30 May 2025
Dispelling Myths
Prohibition-Related Harms & Safer Psychedelic Use
By: Philippe Lucas, PhD
MAPS Bulletin: Volume XXXIV
Following endless articles unreservedly touting the potential benefits of psychedelics, media affection for psychedelic substances and altered states appear to have taken a downturn. It now seems like nearly every few days another column or op-ed highlights some of the potential harms associated with psychedelic use, urging a slowdown on the approval of these substances as a medicine until proper “guardrails” are in place to protect patients and the general public.
While many of these appeals may be well-intentioned, they all too often rely on personal experiences or opinions while ignoring much of the available evidence regarding the relative safety of psychedelic substances. Furthermore, in calling for a slowdown of progressive, evidence-based policy decisions informed by the principles of harm reduction and benefit maximization, they may further exacerbate potential risks and harms to psychedelic consumers, with associated negative impacts on public health and safety. This piece aims to inject some evidence into these important public health and policy discussions, some of which will be drawn from the Global Psychedelic Survey (GPS), a large international survey of psychedelic consumers which is now in its 3rd iteration and involves over 80 academic collaborators from around the world.
To start, I believe that serious and consequential harms can occasionally be an outcome of psychedelic use. In fact, Jules Evans (Challenging Experiences Project), Jacob Aday (UMich) Matt Johnson (Shephard Pratt) and I have developed and will be analyzing a section in GPS 2025 to explore acute and long-term challenges and harms associated with psychedelic use. However, I have spent my adult life working towards evidence-based drug policies, so recommendations to slow the already glacial progress towards safe, legal access to psychedelics raise some significant concerns. While evidence does suggest that there exists a very real potential for serious and lasting harms resulting from psychedelic use, these outcomes are surprisingly rare and most often stem from prohibition-related harms rather than from the substances themselves.
Indeed, over 50 years of research has shown that most psychedelics are relatively safe, particularly when compared not only to other psychoactive substances like alcohol and tobacco, but also compared to other pharmacotherapies to treat chronic mental health or pain conditions, particularly when known doses from a quality-controlled supply are used in clinical settings. These were certainly the findings of a recent systematic review of 114 clinical trials investigating classical psychedelics (ie. LSD, psilocybin, DMT, etc.) with a total of 3504 participants, which concluded that “SAEs (Serious Adverse Events) were reported for no healthy participants and for approximately 4% of participants with preexisting neuropsychiatric disorders”, concluding that these results “…indicate that certain catastrophic events reported in recreational or nonclinical contexts have yet to be reported in contemporary trial participants” (Hinkle et al., 2024)
However, even when psychedelics are experienced in non-clinical settings (which represents the overwhelming majority of current use), very few individuals report serious negative outcomes. Data from the Global Psychedelic Survey 2023 (n=6379) suggests that out of all respondents that identified having a “peak awe experience” with psychedelics (n=4745), only 7.4% describe that experience as being largely negative, with 44% reporting a largely positive peak experience, and 49% describing a combination of positive and negative attributes (Lake & Lucas, 2024). Nonetheless, of the 351 respondents that reported negative experiences, 44% thought they might never be the same, and 34% thought they might die. Nonetheless, even in this subgroup, 62% reported that at least some good ultimately came from this negative experience, including gaining insight into difficult problems (55%), overcoming personal fears (38%), and/or addressing physical or psychological trauma(s) (28%).
In fact, there is much research to suggest that in certain instances challenging experiences may be a component of successful therapeutic outcomes when using psychedelics in the treatment of intractable mental health conditions like depression, anxiety and PTSD (Andión et al., 2025; Bouso et al., 2022; Wood et al., 2024). Indeed, patients that have undergone psychedelic-assisted therapy for PTSD often attest that it often involves challenging, discomforting work and experiences, just like any other psychotherapeutic intervention that involves self-reflection, introspection and addressing long held beliefs and behaviors.
