 |
| Ability to self-guide | 1.4 |
| Long duration | 1 |
| Not addictive | 1 |
| Fast onset | 1 |
| Favorable/predictable duration | 0.8 |
| Few GI issues | 0.8 |
| Lack of residual effects | 0.6 |
| Slow onset | 0.6 |
| Few contraindications | 0.4 |
| Ecological sustainability | 0.2 |
| Positive effects | 28.9 |
| Cognitive enhancement | 8.5 |
| Empathogenic/prosocial | 7.4 |
| Calming/peaceful | 3.7 |
| Euphoria | 3.3 |
| Spiritual | 1 |
| Beautiful | 1 |
| Ego death/dissolution | 0.6 |
| Clean/pure effect | 0.4 |
| Existing knowledge on substance | 16.7 |
| Personal experience | 12.2 |
| Science/research | 2.1 |
| History/cultural traditions/indigenous practices | 1.7 |
| It depends | 10.5 |
| Depends on set and setting | 6.2 |
| Need the right fit for person | 3.5 |
| All are OK in the right circumstances | 2.3 |
Substances not recommended for first-time psychedelic experiences
| Major themes | % |
|---|---|
| Characteristics of substance | 70.4 |
| Risks/safety concerns | 30.1 |
| Knowledge/Information is limited | 21.3 |
| Not therapeutic/No therapeutic indications/Lack of benefit* | 2.8 |
| Lack of Availability/Accessibility/Approval* | 1.5 |
| Depends on the person / Any can be OK in right circumstance* | 1.5 |
| Characteristics of substance | 70.4 |
| High potency/Too intense | 52.4 |
| Long duration | 11.6 |
| Synthetic/Not natural | 6.8 |
| Difficult to dose properly/precisely | 6.8 |
| Unpleasant/strange/weird/not representative of other psychedelics | 6.8 |
| Too unpredictable | 4.6 |
| Difficult to control purity/unreliable purity | 3.3 |
| Too rapid onset | 2.3 |
| Requires an experienced guide / facilitator | 2.3 |
| Long recovery time | 1.5 |
| Not psychedelic | 1 |
| Crash/empty feeling after use | 1 |
| Visually overwhelming | 1 |
| Difficult to prepare/administer | 1 |
| Lack of visuals | 0.5 |
| Too weak | 0.3 |
| Addictive | 0.3 |
| Creates vulnerability | 0.3 |
| Contraindications | |
| Mental health risks/safety concerns | 19.2 |
| Prone to adverse experiences (traumatizing, triggering, bad trips) | 7.9 |
| Anxiety/Fear | 6.1 |
| Exacerbation of existing mental health issues | 1.5 |
| Dissociative | 1.3 |
| Ego death/dissolution | 1.3 |
| Disorienting | 1 |
| Repressed memories may surface | 1 |
| Psychosis | 0.5 |
| Depression | |
| Physical health risks/safety concerns | 14.9 |
| GI upset | 3.3 |
| Purging | 1.8 |
| Toxic | 1.3 |
| Death/fatal overdose/risk of death from overdose | 1 |
| Heavy Body Load | 0.8 |
| Infertility | 0.3 |
| Knowledge/Information is limited | |
| No personal experience with substance | 17.7 |
| Unpleasant personal experience | 1 |
| Lack of research | 0.5 |
| No cultural traditions | 0.5 |
| Respect indigenous traditions by not stealing them | 0.5 |
Combinations recommended and not recommended for first-time psychedelic experiences
| Recommended combinations | % |
|---|---|
| Psilocybin and cannabis | 12.6 |
| Psilocybin and MDMA | 9.1 |
| LSD and MDMA | 7.6 |
| LSD and cannabis | 5.2 |
| Cannabis and other drugs | 3.6 |
| Psilocybin and LSD | 2.9 |
| Cannabis and MDMA | 2.2 |
| Ketamine and MDMA | 1.9 |
| Cannabis and Ketamine | 1.4 |
| LSD and Nitrous oxide | 1 |
| No recommendation left | 20.7 |
| Unsure, do not know left | 10.2 |
| Recommended to not combine | % |
| Do not mix any psychedelics | 14.8 |
| Psilocybin and LSD | 1.5 |
| Psilocybin and cannabis | 1 |
| No recommendation left | 14.3 |
| Unsure, do not know left | 72 |
| Do not mix with… | % |
| Alcohol | 20.8 |
| Stimulants | 5.3 |
| Antidepressants | 4 |
| Methamphetamine | 1.5 |
| Cocaine | 1.4 |
| Narcotics/opiates | 1 |
| Depends on the person | 1 |
Other recommendations
One fifth (21.7%) of participants mentioned preparation related to the substance used, particularly starting with low doses and increasing doses incrementally. A few participants mentioned knowing the source of the substance (3.2%) and testing the substance (1.9%). A subset of participants (7.6%) advised dietary preparation, such as eating healthy food, not eating too much food, and not drinking alcohol before the experience. A few participants (5.3%) advised preparing for emergencies, such as telling plans to someone else, having an exit strategy, and asking for help when needed.
