The Trifecta of Psychedelic Safety: Screening, Setting, and Support

"Screening, setting, and support" is the new "set and setting"

TLDR

After conducting more than a dozen interviews for my upcoming book, Welcome to the Psychedelic Renaissance, I’ve converged on three universal principles which will maximize benefits from psychedelics while minimizing risk and harm.

1. Screening: Filter out people who are not ready or not suitable for psychedelics.

2. Setting: Create safe, controlled settings that are conducive to beneficial sessions.

3. Support: This includes preparation before, support during, and integration after.

Context

I recently “quit AI”, though the assertion of finality is more or less dubious. I’m not making AI-specific content and I’m also stepping away from leading communities. The AI-content treadmill plus managing communities was really driving my burnout. However, between cutting out stuff and realigning my focus, I’ve settled on my two main missions:

1. Post-Labor Economics. The world is asleep at the wheel with AGI just around the corner. Neoliberalism (the current prevailing economic theory) is woefully inadequate. We need something new.

2. Psychedelic integration into society. We need a meaning, intellectual, and healing revolution. Psychedelics are extraordinarily powerful. However, we must integrate them carefully.

As such, I’m working on a couple of books, plus these blogs and Tweets and everything else.

Psychedelics are enormously powerful. I speak from personal experience as well as scientifically documented data. I even ran my own miniature study:

The vast majority of people who use psychedelics benefit from them. But in order to integrate them into society successfully, we need a simple, safe, repeatable framework for harm reduction.

For psychedelic safety, in the good old days, they said “set and setting” which is a shorthand for saying “go in with the right mindset and do it in the right context.” Basically: do it with safe people and make sure you’re ready for what’s coming.

However, this mantra of “set and setting” is just not sufficient as a public health policy. This does not present a comprehensive framework that is reliable, repeatable, and scalable. However, having spoken to leading experienced and experienced psychonauts, we have settled onto a simple, scalable, durable safety framework that will reduce harm, prevent negative outcomes, and thus help us to reliably integrate psychedelics into society.

The last thing we want is people getting hurt. Preventing harm and catastrophic outcomes is the best way to prevent backlash and ensure the public is comfortable with legalization and/or decriminalization of psychedelics.

Note: Massachusetts just voted against decriminalization :(

“Critics warned it could lead to a black market. They also argued the centers would not be prevented from giving psychedelics to people considered high risk, like those with schizophrenia, bipolar illness or who are pregnant or breastfeeding.” - Boston Herald

Screening

The first step to harm reduction and de-risking psychedelics is simple: screening. Filter out people who are less likely to benefit and more likely to have negative outcomes. The basics are this:

• Mental health disorders, specifically manic, psychotic, and personality disorders.

• Physical health indicators, such as CVD or drug interactions

• Active suicidal ideation

• Severe substance abuse disorders (namely heavy pot smokers)

The greatest risk, other than direct medical episodes, seems to be psychotic breaks. Psychedelics have the ability to trigger people who are at risk for psychosis or similar episodes. In other cases, people who are at risk for self harm might actually succeed in doing so. In my research, several catastrophic outcomes have been documented recently.

1. A student cut his own throat while on LSD

2. A man cut off his own penis

3. Another man removed at least one of his eyes

These sorts of outcomes are dramatic and terrifying even if they are exceptionally rare. However, in pretty much all cases, they would have been prevented by the trifecta of adequate screening, safe setting, and professional supervision.

You can find more research on the negative outcomes and statistics here.

Medical screening is pretty much mandatory.

Setting

Setting is basically broken into two criteria: safe and controlled. Beyond that, there’s a lot of flexibility. Setting can be ceremonial, traditional, or ritualistic. It can also be clinical, individual, or group. Lots of people have had remarkable experiences in groups with close friends, though this is not recommended for anyone inexperienced.

However, the overarching themes are safety and control. Both of these can be further subdivided.