Nonetheless, it is beyond question that under certain circumstances lasting psychological harms can be associated with psychedelics in some individuals, and safer use advocates on both sides of this discussion share a conviction that a public health-centred approach to psychedelic use would seek to reduce negative occurrences/traumatic experiences, and to provide treatment and support if and when they do take place. However, as an academic researcher and safer use advocate, I’m concerned when I see all the potential harms of substance use placed squarely on the substance itself, rather than giving due consideration to public policies that may be significantly increasing the risk and severity of harms. In the case of psychedelics – substances for which the set and setting of use has been shown to play such a key role – it is quite simply impossible to separate the broader context and circumstances of use from the associated outcomes, be they beneficial or harmful.
Unfortunately, all evidence suggests that prohibition not only fails to protect psychedelic consumers and the general public from substance use-related harms, it greatly increases the potential risks. Exploring deep altered states of consciousness can be inherently challenging, and unfortunately prohibition imposes significant additional external psychological and physical threats on psychedelic consumers and practitioners, including the potential of arrest and prosecution and the risks of taking a substance of unknown chemical constituents and of questionable potency and doses. Moreover, prohibition obstructs harm reduction efforts by hindering drug testing programs and allowing unrestricted access via the black market, without screening for mental health issues or limiting access to adults. Ironically, if/when these potential harms do come to pass, prohibition makes it far less likely that those experiencing acute or long-term difficulties will seek the help and support they may need for fear of arrest and/or loss of employment or reputation.
Perhaps most critically, evidence clearly shows that with or without legally regulated therapeutic programs people with intractable mental and physical health conditions will continue to self-medicate and/or to seek out psychedelic-assisted therapies. Data from GPS 2023 suggests that approximately 60% of respondents self-report therapeutic use of psychedelics (n=5346) – 48% for mental health conditions like depression, anxiety and PTSD, and 22% for physical health conditions like chronic pain, headaches/migraines and sleep disorders. However, just over 24% of respondents that used psychedelics therapeutically benefited from the guidance of a health care professional (HCP).
All of this suggests that if we’re truly concerned about “adequate protections” from the potential harms of psychedelic use for both medical and non-medical consumers, then ending prohibition and regulating adult access to psychedelics is the strategy with the greatest potential to improve public health.
In a recent NYT essay calling for a slowdown on psychedelic access, Jules Evans shared the story of a personal LSD trip when he was 18 that left him traumatized. I appreciate his willingness to share his experiences, and he’s certainly not the only individual to share similar stories. In fact, I too suffered through a very challenging psychedelic experience at the same age during which I spent much of the night lying on my bed surrounded by friends who worked hard to relieve me of the irrational fear that I was going to stop breathing. Despite what at the time felt like quite a dramatic incident, this did not end my use of psychedelics, and in my 20s I had additional experiences that were certainly fun, but far from transformative.
However, in my thirties I had an ayahuasca journey about a decade after my father’s suicide during which I wept uncontrollably and truly felt connected to his presence. For years I had harbored tremendous anger at the choices he made in leaving our family behind, but that journey led me to acknowledge a terrible guilt that I couldn’t help my father during his time of need. While the experience left me shaken and drained, I also felt much lighter, and I’ve never felt that same anger towards my father again. Indeed, it was that specific experience resolving deep trauma and loss that led me to a career in psychedelic research and to advocate for policies that promote and support safer access and use.
Rather, I join the growing chorus of academics and harm reduction advocates that suggest an evidence-based public health policy informed by the principles of harm reduction, benefit maximization, cognitive liberty, and personal rights and freedoms would take many measures to balance safe, legal adult access with desirable public health outcomes.
Nonetheless, I don’t propose that the preferred alternative to prohibition should be a completely unregulated system. Rather, I join the growing chorus of academics and harm reduction advocates that suggest an evidence-based public health policy informed by the principles of harm reduction, benefit maximization, cognitive liberty, and personal rights and freedoms would take many measures to balance safe, legal adult access with desirable public health outcomes.
