Reported Safety Practices of Publicly Advertised Psychedelic Retreats.

Reported Safety Practices of Publicly Advertised Psychedelic Retreats Key Points Question What safety precautions are implemented by psychedelic retreat organizations? Findings This qualitative study with representatives from 49 publicly advertised psychedelic retreat organizations found that most organizations collected medical histories about participants prior to participation, as well as required or recommended cessation of pharmaceutical drugs prior to attendance. Meaning These findings suggest that the proliferation of psychedelic retreats can pose safety risks and policy challenges despite the implementation of some safety practices, highlighting the need for continued research and best practice guidance. This qualitative study describes safety precautions reported by representatives of publicly advertised psychedelic retreat organizations. Importance The availability of psychedelic retreats has grown to meet the demand for access to these substances. Despite centuries of use among Indigenous communities, psychedelics can pose serious risks for some users. Objective To determine safety precautions that retreat organizations that offer psychedelic substances currently use. Design, Setting, and Participants This qualitative study included structured interviews conducted by phone or email with representatives from 49 organizations publicly advertising psychedelic retreat offerings from July to October 2023. Organizations were eligible if they marketed their services in English, offered at least 1 psychedelic substance, and made contact information available online. Organizations were selected using convenience sampling from a broader pool of organizations identified in a prior study. Data were analyzed from March 2024 to November 2025. Main Outcomes and Measures The main outcomes of interest included the types of drugs offered and presence of polysubstance use, collaboration with health care professionals, presence of health care professionals during retreats, disqualifying conditions, medication washout procedures, and integration practices. Descriptive statistics were used to characterize organizational practices and locations; content analysis was used to categorize medical exclusion criteria, medication washout protocols, involvement of health care professionals, integration offerings, and training of integration facilitators. Results Of 48 organizations that reported what substances they offered, all offered either ayahuasca, psilocybin, or both. Nineteen organizations (38.7%) offered more than 1 psychedelic substance. All organizations collected participant medical histories; 36 organizations (73.5%) excluded individuals with certain health conditions. Most (43 organizations [87.8%]) required or recommended medication washout for varying lengths of time, ranging from 1 day to more than 6 weeks. Most (34 organizations [69.4%]) worked with a licensed health care professional or someone with emergency response training, and 32 organizations (65.3%) had someone with those qualifications in attendance at retreats at least some of the time. All organizations offered some sort of integration support. Conclusions and Relevance This qualitative study of the practices implemented by psychedelic retreat organizations found substantial variability in the implementation of safety precautions. Some practices related to medication washout and polysubstance use may pose increased risks to participants. Best practice guidelines are needed and should be codeveloped with Indigenous and nonclinical communities. Introduction Psychedelic policy in the US is rapidly evolving. Department of Health and Human Services (DHHS) Secretary Robert F. Kennedy, Jr., recently endorsed their therapeutic potential, stating that his office aims to make psychedelics available in clinical settings within 12 months despite considerable scientific uncertainty and outstanding questions regarding clinical implementation. Meanwhile, nonclinical psychedelic use is on the rise, with 8.9% of young adults reporting use in 2023. In the absence of US Food and Drug Administration approval, users access psychedelics through illicit sources; so-called gray markets, which emerge in circumstances where state or local regulatory changes create legal ambiguities in the absence of official regulatory frameworks; state regulated programs; or international travel to countries with more lenient drug policies and/or religious traditions using psychedelics. To meet demand, psychedelic retreat organizations have proliferated, primarily in North and South America, with a considerable number located in the US. There is considerable variability in the duration and cost of psychedelic retreats, and although only a few publicly advertised retreat organizations purport to be providing medical care, studies of retreat participants suggest many retreat attendees are seeking relief from serious, often intractable, illnesses, among other motivations. This trend raises concerns about the potential for physical, psychological, and interpersonal harms stemming from psychedelic use, which are often left for health care practitioners