Where we stand
We do not audit, endorse or oppose work that happens outside supervised programs. We understand why it exists. Psychedelics remain controlled substances in most countries, and a 2021 paper observes that people respond by seeking underground (illegal) therapy, traveling to countries where they are legal, or using on their own [3]. Metanoia's own focus is growth in healthy adults, and we meet the same interest from the research side. Researchers who study these settings also describe missing oversight as a real problem for the people who take part, and we take that seriously.
What we offer is knowledge. We read the published research and the documented traditions, mark each claim with its source and a reliability level from 1 to 4, and publish the result free. Anyone who works this way, and anyone who studies it, can read the most current material we have found. In time, Metanoia's own studies, run under full legal authorization, may add evidence of their own. None exists today.
What the research shows about the field
People have used these substances in ritual and healing settings for a long time. A 2020 field study lists the Huichol use of peyote, the Mazatec use of psilocybin mushrooms, the Bantu use of iboga in Gabon and the ayahuasca traditions of the Amazon. Its authors describe a continued rise in ayahuasca tourism, and they conducted their study at a retreat in the Peruvian Amazon [2].
In the United States, national survey data point in a similar direction. An analysis of 1,006,051 respondents to the National Survey on Drug Use and Health found that lifetime illicit psilocybin use rose between 2002 and 2019, driven by adults aged 26 and older, and fell among people aged 12 to 25. The authors call use in the general population rare. They also name what the survey cannot show: whether use was supervised, in what setting and why [5].
We have no reliable figure for the size of this field, so we offer none. The authors of the 2021 paper know of no study that documents rising demand for support, although they describe indirect signs of interest, such as training programs and clinical trial volunteers [3].
What is documented about risk
The evidence on risk comes mostly from surveys with known limits. We report them with those limits. These are research findings, not guidance. They are described here to report what a study measured, not to suggest a dose.
A Johns Hopkins team surveyed 1,993 adults about their most difficult experience with psilocybin mushrooms outside any research study. Of the respondents, 10.7% put themselves or others at risk of physical harm and 2.7% received medical help. Of the 1,339 whose experience lay more than a year back, 7.6% sought professional treatment for lasting symptoms. The authors describe three cases that appeared linked to lasting psychotic symptoms and three to suicide attempts. They write that these rates probably run higher than in users overall, because people described their worst experience and chose to answer. Most respondents (84%) rated that they benefited from the challenging parts of their sessions, and 8% reported a decrease in well-being. The authors conclude that the findings affirm concerns about taking psilocybin in uncontrolled environments [1].
In that sample, physical risk was less likely when people reported physical comfort and social support. Only 25% had a guide or sitter present, and 2.7% had a trusted, sober guide experienced with such sessions. Having a guide was associated with a shorter difficult phase, and not with a lower peak of difficulty. The same authors report much lower rates in laboratory studies of screened, prepared and supported volunteers. These are associations in a retrospective, self-reported survey of people's most difficult experiences, and the authors do not claim cause. The paper also reports associations between estimated dose and difficulty. This page does not report amounts [1].
Researchers who describe ayahuasca retreats in Peru raise concerns about potential contraindications, unsafe preparation of brews, financial and other exploitation, and potential cases of sexual abuse by people posing as healers, citing earlier work [2]. A 2021 paper notes reported instances of sexual abuse by shamans or guides in psychedelic contexts [3], and a 2025 paper notes that inappropriate sexual contact has been reported in therapeutic settings too [4]. At the retreat described in [2], participants' medical histories were self-reported and not checked. The 2021 paper also cites a potentially lethal interaction between ayahuasca and certain antidepressants [3].
A 2025 survey of 581 people with psychedelic experience, 54.7% of them in an expertise role such as guide or sitter, therapist, educator or researcher, collected advice for first experiences. The authors report that few respondents mentioned serotonin syndrome when asked about harmful combinations, and that many recommendations contradicted one another. They call for better education and further research [4].
What researchers agree matters about context
In 2025, 89 experts from 17 countries agreed on 30 context variables that clinical trials should report. They fall into four groups: the physical environment, the dosing session procedure, the therapeutic framework (including preparation, integration and staff qualifications), and the participant's experience of comfort, alliance and safety. The authors note that the panel focused on clinical trials and left out nonclinical perspectives, and that further empirical research is needed to establish how much each variable matters [6]. Accounts from outside clinical trials are part of what the authors say the panel did not cover.
