Written by Dr Sara Tookey
A True North Psychology Publication
As research into psychedelic-assisted therapies continues to show promising results for the potential to treat various mental health conditions, public interest in these substances is growing rapidly. While psychedelics are currently prohibited substances in most countries, the growing popularity of their therapeutic potential has led some to use psychedelics on their own rather than waiting for legal medical access. However, with increased interest comes increased risk, especially as psychedelics remain largely illegal and unregulated - underscoring the critical need for harm reduction approaches.
Mental health professionals are increasingly encountering clients who are either considering or actively using psychedelics for therapeutic purposes. To address this growing phenomenon, there is an urgent need for comprehensive education within the mental healthcare field. Practitioners must be equipped to engage in informed, non-judgmental conversations with clients about psychedelic use, focusing on harm reduction strategies and evidence-based information.
This article aims to outline a harm reduction approach tailored to individuals seeking support for psychedelic use in the context of personal growth or healing (highlighting the intersection between mental health support and psychedelic harm reduction).
If you like this article you might enjoy reading our other psychedelic-assisted therapy related articles:
Psychedelic Integration: What is it and who can benefit from it? by Dr Sara Tookey
Psychedelic Integration Tools and Techniques by Dr Sara Tookey
Psychedelic Preparation: What is it and who can benefit from it? by Dr Sara Tookey
Beyond the Hype: A Balanced Look at Psychedelic Therapy Risks by Dr Sara Tookey
Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health by Dr Sara Tookey
Table of contents:
What is Harm Reduction?
Harm reduction is a public health approach that aims to support the health and well-being of people who use substances. It focuses on minimising the negative health, social, and legal impacts associated with drug use, drug policies, and drug laws (Marlatt, 1996). At its core, harm reduction starts with recognising that all individuals, regardless of circumstances, deserve safety and dignity. It’s not about passing judgment on drug use but about providing compassionate care and support. It acknowledges the reality of drug use in our society and understands that traditional law enforcement or abstinence-based approaches have not effectively reduced drug use or its associated harms.
Harm reduction does not encourage drug use but aims to make drug use safer. People will use drugs regardless of the availability of harm reduction services, but these services significantly reduce the associated risks and harms. This approach is about making drug use safer and less detrimental to individuals and communities.
In practice, harm reduction focuses on positive change and on working with people without judgment, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.
When applied to psychedelics, harm reduction involves providing accurate information, promoting safety, and supporting individuals before, during, and after their psychedelic experiences—without judgment or condemnation. Psychedelic Harm Reduction and Integration (PHRI) is defined as a clinical approach to working with patients who are using or considering using psychedelics in any context (Gorman et al., 2021). It can be applied in both brief and ongoing psychotherapy interactions.
Why is Harm Reduction Important for Mental Health Professionals?
Addresses Current Needs: With the ongoing discussion of psychedelics in academic research and mainstream media, this approach is timely and necessary (Gorman et al., 2021).
Prevalence of Use: Recent reports indicate a significant and growing use of psychedelics globally. In the United States, approximately 5.5 million adults reported using hallucinogens in 2019 (Livne et al., 2022). In England and Wales, 1 in 100 people reported using hallucinogenic substances in 2023, with the UK seeing about a 39% increase in psychedelic mushroom use between 2022 and 2023 (Office of National Statistics, 2023).
Client Safety: Mental health professionals equipped with harm reduction knowledge can help to support their clients' safety by providing accurate information and helping them make informed decisions (Pilecki et al., 2021).
Destigmatisation: Many clients may hesitate to disclose their interest in or use of psychedelics due to fear of judgement. By adopting a harm reduction approach, therapists create a safe space for open dialogue, allowing for more honest and effective therapeutic relationships (Pilecki et al., 2021). Harm reduction acknowledges that drug use is a reality for many people and aims to address it with compassion and practical support rather than stigma.
Legal and Ethical Considerations: While psychedelics remain illegal in most contexts, clients may still choose to use them. Harm reduction allows professionals to support clients within legal and ethical boundaries, without encouraging illegal activity (Pilecki et al., 2021).
Bridging the Gap: Limited legal access to therapeutic psychedelics has driven “underground” (i.e. illegal) therapy, travel to countries with more permissive laws (attending retreats or 1:1 sessions with guides), engaging in independent use or with trusted friends as guides during their psychedelic experience. This trend has created a growing need for support services in users' home countries, which mental health professionals are uniquely positioned to address. (Pilecki et al., 2021).
Key Harm Reduction Strategies for Mental Health Professionals:
While maintaining ethical and legal boundaries, mental health professionals can incorporate the following strategies:
Education and Self-awareness: Stay informed about current psychedelic research, legal status, and potential risks and benefits (Pilecki et al., 2021). This knowledge base allows you to provide accurate information to clients and recognise when referral to a specialist might be necessary. See resources from The OPEN Foundation, whom, since 2007, provide an archive of activities related to psychedelic research and therapies, including research publications, talks, and books.
