How safe is your psychedelic trip?
Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
Life-changing. It’s one of the great soundbite promises of the wellness world. The pursuit of sleeker, longer-living, generally better versions of ourselves has begotten a global industry that was recently valued by McKinsey at $1.5tn.
Though body and soul have long been wellness’s twin focal points (having your chakras and your colon manipulated on the same day? Possibly by the same therapist? Not at all outside the realm of possibility), increasingly those wanting to change their lives are doing so by changing their minds. The controlled ingestion of consciousness-altering plant compounds, for years a vanguard trend, is now edging towards the mainstream, and taking on the contours of a major industry. Last May, for the inaugural US edition of the FT Weekend Festival in Washington DC, I moderated a panel called Microdosing, Mushrooms and the Million-Dollar Boom in Marijuana. As we were being mic’ed up for the session, one of the panellists noted with amusement that the title, while catchy, sold the whole enterprise rather short: not only is cannabis a multi-billion-dollar commercial juggernaut already, but psychedelics – despite being classified as Schedule 1 drugs in the US and illegal in many other countries– could have a potential market worth of more than $10bn by 2027.
The benefits are compelling, and increasingly evidence-based. Psychedelics and psilocybin (mushrooms) could help combat anxiety, anorexia, obsessive-compulsive disorder, cluster headaches, substance abuse, and PTSD – in some cases allowing users to process trauma at a pace that far outstrips conventional psychotherapy. In a recent US clinical trial, it was found that psilocybin may be effective in treating major depressive disorders that are resistant to antidepressant drugs. And then there’s the neuroscience: research from the Centre for Psychedelic Research at Imperial College London found that psilocybin treatment increased brain connectivity for up to a month after one treatment in people with depression. The results were consistent with animal data showing that psychedelics increase neuronal outgrowth; which is to say, augmenting actual neuroplasticity. In other words: they do, literally, change your mind.
In tandem, consciousness-expanding retreats in destinations where the substances used are legal (or at least not explicitly illegal) are becoming an increasingly popular wellness ‘holiday’. You can partake of ayahuasca prepared by shamans or curanderos in Peru or Brazil, Costa Rica or Mexico. In Jamaica you can (legally) ingest mushrooms, the preferred choice among many psychiatrists and licensed practitioners who study the effects of psychedelics. By 2023, you will also be able to have a psilocybin experience in the state of Oregon, where Ballot Measure 109 legalising therapeutic use was tabled in 2020 (implementation is what’s complicated, and thus pending). Anecdotally, one hears about operators who facilitate LSD- or MDMA (ecstasy)-led experiences from the Catskills to Ibiza, both one-on-one and for groups (of the handful of people I know who have done this, none would speak to me on record – though “life-changing” was used, free of all irony, more than once).
Ayahuasca – a brew of Psychotria viridis and Banisteriopsis caapi, Amazonian plants which together form a potent hallucinogen – is at the forefront of consumer awareness. One of the best known retreat operators is Soltara Healing Centre. With two sites in Costa Rica and one in Peru, it offers retreats lasting from five to up to 13 days (the latter includes seven ayahuasca ceremonies); the brew is made and administered by healers and “masters” from the Peruvian Shipibo nation.
“This is becoming not just mainstream, but trendy,” says Daniel Cleland, Soltara’s founder and CEO. “With that shift in public opinion, we’ve seen a massive wave of “normal” people – who maybe 10 years ago would never had considered psychedelics in any form – showing curiosity. We’re getting 70-year-olds and soccer moms. They’re seeing these documentaries and hearing about it on the news. We sometimes have 10 times the demand for what we’re able to accommodate,” he says, adding that all remaining 2022 Soltara retreats are now subject to waiting lists.
This is important because as with any form of wellness (or therapy), the quality and safety of the experience depend on the skill, expertise and due diligence of the provider. “People are in an extremely vulnerable, suggestive state with psychedelics,” says psychiatrist and psychopharmacologist Julie Holland. “There’s a lot of good that can happen, but they’re not risk-free.” Holland, who participated in May’s FT panel, is the author of books including Ecstasy: The Complete Guide and Good Chemistry: The Science of Connection, from Soul to Psychedelics. “The proliferation [of psychedelic retreats] is concerning, in that the more popular and more of them there are, it’s probably safe to assume that the less well-trained or scrupulous some providers will be,” she says. Psilocybin and LSD, she notes, are not physiologically toxic and it isn’t thought you can die from an overdose. “The danger is in the potential behavioural toxicity” – what you do when you’re in your altered state: “you know, you see some traffic lights and think they’re incredibly beautiful, so you go to cross the street to look more closely and might get hit by a taxi.”
Beyond medical and psychological vetting, she says, ample facilitation and supervision are key. At Synthesis, a psychedelic retreat in Zandvoort in the Netherlands, guests fill out a health screening form before they can book or begin the programme. Similar screenings are built into the intake process at Soltara.
