Human hallucinogen research: guidelines for safety
This paper reviews the psychological risks of human research with classical hallucinogens and provides practical safety guidelines—rigorous screening, preparatory rapport, a controlled physical setting and interpersonal support from at least two monitors—to minimise acute distress (“bad trips”) and the risk of prolonged psychosis. The authors conclude that persisting adverse reactions are rare when these safeguards are followed, allowing ethically conducted research that may advance psychiatric treatment and basic science.
Authors
- Roland Griffiths
- Matthew Johnson
- William Richards
Published
Abstract
There has recently been a renewal of human research with classical hallucinogens (psychedelics). This paper first briefly discusses the unique history of human hallucinogen research, and then reviews the risks of hallucinogen administration and safeguards for minimizing these risks. Although hallucinogens are relatively safe physiologically and are not considered drugs of dependence, their administration involves unique psychological risks. The most likely risk is overwhelming distress during drug action ('bad trip'), which could lead to potentially dangerous behaviour such as leaving the study site. Less common are prolonged psychoses triggered by hallucinogens. Safeguards against these risks include the exclusion of volunteers with personal or family history of psychotic disorders or other severe psychiatric disorders, establishing trust and rapport between session monitors and volunteer before the session, careful volunteer preparation, a safe physical session environment and interpersonal support from at least two study monitors during the session. Investigators should probe for the relatively rare hallucinogen persisting perception disorder in follow-up contact. Persisting adverse reactions are rare when research is conducted along these guidelines. Incautious research may jeopardize participant safety and future research. However, carefully conducted research may inform the treatment of psychiatric disorders, and may lead to advances in basic science.
Research Summary of 'Human hallucinogen research: guidelines for safety'
Introduction
After decades of near-dormancy, human research with classical hallucinogens has been renewed, producing studies that probe basic neuroscience, perception, pharmacokinetics, and potential clinical applications (for example, anxiety in advanced cancer and obsessive–compulsive disorder). Johnson and colleagues place this revival in historical context: early widespread research in the 1950s–1960s was followed by sensationalism, political restriction and a long hiatus, and contemporary investigators therefore face particular scientific and sociopolitical sensitivities when designing human-administered hallucinogen studies. This paper sets out to describe the unique risks of administering high doses of classical hallucinogens and to propose practical guidelines to minimise those risks. The authors focus on safety-related recommendations for high-dose administration (illustratively defined as ≥25 mg psilocybin or 200 µg LSD), addressing volunteer selection, study personnel and training, physical environment, volunteer preparation, session conduct, and post-session follow-up. They also review relevant historical and clinical literature to justify and illustrate the proposed safeguards.
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Johnson, M., Richards, W., & Griffiths, R. (2008). Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology, 22(6), 603-620. https://doi.org/10.1177/0269881108093587
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