Overview of Online-Promoted Psychedelic Retreat Groups

Psychedelics are a class of naturally occurring and synthetic psychoactive substances grouped for their similar phenomenological profiles and pharmacological action. Several of these substances are used by indigenous groups as part of spiritual, religious and healing practices, and the historical and archeological record indicates psychedelics have been used by humans for millennia [1–5]. In the United States (U.S.) these substances are legally classified as Schedule I, which characterizes them as having a high potential for abuse and no accepted medical use. Recent clinical investigations, however, suggest psychedelics can be effective for treating several psychiatric indications such as post-traumatic stress, depression, anxiety, and substance use disorder [6,7]. Contemporary research has generated substantial public interest in and enthusiasm for psychedelics. It has also led to bipartisan support for psychedelic research and the revitalization of psychedelic culture online and in person [8]. This represents a significant shift from the cultural stigma attached to these substances that contributed to the passage of the Controlled Substances Act in 1970, which effectively enacted a moratorium on psychedelic research that would last more than twenty years.

The resurgence of public interest in psychedelics has led to a corresponding increase in rates of adult use of psychedelic substances such as psilocybin, Lysergic acid diethylamide (LSD), and N,N-Dimethyltryptamine (DMT) [9–13]. Several pathways to access psychedelics that circumvent federal prohibition have grown alongside rates of adult use. First, some state- and local-level legal reform efforts have pursued the de-prioritization of law enforcement around psychedelics and acted to establish state-sanctioned avenues for accessing psychedelic substances [14,15]. Second, so-called “gray markets” have emerged in municipalities with loosened legal restrictions and through digital marketplaces to facilitate access [16,17]. Third, there has been a growth in psychedelic drug tourism and the formation of organizations hosting psychedelic retreats domestically and abroad to meet this demand. The present study addresses this third development by exploring the landscape of psychedelic retreat organizations marketed online to English-speaking consumers.

Psychedelic retreats are central to the phenomenon of drug tourism, which entails tourist experiences involving or specifically aimed at the procurement or consumption of drugs in locales with more permissive or ambiguous drug laws. Prior research on psychedelic retreats has predominately addressed the growth of ayahuasca tourism, which is central to the religious practices of indigenous groups in South America and syncretic new religious movements [18–20]. Due to the cultural significance of ayahuasca and the association of psychedelic effects with spiritual and mystical experience, ayahuasca retreats often draw individuals seeking out spiritual and cultural experiences [21–23]. This has been similarly observed with psilocybin tourism in Mexico [24]. Some retreats, however, offer psychedelics divorced from their original cultural context [25–27].

Motivations for attending psychedelic retreats are consistent with the reasons people report using psychedelics in general, which tend to reflect health, wellness, and enhancement narratives that inform contemporary interest in psychedelics [28,29]. For instance, psychedelic users commonly cite reasons such as management of or coping with mental health ailments, self-improvement or enhancement, or a desire for self-knowledge [30–36]. In addition to health and wellness motivations, spirituality (in line with historical and contemporary associations with religious and mystical experience), and curiosity are common reasons people report using psychedelics [32–34,37]. A recent study of 26 individuals who participated in psychedelic retreats found similar motivations for participation. Personal development and self-medication were the most common motivations, however participants also cited curiosity, peer recommendation, dealing with relationship issues, spirituality, and professionalization for careers in psychedelic therapy as reasons to seek out a psychedelic retreat [38]. Other studies specifically focusing on ayahuasca have found that retreat attendees sought out ayahuasca to treat illness or addiction, attain self-knowledge, grow or develop spiritually, address psychological ailments, deal with personal crises, or achieve “inner healing” [21,22,39]. As the field of psychedelic science continues to expand and public interest in using psychedelics grows, understanding the ways in which people access psychedelics takes on greater importance, especially given the health motivations of many users.

While some retreats have been characterized in the scientific literature [19,21,22,26], the scope and nature of the psychedelic retreat industry remains unknown. This study aims to fill this gap by describing the landscape of psychedelic retreat organizations marketing to English-speaking consumers using online information. Examining psychedelic retreat organizations and their offerings is critical to understanding the associated ethical, legal, and social implications, as well as ensuring the safe and responsible use of psychedelics.