to address without access to medical records or dosing information and with no clear oversight or clinical coordination. Although psychedelics have been shown to be relatively safe for healthy adults and have been used for centuries in Indigenous traditions, they can pose serious medical and psychiatric risks. Some psychedelics, like ibogaine, have been shown to be cardiotoxic, and individuals with cardiac abnormalities may be especially vulnerable to psychedelic use due to sympathomimetic effects and serotonin toxic effects. Those with personal or family histories of psychosis or bipolar disorder also face increased risk of negative effects. Furthermore, the psychoactive effects of psychedelics can leave individuals vulnerable to a variety of interpersonal harms. Harm is more likely when retreats lack proper screening, medication oversight, trained medical staff, or adequate integration and follow-up care. Between 1994 and 2022, 58 participant deaths were reported during ayahuasca retreats. None of the deaths in events where a cause was determined were attributed to ayahuasca toxic effects and instead were attributed to homicide, suicide, heart attack, drowning, or toxic additions to the ayahuasca brew—indicating that these deaths could have been preventable with proper screening and safety protocols. Yet, little is known about the precautions retreat organizations currently use or how practices vary. Here we report findings from a qualitative study intended to investigate these practices. Methods This qualitative study was approved by the Baylor College of Medicine institutional review board. All participants provided verbal informed consent. The Standards for Reporting Qualitative Research (SRQR) reporting guidelines were followed. Study Design and Data Collection We conducted interviews with representatives who were willing to speak to us from 49 organizations that publicly advertised psychedelic retreat offerings to English-speaking consumers, identified from a broader pool of 298 organizations identified in a prior landscape analysis. Eligible organizations had online contact information and were selected using convenience sampling; purposive sampling ensured representation outside the US. Up to 3 contact attempts were made. Interviews took place via phone or email between July and October 2023. Interviews were conducted by a trained research coordinator (C.S.B.), following a structured guide tailored to each organization to confirm and supplement publicly available information (eMethods in Supplement 1). We asked representatives about their organizations’ standard procedures regarding substances offered, safety procedures for screening, medication washout, medical oversight, and the provision and staffing of integration or aftercare services. Responses were recorded via typed notes, entered into REDCap (Vanderbilt) for data management, and exported to Excel 365 (Microsoft) for analysis by 3 team members (L.N.-S., J.O.R., and C.S.B.) Interviews were not recorded because their primary purpose was to verify and supplement data collected online. Data Analysis We used descriptive statistics to characterize organizational practices and locations, categorized as US- or non–US-based. Substances were tallied based on organizational reports. Interview notes were analyzed using content analysis to categorize medical exclusion criteria, medication washout protocols, involvement of health care professionals, integration and aftercare offerings, and the training of integration facilitators. We used descriptive statistics to characterize the data according to the categories developed through content analysis of interview notes. Data were analyzed from March 2024 to November 2025. Results We contacted 81 eligible organizations; 5 organizations declined and 26 organizations did not respond, yielding a 61.7% response rate. Most interviews were conducted by phone (44 interviews [88.0%]); 6 interviews (12.0%) were conducted by email. One organization was excluded because it did not host retreats. Our final sample included 49 organizations. Most (30 organizations [61.2%]) were US-based. Five organizations (10.2%) self-identified as medical, offering psychedelics for therapeutic purposes or within psychedelic-assisted therapy models (Table 1). Substances Offered Forty-eight organizations (97.9%) disclosed the psychedelic substances they offered. Ayahuasca (30 organizations) and psilocybin (28 organizations) were most common; all reported offering at least 1 of these. Others included San Pedro cactus (also known as mescaline) (9 organizations), mebufotenin (also known as 5-methoxy-N,N-dimethyltruptamine [DMT]) (6 organizations), DMT (4 organizations), changa (3 organizations), and ibogaine (2 organizations). Two also offered 3,4-methyllenedioxymethamphetamine (MDMA), and 1 offered ketamine. Most (34 organizations [71.4%]) offered more than 1 substance; 19 organizations (38.7%) offered more than 1 psychedelic substance; and 15 organizations (30.6%) offered a psychedelic and a nonpsychedelic substance, like kambo, hapé, cacao, sananga, or cannabis. Of organizations that offered more than 1 psychedelic, some combined multiple psychedelics in a single