Our team often receives questions around psilocybin’s physical safety profile and any risks associated with psilocybin therapy. This article provides factual information about psilocybin’s safety and risk factors from both a physical and mental-emotional standpoint.

IMPORTANT NOTE: This article is provided for general education purposes only and should not be construed as medical advice. You should always consult with your existing medical provider(s) for detailed medical advice specific to your medical history.

SOMATIC ACUTE TOXICITY

This chart shows common substances, their classes, and their safety from a dependence potential and active vs lethal dose. As you can see below, psilocybin is rated as ‘very low’ in terms of dependence potential and is also low on the scale of active vs lethal dose. Please note the relative locations of alcohol, caffeine and nicotine.

To put things into perspective, by sheer volume required to reach acute toxicity in the body, psilocybin-containing mushrooms are safer to ingest than water. The lethal dose of water is roughly 5 liters (kg) drank within a couple of hours, whereas the lethal dose of psilocybin mushrooms has been measured at somewhere between 17 and 30 kg which is 37 to 66 pounds of mushrooms. Obviously, consuming such quantities is a physically impossible task. 

For further comparison, a median lethal dose of alcohol is 300mg, or roughly 30 ‘standard unit’ drinks. You can see from the chart above that alcohol has moderate chance for abuse (though that might be disputed) and a lethal dose level that is second only to heroin. Yet alcohol is not only not on the Schedule 1 drug list (the definition of which are no known medical use and high risk of abuse), it is also fully legal in most countries around the world with varying minimum legal ages, some as young as 15.

The bottom line: Psilocybin, from a physical acute toxicity perspective, is almost absurdly safe. It is not possible to physically ‘overdose’ on psilocybin. When the term ‘overdose’ is used with psilocybin, it refers to taking a dose which causes an overwhelming experience.

HEALTH CONDITION CONTRAINDICATIONS

It is very important to note that there are some people who either should not take psilocybin until more clinical research has been completed, or who should get their medical professional’s approval before taking a full dose journey.

People who should not take psilocybin until more research is done:

Psychotic Disorders

Psychotic disorders are a group of serious illnesses that affect the mind. They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. The brains of schizophrenic people, for example, are physically different from neurotypical people. https://www.healthline.com/health/schizophrenia/schizophrenia-brain-vs-normal-brain#gray-matter-and-white-matter 

Psilocybin is contraindicated for people with a personal or familial history of any form of psychosis.

For one experience of a woman with schizophrenia who took psilocybin, you can watch the video she put together here: https://www.youtube.com/watch?v=yaLAwAaFFoA. She does discuss doing mushrooms four times, the first two times which she describes as wonderful, the third time as on the fence, and then doing a fourth time hoping it would go back to great but instead turned into what she calls it ‘a bad trip’. She then tries it a fifth and final time and it was very bad, her psychosis was completely triggered.

Please remember that this is a result for those with schizoaffective disorder, not for those with neurotypical brains.

Bipolar Disorder

Psilocybin can worsen symptoms of mania in individuals with Bipolar 1 (Mania present) or other disorders with mania symptoms. In one survey by Sage Journals of 541 individuals with Bipolar, manic symptoms appeared or increased after psilocybin use in one-third of individuals.

Psilocybin is currently being investigated as a potential treatment for Bipolar, in particular the depressive side of bipolar. Because bipolar has a wide range of symptom manifestations in individuals, and is also sometimes over-diagnosed, our team will generally have a conversation with individuals to assess risk of triggering a manic episode. Clients who have history of manic episodes will likely be advised not to continue.

https://journals.sagepub.com/doi/full/10.1177/02698811221131997

Epilepsy or History of Seizures

Epilepsy is a neurological disorder affecting people of all ages. It is a condition that causes grand mal seizures resulting from a disturbance in the normal pattern of transmission of brain signals. This neurological disorder affects people in different ways.

Taking large doses of psilocybin can potentially trigger or exacerbate seizures in people who have had seizures in the past. However, there is promising research about microdosing in those with epilepsy, especially combined with elimination of alcohol consumption. 

For now, we are not accepting clients with history of epilepsy. We will update our policies as research emerges. You can read more at this article:

https://sanctuarywellnessinstitute.com/psilocybin/psilocybin-and-epilepsy.php

It is important to know that the brains of individuals with psychosis, mania or seizures are physically different than in neurotypical individuals. There is no evidence that psilocybin causes psychotic symptoms in non-psychotic individuals, cause mania symptoms in non-manic individuals, or cause seizures in those who do not have a history of seizures.

