This data analysis study (n=884) examines the impact of a psychedelic helpline on mitigating risks associated with nonclinical psychedelic use. The findings suggest that 65.9% of callers experienced a de-escalation in psychological distress due to the helpline. Additionally, 29.3% reported they could have been harmed, 12.5% might have dialed 911, and 10.8% could have visited an emergency room had it not been for their interaction with the helpline, implying the helpline may prevent harmful outcomes and alleviate strain on emergency and medical services.
Introduction
A resurgence of interest in the use of psychedelics for mental health and wellness has stimulated greater experimentation with psychedelics in society. Although clinical psychedelic trials protect research participants by offering a safe setting, thorough preparation, and containment during and after ingestion of psychedelic medicines, many try these substances without the benefit of these safeguards.
Materials and Methods
We analyzed data gathered from 884 callers to a psychedelic helpline to determine whether a helpline model could reduce the risks associated with nonclinical psychedelics use.
Results
In total, 65.9% of callers indicated that the helpline de-escalated them from psychological distress. If not for their conversation with the helpline, 29.3% of callers indicated they may have been harmed; 12.5% indicated that they may have called 911; and 10.8% indicated they may have gone to the emergency room.
Conclusion
The data suggest that access to a psychedelic helpline surrounding psychedelic experiences may avert harmful outcomes and offset the burden on emergency and medical services.
Papers cited by this study that are also in Blossom
Carhart-Harris, R. L., Giribaldi, B., Watts, R. et al. · New England Journal of Medicine (2021)
Davis, A. K., Barrett, F. S., May, D. G. et al. · JAMA Psychiatry (2021)
Goodwin, G. M., Aaronson, S. T., Alvarez, O. et al. · New England Journal of Medicine (2022)
Mitchell, J., Bogenschutz, M. P., Lilienstein, A. et al. · Nature Medicine (2021)
Earlier research indicates that psychedelic-assisted therapy (PAT) delivered in clinical settings includes multiple safeguards — medical and psychological screening, preparatory sessions, supervised dosing, and postdosing integration — which aim to maximise therapeutic benefit and reduce risk. By contrast, many people now use psychedelics outside clinical settings where those protections are absent. The extracted text notes rising nonclinical use in recent years, citing survey data that show increased past-year use among young adults and middle-aged adults, and highlights that harms from nonclinical use tend to be psychological (for example, distress, panic, or risky behaviour during so-called "bad trips") rather than toxicological in nature. This study sets out to examine whether a peer-support telephone helpline can reduce risks associated with nonclinical psychedelics use. Specifically, Pleet and colleagues piloted an existing peer-support helpline to determine whether conversations with trained volunteers de-escalated callers in distress and might avert emergency service use or other harms in naturalistic psychedelic contexts.
The investigators conducted a pilot, descriptive analysis using routinely collected, anonymous data from a psychedelic helpline operated by the nonprofit Fireside Project. The study period covered April 2021 to September 2022, and the University of California, San Francisco Institutional Review Board reviewed the work and deemed participant consent unnecessary because the data were anonymous (IRB no. 21-34162). Fireside Project offers free peer support during and after psychedelic experiences; volunteers receive a 50-hour training. The helpline is publicised via social and traditional media. Two data sources were analysed: an anonymous postcall survey texted to callers 24 hours after conversations, and call logs that peer-support specialists complete after each call. Peer-support specialists were instructed to ask only rapport-building and need-directed questions, so call logs reflect information volunteered by callers rather than a structured clinical interview. The authors analysed descriptive outcomes from these two sources. The text reports counts and percentages from the postcall survey and from the call logs (for example, social context, emotional content, and mention of underlying psychiatric conditions). The extracted text does not describe inferential statistical methods, hypothesis testing, or linkage of survey and call-log records, and it reports that the two data systems could not be linked.
During the study window, Fireside Project sent 4,047 postcall surveys and completed 4,047 call logs. Of the surveys sent, 848 were returned, a response rate of 20.9%. Postcall survey findings: Among the 848 respondents, 106 callers (12.5%) indicated that if not for their helpline conversation they might have called 9-1-1; 92 callers (10.8%) said they might have gone to an emergency room; and 249 callers (29.3%) reported they might have been physically or emotionally harmed had they not spoken with a peer-support specialist. For the subsample of 259 respondents who contacted the helpline to discuss past psychedelic experiences, 172 callers (66.4%) reported that the conversation de-escalated them from psychological distress. Within this subsample, 60 callers (23.2%) indicated they may have been physically or emotionally harmed without the call; 16 callers (6.1%) said they may have called 9-1-1; and 14 callers (5.4%) said they may have gone to the emergency room. Call-log findings: The call logs show that 3,386 callers contacted the helpline to discuss current or past psychedelic experiences and reported a range of difficult emotions, with "Fear," "Anxiety," "Confusion," and "Overwhelm" listed as distress-specific options. Among the 1,630 call logs for callers who were in the midst of a psychedelic experience, 650 callers (39.9%) reported taking the psychedelic alone; of these 650, 501 callers (77.0%) were at home and 28 callers (4.3%) were outdoors in nature. The logs also indicate that 909 of the 3,386 callers (27.4%) who discussed current or past experiences mentioned an underlying psychiatric condition. The extracted text refers to figures for further breakdowns but the numeric details reported above are those provided in the prose.
