Dr Lee here and I get this question almost every single day! While many people can picture themselves tolerating common side effects like headaches and nausea, it’s the long-term psychiatric consequences that I field the most questions on. People are worried they will have some type of long-term issue after doing drugs!
When it comes to ‘having a bad trip,’ I actually think there’s two questions here:
- The possibility of a serious adverse event (an SAE) or a long term psychiatric issue- like worsening depression, or developing schizophrenia. This we can give a pretty clear evidence based answer: psilocybin is safe and has a track record in research that is pretty incredible.
- The possibility of challenging material arising during the journey. This is pretty much inevitable and indeed why most people need to come here. I don’t sugar coat this part. Tough things come up, and it needs to happen.
THE BIG IDEA
Serious psychiatric adverse events are not linked to psychedelic use in research! I bolded it because it’s so important to say it clearly and succinctly.
I want to take some time to review an excellent research article that I read this week. It is titled “Adverse Events in Studies of Classic Psychedelics: A Systematic Review and Meta-Analysis.”
First let’s break down the title! Adverse events are side effects.
A systematic review and meta-analysis means that this paper combines the data and information from OTHER trials and research to make a conclusion. This is a common research method once we start accumulating a lot of trials. We can combine them and make stronger conclusions. It involves a ton of smart people and a bunch of math.
The specific article combined information from 214 studies of psychedelics (3504 participants). Each study might only have 20-30 people in it. By combining a bunch of studies, we can draw better conclusions about side effects that do happen.
THE DETAILS AND FINDINGS
This article explores the types of adverse events that occur with psychedelic use, and how often they occur. It notes that non-significant adverse events aren’t that rare- nausea and headache occur in a pretty significant number of people that use psychedelics. But what the article really highlights is the remarkable safety of psilocybin in regards to serious adverse events.
-Significant Adverse Effects (SAEs) are defined as worsening depression, suicidal behavior, psychosis, and convulsive episodes
-SAEs were reported for no healthy participants. Literally zero!
-SAEs were reported for approximately 4% of participants with preexisting neuropsychiatric disorders (like depression or bipolar disorder). However, many of these are from trials in the 50s and 60s.
-In contemporary research settings, there were no reports of serious adverse events(deaths by suicide, persistent psychotic disorders, or hallucinogen persisting perception disorders following administration of high-dose classic psychedelics)
I think the best comparison is to think about what traditional mental health care treatment looks like. For many of us that have tried traditional psych medication, side effects for months at a time are almost a guarantee. Psych medications also have overdose potential that is absent with psychedelic therapy.
HOW DOES THIS AFFECT WHAT WE DO AT SPACE?
The knowledge in this article is something I use every single day. It makes me feel really good about my work- I’m managing a substance that has a really incredible safety record, and I feel great about communicating the risks and benefits of psilocybin with our potential clients.
I think other clinicians should also pay attention to this! When I was working as a doctor I felt pretty constrained by the tools that I had. If a patient was depressed or had anxiety, the gold-standard treatments we had were medication and therapy, and both of those take months and have their own special issues.
Psychedelic facilitation is special in that way. We’re dealing with something that works quickly and effectively when executed properly. And now there’s a growing body of evidence that psilocybin is remarkably safe as well.
THE SECOND KIND OF ‘BAD TRIP.’
Earlier in this post I said that there were two components of a ‘bad trip.’ The first, lasting psychiatric issues or serious adverse events, aren’t represented in literature. I don’t worry about that so much.
But the second part of a ‘bad trip’ is the idea that challenging material will arise. And to this I say: “No pain, no gain.”
People come to us for all kinds of crazy shit. Most people have spent years getting to the mental health place they’re in. The idea that you’ll get something amazing out of psilocybin in just 6 hours with *no* difficulties- I just don’t want people to have that presumption. You will be challenged with psilocybin, and that’s kind of the point.
Don’t be afraid of this kind of challenge, lean into it. It’s how we grow as humans, and psilocybin is just a small representation of that. When you book at Space, we will help you develop intentions and really understand what you are getting yourself into. That way, you can lean into the uncomfortable parts of the journey with preparation and understanding.
CITATIONS:
- Hinkle JT, Graziosi M, Nayak SM, Yaden DB. Adverse Events in Studies of Classic Psychedelics: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2024 Dec 1;81(12):1225-1235. doi: 10.1001/jamapsychiatry.2024.2546. PMID: 39230883; PMCID: PMC11375525.