| Theme | % |
|---|---|
| Mental preparation | 65.7 |
| Embrace the experience and whatever you encounter on your journey | 30.3 |
| Learn about psychedelic experiences/substance you are taking | 13.9 |
| Set intentions for what to accomplish through the experience | 13.3 |
| Clear time before and after for preparation and recovery | 9.5 |
| Prepare for anxiety/challenge, whatever you are feeling will go away | 9.1 |
| Meditation, breathwork, etc | 7.2 |
| Environment | 50.9 |
| Be with people you love/trust | 23.8 |
| Have a guide/sitter/facilitator | 18.1 |
| Be in a safe, familiar, and comfortable location | 12.8 |
| Be in nature | 6.7 |
| Have on hand | 24.2 |
| Music that will facilitate trip | 9.5 |
| Water/hydrate often | 7.8 |
| Journal | 5.5 |
| Comfortable clothing/blankets | 3.2 |
| Snacks (healthy, especially fresh fruit) | 2.1 |
| Eye masks | 1.9 |
| Trip killers | 1.7 |
| No phones | 1.7 |
| Prepare activities (drawing, creative activities) | 1.7 |
| Substance preparation | 21.7 |
| Start small (low doses) | 15.2 |
| Go slow (increase doses incrementally) | 8.6 |
| Know the source of your substance | 3.2 |
| Test your drugs | 1.9 |
| Diet preparation | 7.6 |
| Healthy food | 1.9 |
| Don't drink alcohol before | 1.9 |
| Don't eat too much before | 1 |
| Preparation for emergencies | 5.3 |
| Tell someone else your plans | 2.7 |
| Have an exit strategy | 2.3 |
| Ask for help when needed | 0.4 |
| Post-Experience Integration | 4.4 |
| Coefficient | B left | SE left | Beta left | t left | p left | B 95% CI LL | B 95% CI UL |
|---|---|---|---|---|---|---|---|
| (Constant) | 24.94 | 5.96 | left | 4.18 | < .001 | 13.23 | 36.65 |
| Age in years | − 0.41 | 0.11 | − .148 | − 3.54 | < .001 | − 0.63 | − 0.18 |
| Total psychedelics taken | 1.81 | 0.58 | 0.13 | 3.12 | 0.002 | 0.67 | 2.95 |
Discussion
Salvia divinorum To our knowledge, this is the first large-scale community-based study to compile recommendations for initial psychedelic experiences. Informed individuals are less likely to experience anxiety while using psychedelics 50. Using the principles of community-based participatory research strengthened our initial survey design, ensuring relevance to individuals using psychedelics. This project recognizes the value of the collective knowledge within the psychedelic community and makes this knowledge accessible to the wider public. Participants who had experiences with specific substances were more likely to both recommend them (Psilocybin mushrooms or truffles, Cannabis, MDMA/MDA, LSD, and Ketamine) and NOT recommend them (Ayahuasca, DMT, 5-MeO-DMT,or salvinorin A, and LSD), indicating that these recommendations are in fact informed by lived experience. We recognize that the psychedelic community is not monolithic and that we recruited participants with a range of roles regarding psychedelics. All participants had personal experience with psychedelics and most reported professional roles (e.g., therapist, sitter, researcher, educator, activist), which may increase confidence in the resulting guidance. Those with professional roles may be providing advice based on content in the scientific literature, though the scarcity of peer-reviewed guidelines was the impetus for creating this project. Participants may also be sourcing advice from popular books and those from the underground press. Simultaneously, we note the need for continual education among those with psychedelic experience. The distribution of this work will aid in harm reduction and improve psychedelic experience outcomes due to the applicability of recommendations generated by the psychedelic community. Par38
Individuals may find information about psychedelics on social media; however, social media platforms may censor this content 51 or eliminate fact checking, making the validity of content questionable. People who use psychedelics only somewhat trust information on psychedelics posted on social media, and consider articles published in peer-reviewed scientific journals as the most trusted source of information 52. Internet websites are one of the most common sources of information on psychedelics 52, though they often contain harm reduction myths, such as advising people to take psychedelics alone, in a dark room or place, and drink orange juice to reduce the risk of adverse experiences 15. Par39
Convergence with current literature
