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When things go wrong: kinds of harm reported

The question here is what kinds of harm published sources report in connection with natural psychedelics, and how each was counted. This card sets out what they report, and the limits of the counting.

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. Metanoia does not receive or investigate complaints about guides or retreats.

The short answer

What kinds of harm have been reported in connection with natural psychedelics, and how were they counted?

Published sources describe psychological distress, emergency visits, reports of sexual and boundary violations, and deaths. Each was counted differently: surveys, a helpline log, poison-centre calls, one hospital's charts, coroners' records and case reports. None gives a rate for a defined group of healthy adults. This card does not say how likely any harm is, and it does not compare settings or substances.

What was found?

Reported findings, not recommendations. Counts describe who was asked, who called or who was seen. Associations are not causes. Each figure names its substance and group.

Psychological distress

  • In a 2021 US online survey with quotas on sex, age and ethnicity, 613 respondents had ever used one of seven classic psychedelics, LSD among them. Of these, 59.1% had never had a challenging experience. After the hardest one, 8.9% reported impairment over a day, 2.6% sought professional help and 6.7% reported thoughts or attempts of harming themselves or others. Source 1, level 1

Emergency care

  • In the 2017 Global Drug Survey (anonymous, self-selected), 19 of 9,233 past-year mushroom users who answered (0.2%) had sought emergency treatment, and 8 were admitted. Source 2, level 1
  • At one San Diego hospital, 232 emergency visits from 2010 to 2023 were judged partly due to recreational psychedelics: LSD in 81, MDMA in 70 and psilocybin in 55. Of all 232, 11.2% needed psychiatric admission. Source 3, level 1

Poison centres

  • US poison centres logged 6,933 psilocybin-related calls from 2013 to 2022, at all ages, including 520 children aged 12 or under, most of them unintentional. Another substance was involved in 31.8%. By the paper's tables, 295 (4.3%) were coded major effect and 8 (0.1%) death, with no causal finding. Calls are voluntary. Source 4, level 1
  • For ayahuasca products, 538 exposures from 2005 to 2015 (107 under age 18, the product not laboratory-confirmed) included 41 major effects and 3 deaths. The authors say many exposures go unreported. Source 5, level 1

Sexual and boundary violations

  • In a 2022 anonymous convenience survey of 1,221 people with past use of several psychedelics, LSD and MDMA among them, recruited at a psychedelic advocacy event in Michigan and online, 7.9% said they know anyone, themselves included, who was a victim of inappropriate sexual contact by a sitter, guide or practitioner. The count is of people known, so one event can be counted more than once, and it is not a rate. Source 6, level 1
  • One US support line classed 43 of 25,419 interactions as reports of abuse by a facilitator, none verified. Source 7, level 1

Deaths

  • A search of Australian coroners' records for 2000 to 2023 found 10 deaths with the person's own psilocybin use recorded as contributing: 4 traumatic accidents, 2 multiple-drug toxicity and 4 undetermined, sudden deaths soon after psilocybin with no other cause found. Psilocybin is not routinely tested for, so cases may be missed. The study's 33 LSD cases are not reported here. Source 8, level 1
  • A 2025 review found five reported deaths after DMT: three case reports (a herbal tonic in the United States, and ayahuasca ceremonies in the UK and Colombia) and two from a UK coroners' database, neither at a ceremony. Other substances were recorded in all five. No ceremonies or participants were counted, so these are cases, not a risk of ceremonies. Source 9, level 1

What is not known?

“Not located” means the searches Metanoia ran on 7 November 2026 did not return it. They covered PubMed (22 strings) and Europe PMC with preprints (2). Google Scholar, legal databases, official reports and other languages were not searched.

  • How often any harm occurs among healthy adults.
  • A count of deaths at retreats or ceremonies, or a death rate for a defined group. The one national count read covers Australia only.
  • Financial exploitation. No peer-reviewed count was located.
  • How many people face arrest. One survey asked about knowing someone arrested, undefined by substance, place or year, and is not used here.
  • Harm that never reaches a survey, a helpline, a poison centre or a hospital.

