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Questions from the field

What published research and documented traditions say about the questions people ask when they guide, sit with or host others, and what we did not find measured. Free, with a source and a reliability level on every claim.

Published Updated Information current to 3 November 2026Review due by 1 February 2027

Many people who guide, sit with or host others say they learned what they know somewhere else. From friends, forums, retreats, books, and from trying things and seeing what happens. We do not judge that. We understand why it happens. People are looking for support, and some say the supervised options are few, costly, or closed to them. We do not audit, endorse or oppose this work, and we are not here to fight it.

What we add is one more source, free, with a reference on every claim and a plain note on how much has actually been studied. Pick a question below. For each one, we show what studies report, what traditions describe, what people in the field say they do, and what we did not find measured. That includes what is known about benefit, and not only about risk. Where a documented search found nothing, we say that.

In time, Metanoia's own research, run under full legal authorization, may add evidence and research-based protocols. None exists today.

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 describes 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.

Ready now

Six questions are written up in full. Every other topic below is in preparation. A topic goes up once its sources have been read in full.

Rules, surveys, traditions

Training and certificates for guides

Is a paid training worth it? What does a certificate give, and does it change how sessions go?

Read the card Studies, field reports

Antidepressants and other psychiatric medicines

Does an antidepressant dull the experience? What about lithium, and what about weight-loss medicines?

Read the card Studies, traditions, field reports

When it gets hard: what helpers do in the moment

What do helpers find out and do when someone is overwhelmed, and how common are hard moments?

Read the card Studies, traditions, field reports

Ayahuasca and San Pedro ceremonies

What do surveys, one placebo-controlled study and traditions describe, and what is not known about the plants and the setting?

Read the card Studies, traditions, field reports

Integration: what happens after a session

What does integration mean, what do retreats and providers report, and does it change how people fare?

Read the card Studies, codes, traditions

Consent, power and boundaries between guides and participants

What do reviews, a trial and one code say about consent, touch and boundaries, and what has not been measured?

Read the card

Each card opens with a short answer in plain words. Below it, in sections you can open one by one, are what people in the field say (marked as reported practice, not a recommendation), what research knows, what is not known, and what traditions describe. At the end come the related elements of the Metanoia Exposure Record data element set and the sources, each with a level and a reading status.

Find a topic

The full list of 49 topics follows, grouped by where they come up in the work.

Before a session: health, medicines, who takes part

  • Screening before a session: what programs ask and whyIn preparation
  • Mental health history and risk: psychosis, mania, traumaIn preparation
  • Heart and blood pressureIn preparation
  • Antidepressants and other psychiatric medicinesReady
  • Weight-loss and diabetes medicines (GLP-1)Short section on the antidepressants card
  • Ayahuasca and antidepressantsIn preparation
  • Pregnancy, breastfeeding and hormonesIn preparation
  • Women, men and the life cycle: cycle, menopause, differences in responseIn preparation
  • Age: younger and older peopleIn preparation
  • Everyday substances around a session: cannabis, alcohol, nicotine, caffeineIn preparation

Preparing the session

  • Preparing and setting an intentionIn preparation
  • Diet, fasting and preparing the bodyIn preparation
  • The room and its safety set-upIn preparation
  • MusicIn preparation
  • One-to-one, group, or couplesIn preparation
  • Alone, at home, or remotelyIn preparation

During the session

Substances and combinations

  • What is in it: identity, testing, variabilityIn preparation
  • Combining substances and multi-day sequencesIn preparation
  • Ayahuasca and San Pedro ceremoniesReady
  • 5-MeO-DMT and bufoIn preparation
  • KetamineIn preparation
  • MicrodosingIn preparation
  • Other substances: iboga and ibogaine, LSD, mescaline, kambo and peyoteIn preparation

After the session

  • Integration: what happens after a sessionReady
  • Lasting difficulties: sleep, feeling unreal, feeling cut offIn preparation
  • Repeated sessions and changing responseIn preparation
  • Support lines, peers and supervisionIn preparation

Conduct, boundaries and law

Getting into the work and running it

  • Training and certificates for guidesReady
  • Getting into the field: apprenticeship, careers, payIn preparation
  • Retreats: what is offered, promised and chargedIn preparation
  • Choosing a guide or a retreat: the questions people askIn preparation
  • The sacred, “the medicine”, the dieta: spiritual and traditional framingIn preparation
  • Using AI as a helperIn preparation

Measuring and outcomes

  • What is claimed about benefit, and what has actually been measuredIn preparation
  • Keeping track: outcomes, follow-up and recordsIn preparation

Records and the set

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. Each card lists the elements of the set that ask about the same area. Fields record what a source reported. None recommends an amount, a route, a preparation or a setting, and publishing the set is not a request for anyone's data.

Read the data element set Comment on the set The anonymous channel, in design (not open)

How to read a card

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.

What people in the field report is level 3 and carries the marking "Reported practice, not a recommendation". It is kept apart from what research knows and is never merged with it into one line that reads like advice. "Not located" always comes with the date and the databases searched, because a later search could find something.

Background reading on what research shows about this field, and the questions and answers about this work, are on the earlier overview page.

Comments and corrections

Comments on the data element set and corrections to what we report are welcome at main@metanoia-ca.org. For the set, put "CDE v1.1" in the subject line. Please leave out accounts of anyone's use, names and anything that identifies a person or a place. If we have reported something wrongly, tell us. We read every comment.