- 1. “Bad Trips”: Difficult Experiences
- 2. Dissociative Effects
- 3. Depersonalization
- 4. Ego Inflation
- 5. Serotonin Syndrome
- 6. Hallucinogen Persisting Perception Disorder (HPPD)
- 7. Potential to Trigger Schizophrenia-like Psychosis
- 8. Hypomania
- 9. Triggering or Worsening Anxiety
- 10. Risk of Accidental Self Poisoning
- 11. Risk of Physical Harm to Self or Others
- 12. Complications from Overdose
- How to Prevent and Reduce Adverse Effects of Psychedelic Substances
- Consider the six S’s: Set, Setting, Substance, Sitter, Session, and Situation
The world of psychedelic substances can be exciting and enlightening. Psychedelics offer a powerful opportunity for self-discovery, transformation and growth. At the same time, the world of psychedelics is not without dangers. While the overall risks associated with usage are relatively small when safety protocols are followed, there are some larger potential consequences which can be permanently life-altering. When considering the use of psychedelics, be knowledgeable and informed so as to minimize the risk of complications.
Many seekers approach the world of entheogens with a desire for inner work and transformation. In this desire for change, the potential risks of psychedelics can sometimes be overlooked. Careful attention to dosage, substance type, environment (setting), and any pre-existing medical, psychological, or physical conditions can influence the difference between a positive psychedelic experience and one that is dangerous.
Read on to find out more about the potential dangers of psychedelic usage and tips and strategies for how to prevent them from occurring.
1. “Bad Trips”: Difficult Experiences
What many in the community refer to as a “bad trip” is more appropriately understood as a “difficult experience.” A trip or journey refers to the period of time in which a person is under the effect of a psychedelic substance. One’s state of consciousness becomes altered by the substance. The goal for most people is to have an experience that leads to further insight or understanding. Often, journeys are beautiful, pleasant, and euphoric. Other times, the experience becomes uncomfortable for an extended period, and this is what is often called a bad trip or difficult experience.
While most journeys might contain elements that are slightly unpleasant, a few moments of discomfort don’t necessarily make an experience difficult. Usually, a difficult experience will consist of a persistent negative sensation that lasts for an extended time and threatens to overwhelm the user, leading to varying levels of distress. It is not possible to stop a difficult experience in progress, but it can be shifted into a positive experience if the user is supported, supervised, and comforted by others.
One common element of a challenging journey is time dilation. The participant feels that time has slowed down, or even stopped entirely. The sensation of time dilation can be incredibly distressing and make one feel that the difficult experience will never end. One way for a sitter or guide to help if someone is experiencing time dilation is to reassure them it won’t go on forever and that the trip will inevitably end. For participants, it is good to remember, as far as it is possible in the moment, to breathe and to keep in mind that a process is unfolding and the process will eventually be over.
Along with time dilation, visions and visual effects can also cause extremely vivid and terrifying distortions in perception, such as a friend or family member’s face morphing into the perceived shape of an entity or demon. Occasionally, a person can encounter things or beings that seem physically real, in the moment. The sometimes disturbing effects of visualizations, which can feel incredibly material, can be tolerated more easily if the guide or sitter reminds the user that these visions are induced by the substance and will pass.
Set and setting are crucial in preventing challenging experiences. It is always recommended to work with an experienced guide. In some instances, at lower doses, difficult journeys can be averted by taking the substances in the presence of trusted friends in an area where one feels comfortable and safe. The more times you take a psychedelic substance, the more likely it is that you will eventually have a challenging experience. Don’t assume that you will never experience a difficult journey, especially if you plan to use the substances more than once.
2. Dissociative Effects
With psychedelic use there is some risk of dissociation. The dissociative effects of psychedelic substances will often depend on dosage and how much of a substance is used. In lower doses, the dissociative effects are relatively mild and can range between disorientation, numbness, clumsiness, visual effects, and increases in blood pressure and heart rate. Dissociation is not necessarily negative; in many cases, it can be a part of ego dissolution, and can lead to positive changes in mood and mindset.
In larger doses, the dissociative effects of psychedelic substances can be much more severe. These can include panic, anxiety, amnesia, drastic mood swings, breathing issues, seizures, and psychotic symptoms. The dissociative effects can result in dangerous behaviors which may lead to destructive tendencies or altering of the body’s internal stasis, prompting a medical crisis.
