Best practices for first psychedelic experiences: harm reduction advice from the psychedelic community

The use of psychedelics is currently increasing in the United States. Awareness of clinical trials investigating the therapeutic applications of psychedelics may result in a record number of people who use psychedelics for the first-time. This study aimed to develop a harm-reduction resource to facilitate safe and successful psychedelic experiences outside of regulated clinical and research settings. We employed a community-based approach to crowdsource practical recommendations for first-time psychedelic experiences from the psychedelic community.

We conducted an online survey with 581 individuals who reported psychedelic use (N = 581) on recommendations for people using psychedelics for the first-time, following the principles of community-based collaborative research. The survey assessed recommendations for and against specific psychedelics for first-time experiences, recommendations for and against combinations of psychedelics, and other advice for first-time experiences. Open-ended follow-up questions were included to understand participants' reasons for their recommendations. An experienced qualitative researcher and two qualitative coders analyzed responses to open-ended items.

Most participants recommended psilocybin for first-time psychedelic experiences, approximately half recommended cannabis, and a third recommended MDMA/MDA (3,4-methylenedioxymethamphetamine/3,4-methylenedioxyamphetamine, ecstasy, molly). These substances were favored for their moderate intensity, dose-dependent effects, precise dosing, and relatively short duration of effects. Conversely, substances such as ayahuasca, DMT (N,N-dimethyltryptamine), 5-MeO-DMT (5-methoxy-N,N-dimethyltryptamine), and Salvia divinorum or salvinorin A were not recommended due to their intensity, mental and physical health risks, and safety concerns. Participants advised against mixing psychedelics with alcohol, stimulants, antidepressants, and narcotics/opiates. Additional recommendations included embracing the experience, learning about the substance and its effects, and setting intentions for the experience.

Given the growing interest in psychedelics despite limited legal access and systematic education available, it is crucial to inform the public about practices that minimize risks. This project compiled recommendations from individuals who self-identified being experienced with psychedelics. The active involvement of the psychedelic community may enhance research quality and public trust in the findings.