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Consent and agreements: what sources describe

The question here is what is documented about consent and written agreements for guided sessions. This card sets out what ethics papers, published codes and state texts say.

Published Information current to 7 November 2026Review due by 5 February 2027

Read this first. This page is education, not instructions to use. Metanoia does not supply any substance. In the United States, most of the substances discussed here are Schedule I under federal law (21 CFR 1308.11). State programs such as Oregon's and Colorado's operate under state law only, and federal law still applies. Legal status differs between countries, and none of this is legal advice. Nothing here is medical advice, and nothing here gives or recommends a dose. People who host, supply or take part in sessions involving controlled substances can face criminal liability under federal and state law. This page does not advise on that. "Healthy adults" means people with no diagnosed psychiatric or major medical condition, the population Metanoia studies. This page reports what published sources say about work done outside supervised programs, and it takes no position on the legality of any setting, practice or person.
Not an emergency resource. Metanoia is not an emergency service. In a medical or mental health emergency in the United States the number is 911, and the 988 Suicide and Crisis Lifeline is available by call or text. Elsewhere, local emergency numbers apply. Nothing on this card is a reason to delay or avoid care. This card describes what sources report. It is not a screening tool, it does not say who should take part in a session or in what setting, and it is not medical guidance.

The short answer

What do sources say about consent and written agreements for guided sessions?

Sources describe consent given before an altered state as contested. The state texts read here answer with process: documents reviewed in advance, separate written consents for items such as recording, and a right to withdraw that Oregon and Colorado word differently. Metanoia's search on 7 November 2026 located no study measuring whether any consent practice prevents harm. This card is not a standard of care or legal advice.

What do ethics papers, codes and state texts say?

Reported findings and published text, not recommendations. Each item applies only to the group or program named.

Ethics papers and codes

  • A 2026 scoping review of 51 articles found consent discussed in 16. Authors doubt that fully informed consent can be given before a session, citing media hype, pressure from enthusiastic researchers and an experience that cannot be described beforehand. A workshop of eight participants said it matters to explain in advance that the ability to consent may be impaired during a session. Source 1, level 1
  • A 2024 philosophical analysis argues that patients can often consent anyway because they want to leave a distressing status quo. By the author's account this depends on seeing one's condition as a major disability and on highly controlled settings. It concerns patients and does not discuss healthy adults. Source 2, level 1
  • Reported practice, not a recommendation. A training program's 2026 code describes ongoing consent covering roles, fees, recordings and observers. Its authors say it is not externally validated. Source 3, level 1
  • A code from a US research nonprofit, dated 2021 on the document, is written for practice within its own trial protocols. It commits to honoring a participant's choice to withdraw at any time and to obtaining consent from everyone present before recording. Source 4, level 3

State texts

In force on 7 November 2026, each for licensed programs in that state only.

  • Oregon requires a consent document that a facilitator reviews with each client in preparation and the client signs before an administration session. Separate written consents cover listed items, such as group sessions and recording. The client bill of rights lists a right “to withdraw or alter my consent to receive psilocybin services at any time prior to beginning an administration session.” A line in the consent document says the client “may decide not to consume psilocybin at any time.” Source 5, level 1
  • Colorado's rules say “A participant may withdraw their consent at any time” and that the facilitator documents it. Completing the informed consent document may not be delegated. Consent information must cover how the substance may disrupt the ability to give or revoke consent. Outside a healing center, a session may not be held if the participant refuses another person's presence or a video recording. Written disclosures signed by the participant must cover current medical and scientific knowledge on efficacy, safety and range of outcomes, and possible interactions with medicines or conditions (rule 6.15 C). Recording needs consent from every person present (rule 6.5 H). Source 6, level 1
  • A New Mexico advisory committee policy of April 2026, not a rule, asks for consent through direct discussion, not writing alone. Source 7, level 1

The two withdrawal texts are worded differently. This card does not say what either permits once a session is under way.

What is not known?

“Not located” means that the searches Metanoia ran on 7 November 2026 in PubMed, ClinicalTrials.gov and the Europe PMC preprint index did not return it. Not every title returned was checked.

