Harm reduction practises for users of psychedelic drugs: a scoping review

Psychedelic use in naturalistic settings in Australia is increasing. Although the risks and harms of psychedelics from a physical perspective are low, psychedelic drugs carry a unique psychological risk profile which is increased in uncontrolled settings. Harm reduction support services align with the Australian Government's Federal Drug strategy, which includes harm reduction as the third pillar in the overall harm minimisation approach to drug use for the period of 2017-2026. This study examined the harm reduction behaviours which users of psychedelics in naturalistic settings currently use, and any harm reduction interventions which have been developed for this population. A scoping review was undertaken using online databases, Psychinfo, Medline, CINAHL and Scopus. Articles were included if they explored or informed harm reduction practices for users of psychedelic drugs in naturalistic settings, which included articles that investigated motivations for psychedelic use. Twenty-seven papers were included, which contained only four intervention-based studies. Harm reduction or benefit enhancing strategies were categorised into three themes: before psychedelic use, during psychedelic experience and after the experience (integration). The review found that users of psychedelic drugs in naturalistic settings employ several different harm minimisation strategies, predominantly before and during use. Motivation for use, social setting and dosage amount were all found to influence the strategies used. There were a limited number of evaluated interventions for users of psychedelics in naturalistic settings, identifying the need for further research in this area. Challenges for harm reduction campaigns such as low uptake of drug checking services and low trust in government institutions were identified. Further research needs to consider the differing motivations of psychedelic users and recognise strategies that promote benefit enhancement and reduce risk.