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People who should receive the appropriate medical professional’s approval who is treating them for the relevant health conditions, before they begin psilocybin therapy:

Serious Heart Conditions

Psilocybin can mildly to moderately increase heart rate during the first 60-120 minutes after ingestion (sometimes just due to anxiety), which is why people with serious heart conditions should seek approval from their cardiologist or family doctor before taking psilocybin for therapy. The litmus test we usually ask new clients is whether it is safe for them to perform moderate exercise. If they do not feel it would be safe to climb up 3 or 4 flights of stairs, for example, then a psilocybin macrodose may not be right for them. (For the record, psilocybin does not cause your heart or breath to increase as much as climbing up 3 or 4 flights of stairs! But this is a good litmus test to assess cardiovascular health and fragility.)

Serious Kidney or Liver Disease

Those with severe kidney or liver disease may have trouble metabolizing or excreting psilocybin. If this applies to you, please have a conversation with your medical provider.

Heavy SSRI/SNRI, Opiod, Cannabis or Alcohol Use

These drugs/substances can cause significant ‘blunting’ effects to psilocybin, because all of them work on the same serotonin receptors and pathways that psilocybin does. The risk for these individuals, especially those with two or more ‘blunting’ factors, is that they will have an underwhelming experience that leads to disappointment or hopelessness. We mention this because most people associate psilocybin risk with an overwhelming experience, but at our clinic we have found it is a far more common risk that people’s prior use of pharmaceuticals, cannabis or alcohol interfered with psilocybin’s ability to get the client into an altered state to do their therapeutic work.

Of course, psilocybin therapy can help clients get off of these substances for good. Talk to our team and your medical provider to devise a safe plan for this, if it is your goal.

If you are on a MAOI or TCA type medication, we will require your prescription provider’s approval before conducting psilocybin services.

MENTAL-EMOTIONAL SAFETY & RISK

Now that we have covered physical safety and risk factors in detail, let’s discuss the more common concern most new psilocybin patients have about taking psychedelics.

We define ‘mental-emotional safety’ as a state of being and environment which allows clients to express a full range of emotions while knowing that they are physically and emotionally safe and that they will not be judged, criticized or shamed. It is akin to a feeling of being held throughout a difficult experience.

It does not mean that a client’s journey will only consist of positive feelings. It only means that if the medicine invites a client to journey through emotional darkness that they will emerge from the other side safe and whole.

ENSURING MENTAL, EMOTIONAL, PSYCHOLOGICAL, SPIRITUAL SAFETY

There are several factors which play into having an emotionally safe psilocybin therapy session:

• an emotionally warm and supportive environment, with trust built between you, the facilitator, and any co-attendees (if applicable)
• prior education on what to expect during your session
• proper and accurate dosing, and 
• the highest commitment to ethical behavior by the facilitator

‘SET AND SETTING’

You may have heard this term before. It refers to Mindset and Environment during a psychedelic therapy session. 

Psilocybin (along with the entire psychedelic drug class) is what experts call a highly ‘suggestible’ drug. This basically means that the experience will be entirely personalized to you, and is one reason why people have different experiences during each journey.

In terms of Setting (Environment), those who desire connection to nature would endeavor to hold their session outdoors. Fractal Soul conducts sessions only indoors, because the physical act of being indoors encourages attendees to focus their attention inward for the purposes of therapeutic processing and healing. Being outdoors, it is easy to get distracted by vibrant colors and the awe of nature itself.

Because we are going into a potentially dark and vulnerable space, every single element of the environment should be chosen with care. Dim lighting, soft music, warm temperature, places to be cozy or snuggle, and symbols or artifacts that you may wish to focus on in your journey, such as a photo of a family member or yourself as a child, can all be included. There should be plenty of space around the attendee so they do not feel closed in or claustrophobic. There may be elements such as water, earth or fire to interact with (safely). Everything about the environment should feel safe, warm and comforting, as well as symbolic to the goals of the journey. The ceremony opening and ritual itself is also part of the setting, as well as the mindset.

