The Risks of Psychedelic Experiences: Myths and Facts

At Psychedelic Support, we’re convinced of the evidence-based potential psychedelic substances have to improve lives. But does our excitement make us overzealous about the risks of psychedelics? Let’s talk myths and facts about the risks of psychedelic experiences. 

In the last few years, psychedelics have been decriminalized in cities across the country, like: Denver, Oakland, Santa Fe, Ann Arbor, Somerville, and Washington, D.C. On top of that, Oregon has gone one step further by aiming for statewide access to psychedelics in early 2023. 

At Psychedelic Support, we’re excited about decriminalization and creating avenues for access. That’s why we’re all about empowering clinicians to confidently offer psychedelic therapy to their patients. But has our excitement about psychedelics led us to move too quickly? Are there significant risks of psychedelics that we’re overlooking? 

Many of our early ideas about psychedelic risks come from criminalization measures. Sensationalized media stories from the mid-1900s painted a scary story about psychedelics and the people who used them. Yet when we look at psychedelic’s risk from an evidence-based perspective, these reports don’t hold up. Reality is more nuanced. Here’s the evidence-based scoop. 

Do Psychedelics Cause Schizophrenia and Psychosis?

For a while now, we’ve had this cultural idea that psychedelics cause psychosis. In research during the 60’s, patients sometimes experienced psychotic symptoms lasting up to 48 hours. This was an important fear to establish when the DEA outlawed psychedelics in 1970.[1]

These early studies often did not meet the standards we require today. For example, may early studies [1]:

• Neglected to control the setting where patients took psychedelics
• Failed to exclude patients at risk for psychosis
• Did not maintain a control group 

As we know now, all these factors make the results of these studies difficult to analyze at best, and irrelevant at worst. 

With what we know now, it’s clear that these adverse patient outcomes often resulted from unethical science. Patients were often given high doses of LSD without preparation, and were even restrained during their experiences. Given this context, it would appear that psychotic episodes were caused not by LSD, but by abusive research methods [1]. 

However, there are rare cases when psychedelics have caused overwhelming hallucinations. People with a history of psychotic disorders may be at a higher risk for these negative outcomes. Modern clinical trials have yet to see psychosis resulting from psychedelic medicine, but it still remains a concern for many people [1]. 

Note: For more about psychedelic medicine and psychosis, read our blog Can Psychedelics Cause Psychosis?.   

Do Psychedelics Cause Dependency?

In the 60’s, the media coined the term “period use amongst arty types”[1]. The root idea being that hallucinogens caused a specific type of substance dependence. Many believed that, since people were using them frequently, they must have a high potential for abuse. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) acknowledges hallucinogen use disorder (HUD). The manual lists three categories of HUD: hallucinogen dependence, hallucinogen abuse, and other HUD. 

Yet psychedelics don’t meet the profile of other substances that cause dependency. Few people find it difficult to cut down on psychedelic use – a hallmark of pathological dependency. The bottom line is that HUD is uncommon, and there’s a low risk of people developing dependency after experiencing psychedelics [2]. The majority of people who use psychedelics are not dependent on them. 

In fact, when compared with other substances, psychedelics have very low abuse and dependency potential. In 2017, the Substance Abuse and Mental Health Services Administration ranked psychedelics at the bottom of their list of dependence risk [3]. 

Psychedelic therapists should still educate themselves about abuse and how to prevent it in the rare cases when it can happen. 

Note: For more about the nuances of psychedelics abuse and dependency, check out our blog Can Psychedelics Be Abused? And How to Prevent It in Patients. 

Can Psychedelics Cause Flashbacks?

Maybe you heard in high school that LSD flashbacks can happen years after a psychedelic experience. This popular legend still persists, and has been documented in some users. But these post-experience hallucinations are not specific to psychedelics. They can also happen with other psychoactive substances, like alcohol and benzodiazepines [1].

If these hallucinations persist, they’re called Hallucinogen Persisting Perception Disorder (HPPD). We’re still not sure how common this syndrome is. The DSM-V reports a prevalence rate of 4.2% in people who use hallucinogens [4]. However, this is even more rare in the clinical context, and we believe this is because of screening and patient preparation [1]. 