More research is needed to understand the potential of long-term dissociative effects, but in some rare cases, psychedelic substance use may be responsible for continued complications even after usage ends, such as psychosis, memory loss, anxiety, depression, weight loss, and suicidal thoughts. This is more likely when the psychedelic substance has been used carelessly in a recreational setting, without attention to set, setting, and sitter. There have also been cases reported anecdotally within the psychedelic community of depression, anxiety and suicide following a psychedelic retreat where the retreat center used deceptive marketing, promising participants a “miracle.” Psychedelics are a powerful tool, but a positive result is never guaranteed. Integration and doing the hard “work” that follows a psychedelic experience is always part of the healing process. In any case, while such effects are not common and benefits may outweigh dangers, it is useful to be aware of all possible risks before embarking on a psychedelic journey.
People with a background of mental illness or a history of mental illness in their immediate family may be at particular risk for dissociative effects and may wish to consider these dangers carefully. The best way to avoid the risk of dissociative effects is either to avoid taking the substance or to start with very small doses. If you start to persistently experience negative dissociative effects after taking lower doses of a psychedelic substance, it is best to discontinue use of the substance.
According to the American Psychiatric Association, depersonalization disorder, also called derealization disorder, is a condition that involves someone feeling detached, outside of his or her body, or experiencing unreal sensations while still maintaining a concept of reality. While this exists as a freestanding disorder, the same symptoms can be experienced while under the influence of psychedelic substances.
Most research has indicated that psychedelic substances are not associated with inciting the development of depersonalization disorders, but sometimes the effects of the substances can exacerbate symptoms of a previously undiagnosed disorder and subsequently lead to a diagnosis of a dissociative disorder. In other words, the entheogenic substance did not cause the person to develop the disorder. Rather, the condition was present with subclinical symptoms prior to substance usage.
If depersonalization is experienced while under the influence of a substance, often the individual will need to be isolated or placed in a quiet, calming environment. The removal of potential environmental stimuli can help reduce distress. Even in a bad trip that involves depersonalization, the overall result can be positive if combined with the correct guidance.
However, if depersonalization symptoms repeatedly occur with continued substance use, it is recommended to discontinue use of the substance or take an extended break.
4. Ego Inflation
Ego inflation is an experience which results in the substance user feeling the magnification of his or her ego, which can result in a superiority complex or projected arrogance. The user feels more confident, intelligent, and often believes he or she is somehow special, “chosen,” and better than everyone else. Symptoms can reflect those seen in the psychiatric condition known as narcissistic personality disorder.
In moderation, a temporary effect of ego inflation can occasionally be desirable and helpful. For instance, the participant may experience boosts in self-esteem and be more apt to handle social interactions due to increased confidence. However, these same traits may also sabotage a participant’s ability to manage situations when they occur on a more intense level. The egotistical behavior frequently displays itself as narcissistic, selfish, and rude.
Repeated exposure to the substance and incitement of the ego inflation effects can result in the reflection of these symptoms even outside of substance use, which can be detrimental to everyday life. Symptoms of superiority can result in other destructive and potentially violent behaviors. Individuals may lose jobs or friendships due to these persistently negative effects.
The best practice to avoid symptoms of ego inflation are to keep substance doses low and to avoid repeated use of any substances which repeatedly evoke these symptoms. Integration practices and post-psychedelic coaching are also useful tools in avoiding sustained ego-inflation.
5. Serotonin Syndrome
Serotonin is a neuromodulator that is a critical component in determining mood and cognition, in addition to a number of other vital bodily processes. It has been identified as a major player in many psychiatric disorders, such as anxiety and depression. Many psychedelics interact with serotonin receptors in the brain.
Serotonin syndrome occurs as the result of taking medications and/or substances that increase serotonin in the body to dangerous levels. An excess of serotonin can cause symptoms that range from relatively mild, such as shivering and diarrhea, to severe, such as seizures and even death. Serotonin syndrome can occur when taking psychedelic substances, most commonly when ingested concurrently with tricyclic antidepressants (SSRIs).
There is a wide range of substance combinations that can result in the development of potentially fatal serotonin syndrome, including over-the-counter agents and even some herbal products. As such, care should be taken to determine whether using a psychedelic substance will interact with other medications and cause the life-threatening serotonin syndrome. Participants should check all medications and seek guidance from facilitators before participating in a psychedelic experience. Always consult a medical professional and follow professional guidance when choosing to come off any prescription medications.
