03 Dec University Michigan Survey of Harm Reduction Advice for First Psychedelic Experience
Editor’s note: Please remember psychedelics remain illegal in most of the US and are not FDA tested or approved. Psychedelics and hallucinogens can have serious short and long term side effects and should be utilized only with careful medical supervision.
Dr. Kruger
MedicalResearch.com Interview with:
Daniel J. Kruger, PhD
Population Studies Center, Institute for Social Research
University of Michigan
MedicalResearch.com: What is the background for this survey?
Response: Multiple studies indicate that psychedelic use is at an all-time high. There are hundreds of clinical trials on the use of psychedelics and psychedelic-derived compounds for potential mental health benefits. Popular books like Michael Pollan’s “How to Change Your Mind” have raised public awareness of these substances and their potential benefits. Legislative changes in some areas have liberalized psychedelic access for therapy and personal use. Still, the vast majority of those who use psychedelics will use them outside of regulated, supervised settings. People are reporting both amazing therapeutic benefits as well as adverse experiences, and sometimes detrimental effects that last well beyond the trip. This study aimed to develop a risk-reduction resource to facilitate safe and successful psychedelic experiences outside of regulated settings. We employed a community-based approach to crowdsource practical recommendations for first-time psychedelic experiences from the psychedelic community.
MedicalResearch.com: What are the main findings?
Response: The most common recommendation theme was mental preparation for the psychedelic experience, including embracing the experience and whatever is encountered, learning about psychedelic experiences/substances being taken, and setting intentions for what to accomplish through the experience. About half of participants recommended preparing aspects of the environment for the psychedelic experience, including being with loved and trusted people, having a person who is experienced with psychedelics as a guide/sitter/facilitator, and being in a safe, familiar, and comfortable location. Participants mentioned items to have on hand, such as music that will facilitate the trip, water (and hydrating often), and having a journal. Participants also mentioned preparation related to the substance used, particularly starting with low doses and increasing doses slowly over multiple trips. A few participants mentioned knowing the source of the substance and testing the substance.
Most participants recommended psilocybin for first-time psychedelic experiences, approximately half recommended cannabis, and a third recommended MDMA (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, 5-MeO-DMT, and Salvia divinorum 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.
MedicalResearch.com: What should readers take away from your report?
Response: The psychedelic risk reduction practices recommended by our survey participants converge with the broader scientific literature. For example, the recommendation of psilocybin is consistent with the assessment of experts in substance use and abuse regarding its properties such as addiction potential, potential harm to individuals using, and potential harm to society. Previous literature stresses the importance of mindset and environment (set and setting) in preparation for psychedelic experiences, as psychedelics tend to amplify whatever it is people are experiencing.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: First, we need systematic research on the effectiveness of specific risk reduction practices. Randomized controlled trials may be helpful but must be conducted carefully to avoid withholding essential safety information and harming participants.
Second, we need more evidence-informed education on psychedelic risk reduction to complement the current abstinence-based approaches. We also need research to evaluate the effectiveness of these educational efforts.
MedicalResearch.com: Is there anything else you would like to add? Any disclosures?
Response: In the 1950s and 1960s, there were very promising research programs demonstrating great potential for treating conditions such as depression and substance addiction with psychedelics. These efforts mostly ground to a halt when psychedelics were criminalized. Now, many people are saying that we are in a new psychedelic era. If we focus efforts on educating people to make informed decisions and reduce risks, we can better support them in their psychedelic journeys.
We do not have any conflicts of interest.
Citation:
Kruger, D.J., Mersereau, G., Sullivan, A. et al. Best practices for first psychedelic experiences: harm reduction advice from the psychedelic community. Harm Reduct J 22, 191 (2025). https://doi.org/10.1186/s12954-025-01337-2
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Last Updated on December 3, 2025 by Marie Benz MD FAAD