These could and should include legally recognizing the long history of traditional Indigenous ceremonial and religious uses, depenalizing the personal use and possession of psychedelic substances, regulating the sale of a quality-controlled supply with proper potency labeling to adults, and providing evidence-based information and outreach strategies to inform consumers of potential harms, benefits, and contraindications. In the longer term, a truly comprehensive approach would also provide and regulate safe public use settings and facilities, much as we currently regulate alcohol use in various public settings.
The development of psychedelic policies should be a thoughtful, deliberate, evidence-based process informed by the experiences and expertise of psychedelic consumers and other key stakeholders. By suggesting a slowing down of evidence-based measures to improve safe, legal access for both medical and non-medical uses, those ostensibly aiming to protect psychedelic consumers instead condemn them to the most harmful potential circumstances of all: the status quo of drug prohibition which criminalizes consumers, provides a supply of substances of unknown quality and potency, and leaves patients to seek unregulated, underground practitioners with little legal or regulatory recourse should things go awry.
This is a truly tragic situation for the millions of patients that might benefit from psychedelic-assisted therapies as well as the otherwise law-abiding individuals around the globe that successfully incorporate psychedelics into their lives for spiritual development, increased wellness, personal improvement, pro-social engagement, and yes, even just for fun. As it stands, psychedelic consumers are like passengers trapped in a car being consumed by the flames of the failed and expensive drug war, and while we should all strongly support preventative safety measures like driver’s education, seatbelts and airbags, the first thing we need to do is get these people out of car and safely away from the fire…
References
- Andión, Ó., Bouso, J. C., Sarris, J. J., Tófoli, L. F., Opaleye, E. S., & Perkins, D. (2025). A new insight into ayahuasca’s adverse effects: Reanalysis and perspectives on its mediating role in mental health from the Global Ayahuasca Survey (GAS). PLOS Mental Health, 2(4), e0000097. doi.org/10.1371/JOURNAL.PMEN.0000097
- Bouso, J. C., Andión, Ó., Sarris, J. J., Scheidegger, M., Tófoli, L. F., Opaleye, E. S., Schubert, V., & Perkins, D. (2022). Adverse effects of ayahuasca: Results from the Global Ayahuasca Survey. PLOS Global Public Health, 2(11). doi.org/10.1371/JOURNAL.PGPH.0000438
- Hinkle, J. T., Graziosi, M., Nayak, S. M., & Yaden, D. B. (2024). Adverse Events in Studies of Classic Psychedelics: A Systematic Review and Meta-Analysis. JAMA Psychiatry, 81(12), 1225–1235. doi.org/10.1001/JAMAPSYCHIATRY.2024.2546
- Lake, S., & Lucas, P. (2024). The Global Psychedelic Survey: Consumer characteristics, patterns of use, and access in primarily anglophone regions around the world. International Journal of Drug Policy, 130, 104507. doi.org/10.1016/J.DRUGPO.2024.104507
- Wood, M. J., McAlpine, R. G., & Kamboj, S. K. (2024). Strategies for resolving challenging psychedelic experiences: insights from a mixed-methods study. Scientific Reports, 14(1), 1–14. doi.org/10.1038/s41598-024-79931-w
Philippe Lucas, Ph.D.
Philippe Lucas, PhD is a cannabis and psychedelic researcher and a safe access advocate. He conducted his graduate work at UVic, earning an MA in Studies in Policy and Practice, and a PhD in Social Dimensions of Health, and is an instructor in UVic’s Continuing Studies Program where he is teaching the university’s first course on psychedelic substances and public health. Additionally, Philippe is a Research Affiliate at the University of Michigan’s Psychedelic Center, and Director, Research and Safe Access at the Multidisciplinary Association of Psychedelic Studies (MAPS), and his studies include the Canadian Psychedelic Survey 2022 and the Global Psychedelic Survey 2023/25. He has received a number of accolades for his work and research, including the Americans for Safe Access Researcher of the Year Award 2021, the Cannabis Council of Canada Lifetime Achievement Award, and the Queen Elizabeth II Diamond Jubilee Medal.
Help Spread Psychedelic Education
Thanks for your contribution to MAPS!
Your tax-deductible contribution supports psychedelic science research, drug policy reform, public education, harm reduction, peer support, and our general operations.