The psychedelic harm reduction practices recommended by our survey participants converge with those given in qualitative studies and content in the broader scientific literature. The recommendation of psilocybin is consistent with the assessment of psilocybin by experts in substance use and abuse regarding its properties such as addiction potential, potential harm to individuals using, and potential harm to society [,]. Extreme toxicity reports are more common with LSD or ayahuasca than psilocybin 19. Those attending electronic music parties and festivals in Israel endorsed similar harm reduction practices, including researching about the substance before taking it, planning what substances to take, not mixing different substances (including alcohol), and being with trusted friends 20. Psychedelic guides and facilitators often suggest specific medication regimens and, in some cases, diets to prevent serotonin syndrome 53. Proper dosing is essential to avoid intense negative trips, which can lead to adverse mental health impacts such as hallucinogen-induced persistent psychosis 34. Many sources recommended taking psychedelics with trusted individuals [,]. Par40
In interviews, people using psychedelics in Norway reported rules they followed, including having a proper mindset and environmental setting, having knowledge of a substance and its effects, and developing a meditation practice to be able to observe and detach mindfully from thoughts 56. These interviewees noted that their adverse experiences usually occurred when they disregarded these rules, and reported other recommendations such as talking to a loved one, sharing a plan, journaling, meditating, and being in a safe place with trusted people 56. Another study reported that adverse outcomes were mostly due to overdosing, combining substances, lack of knowledge, police intervention, reckless attitudes, or substance misidentification 53. A study examining mental health outcomes of naturalistic psychedelic use found that only 13% of participants reported negative mental health outcomes 5, which were associated with cannabis misuse and cigarette smoking 5. Par41
Set and setting
The primary focus of recommendations in the current literature is to have a conducive "set and setting." "Set" refers to one's psychological state, including mood and intentions for using a psychedelic, as well as experiences and memories that are salient 55. "Setting" refers to the environmental context in which the use occurs 55. Participants in our survey noted that the outcomes of psychedelic experiences depended on set and setting, pieces of which aligned with the wide variety of advice across the literature on what constitutes a proper mindset. This includes specific advice such as limiting time on screens and social media, practicing meditation, having music playlists, and not having any prior commitments on the day of the trip 15. Some sources advise to be in a good mood before tripping 15, whereas others argue that even negative experiences can be beneficial because they bring positive insights and help work through repressed traumas 56. Some sources advise to set intentions or goals for the psychedelic experience, such as expanding thought, escaping routine, and seeking companionship and deeper human experiences 54. Others argue that preconceived Western perspectives on psychedelics and society's obsession with personal goals makes it difficult for some individuals to detach fully and enjoy their experience 57. Forstmann et al. 18 note that those who intended or expected to have a transcendent experience often reported one after psychedelic use, which they attributed to a self-fulfilling prophecy. Other research has found that the ability to surrender to the experience was the strongest predictor of having a mystical experience 57. Our participants offered advice resembling the recommendations outlined above, suggesting that there are many considerations to keep in mind for first time psychedelic use. Par42
In contrast to the increasingly standardized environments or "settings" in psychedelic clinical trials, there is no standard environment for naturalistic use, even for those with therapeutic intentions. These settings range from music festivals [,] to natural environments providing solitude 27. Our participants advised others to be in safe, familiar, and comfortable locations with trusted individuals, advice echoed in the existing literature [,,,]. Par43
The need for ongoing research and education
Few of our participants offered a comprehensive set of advice. This may result in part from the study methodology of an on-line survey with multiple components. More extensive advice might be obtained with other methods such as individual interviews. Still, few participants noted important issues such as serotonin syndrome even when asked specifically about harmful drug combinations. It is apparent that better education is necessary even for those with psychedelic.