Pleet and colleagues interpret these descriptive results as preliminary evidence that access to a peer-support psychedelic helpline may reduce harms associated with nonclinical use. The investigators argue that helpline conversations appeared to de-escalate callers in psychological distress and that some callers reported they might otherwise have sought emergency services or experienced physical or emotional harm. In this framing, a psychedelic helpline could help fill a gap left by the absence of clinical safeguards in naturalistic settings and might offset some burden on emergency medical services. The authors position these findings against broader trends of increasing nonclinical psychedelics use and note an ethical imperative to develop responsible, scalable supports for people using psychedelics outside clinical contexts. They are cautious about generalisability and list several limitations. Callers were self-selecting and therefore may not represent all people who use psychedelics; the postcall survey had a 20.9% response rate; call logs reflect information volunteered to peer-support specialists rather than systematic ascertainment; call logs were completed by peers rather than clinicians, limiting the validity of reported psychiatric conditions; and free-text explanations in surveys were infrequent, constraining qualitative understanding of respondents' reasons. Finally, the two data systems could not be linked, preventing matched analyses of individual callers' survey and call-log data. Taken together, the authors suggest more research is needed but conclude that these early, descriptive data indicate a helpline model warrants further evaluation as a harm-reduction strategy for nonclinical psychedelics use.
Evidence is emerging that psychedelic-assisted therapy (''PAT'') may be an effective treatment option for a range of psychiatric and psychological conditions. For example, psilocybin has been examined as a treatment for depression, 1-3 and 3,4-methylenedioxy-methamphetamine (MDMA) has shown promise as a treatment for posttraumatic stress disorder.When PAT is conducted in clinical research settings, participants engage in regular medical and psychological assessments, preparation ses-sions with therapists, supportive dosing sessions, and postdosing ''integration'' sessions, during which therapists care for participants as they process the sometimes challenging psychological material that can arise during the sessions.The primary aim of this approach is to help participants derive as much meaning and therapeutic gain as possible, while also ensuring their safety. Participants in research are also protected by restrictive criteria that are designed to exclude those with contraindications such as comorbid medical or psychiatric conditions, ongoing trauma or environmental stressors, and poor social support.The safeguards that protect research participants in clinical trials of PAT are generally absent when psychedelics are consumed in nonclinical settings. This is particularly concerning, given that the use of psychedelics in nonclinical contexts is dramatically increasing. According to an NIH-funded survey released in August 2022, the use of psychedelics is at an all-time high.Although past-year psychedelics use had remained stable over the recent decades, it increased in 2021 when 8.1% of adults in the United States aged 19 to 30 years reported past-year psychedelics use (up from 5.1% in 2019 and 3.4% in 2011). Psychedelics use also increased significantly among adults aged 35 to 50 years (2.5% indicated psychedelics use in the last year, up from 0.4% in 2008).Nonclinical psychedelics use creates risks that can necessitate the use of emergency services.These risks are not generally associated with toxicity or overdose of the compound,but rather are psychological in nature, presenting as distress, panic, or inability to control the impact of the altered state of consciousness.In short, some people who try psychedelics nonclinically may not be prepared for the feelings of openness or vulnerability that often accompany psychedelic journeys. When there is no conduit for processing these emotions, adverse effects can occur. In one study of 1993 psilocybin users who experienced ''bad trips,'' 10.7% reported that they placed themselves or others at risk of physical damage, 2.6% reported being violent or physically aggressive, and 2.7% reported having sought help in a hospital or emergency room.According to a recent survey, in 2020, 1.0% of people who consumed lysergic acid diethylamide, 1.0% who consumed MDMA, 0.6% who consumed ketamine, and 0.6% who consumed psilocybin sought emergency medical care.These percentages are concerning given that rates of psychedelics use are bound to increase, perhaps in part due to the high prevalence of mental health issuesand efforts to decriminalize or legalize psychedelics.An absence of resources to support people using psychedelics could lead to increased reliance on an emergency medical system already overburdened by avoidable visits.Accordingly, it is imperative to address the question of how to reduce the risks associated with nonclinical psychedelics use. In community mental health contexts, helplines such as suicide-prevention hotlines provide a useful model for how to de-escalate high-risk callers and reduce the burden on emergency services.For instance, in 2021 the National Suicide Prevention Lifeline, a network of crisis centers in the United States, received >3.3 million calls, chats, and texts, 19 and crisis-line utilization is only increasing.