Clinically, serotonin syndrome usually presents as cognitive changes, such as confusion, agitation, hypomania, as well as neuromuscular disorders, including spasms, rigidity, and tremors. In addition, those with serotonin syndrome also tend to have a hyperactive autonomic system, meaning increased incidence of diarrhea, fever, blood pressure fluctuations, and pupil dilation.
6. Hallucinogen Persisting Perception Disorder (HPPD)
Arguably one of the most disruptive potential side effects of psychedelic substance usage is hallucinogen persisting perception disorder (HPPD). HPPD is a rare condition in which certain experiences from past experiences occur sporadically, without warning, days or even years after taking the substance. Current research suggests that HPPD is more likely to occur in individuals who have a history of psychological illness, but it can occur in anyone. An uncomfortable vision or distortion in perception might recur as a “flashback” long after the substance was used and can occur whether the substance was used a number of times or only once.
It has been reported in various studies that between 5% to 50% of psychedelic substance users report some instance of experiencing a flashback. A psychedelic flashback specifically occurs during a substance-free period.
The psychedelic experiences which occur as flashbacks can vary, ranging from the perception of geometric shapes, colorful light flashes, after images, halos, and perceiving objects in the peripheral visual field. These individual perceptions can last seconds to minutes, and the episodes themselves may occur over the course of years.
Patients with HPPD are able to realize that the visual disturbances they are perceiving are unreal, which is what differentiates the condition from most psychotic disorders.
Treatment for HPPD is not always successful. For some, antidepressants and antipsychotic medicines may help alleviate the symptoms and limit the psychedelic flashbacks. For many, it can be very disruptive to daily life and can result in significantly decreased productivity and overall wellbeing. To help avoid HPPD, participants should work with an experienced, trusted guide who understands correct dosages.
7. Potential to Trigger Schizophrenia-like Psychosis
While there are a number of genetic and environmental factors that are implicated in the development of schizophrenia, it has been shown in some research that some psychedelic substances may elicit a schizophrenia-like psychosis.
One of the first psychedelic substances to be linked to schizophrenia was lysergic acid diethylamide, more commonly known as LSD. A study in the 1970s linked LSD use to earlier onset of schizophrenia and indicated that LSD may have a precipitating effect in regard to the onset of clinically diagnosed schizophrenia, in addition to inducing schizophrenia-like symptoms and visual effects during the actual intoxication period.
Even substances that are traditionally considered milder, such as cannabis, have been shown to have a relationship to schizophrenia. In a study known as the Swedish Conscripts Study, 45,000 individuals were studied over a period of fifteen years. The risk of developing schizophrenia was 2.4 times higher in those who had reported using cannabis. Those who reported heavy cannabis use saw a six times greater risk of schizophrenia.
To read more about each individual psychedelic and its relationship to schizophrenia, check out this article which provides a detailed, scientific explanation of each substance and its potential mechanisms for causing schizophrenia-like psychosis and increasing the risk of later developing clinical schizophrenia.
In relation to schizophrenia, psychosis, and psychedelics, it is also useful to consider alternative, non-Western concepts of thinking about mental illness. In many tribal cultures of the Amazon, for instance, psychosis is sometimes seen as a shamanic initiation process. Within these non-Western perspectives, what we often call “psychosis” does not always signal illness, but can be part of a powerful process of spiritual transformation and growth. In fact, what the Western, Anglo-European gaze sees as psychosis can be a requirement of shamanism in indigenous traditions. At the same time, psychedelics are increasingly consumed in a Western context outside of strictly traditional frameworks and Western participants should always be aware of the risks involved.
Many might seek out psychedelic substances in order to feel intense emotional highs, known as hypomania. In some rare cases, however, such mood swings can be disruptive to daily life and affect the ability to think clearly and execute good judgement. Current research suggests that the risk of hypomania is rare, especially when psychedelics are used in a therapeutic context. Nonetheless, in people with certain predispositions, the hypomania induced by some substances can have dangerous effects.
Mania and hypomania are often most notable in those with bipolar disorder, representing intense periods of excitability, elevated mood, and hyperactivity in stark contrast to periods of crippling depression. Those who have a strong family history of bipolar disorder should approach psychedelic substances with caution. Current research suggests that ketamine may be safer than psilocybin or MDMA when used as a therapeutic tool for individuals with diagnosed bipolar disorder. Although some individuals with bipolar disorder have successfully used psychedelics and have even found them beneficial, care is needed in this area and cases should be assessed on an individual basis.