experience. Even those with very extensive psychedelic experiences can have serious adverse events 58. Many recommendations were also contradictory across participants (e.g., whether to combine substances or not), further research will be necessary to provide empirical support for many of these specific recommendations. We also acknowledge inconsistencies in opinions expressed in the peer-reviewed literature, as noted above. Par45
Limitations and recommendations for future research
Our study utilized a convenience sampling approach, which allowed us to include a large sample of participants. However, this sample may not be representative of the national or global population using psychedelics. Our sample was a conglomeration of participants with different roles regarding psychedelics, rather than a panel of experts in a single domain, such as substance abuse researchers [,]. Although the most common roles participants cited regarding psychedelics were related to personal use (User, Personal Researcher, Psychonaut; See Table ), most participants (54.7%) indicated having a role with expertise (Guide/Sitter, Therapist, Educator, Healthcare provider, Academic Researcher, Shamanic practitioner, Coach, Indigenous facilitator, Industry researcher, Trainer), with a third (34.4%) having two or more of these expert roles. Par46
We did not ask participants to indicate the sources of their knowledge, e.g., personal experience or literature. We also conducted the survey in English. Recommendations may differ considerably in non-Western populations, especially in indigenous cultures with traditions of psychedelic practices. As the first study of its kind, we chose to use open-ended questions. We focused on recommendations for first experiences, and thus such advice may emphasize minimizing the risks of harm from psychedelic use. Maximizing benefits from psychedelic use would have a substantial relationship with minimizing risks but may also be a broader topic with substantial distinctions (e.g., continued use of psychedelics). The relationship between these aspects is an important question for future research which may also benefit from community-based approaches. The current project provides direction for more specific questions, e.g., choosing among response options. Future research would benefit from participant samples with greater national, racial/ethnic, and language diversity.
Further, because some participants had used psychedelics for many years, their views of what could lead to a positive first experience may be skewed by their current habits and use patterns, which may not translate to those using psychedelics for the first time. Recruitment from those participating in live and online psychedelic forums may bias the sample towards those who are more enthusiastic about psychedelics. However, the purpose of this project is to provide guidance for first-time psychedelic experiences. There is already an abundance of abstinence-based approaches recommending that people do NOT use psychedelics. It is also uncertain whether aspects of the harm reduction guidance offered apply more strongly to a therapeutic or recreational context, a topic that could be assessed in future research. As noted above, systematic empirical research regarding many of these topics is lacking. The guidance provided by our participants may be seen as a roadmap for future research programs. Randomized controlled trials examining the results of specific practices may be helpful but must be conducted carefully to avoid withholding essential safety information and harming participants.
Conclusions
To our knowledge, this study represents the first large-scale community-based effort to compile recommendations for initial psychedelic experiences. Informed use and harm reduction practices can significantly enhance the safety and positive outcomes of psychedelic experiences. The convergence of our participants' recommendations with existing literature highlights the value of community knowledge in guiding safe and beneficial psychedelic use. However, the need for ongoing education and more comprehensive advice remains evident. Future research should aim to include more diverse participant samples and explore additional methods to gather detailed recommendations. By continuing to integrate community insights with scientific research, we can better support individuals in their psychedelic journeys and contribute to the broader understanding of these substances.
Supplementary Information
Additional file. 12954_2025_1337_MOESM1_ESM.docx local-data MOESM1