• Physical safety: Accidents happen. Remove fire hazards, weapons, fall hazards, drowning hazards, and so on.

• Emotional safety: This is critical. People on psychedelics need emotional safety above all else.

There have been several documented instances of sexual abuse or otherwise nonconsensual contact between shamans or gurus and journeyers, particularly for women. In some cases, this is chalked up to “cultural miscommunications” but in some cases, there is a pattern of abuse and exploitation.

Ayahuasca retreats in the Amazon are only one option.

Controlled, in the case of psychedelic sessions, pertains to environmental controls and unintended events. In other words, a secure location that provides a stable, quiet environment where there will not be intrusion from the outside, or disruption from the people doing their trip, is required. Some people go deep into the woods or to spiritual retreats. Other prefer “trip rooms” with friends or therapist offices.

Good settings:

• A dedicated trip room that is adequately prepared with experienced friends and trip sitters.

• A clinical office for individual or group sessions.

• Deep in nature with adequate supervision and safety precautions.

• A spiritual or wellness retreat with professional facilitation.

Bad settings:

• A dorm room by yourself

• In public

• With unsafe or unhealthy people

• Anywhere that interlopers might interfere or intrude

Support

Support is also somewhat straight forward and obvious. However, it can be broken down into three overall phases.

1. Preparation: In many cases, inadequate psychological preparation is implemented, as little as an hour. Ideally, people have several sessions, many hours, and several weeks to prepare. This is often aided by professionals, groups, and reading, meditating, and so on. It mostly comes down to education.

2. During Sessions: Professional supervision is usually required, particularly for therapeutic events. This doesn’t necessarily have to be a psychologist or therapist. It can be a professional trip sitter, a professional facilitator, or even a shaman or guru. So long as they embody professionalism (skill, training, ethics) it should be fine.

3. Integration: One of the most lacking aspects of psychedelic support is integration. This requires ongoing support, such as peer groups, regular follow-ups, and a social context that gives people a healthy and safe space to talk about their experiences. In my case, coming home with my wife was critical after the retreat we went to.

Many people I’ve spoken to have talked about the lack of integration groups, meetups, and circles has been a major hindrance.

Support can come in many forms, from supportive peers and friends to licensed clinical providers to spiritual healers. As I mentioned, professionalism is the most important feature of these folks. There are a lot of ways to do it wrong, but there are a lot of ways to do it right as well. There’s no one-size-fits-all model for trip sitting or facilitating, but there are plenty of books out there, and multiple cities and states are working on licensing and training regimes.

Social Containers

Another major missing piece is the “social container” for psychedelics. They are still taboo, there are no “integration centers” where you can visit, and there are relatively few meetups. Right now, it’s all done very hush-hush, whispered between friends. This creates many barriers, such as onboarding curious and new people with education and supportive groups, as well as providing ongoing support after sessions. Social containers can be:

• Local establishments that provide a venue for education and connection

• Programs in universities and governments

• Clinical and outpatient practices

Conclusion

There’s really not much else to say. This framework may seem obvious, but that’s not necessarily bad. That it is so obvious and straightforward means it’s easy to study, implement, replicate, and scale. Furthermore, this model has been validated by clinical researchers, experienced psychonauts, and retreat founders that I’ve talked to.

Creating mystical, healing experiences is relatively easy when you are empowered by these incredible plant medicines and synthetic compounds. As many say; psychedelics are not created equal, so substance matters! But that goes outside the scope of this article.

Ongoing Work

My work in the psychedelic space is ongoing. I will be addressing numerous questions, ranging from:

1. Legalization vs decriminalization: What’s the difference and what are the arguments for and against each? We’ll look at regulation, markets, dispensaries, and quite a few other facets of this question.

2. Accessibility: Retreats are ludicrously expensive, so how do we lower costs and ensure that everyone can benefit from these powerful medicines and life-changing experiences?

3. Deployment Models: How do you scale delivery? It comes down to venues, containers, education, and community.