The best way to avoid the effects of hypomania is to have a support system in place. Friends or family who notice signs of mania, such as lack of sleep and losing touch with reality, need to make the user aware of the symptoms so the substance user can stop using the psychedelic substance. Most commonly, a period of sobriety is necessary to help stabilize the individual and avoid future complications from the substance.
9. Triggering or Worsening Anxiety
An increasing number of studies show that psychedelics can be incredibly effective in treating depression and anxiety. At the same time, for certain individuals, psychedelic substances can incite or worsen anxiety, panic, and paranoia. There is no guarantee with taking a substance that no negative symptoms will be experienced, and as such it is difficult to determine how serious the dangerous effects of a substance may be for an individual. Psychedelics help many people but they are not for everyone. While benefits can be significant, participants should also be aware of risks.
Many times, a psychedelic substance user may experience a sense of panic or persecution while under the intoxication of the substance, but the sensation of anxiety can persist even after the substance use, lasting for weeks to months later. This type of negative reaction is especially likely in a setting where there is no guide or group support.
When used recreationally in the absence of support and guidance, it is more likely the user will develop future anxiety disorders. Those who experience these intense sensations of anxiety that persist after the psychedelic journey is over should discontinue use of the substance.
The basic standard of care for those who have taken a psychedelic substance and are experiencing extreme anxiety is to attempt to calm the user and to place the user in a relaxing, stress-free environment while offering supportive, reassuring dialogue. Sometimes, in extreme cases when the individual cannot be calmed, a medical professional may need to be contacted in order to sedate the user or physically restrain them until the effects of the substances have worn off. Following the experience, integration and psychedelic coaching are useful ways to process the anxiety and understand its root cause.
10. Risk of Accidental Self Poisoning
One often-overlooked danger of psychedelic substance use is the potential effect of being poisoned. This occurs most frequently in those who seek out psychedelic mushrooms and accidentally select poisonous mushrooms, instead.
Psilocybin mushrooms contain an organic chemical which causes psychedelic effects. However, many types of mushrooms can appear similar in shape and color, and so it can be challenging to determine which type of mushroom one is consuming.
Mycologists, those who study fungi, have said that many amateur mushroom hunters have inadvertently consumed toxic mushrooms while pursuing the psilocybin mushrooms. Often, eating a poisonous mushroom can result in severe sickness, with vomiting and diarrhea. This can result in trips to the emergency room and, in worst-case scenarios, death.
One of the best and simplest ways to avoid the risk of poisoning yourself with incorrect types of mushrooms is to obtain psychedelic mushrooms only from an educated, trustworthy source, or to grow your own supply. Some mushrooms sold on the streets have even been reportedly laced with more potent psychedelics, such as LSD. It is always best to practice caution.
11. Risk of Physical Harm to Self or Others
According to a study that specifically analyzed individuals reporting negative outcomes after ingesting psilocybin mushrooms, 11% of users reported putting themselves or others at risk of physical injury. These dangers seemed to increase based on dose and duration of substance use. Ingesting psychedelics alone or in a non-ritual setting are also more likely to result in harm.
Due to the altered state of consciousness incited by psychedelic substance use, users sometimes do not even realize they are putting themselves or others at risk of injury. Strong visual effects might result in warped perceptions, such as the idea that a friend is suddenly a demonic figure wishing to inflict harm, and a substance user might inadvertently harm someone out of a sense of self-defense.
While psychedelics do not tend to evoke violent behavior as a rule, psychedelics can result in a higher potential for accidents or dangerous behaviors. As mentioned above in relation to ego-inflation, some of the effects of psychedelic substances can result in an inflated sense of self, which can lead to a superiority complex that may leave the user feeling practically invincible. It may result in a user engaging in dangerous activities that a sober individual would not pursue. The altered perceptions inherent with psychedelic substances can also, rarely, result in a user misperceiving the danger associated with a particular environment or behavior. For example, while intoxicated, a user may think he can safely run into traffic or that he has the ability to fly. To avoid this, it is advised to remain in a contained, safe area when taking psychedelic substances. Again, this is a reason to experience psychedelics in the care of an experienced guide and/or a ritualized group setting, where experienced support and supervision is in place.