Legal and Ethical Awareness: Understand the legal and ethical boundaries of discussing psychedelic use with clients (See Pilecki et al., 2021). This involves being clear about what you can and cannot do within your professional role.
Non-judgmental Listening: Create a safe space for clients to discuss their experiences or intentions without fear of stigma (Gorman et al., 2021; Pilecki et al., 2021). This might involve examining and setting aside personal biases about psychedelic use. A strong therapeutic alliance allows for more honest communication about psychedelic use, and is a key factor in reducing drug-use-related risk (Gorman et al., 2021; Pilecki et al., 2021).
Open and Informed Dialogue: Mental health professionals play a crucial role in educating clients about psychedelics. By facilitating open discussions, they can share essential information about the potential benefits, risks, and legal implications of psychedelic use. This approach empowers clients to make well-informed decisions about their mental health care and potential psychedelic use (Carrington, 2024; Pilecki et al., 2021)). It's important to provide balanced, evidence-based information without endorsing illegal activities.
Comprehensive Screening: Help clients assess their suitability for psychedelic experiences, considering factors like personal and family mental health history (Carbonaro et al., 2016; Roth & McClure-Begley, 2022). Assess their psychological readiness for a psychedelic experience and discuss potential psychological risk-factors.
Preparation Support: While not encouraging use, assist clients who have decided to use psychedelics in setting intentions, understanding potential risks, and creating a safe setting for their experience (Gorman et al., 2021; Hartogsohn, 2017). This might involve discussing the importance of "set and setting" in psychedelic experiences.
Integration Support: Support clients in processing and integrating their psychedelic experiences into their daily lives (Gorman et al., 2021). This could involve techniques from various therapeutic modalities to help clients make meaning from their experiences and implement positive changes. Marc Axillia’s book, “Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness Integration” is a comprehensive resource for practitioners interested in learning about psychedelic integration.
Harm Reduction Education: Provide information on safer use practices, such as the importance of having a trusted guide or sitter, starting with lower doses, and avoiding mixing substances (Marlatt, 1996; Pilecki et al., 2021).
Recognise Red Flags: Be aware of signs that might indicate a client is at higher risk or experiencing adverse effects from psychedelic use. This could include symptoms of prolonged psychological distress Prior trauma or major life events (Evans et al., 2023; Simonsson et al., 2023).
Develop a Referral Network: Build connections with specialists in psychedelic integration and ensure you are receiving supervision from a practitioner who specialises in these areas. This ensures clients can receive specialised care when needed.
Cultural Sensitivity: Acknowledge the importance of diversity, equity, and inclusion in the context of psychedelic use and therapy (George et al., 2020). This includes understanding the historical and cultural significance of psychedelics in various communities.
By incorporating these strategies, mental health professionals can provide valuable support to clients considering or using psychedelics, even if not directly working in psychedelic-assisted therapy. The goal is to reduce potential harms, increase safety, and support clients in making informed decisions about their mental health care (Gorman et al., 2021; Pilecki et al., 2021).
Training Programmes and Ethical Considerations: Psychedelic Harm Reduction and Integration
As interest in psychedelic-assisted therapies grows, many mental health professionals are seeking training in this emerging field. There are a growing number of centres opening offering training to become a psychedelic-assisted therapist. However, the current landscape presents several challenges, including lack of standardisation and agreed good clinical practice guidelines, legal ambiguity, ethical concerns, and growing yet limited evidence base (Pilecki et al., 2021; Siegel et al., 2023; Carrington, 2024). Given these challenges, mental health professionals should approach training with careful consideration.
It's important to note that in the UK, currently psychedelics remain illegal outside of approved research contexts and most research trial work requires therapists to complete their own specialised training prior to working in the trial. There are currently no approved training programmes for psychedelic-assisted therapy or accrediting bodies in the UK. As a consequence professionals may find themselves making a high cost (time and money) investment into a certificate that won’t be recognised when psychedelics potentially become legalised for medical treatment.
Ethical and Legal Considerations
Mental health professionals applying psychedelic harm reduction and integration approaches in their practice must carefully consider the following:
Scope of practice: Ensure that discussions about psychedelics remain within the boundaries of professional competence and legal limitations (See suggested guidance in Pilecki et al., 2021).
Legal Compliance: Stay informed about local and national regulations regarding psychedelic use and therapy. Practitioners should remain vigilant about the legal and ethical guidelines that govern their practice. Given the ongoing debates and legal restrictions, ensuring compliance with the latest regulations is crucial to maintaining professional integrity and safeguarding client well-being.
Informed consent: Ensure clients fully understand the nature of any discussions or support related to psychedelics, including potential risks and benefits. Provide clients with comprehensive information about the potential risks and benefits of psychedelic use, emphasising the current legal status (Carrington, 2024).
Harm reduction focus: Adopt a non-judgmental, person-centred, harm reduction approach that prioritises client safety and well-being without endorsing illegal activities (Gorman et al., 2021).