Speaking of mindset, during the first phase of the journey while the medicine is converting in the body and taking effect, it is incredibly helpful to meditate, focus, set intentions. Physically ask the medicine to teach you or give you messages, to release your trauma around a specific event, or any other desired outcome. Physically say to yourself that this medicine is welcome in your body, that this experience is welcome, that you know you are safe, and that you trust the process and will let go when asked to. Making these affirmations to yourself will only serve to strengthen you for the actual session.

Part of your mindset coming into the session also will be your prior education. The orientation and education provided will reduce your fear or eliminate it altogether, which will increase your confidence and make letting go more likely than resisting when the time comes.

DOSING

As with everything things in life, the more you take of something, the stronger its effects. (There’s a big difference on impact to the body between eating a few bites of ice cream versus eating an entire tub.) You’ll only gently perceive a microdose of 1-2mg psilocybin, while 20-30mg doses consistently cause anxiety, fears and superficial narratives to crumble away, allowing clients to explore their Pure Self/Consciousness. This is what we refer to as an altered or expanded state of consciousness.

And, also with most things in life, too much of a good thing becomes a bad thing. All Fractal Health clients will discuss their intentions and various internal and external factors with their professional facilitator in order to come up with the proper dosing for them. Since we are dosing in terms of actual psilocybin content and not just dried mushroom weight, we can get very specific and accurate with our dosing. Usually we follow Johns Hopkins recommendations of 20-30mg for those with no blunting factors, 30-40mg for one blunting factor and 40-50mg for multiple blunting factors. Oregon State Law does not allow us to offer doses higher than 50mg of psilocybin analyte to any client.

What’s a Hero’s Dose?

Much has been discussed of the so-called ‘Heroic Dose’, involving consumption of 5+ grams of dried psilocybe mushrooms. The term ‘hero dose’ can play into ego and the daredevil persona, chasing adrenaline or other extreme experiences. Typically, a very strong dose of psilocybin will cause an entire crumbling away of Self (sometimes referred to as Ego Death) and can feel – especially to those who were not prepared or lack knowledge – as a literal physical death. Those who are experienced with psychedelics and are ready for this experience may desire to go this deep. However, it is not appropriate for most first-timers. More is not always better.

FACILITATOR ETHICAL CONDUCT

We go into this in a whole separate article, but psilocybin Facilitators undertake the most sacred of work. We sit alongside other human beings as they heal themselves in a very vulnerable and suggestible state, and that is something that must be taken with the highest level of duty, honor, respect and ethical compass.

There are several code of ethics developed by the State of Oregon as well as MAPS, which we uphold to the highest degree. Two major elements of ethical facilitation include:

• Supporting the journey versus leading it (the medicine will lead you, not us)
• Ethical supportive touch and establishment of a client touch plan ahead of time (do you not want to be touched at all? Is hand and shoulder okay?) Under no circumstances do we touch clients’ bodies in the areas from their knees to collarbone area before, during or after sessions. When we hug, we do so around the shoulders only.

You can read our full Code of Ethics, the standards by which we hold all facilitators (and clients!) to here.

WHAT HAPPENS IF I EXPERIENCE CHALLENGES DURING A TRIP?

As Michael Pollan defines, a ‘bad trip’ is usually the mind and ego’s response to the suggestion of letting go. Usually this happens for two reasons:

• A person’s grief, trauma or harmful habits are embedded deeply in the individual’s Identity of Self, such that unconsciously they may not be willing or ready to give them up, or
• The individual is afraid of experiencing or re-experiencing the pain associated with releasing things like prior traumas and griefs

If you have repressed emotions (like stored trauma), you will likely need to cry and/or have another somatic release to get these feelings processed and let them go. We offer a safe environment for you to do so and will be right by your side during the whole time. 

Most of our clients begin this journey being ‘afraid to cry’. However, they come to realize that if they have the option to cry for an hour or two straight but then be healed for the rest of their lives from a prior adverse event, that’s something they should welcome with open arms. And of course, any clients who experience heavy anxiety or panic (though this is usually transient and only applicable during onset), the facilitator you are working with will help you with breathing, calming and grounding activities to get you through that phase and settle into the experience more fully.

So there you have it! We hope this info has been helpful in understanding the physical and emotional risks, and how we approach them with clients. We acknowledge that every client is a bio-unique individual and that is why journeys, dosing and program plans are customized to each client.