We sought to determine whether a helpline could reduce the risks for those experiencing difficulties during and after nonclinical psychedelics use. To do this, we conducted a pilot study using data gathered through a psychedelic helpline operated by the nonprofit organization Fireside Project. The study received ethics approval from the University of California, San Francisco Institutional Review Board (IRB no. 21-34162), which deemed participant consent unnecessary due to the anonymous nature of our data. Fireside Project provides free peer support to people during and after their psychedelic experiences and is staffed by volunteers who undergo a 50-h training. The helpline is advertised through social media and in national and local media. Data for this study were obtained from two sources that Fireside Project routinely uses to collect information from callers after every conversation. The first was an anonymous postcall survey (accessible at) texted to callers 24 h after every conversation. The second was call logs completed by peer-support specialists after every conversation. Each log contains questions with answer choices quoted below. Peer-support specialists were instructed to ask only questions that build rapport and address callers' needs; thus, logs do not contain responses to all questions.
Below we present data gathered between April 2021 and September 2022. During this period, surveys were sent to 4047 callers: 848 responses (20.9%) were received, and 4047 call logs were filled out by peer-support specialists.
Offsetting the burden on emergency services. Of the 848 respondents, 106 callers (12.5%) indicated that if not for their conversation with a peer-support specialist, they may have called 9-1-1; 92 callers (10.8%) indicated they may have gone to the emergency room; and 249 callers (29.3%) indicated that they may have been physically or emotionally harmed. De-escalating callers from distress. As shown in Figure, helpline conversations played a significant role in de-escalating callers from emotional, mental, or physical distress. Reducing risks during psychedelic integration. Of the 259 survey respondents who contacted the helpline to discuss past psychedelic experiences, 172 callers (66.4%) indicated that their conversation de-escalated them from psychological distress. If not for their conversation with a peer-support specialist, 60 callers (23.2%) indicated that they may have been physically or emotionally harmed, 16 callers (6.1%) indicated they may have called 9-1-1, and 14 callers (5.4%) indicated they would have gone to the emergency room. To our knowledge, these are the first data suggesting that a lack of support during the process of psychedelic integration may lead to harm.
Emotional content of callers' psychedelic experiences. The call-log section entitled ''Trip Content'' included the following distress-specific response options: ''Fear,'' ''Anxiety,'' ''Confusion,'' and ''Overwhelm.'' Figureillustrates that the 3386 callers who contacted the helpline to discuss current or past psychedelic experiences reported experiencing a range of difficult emotions. Taking psychedelics alone. The call-log section entitled ''Social Context'' provides the following response options: ''Alone,'' ''With one or a few close others,'' ''With a group of intentionally gathered people (i.e., for a ceremonial purpose),'' ''With a large group of known and/or unknown people,'' and ''Other,'' with the option to enter a response. Of the 1630 call logs for callers who were in the midst of a psychedelic experience, 650 callers (39.9%) reported taking the psychedelics on their own, without other people present. Of those 650 callers, 501 callers (77.0%) were at home and 28 callers (4.3%) were outdoors in nature. Consuming psychedelics with underlying psychiatric conditions. Our data suggest that people may be consuming psychedelics in nonclinical contexts to address symptoms related to underlying psychiatric disorders. Of the 3386 callers who contacted Fireside to discuss current or past psychedelic experiences, 909 (27.4%) mentioned an underlying psychiatric condition. The frequency of each condition is illustrated in Figure.
Our study implies that people who use psychedelics in nonclinical settings often do so without necessary safety precautions. This creates an ethical imperative to delineate responsible solutions to reduce the risks associated with naturalistic psychedelics use. Although more research is needed, our early data suggest that access to a psychedelic helpline may avert harmful outcomes, reduce the risks sometimes associated with nonclinical psychedelics use, and offset the burden on emergency services.
This study has several limitations. First, callers are selfselecting individuals likely in need of psychedelic support. Caution should be used in generalizing results to all people who consume psychedelics in nonclinical contexts. Second, our survey had a 20.9% response rate. Caution should be exercised in generalizing results to all callers to the psychedelic helpline. Third, peersupport specialists who completed the call logs were instructed to ask only questions to build rapport and address callers' needs. As such, information in the call logs was volunteered by callers and should not be generalized to other helpline callers or to people who consume psychedelics in nonclinical contexts more generally. Fourth, logs were filled out by peer-support specialists, not clinicians, which limits the validity of the question regarding psychiatric conditions. Fifth, although postcall survey respondents have the option to provide explanations for their answers, few actually do. This limits our ability to understand the reasons for their responses. Finally, because Fireside Project's call log and survey systems run on different software platforms, we were unable to link survey responses to call logs, which limited our understanding of callers' experiences. We have communicated this limitation to Fireside Project to improve data collection for future studies. PLEET ET AL.
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