We identified 338 potential retreat organizations. We excluded 40 organizations: 23 did not offer psychedelics, seven did not have fully operational websites, five were duplicates, and five were excluded for other reasons, such as being a general website for an overarching organization, being the webpage of a specific shaman, or being a third-party organization that was not directly organizing retreats. A total of 298 (88.2%) organizations met the above criteria and were included in our analysis.

To our knowledge, this paper is the first to characterize the growing number of psychedelic retreat organizations that market to English-speaking consumers. With 298 organizations offering 648 distinct psychedelic retreat experiences, our study provides an expansive look at the rapidly changing landscape of retreat-based psychedelic tourism amid the growth of scientific knowledge and public interest surrounding these substances [44].

The majority of organizations we identified offered naturally occurring substances and preparations during their retreat(s). Substances such as ayahuasca, psilocybin, and San Pedro were the most common individual substances offered, whereas substances such as MDMA and LSD were relatively infrequent offerings. This is likely because naturally occurring substances are more easily accessible, less subject to legal restrictions, more difficult to detect or identify by law enforcement, and/or used in traditional rites of indigenous groups local to the Americas. Ayahuasca, for instance, was the most commonly offered substance by retreats we identified, despite the fact that it has not been as extensively studied in clinical trials [45–48]. This is unsurprising, however, given the longstanding use of ayahuasca among indigenous groups in Latin America and the proportion of retreats we identified that were based and held in South America. Yet, consistent with the globalization of ayahuasca practices through syncretic religions, neo-shamanism, and Western biomedical interests, we found ayahuasca being offered by retreats globally in locations where the plant constituents of the brew do not occur naturally and no local ayahuasca traditions exist. Additionally, although ayahuasca was by far the most commonly offered substance, the variety of substances being offered by retreat organizations marks shifting demands in the drug tourism market. Specifically, while ayahuasca has historically been the primary draw for psychedelic tourists, the diffusion of knowledge about psychedelics stemming from the psychedelic science movement may contribute to interest in more diverse types of experiences with different drugs. For instance, some may be searching for effects specific to certain drugs, as in the case of individuals with substance use disorder seeking out ibogaine. Alternatively, the use of synthetic psilocybin in clinical trials of PAT may be driving a demand for opportunities to use psilocybin mushrooms in retreat contexts employing similar procedures. Regardless of substance type, presentation of the psychedelics on offer as tools for improving or optimizing health and wellness was common for the retreats we identified.

Consistent with the growth of health and wellness narratives associated with psychedelics [28,29], wellness organizations were the most prevalent in our sample, as well as the most common type of psychedelic organization based outside the U.S. These organizations often presented psychedelics as holistic medicines, incorporated other spiritual or wellness practices (such as yoga, meditation, or reiki) into their retreat offerings, or associated themselves with specific indigenous communities (such as the Shipibo people of the Peruvian Amazon) and their traditions. Religious organizations were considerably less common in our overall sample and were concentrated in the U.S. Organizations that explicitly claimed to employ medical techniques or hold medical licensure, use psychedelics for treatment or rehabilitation of specific ailments, or facilitate psychedelic retreats in addition to broader aims of conducting clinical research were least prevalent in our sample, with only three organizations in the U.S. falling into that category. This is unsurprising given that no psychedelic substance is currently FDA approved for medical use and our focus was on retreat organizations operating outside the healthcare system. However, as psychedelic medicines near approval in the U.S. and public enthusiasm about their therapeutic potential surges, there is an increased risk that individuals will self-treat serious medical conditions by participating in non-medical retreats without appropriate supervision. This may be particularly problematic given that in some cases psychedelics can lead to psychologically destabilizing consequences, such as disorientation or increased sensitivity following the experience, exacerbate mental health conditions, or instigate new symptoms [49]. It is also not clear how psychedelic substances are dosed or administered in the retreat setting (i.e., both the amount of a given substance and the nature and extent of psychological support), and there is only some scientific evidence examining clinical outcomes when psychedelic substances are administered outside standard protocols of PAT [50–56].

Studies of psychedelic retreats suggest that retreat participants perceive several benefits to mental health and well-being from their retreat attendance, which are often attributed to “transformative” changes stemming from psychedelic experiences had during the retreat [26,38,54,55]. The methodology employed here was not geared toward understanding the experiences of retreat participants. However, psychedelic retreats are not without risks, and our analysis highlights several potential concerns.