What this card does not say

  • It does not say how likely harm is, rank settings or substances, or set a standard of care. It names no person and no organization.
  • Deaths after ibogaine are left to the entry on other substances, not yet written. A 2012 series was seen only as an abstract and carries no claim.
  • Lasting difficulties and physical risk have entries not yet written. Related cards: crisis during a session, mental health history and consent, power and boundaries.
  • 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. 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. Simonsson O, Hendricks PS, Chambers R, Osika W, Goldberg SB. Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics. J Affect Disord 2023, 326:105-110. DOI 10.1016/j.jad.2023.01.073 PMID 36720405. Grade 1. Cross-sectional online survey, quota sample. Read in full 7 November 2026 in the author manuscript (supplement not read).
  2. Kopra EI, Ferris JA, Winstock AR, Young AH, Rucker JJ. Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms. J Psychopharmacol 2022, 36(8):965-973. DOI 10.1177/02698811221084063 PMID 35388724. Grade 1. Anonymous online survey, self-selected, and one author owns the survey. Read in full 7 November 2026 (supplement and figures not read).
  3. Bhatt KV, Friedman J, Benster L, Narasimhan R, Yang K, Mishra J, Weissman CR, Ramanathan D. Clinical characteristics of emergency visits related to recreational psychedelic use. Community Ment Health J 2026, 62(7):1252-1260. DOI 10.1007/s10597-026-01620-x PMID 41920509. Grade 1. Retrospective chart review at one hospital. Read in full 7 November 2026 (supplements not read).
  4. Montoy JCC, Wang RC, Coker AR, Smollin CG, Anderson BT. US poison center encounters for psilocybin-related exposures: 2013-2022. J Am Coll Emerg Physicians Open 2025, 6(5):100231. DOI 10.1016/j.acepjo.2025.100231 PMID 40927687. Grade 1. Retrospective analysis of voluntary calls. Read in full 7 November 2026 (supplements not read). The text and the tables differ in places, so outcome counts are taken from the tables, and the yearly rise is from the text. One author was employed by a sponsor of psychedelic trials until 2022.
  5. Heise CW, Brooks DE. Ayahuasca exposure: descriptive analysis of calls to US poison control centers from 2005 to 2015. J Med Toxicol 2017, 13(3):245-248. DOI 10.1007/s13181-016-0593-1 PMID 27896660. Grade 1. Retrospective analysis of voluntary calls, no laboratory confirmation. Read in full 7 November 2026 (reference list not read).
  6. Kruger DJ, Aday JS, Fields CW, Kolbman N, Glynos N, Barron J, Herberholz M, Boehnke KF. Psychedelic therapist sexual misconduct and other adverse experiences among a sample of naturalistic psychedelic users. Psychedelic Med 2025, 3(1):41-47. DOI 10.1089/psymed.2024.0011 PMID 40342400. Grade 1. Anonymous online convenience survey. Read in full 7 November 2026 (reference list skimmed, not read in full).
  7. Schoeller F et al. The Fireside Database: large-scale evidence from 25,419 psychedelic support interactions. Sci Adv 2026, 12(44):eaeg4737. DOI 10.1126/sciadv.aeg4737 PMID 42962007. Grade 1. Service data coded by volunteers. Read in full 3 November 2026 (appendix not read), and the figure of 43 checked again in the text on 7 November.
  8. Darke S, Duflou J, Peacock A, Farrell M, Hall W, Lappin J. A retrospective study of the characteristics and toxicology of cases of lysergic acid diethylamide (LSD)- and psilocybin-related death in Australia. Addiction 2024, 119(9):1564-1571. DOI 10.1111/add.16518 PMID 38771189. Grade 1. Retrospective case series from a national coroners' database. Read in full 7 November 2026 in the open-access publisher text (figure and reference list not read).
  9. Pullen J, Copeland CS, Moore R, Wood R, Rab E, Couchman L. Fatalities following DMT use: two case reports and a review of the literature. J Anal Toxicol 2025, 49(9):725-733. DOI 10.1093/jat/bkaf064 PMID 40632616. Grade 1. Case reports and a literature search, with a voluntary registry. Read in full 7 November 2026 (figures not read).