Extensive preparation and post-experience integration are also crucial, says Holland. “I’d ask a lot of questions about those” before embarking on any experience, she says. “Integration especially is so important. With psychedelics, there is sometimes this issue of uncovering trauma, or having a very challenging revelation. What is the timing involved? Is the ceremony on a Thursday, and you’re packing up and leaving the Friday? Who is there” – a shaman or healer; a psychiatrist; a medical doctor – “to help you process whatever you might have unearthed?”
Guidance is also vital at the preparation stage. Beware the retreat operator that offers no structured preparation programme: “One of my issues with ayahuasca is that you have to get off all your medications before you can take it – SSRIs [antidepressants such as sertraline, Prozac and citalopram], anti-psychotics, stimulants, anti-anxiety drugs.” (The list at Soltara includes antiallergans, antihistamines, high blood pressure medicines, St John’s wort, and all cannabinoids. It also suggests forgoing sexual activity, including masturbation, for two weeks prior.) Holland’s concern is that if this is done without appropriate medical supervision it can start a participant off on a potentially destabilised footing; if there isn’t a strong preparation-integration strategy in place, both the lead-in and the experience could be traumatic in themselves.
“We’ve had to filter a lot more intensely because of this change in demographic,” says Daniel Cleland, “and have added additional layers of screening to our intake process. Some people want to do it so badly that they’re dishonest about their mental-health and medical histories. And there are people who really should not be drinking ayahuasca.” Today at Soltara, in addition to completing the health screening online, there is a compulsory one-to-one consultancy with a staffer who has been working with ayahuasca as a facilitator for years; ”to talk them through, to mitigate expectation, to make sure they’re very clear on their reasons for wanting to take ayahuasca. And in some cases, to discourage them from coming – to turn them down.”
“Unfortunately, there is that median out there: peak mystical experiences on their own, but sometimes not a lot of thought given to the preparation and the integration,” affirms Neil Markey, co-founder and CEO of Beckley Retreats. Beckley is an affiliate of (though separate from, and not funded by) The Beckley Foundation, established in 1998 by Amanda Feilding, who for decades has supported research into the benefits of psychedelics and advocated for their decriminalisation. It operates medically staffed, facilitator-run experiences in Jamaica and the Netherlands. “You have to do your research. You have to feel – you have to be – safe,” says Markey. “What are the staff credentials? Does the organisation have insurance? Is it even all legal? All these questions are important.”
Markey, who as an elite US Army Ranger did tours of Iraq and Afghanistan before attending Columbia Business School and working for McKinsey, has experience of both armed combat and the C-suite, and understands the (perhaps not dissimilar) mindsets that drive success in each. He also suffered acute PTSD as a result of his experiences in the two wars; the search for an effective treatment is what led him to plant-based compounds. (These are increasingly advocated for use in treatment programmes for veterans of combat; Markey and his team will underwrite a retreat exclusively for a group of them suffering from severe PTSD in spring 2023).
With Beckley Retreats Markey wants, as he says, “to up the standards around this kind of experience so more people will do it”. A large part is commitment: the retreats last just five to six days, but the programme spans 11 weeks: four of preparation, the retreat itself, then a full six of supervised integration. In the preparation stage, self-reflecting, exercise, and meditation are encouraged, as are modifying what you put in your body – and your mind. “If you’re in that caffeine-alcohol, upper-downer mode, or spending five hours a day interacting with your phone, wiring the hell out of your central nervous system… those need to be addressed.”
Regular remote group meetings are strongly encouraged: “We find that starting that group dynamic early is important. The research is pointing to the benefits of doing this type of work in groups, instead of one-on-one,” he says. “That, and being in nature; they are linking both those things to better experiences.” Groups are usually 12 to 18 people with five or six facilitators; a minimum of one for every three participants, at least one of whom is a psychotherapist. Synthesis allows a maximum of 21 participants at a time and Soltara, 22. Beckley Retreats is lucky enough to have a couple of what Markey calls “these amazing ‘unicorns’ – practitioners with formal western medical training, but who have been doing this work for years and years, who have facilitated hundreds of psilocybin sittings.” Not that you won’t have a challenging experience; “but it won’t be traumatic. That’s the seasoned facilitators, that’s being in nature, that’s having settled the nervous system” for weeks beforehand.
The endeavour doesn’t come cheap; Beckley Retreats start from €3,600 in the Netherlands and $5,500 in Jamaica; Soltara’s start at around $1,875; the five-day Expansion retreat at Synthesis costs almost $6,500. Beckley Retreats has a scholarship programme, and aims to subsidise at least one, and ideally two, participants on every retreat; it also allows some attendees to participate at cost. But the numbers highlight another, wider issue: the financial barriers to entry. The legalities around schedule 1 substances mean research is expensive; so is procurement; so, therefore, are most retreats worth considering, not just the ones cited here. Advocating to reschedule the compounds, being able to offer them closer to home at much lower cost: that appears to be the next frontier of consciousness-expanding – and would constitute wellness of a much more inclusive nature.
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