Psychedelic experiences can be transformative, changing how people think and behave. In interviews with 26 participants in psychedelic retreats, 20 reported insights or experiences they believed were inaccessible without the drugs' psychoactive effects. All but one participant reported changes in identity, values, beliefs, desires, or behavior, with behavioral changes being most common. Participants felt capable of deciding to use psychedelics partly because they sought information beforehand. Several reported an enhanced ability to make changes in their lives. The findings highlight the importance of subjective embodiment and personal agency in shaping outcomes, raising neuroethical issues about consent and moral psychopharmacology.
The FDA rejected Lykos Therapeutics' application for MDMA-assisted therapy for PTSD in August 2024, partly due to a highly publicized case of alleged sexual misconduct by an unlicensed therapist during a Phase 2 trial. Several other cases of misconduct by facilitators at psychedelic retreats have raised questions about whether physical contact is ever appropriate during psychedelic-assisted therapy. Drawing on research about supportive touch in other clinical settings and considering features of psychedelics that increase the potential for harm, the authors advocate for a precautionary approach to harm-reduction while arguing that supportive touch should not be entirely discarded.
Public interest in psychedelics and adult use has grown alongside research into their clinical potential. A landscape analysis of online, publicly available information identified 298 organizations offering psychedelic retreats to English-speaking consumers between July and December 2023. Most organizations focused on general wellness rather than religious identity. Ayahuasca was the most commonly offered substance, followed by psilocybin and San Pedro. Retreats were held at 440 distinct physical locations worldwide, with 130 inside the United States and 310 outside. Prices varied widely. Further research into retreat practices is recommended to reduce harm and support consumer education.
Psychedelic retreat organizations vary widely in their safety precautions. All 49 organizations interviewed collected participant medical histories, and 73.5% excluded individuals with certain health conditions. Most required or recommended medication washout periods ranging from one day to over six weeks. While 69.4% worked with a licensed health care professional or someone with emergency response training, only 65.3% had such personnel in attendance at retreats at least some of the time. All organizations offered integration support. The variability in practices, particularly around medication washout and polysubstance use, may increase risks to participants. Best practice guidelines are needed and should be codeveloped with Indigenous and nonclinical communities.