One issue associated with the growing market for psychedelic retreats is the risk that opportunistic actors lacking sufficient knowledge of psychedelics and how to care for people experiencing their effects will generate harm by providing psychedelics to those who ought to refrain, being unable to help people through challenging experiences, or engaging in other potentially unsafe practices. Several unsafe scenarios may arise to cut costs and maximize profits, such as accommodating more retreat participants than there is staff to handle. Additionally, perhaps in an attempt to cater to retreat participants’ work schedules and limited budgets, some organizations offered one-day or short, weekend retreats. These shortened experiences may increase the likelihood of negative outcomes for participants who become overwhelmed due to the condensed timeline and lack of adequate preparation. Alternatively, should psychologically difficult material emerge during a short psychedelic retreat, participants may require more time to adequately process their experiences before returning to their daily lives. Both preparation and integration are considered important—and time-consuming—components of contemporary PAT [57], which are likely to be overlooked during a retreat lasting only a few days.

Polydrug use is another notable safety concern that emerged in our landscape analysis. Many of the retreats we identified offered more than one drug over the course of a single retreat. Although some polydrug combinations have traditional significance and others may be benign from a safety standpoint [58], there is little research that addresses the safety of mixing psychedelics. Further research is necessary to determine the possible risks and benefits of mixing multiple psychedelics. In the meantime, the potential for retreat organizers to administer multiple substances to cater to retreat participants seeking remarkable experiences raises concerns about both drug interactions and psychological consequences.

We also found that the information presented on retreat organizations’ websites and social media pages—a mixture of marketing and educational material—was often incomplete. Although potential retreat participants could learn more information by contacting retreat organizations directly, disparities in the information available online may hinder retreat participants’ ability to make an informed choice. For example, in our sample, eight organizations did not disclose the specific psychedelic substances they offered, and it was not possible for us to verify if the substances listed online were the only substances offered at the retreat. This approach may have been adopted by these organizations to avoid legal scrutiny or liability given the often-ambiguous legal status of psychedelic retreats in various locations [59]. However, this omission may impede a consumer’s ability to make informed choices when selecting a retreat experience. As decision making regarding psychedelic retreat attendance ultimately falls on consumers, the question of harm-reducing consumer education takes on greater importance.

Future research should seek to identify other domains of information that may be missing on these organizations’ websites and social media pages. Although some researchers, advocacy groups, and retreat organizations have sought to develop ethical guidelines and best practices [60–62], there are currently few reliable markers for identifying trustworthy retreat organizations, nor does there seem to be an adequate understanding of the baseline level of knowledge characteristic of the average psychedelic retreat participant. Some services, such as review platforms like AyaAdvisors (https://ayaadvisors.org/↗), Retreat.guru (https://retreat.guru/↗), and TheThirdWave (https://thethirdwave.co/↗), or psychedelic concierge services, which advise paying customers on which psychedelic retreats to attend based on practices, protocols, and personal networks have emerged to fill this gap [63]. Nonetheless further research geared toward harm reducing education is necessary since these services are subject to bias and can be exceedingly expensive, thereby limiting reach and effectiveness. For instance, while some concierge services are volunteer based, others charge “$10,000 or more for [their] services” with some clients paying “six figures for a consultation” [63].

Clinicians can also play a prominent role in addressing inequity and reducing potential harms associated with unregulated psychedelic use. Given the increased interest in psychedelic retreats, consulting with patients about risks and possible contraindications with preexisting conditions and medications will be important to help them make informed decisions about retreat participation. Therefore, concurrent with educating potential users about important considerations for taking psychedelics on a retreat, further efforts should be made to educate clinicians to prepare them for addressing these questions with their patients. Currently, little is known about clinicians’ knowledge about psychedelic retreats. While the increase in use of psychedelics and potential for clinical approval warrants greater efforts to educate clinicians about psychedelic substances more generally, further research should also explore relevant healthcare professionals’ perceptions of psychedelic retreats and what information they need to appropriately counsel patients seeking this type of experience.