One small study seemed to show that people who experienced anxiety and panic during their psychedelic experiences were more likely to experience HPPD afterward. Because of this, symptoms of flashbacks may be more similar to a trauma response rather than residual effects from the psychedelics [5]. 

What if Patients Experience a “Bad Trip” in Therapy?

Your patients may be worried about having challenging experiences, or “bad trips,” while taking psychedelics. This can happen, although it’s more rare in the context of therapy. There’s no exact definition of this experience. Generally people describe feelings of fear, anxiety, dysphoria, and paranoia that don’t last past the acute hallucinogenic period [1]. 

Yet even these “bad trips’” may not be all bad. One 2016 survey measured outcomes from people who self-reported challenging experiences from psychedelics. 84% of this group said that they still benefited from their experiences in the long-term, despite these “bad trips” [6]. Research suggests that these unpleasant experiences are transient, and they don’t take away from the therapeutic benefits of psychedelics [7]. 

We’re still not sure why some people have negative experiences and others don’t. Some research suggests that people with high levels of openness, acceptance, and absorption may be more likely to have positive experiences. People who are more apprehensive or preoccupied may be more predisposed to “bad trips” [8]. 

To mitigate this risk, psychedelic experiences should be paired with therapy sessions and close supervision. Setting and dose should also be carefully controlled in order to decrease the likelihood of negative experiences. With time, we’ll know more about how to prevent or interpret challenging experiences in patients.

Interested in preventing bad trips with evidence-based harm reduction? Check out our free guide.  

Can People Hurt Themselves While on Psychedelics?

It’s no secret that psychedelic experiences can be emotional for people. Psychedelics can bring past trauma to the surface, and make people see the world differently. Sometimes folks are overwhelmed with their experience. If they’re unprepared, or in the wrong setting, the effects of psychedelics may cause people to act out in dangerous ways [9]. 

In rare cases, people experiencing psychedelics have jumped from buildings and did not survive [10]. This is a serious risk for people who undergo psychedelic experiences without supervision. 

Other substances such as alcohol and opiates cause thousands of deaths per year. Compared with other substances, the risk for physical harm is relatively rare [11]. 

Within psychedelic medicine, physical harm is mitigated by using safe standards of care for all patients. Establishing rapport and trust with patients before their experiences helps them feel safe. The controlled setting of supervised therapy ensures that patients can’t hurt themselves or others. That’s why proper education is vital for the success and safety of patients. 

Can You Overdose on Psychedelics?

At normal doses, psychedelics are physiologically safe. Overdoses have happened under very large doses, for example, at more than 550 times the recommended LSD dose [1, 12]. Even at these high doses, they have made full recoveries. Mixing psychedelics with other substances like alcohol can also increase the chances of toxicity [13]. 

However, in the clinical setting, dosage is set and controlled. Clinicians strictly monitor patients for physiological symptoms outside of the norm, or symptoms of overdose. Because of psychedelic medicine’s strict standards, toxicity and overdose have not occurred within the clinical setting. 

Are Psychedelics Neurotoxic?

Early, flawed research in psychedelic medicine promoted the idea that psychedelics were toxic to the brain, and could even damage chromosomes. These early conclusions were widely publicized. Unfortunately, when these ideas were disproven or retracted, the damage to public perception had already been done [1]. 

Most researchers believe that psychedelics are non-toxic. They don’t damage mammalian organs, and they’re generally physiologically safe [14]. We’ve failed to see any neurocognitive problems from contemporary research [15]. In fact, some research even suggests that psychedelics promote neuroplasticity and neurogenesis  – meaning they may actually help us build more connections and new neurons [16].  

Learn more about how psychedelics help neurons grow on our blog.

Key Takeaways About the Risks of Psychedelic Medicine

So often in medicine, we look for answers that are “right” and “wrong.” We want to give patients clear answers that don’t confuse them. 