Documentation: Maintain clear, detailed records of all discussions related to psychedelic use, emphasising the harm reduction and educational nature of these conversations (Pilecki et al., 2021).
Continuing education: Stay informed about the latest research and legal developments in the field of psychedelic-assisted therapies (Carrington, 2024).
Referral networks: Develop connections with specialists in psychedelic integration for complex cases that may be beyond one's scope of practice.
Mental health professionals can ethically and responsibly address psychedelic use in their practice by staying informed and seeking appropriate resources. Organisations like True North Psychology offer evidence-based education and supervision to support practitioners in navigating these complex issues, helping them to address client needs while minimising legal and professional risks.
Conclusion
As the landscape of mental health treatment evolves, so too must our approaches as mental health professionals. Harm reduction in the context of psychedelic use is not about encouraging illegal activity, but about ensuring the safety and wellbeing of our clients in a changing world.
Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance.
We welcome your thoughts and reflections on this article.
FREE Resources on Psychedelic Harm Reduction:
Free video series on psychedelic-harm reduction, by Robin Carhart-Harris
PsyCareUK: Provides welfare and harm reduction services at music festivals and events throughout the UK and internationally.
At TNP, our preparation and integration therapists are a part of the Psychedelic Support Professionals Community.
The Psychedelic Support website is a useful resource and provides FREE courses on harm reduction, substances guides and other information to help people make informed decisions about engaging in psychedelic therapies.
F.I.V.E, is an organisation providing necessary education for individuals to make informed decisions when considering taking 5-MeO-DMT, has provided key resources to learn more about red flags and what to look for in a safe facilitator.
The Psychedelic Participant Advocacy Network (PsyPAN) - a non-profit organisation connecting aimed at connecting psychedelic participants, improving patient safety and wellbeing, and building best practices across all levels of the global psychedelic sector.
See further resources on our integration therapy page (scroll to the bottom).
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We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited.
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References
References from research cited:
Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 30(12), 1268-1278. https://journals.sagepub.com/doi/10.1177/0269881116662634
Carhart-Harris, R. L., & Goodwin, G. M. (2017). The therapeutic potential of psychedelic drugs: past, present, and future. Neuropsychopharmacology, 42(11), 2105-2113. https://doi.org/10.1038/npp.2017.84
Carrington, K. (2024). Navigating New Terrain: Clinician Education at the Crossroads of Psychedelics and Medical Ethics. Psychiatric Times. https://www.psychiatrictimes.com/view/navigating-new-terrain-clinician-education-at-the-crossroads-of-psychedelics-and-medical-ethics
Evans, L., Tron, L., Bremner, A., Peill, J., Stafford, T., Erritzoe, D., & Nutt, D. J. (2023). Understanding prolonged negative effects from psychedelic use: A mixed-methods study. Psychopharmacology, 240(7), 1889-1903. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10597511/
George, J. R., Michaels, T. I., Sevelius, J., & Williams, M. T. (2020). The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion. Journal of Psychedelic Studies, 4(1), 4-15. https://akjournals.com/view/journals/2054/4/1/article-p4.xml
Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Frontiers in Psychology, 12, 645246. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.645246/full
Hartogsohn, I. (2017). Constructing drug effects: A history of set and setting. Drug Science, Policy and Law, 3, 2050324516683325. https://doi.org/10.1177/20503245166833
Marlatt, G. A. (1996). Harm reduction: Come as you are. Addictive behaviors, 21(6), 779-788. https://www.sciencedirect.com/science/article/abs/pii/0306460396000421
Livne, O., Shmulewitz, D., Walsh, C., & Hasin, D. S. (2022). Adolescent and adult time trends in US hallucinogen use, 2002-19: any use, and use of ecstasy, LSD and PCP. Addiction (Abingdon, England), 117(12), 3099–3109. https://doi.org/10.1111/add.15987
Marlatt, G. A. (1996). Harm reduction: Come as you are. Addictive Behaviors, 21(6), 779-788. https://doi.org/10.1016/0306-4603(96)00042-1
Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18(1), 40. https://doi.org/10.1186/s12954-021-00489-1
Roth, B. L., & McClure-Begley, T. (2022). Psychedelics and brain plasticity. Neuropsychopharmacology, 47(1), 1-2. https://www.med.upenn.edu/ngg/assets/user-content/documents/journal-club-2022-2023/jc-roth-2.pdf
Siegel, J. S., Daily, J. E., Perry, D. A., & Nicol, G. E. (2023). Psychedelic Drug Legislative Reform and Legalization in the US. JAMA psychiatry, 80(1), 77–83. https://doi.org/10.1001/jamapsychiatry.2022.4101
Simonsson, O., Hendricks, P. S., Chambers, R., Osika, W., & Goldberg, S. B. (2023). Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics. Journal of affective disorders, 326, 105–110. https://www.sciencedirect.com/science/article/pii/S0165032723000915
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