retreat—eg, ayahuasca on 4 days, San Pedro cactus on 2 days—while others offered different psychedelic substances at separate events. Medical Screening Practices All 49 organizations collected participant medical histories. Thirty-six organizations (73.5%) excluded individuals with certain conditions; 32 organizations (65.3%) specified at least 1 exclusion criterion. Mental health concerns were most common: 26 organizations (53.1%) excluded participants with a mental illness, especially schizophrenia or psychosis (24 organizations [48.9%]) and bipolar disorder (16 organizations [32.7%]). Four organizations also disqualified participants with a family history of psychosis. Cardiovascular and neurological conditions followed in prevalence. A few organizations excluded for other health conditions (Table 2). Medication Washout Procedures Thirty-six organizations (73.4%) asked participants about prescription drug use, typically via intake forms or interviews. Seven others did not ask directly but informed participants of medication risks. Most organizations (43 [87.8%]) required or recommended stopping certain medications before the retreat. Thirty-three organizations (67.3%) mandated discontinuation of drugs, such as selective serotonin reuptake inhibitors [SSRIs], monoamine oxidase inhibitors (MAOIs), lithium, and benzodiazepines. Measures to confirm adherence varied and were not always clear: 1 organization required a drug test; another asked for physician clearance. Eleven organizations (22.4%) recommended, but did not require, discontinuation of certain medications. One organization required cessation of SSRIs and recommended stopping other medications. Two organizations advised dose reduction on a case-by-case basis. Overall, 31 organizations (63.3%) encouraged participants to consult their physician for tapering guidance; 1 organization deferred entirely to the participant’s own health care practitioner. Washout timelines varied from 1 day to more than 6 weeks (Table 3). Seven organizations (14.3%) reported consulting medical professionals to guide these protocols. Involvement of Licensed Health Care Professionals Twenty-one organizations (42.9%) worked with at least 1 licensed health care professional—typically physicians (14 organizations), nurses (12 organizations), therapists (11 organizations), or pharmacists (2 organizations) (Table 4). Their roles included advising on medication washout, screening for contraindications, and supporting participants during or after the retreat. Two organizations noted that these professionals could not legally practice under their licenses in this context. One reported occasional oversight from a non–US-based physician. Of 21 organizations that worked with a licensed health care professional, 6 also worked with emergency-trained personnel (eg, emergency medical technicians or cardiopulmonary resuscitation–certified staff). Among the 28 organizations that did not work with licensed professionals, 13 worked with individuals with emergency response training. Twenty organizations (40.8%) reported that a health care professional was present during at least part of the retreat. Some were available for dosing support, intake assessments, or emergency monitoring. Among organizations without a professional in attendance, 12 relied on emergency-trained staff. In total, 32 organizations (65.3%) had some trained personnel onsite at least occasionally. Two religious groups lacking licensed or emergency-trained staff relied on sober volunteers in case of emergencies. Among the 5 self-described medical organizations, all worked with licensed professionals. Among the 42 wellness-focused retreats, 17 (40.5%) worked with health care professionals and 16 (38.1%) had them in attendance at retreats. Of the 4 exclusively religious organizations, only 1 reported such involvement. Twenty-nine organizations (59.2%) said that facilitators used psychedelics during ceremonies, with 7 organizations specifying smaller doses and 4 organizations clarifying that there is always someone sober in attendance. In 3 organizations, licensed professionals also used the substances. Six organizations said facilitator use occurred at their discretion or with participant approval. Integration Services All 49 organizations offered some form of integration support, ranging from structured programs to less structured programs involving informal group circles or ad hoc discussions (Table 5). Thirty organizations (61.2%) included integration activities as part of the retreat [Full text truncated at 15000 characters. The complete article is available from the publisher at the DOI above.] Source and licence McGuire AL, Neitzke-Spruill L, Robinson JO, Beit CS, Singh N, Mathai DS, Averill LA (2026). Reported Safety Practices of Publicly Advertised Psychedelic Retreats.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2025.52505 PubMed Central PMC12780929. Distributed under CC BY, https://creativecommons.org/licenses/by/4.0/ . Reproduced on dmtcode.com under that licence. Changes made: full text extracted from the PubMed Central BioC service, reference list, figures, tables and funding statements removed. No wording was altered. Retrieved 2026-08-21.