It is likely that psychedelic retreat offerings will continue to expand, even post regulatory approval of psychedelic medicines, given the health-related motivations for many psychedelics users [21,30,32,35,39], these organizations’ appeals to principles of wellness, and especially in light of the projected cost of PAT. Psilocybin assisted therapy is estimated to cost 7747.80–9668.33 USD “depending on the price of psilocybin” [64]. Phase 3 trials of MDMA cost over 11,000 USD per patient [65]. While studies estimating high costs suggest overall savings in terms of added quality of life years, the psychedelic retreat space may allow for supervised use of psychedelics at a comparatively cheaper cost than traditional medical care, with the exception of some retreat offerings that consist of weeks-long stays complete with menus of wellness amenities. In general, the average retreats we found were less expensive and tout similar potential for healing, making them seem more attainable comparably for the average person seeking mental health treatment. Yet, the cost of a psychedelic retreat may still be prohibitive for many people, and if costs remain prohibitive, bad actors may arise offering lower prices with greater risks as demand increases. Inequitable access to psychedelics, which has already been identified as an issue in clinical research [66–68], may be further exacerbated by the potential for the emergence of a two-tiered system based upon an individual’s resources and access to medical care. The portrayal of wellness-oriented retreats as a potentially lower-cost alternative to PAT in clinical settings could further exacerbate health disparities, since retreat settings may be less standardized, riskier, and less likely to employ evidence-based practices.

There are also potential legal risks associated with retreat participation that consumers should be aware of. Many of the countries where retreats are being held prohibit the use of psychedelics with some exceptions for research and religious practices. For example, 28.2% of retreat organizations that we identified were based in the U.S. and 29.5% offered retreats at a location in the U.S., even though all classic psychedelics are federally illegal under the U.S. Controlled Substances Act. Some are willing to assume these risks, while others seek to avoid them by traveling to countries with long traditions of psychedelic use and more permissive drug policies [69,70]. This trend is reflected in the number of retreats we identified that were held in South America, which accounted for 44.2% of all international locations in our sample. For consumers, traveling to South America for a psychedelic retreat may be more expensive, but it can afford them greater legal protection and may also provide the impression that they are receiving a more “authentic experience” in a traditional context, which research suggests some consumers value [20,22,69,71].

Finally, the proliferation of psychedelic retreats and the demand for “authentic” indigenous healing experiences potentiates broader social and ecological harms. Specifically, there are several implications associated with the commodification of plants used as traditional sacraments and medicines by indigenous groups, such as ayahuasca, San Pedro, and peyote. Several have raised concerns over the commercialization of indigenous culture and the need for reparations and reciprocity with the communities whose practices are central to the offerings of retreat organizations [72–75]. This is particularly a concern given assumptions about foreign ownership of retreat organizations operating in Latin American countries that utilize local labor for shamanic ceremonies and accommodations for psychedelic tourists. Similar to other instances of commercial interest in natural resources that exist in the homelands of indigenous people, the demand can create community-level conflict over whether to help facilitate or participate in an extractive industry. Future research should continue to critically examine these issues, including indigenous perspectives on psychedelic tourism and the potential for cultural appropriation when ceremonial practices are integrated into retreats that are facilitated by non-indigenous practitioners.

This research is subject to several limitations. First, our compiled list of 298 psychedelic retreat organizations, though substantial, may not encompass all organizations and the information may change or become obsolete over time. Second, the data we collected were based on publicly available, online information, which can be incomplete or inaccurate, especially given the dynamic and growing nature of the psychedelic retreat landscape. Most companies provided limited descriptive information about their retreat offerings, which did not allow for more in-depth analysis of other key dimensions, such as staff-to-participant ratio or adoption of specific safety protocols. This information is important and should be made more easily accessible to prospective consumers. However, the completeness and accuracy of the information that is made available may be impacted by the varying legal status and ramifications of psychedelics, especially in locations with stringent laws. While we reviewed the data collected for accuracy, additional research to gather more complete information and verify the accuracy of publicly available information is warranted. Future research should also focus on collecting systematic information about long-term outcomes of retreat participation, including lasting benefits and adverse events. Despite these limitations, the comprehensive and expansive nature of our landscape analysis serves as a valuable overview of the current status of psychedelic retreat organizations and offers essential insights for both consumers and researchers.

Our analysis of 298 psychedelic retreat organizations provides a powerful and comprehensive overview of the psychedelic retreat landscape, especially as it markets to English speaking consumers. This paper highlights the importance of harm reduction in an unregulated drug market. While many organizations provide essential information online, significant gaps hinder consumers’ ability to make informed decisions. As the psychedelic retreat industry continues to grow, further monitoring is essential to ensure the safety of retreat participants and the sustainability of the industry.