12. Complications from Overdose
The risk of overdose with psychedelics is extremely rare, but can occur. A psychological overdose is more common than a physical overdose. With psychedelic substances, what may seem like a very tiny dose to an inexperienced user can actually be an incredibly concentrated and potent dosage. Psychedelic substances affect the nervous system and in rare cases, an overdose can result in severe physical symptoms, like serotonin syndrome.
Mixing psychedelic substances with other substances can also result in accidental overdoses and fatality. Some psychedelics interact severely and should never be combined, such as 5-MeO-DMT and DMT (including ayahuasca), or DMT and iboga/ibogaine. Mixing alcohol with psychedelics can significantly damage organs and can result in death. As a general rule of thumb, do not mix psychedelics with any other substances, including other psychedelics.
As with all substance use, it is important to carefully monitor dosage amount and be conscious of the substance’s interaction with all other medication, both prescribed and over the counter.
How to Prevent and Reduce Adverse Effects of Psychedelic Substances
For many, the benefits of psychedelics outweigh the risks outlined above. At the same time, it is important to know what precautions to take in order to reduce the incidence of complications if a person chooses to participate in psychedelic substance use.
One of the biggest safety precautions you can take if using a psychedelic substance is to do so in a ritualized setting under the care of a trained facilitator or guide, with sober supervision. If a ritual setting is not possible, an alternative is to enlist the help of a trusted friend or family member as a “sitter.” This will ensure that someone will be able to monitor you, help you navigate challenging moments, and look for any early signs of negative effects. A supportive individual or group of friends can help keep you safe while on the substance and seek proper medical attention, should anything harmful occur.
Another important component of using psychedelic substances to help reduce the risk of complications is to have the correct mindset as a user before even taking the substance. By approaching the experience with an appreciation for the seriousness of potential complications, one can take appropriate precautions to prevent adverse outcomes. A high level of sincerity and reverence for the power of these entheogenic substances is important, along with intentional preparation on the physical, mental, and spiritual levels.
What Precautions Should I Take Before Using a Psychedelic Substance?
Consider the six S’s: Set, Setting, Substance, Sitter, Session, and Situation
- Set: Your mindset before the trip should be calm and prepared, including setting clear intentions.
- Setting: The setting (your environment) should be comfortable, harmonious, and familiar.
- Substance: The substance and dosage should be carefully considered, researched, and understood.
- Sitter: A sitter is critical for a safe experience.
- Session: One should be aware of the session timeline for the substance being consumed (i.e. the amount of time in which the substance will be active).
- Situation: Situation refers to intention and how a participant will integrate the substance use into their life.
First of all, experienced users recommend approaching psychedelic substance use with a proper mindset. This includes knowledge about the substance and a calm, unhurried approach to the experience. A daily meditation practice of any kind, for any length, is an excellent way to prepare one’s mindset prior to a psychedelic experience. Setting clear intentions for the experience and journaling about these intentions is also useful.
It is also recommended that the setting, or environment, in which the substance is taken is preferably familiar, harmonious, comfortable, and uncluttered. Many of the negative and dangerous effects associated with psychedelics, including challenging journeys and more serious complications, are related to having a dirty, cluttered, overwhelming environment. For this reason, it is advised that environments be kept minimal, with soft, comfortable surroundings, limited visual distractions and with relatively calming, non-distracting audio stimuli. For ritual group settings, live music is preferable to recorded music, although carefully selected recorded music can also be very useful. Choose beautiful, calming, inspirational musical selections and avoid heavy, driving beats or aggressive, dissonant sounds.
Familiarity with your environment will help reduce the likelihood of negative sensations associated with the substance, but as mentioned above, it is highly encouraged to have a “sitter,” or someone with you who is sober. Even if taking the substance in a social setting with other users, it is still important to have at least one sober individual who can assist if things begin to become dangerous.
When selecting someone to be a sitter, it is often better to have someone who has had experience with psychedelic substances so they can help guide you and recognize ill effects. The sitter must be completely sober, however, in order to function as the reassuring and responsible party during the journey. Sitters must be competent and ready to act suddenly and safely in an emergency situation.
Psychedelics are powerful substances and deserve respect. Although these substances have the ability to transform lives, they can also do harm if not properly handled and understood. All participants and seekers have a responsibility to educate themselves and to be aware of the risks associated with psychedelics.