Recognition of contraindications and risk states

The manuals converge on the idea that safe psychedelic or ketamine-assisted work depends on careful screening for psychiatric, medical, and substance-use risk states before treatment. Across the extracts, exclusion of people with serious mental illness, seizure-related risk, active substance problems, pregnancy, and other significant medical instability is treated as central to safety, not as a peripheral administrative step. They also overlap in highlighting suicidality and medication-related risk. The psilocybin trial excludes active suicidal ideation with intent or plan and recent suicidal behaviour, while the BPL-003 report notes suicidality among major exclusions and flags MAOI use, pregnancy or lactation, and serious prior medication reactions. The ketamine protocol similarly frames eligibility as a risk-management process and adds family psychiatric history and legal or incarceration risks as part of that assessment. The manuals differ in the specific conditions they name, reflecting the different compounds and study populations. The ketamine protocol is the broadest on medical instability, excluding advanced neurological, cardiovascular, renal, or hepatic disease, active tuberculosis, febrile illness, AIDS-defining illness, and clinically significant cognitive impairment. The BPL-003 report is more specific to intranasal administration, noting nasal obstruction or congestion, while the psilocybin trial emphasises psychosis, mania, active substance use disorder, and psychotropic medication tapering and eligibility review.