A shared vocabulary for records
Metanoia has published a draft set of 23 common data elements for records of exposure that arise outside clinical trials. It is version 1.1, open for comment until 2 December 2026. It has six groups: substance, person, purpose, setting, outcome and provenance. It uses age bands, has no field for names or contact details, and records the roles of other people, never their identities. Fields record what a source reported. None recommends an amount, a route, a preparation or a setting. Read the data element set [7]
The set also warns that a few fields together can identify a person, and that records can describe conduct that is unlawful where it occurred. Metanoia gives no legal advice, and publishing the set is not a request for anyone's data.
Comments and corrections
One route is open today and a second is being designed.
Comment on the data element set. Write to main@metanoia-ca.org with "CDE v1.1" in the subject line. Comments concern the specification and corrections to what we report. Please leave out accounts of anyone's use, names and anything that identifies a person or a place.
An anonymous channel, in design. Metanoia is designing an anonymous channel for accounts from people who took part in sessions or retreats, or who host them, that would otherwise go unrecorded. The form asks for roles and never for names. It is designed to collect no names, contact details or IP addresses. The form is published for reading and comment on the field reports page. It is not accepting reports and has no opening date. We will settle its legal form, including anonymization and data protection, before it opens [8].
If we have reported something wrongly, tell us. We read every comment.
Questions and answers
Does Metanoia recommend that anyone use a psychedelic or run sessions?
No. Metanoia supplies no substance, gives no amounts or protocols, and does not encourage use.
Is this page telling practitioners what to do?
No. It states what a source says, what the source leaves out, and how much weight it carries. The decisions stay with the reader.
What do the reliability levels mean?
Level 1 is a primary or peer-reviewed source. Level 2 is a reliable secondary source. Level 3 is grey literature such as community material. Level 4 is traditional or ethnographic. Levels 3 and 4 describe the type of source and do not rank its quality.
Sources
Grade key: 1 = peer-reviewed publication or primary record. 2 = reliable secondary source. 3 = grey source (community, social media). 4 = traditional or ethnographic source. Grade describes the type of source, and the design and its limits are given in the text. "Full text" means Metanoia read the body of the paper in full on 2 November 2026, and any part not read (supplements, cited references) is named.
- Carbonaro TM et al. J Psychopharmacol 2016, 30(12):1268-1278. DOI 10.1177/0269881116662634 PMID 27578767. Grade 1. Online survey of 1,993 adults about their most difficult experience with psilocybin mushrooms outside research. Full text. Self-selected sample, so the rates are not population rates (the authors say so).
- Netzband N et al. Psychopharmacology 2020, 237(10):3161-3171. DOI 10.1007/s00213-020-05601-0 PMID 32700023. Grade 1. Observational study at an ayahuasca retreat in the Peruvian Amazon, 24 participants and 24 comparison participants. Full text. The traditions and the concerns about ayahuasca tourism come from its introduction and discussion, where they are cited to earlier work, and are not findings of the study.
- Pilecki B et al. Harm Reduct J 2021, 18:40. DOI 10.1186/s12954-021-00489-1 PMID 33827588. Grade 1. Peer-reviewed letter on ethical and legal issues in harm reduction and integration therapy, with no original data. Full text. Its statements on demand and on guides are the authors' own.
- Kruger DJ et al. Harm Reduct J 2025, 22:191. DOI 10.1186/s12954-025-01337-2 PMID 41291774. Grade 1. Community-based online survey of 581 people with psychedelic experience, convenience sample. Full text (supplement not read).
- Walsh CA et al. Addict Behav Rep 2022, 16:100454. DOI 10.1016/j.abrep.2022.100454 PMID 36119808. Grade 1. Time trends in the National Survey on Drug Use and Health, 2002 to 2019, 1,006,051 respondents. Full text. Lifetime use only for psilocybin, and data end in 2019.
- Pronovost-Morgan C et al. Nat Med 2025, 31(7):2186-2195. DOI 10.1038/s41591-025-03685-9 PMID 40461819. Grade 1. Four-round Delphi consensus, 89 experts from 17 countries. Full text (supplements not read).
- Metanoia. Minimum Common Data Element Set for Non-Clinical Psychedelic Exposure Records, version 1.1, draft for comment, 2026. Own publication.
- Metanoia. Reports from the unsupervised field. Own publication.