  • Whether any consent practice reduces harm.
  • How consent is handled outside licensed programs. A survey of 49 retreat organizations did not describe it (source 9).
  • Whether Oregon's coming rule changes alter these texts. The state health authority gives a planned effective date of 15 January 2027 and held advisory committee meetings on draft rules on 2 and 4 November 2026 (source 8). The drafts were not used.
  • Rules in other places, other codes and traditional ceremonies were not examined.

What this card does not say

  • It does not say whether to sign anything, what an agreement should contain or what counts as valid consent in law. It offers no template, rates no text as adequate and is not legal advice. Metanoia does not certify guides.
  • Touch is a separate topic. Power and boundaries are on the card consent, power and boundaries.
  • It does not rate how risky, safe or worthwhile any practice is. This is not an emergency resource. In the United States, 911 and the 988 line are available.

Send a correction

If this card reports something wrongly, tell us. Write to main@metanoia-ca.org and keep the card name in the subject line. Accounts of what happened in a session belong in the field reports channel, not in email. Please leave out names and anything that identifies a person or a place. We read every message.

Where does this come from?

Grade key: 1 = peer-reviewed publication or official document, 3 = a source published by an organization about itself. A grade names the type of source, and the design and limits are given in the text. “Read in full” means Metanoia read every sentence on the date given, and any part not read is named.

Review due by 5 February 2027.

  1. Brittain N et al. Ethical issues and recommendations in psychedelic research and practice: a scoping review. J Bioeth Inq 2026. DOI 10.1007/s11673-025-10454-3 PMID 40773130. Grade 1. Scoping review. Read in full 3 November 2026, the consent passages read again 7 November 2026 (appendix not read).
  2. Villiger D. Giving consent to the ineffable. Neuroethics 2024. DOI 10.1007/s12152-024-09545-6 PMID 38371714. Grade 1. Philosophical analysis, which is opinion. Read in full 7 November 2026 (reference list not read).
  3. Dames S et al. Competencies and ethical governance for psychedelic-assisted therapies: a practice-embedded quality-improvement framework. J Eval Clin Pract 2026. DOI 10.1111/jep.70556 PMID 42574657. Grade 1. Framework from one training program. Read in full 3 November 2026, the consent passages read again 7 November 2026 (appendices not read).
  4. MAPS, Code of Ethics for Psychedelic Psychotherapy, version 4, dated 7 January 2021 on the document, file name dated 22 June 2022. PDF on the organization's site. Grade 3. An organization's own code, written for practice within its trial protocols, and not a standard. Read in full 7 November 2026 (five pages). Whether a newer version exists was not checked.
  5. Oregon Administrative Rules 333-333-4520 (Client Bill of Rights), 333-333-5000 (Preparation Session Requirements) and 333-333-5040 (Informed Consent), Oregon Secretary of State, chapter 333, division 333. Grade 1. State rule text. The three rules were read in full on 7 November 2026 on the official site, and the quoted lines were checked there again on the same date. Other rules in the division, including those on sessions, were not read for this card.
  6. Colorado 4 CCR 755-1, Natural Medicine Licensure Rules, rules 6.3, 6.5 and 6.16 read in full on 7 November 2026. The text is the document titled “Rules Currently in Effect” that the state Division of Professions and Occupations links from its Natural Medicine page, whose revision history ends with an emergency rule effective 5 December 2025. Grade 1. State rule text, taken from the agency's posting. On 8 November 2026 rules 6.5, 6.6, 6.15 and 6.16 were read in full again from the Secretary of State's official PDF, whose current version lists the same emergency rule of 5 December 2025. The two texts were not compared line by line. The rest of the document was not used.
  7. New Mexico Medical Psilocybin Advisory Board, Patient Qualification and Safety Committee, Psilocybin Informed Consent, adopted 6 April 2026. Document on the Department of Health site. Grade 1. Official committee policy, not a rule. Read in full 7 November 2026 (one page).
  8. Oregon Health Authority, Psilocybin Administrative Rules page. Grade 1. Official page, read in full 7 November 2026. The draft rule documents linked from it were not used.
  9. McGuire AL et al. Reported safety practices of publicly advertised psychedelic retreats. JAMA Netw Open 2026. DOI 10.1001/jamanetworkopen.2025.52505 PMID 41499117. Grade 1. Interviews with 49 organizations. Read in full 7 November 2026 (supplement not read). Used only for what it did not cover.