But psychedelic medicine, like all medicine, is more complicated than that. Just like when prescribing any other medication, psychedelic clinicians must understand that one therapy won’t be useful for all patients. Every medical intervention has its risks and benefits. By dismantling old misconceptions, we hope to create a better understanding within this growing field. 

Psychedelics medicine holds the potential to change countless lives. With the right education, high standards, safety precautions, and increased research – we can mitigate the risks of psychedelic therapy in order to unlock its potential for healing. 

Want to learn more about reducing the risks of psychedelic experiences? Psychedelic Support has created a free learning course on psychedelic harm reduction. In this course, you’ll learn how to limit the harm of “bad trips” and understand the risks of psychedelic use. Sign up for this online course today!

References:

1. Schlag AK, Aday J, Salam I, Neill JC, Nutt DJ. Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. J Psychopharmacol. 2022 Mar;36(3):258-272. doi: 10.1177/02698811211069100. Epub 2022 Feb 2. PMID: 35107059; PMCID: PMC8905125.
2. Shalit, N, Rehm, J, Lev-Ran, S (2019) Epidemiology of hallucinogen use in the U.S. results from the National epidemiologic survey on alcohol and related conditions III. Addictive Behaviors 89: 35–43.
3. Substance Abuse and Mental Health Services Administration (SAMHSA) (2017) Results from the 2017 National Survey on Drug Use and Health: Detailed Tables. Available at: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.htm#lotsect1pe
4. American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: APA.
5. Halpern, JH, Lerner, AG, Passie, T (2016) A review of hallucinogen persisting perception disorder (HPPD) and an exploratory study of subjects claiming symptoms of HPPD. In: Halberstadt, Vollenweider, Nichols, DE (eds) Behavioral Neurobiology of Psychedelic Drugs. Berlin; Heidelberg: Springer, pp.333–360.
6. Carbonaro, TM, Bradstreet, MP, Barrett, FS, et al. (2016) Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology 30: 1268–1278.
7. Carhart-Harris, RL, Bolstridge, M, Rucker, J, et al. (2016) Psilocybin with psychological support for treatment-resistant depression: An open-label feasibility study. The Lancet Psychiatry 3(7): 619–627.
8. Aday, JS, Davis, AK, Mitzkovitz, CM, et al. (2021) Predicting reactions to psychedelic drugs: A systematic review of states and traits related to acute drug effects. ACS Pharmacology & Translational Science 4(2): 424–435.
9. Johnson, MW, Richards, WA, Griffiths, RR (2008) Human hallucinogen research: Guidelines for safety. Journal of Psychopharmacology 22(6): 603–620.
10. Honyiglo, E, Franchi, A, Cartiser, N, et al. (2019) Unpredictable behavior under the influence of ‘magic mushrooms’: A case report and review of the literature. Journal of Forensic Sciences 64(4): 1266–1270.
11. Nutt DJ, King LA, Phillips LD; Independent Scientific Committee on Drugs. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010 Nov 6;376(9752):1558-65. doi: 10.1016/S0140-6736(10)61462-6. Epub 2010 Oct 29. PMID: 21036393.
12. Haden M, Woods B. LSD Overdoses: Three Case Reports. J Stud Alcohol Drugs. 2020 Jan;81(1):115-118. PMID: 32048609.
13. Van Amsterdam, J, Opperhuizen, A, Van den Brink, W (2011) Harm potential of magic mushroom use: A review. Regulatory Toxicology and Pharmacology 59(3): 423–429.
14. Malcolm, B, Thomas, K (2021) Serotonin toxicity of serotonergic psychedelics. Psychopharmacology. Epub ahead of print 12 July. DOI: 10.1007/s00213-021-05876-x.
15. Aday, JS, Mitzkovitz, CM, Bloesch, EK, et al. (2020b) Long-term effects of psychedelic drugs: A systematic review. Neuroscience and Biobehavioral Reviews 113: 179–189.
16. Ly, C, Greb, AC, Cameron, L, et al. (2018) Psychedelics promote structural and functional neural plasticity. Cell Reports 23(11): 3170–3182.