This article provides factual information about psilocybin’s safety and its risk factors from both a physical and mental-emotional standpoint. Before you take your first consciousness-altering psilocybin dose (considered to be roughly 1 gram or more of dried mushroom, with ‘full dose’ ranging between 2-3 grams), you should be well educated. Keep in mind that as low ask the risks are for a full dose, microdoses are so small and sub-perceptual they do not carry the same contraindications. To the best of our current knowledge, microdoses are safe for all adults.

So how safe IS a full dose (journey) of psilocybin, really? Let’s break this topic down into 1) acute physical toxicity and medical contraindications, and 2) mental-emotional safety and risk.

SOMATIC (PHYSICAL) ACUTE TOXICITY

The first thing you should know is that Psilocybin is consistently rated as the least toxic among common street drugs, legal drugs and prescription drugs (see this chart, where classic psychedelics LSD and psilocybin can be found in the bottom left):

The median lethal dose of psilocybin in humans is very low at 280mg per 1kg of body weight. (Please keep in mind this is for pure psilocybin/psilocin content, which is usually .6% to 1.2% of the total dried mushroom weight, 1% being average.) Source.

To put things in practical terms, a 130 pound person would need to consume 16,520 mg of pure psilocybin content (analyte), which assuming 1% average potency, is equivalent to 1,652 grams of dried mushroom (1.65kg or 3.6 lbs). For a 200 pound person that amount goes up to 25,200 mg of pure psilocybin analyte – 2,520 grams of dried mushroom, equivalent to 5.5 lbs.

By comparison, therapeutic ‘full doses’ administered at Fractal Soul are between 2 to 3 grams of dried mushroom, or 20-30mg of pure psilocybin.

Let’s compare these numbers to a common legal intoxicant, alcohol. A median lethal dose of alcohol is 5-8 grams per 1kg of body weight. Though there are many factors, this equates to roughly 30 ‘standard unit’ drinks or around four bottles of wine. (Source.) You can see from the chart above that alcohol is considered to have a moderate potential for abuse (though this might be disputed). However, its active/lethal dose level 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), but is fully legal in most countries around the world. Of course, we do not dose psilocybin in rates anywhere close to alcohol levels, even though it is far less toxic.

The bottom line: Psilocybe genus mushrooms, from a physical toxicity perspective, are extremely safe. Unlike another common and legal intoxicant, it is nearly physically impossible to ingest toxic doses of psilocybin without the help of a synthetic version in pill form.

HEALTH & MEDICAL CONTRAINDICATIONS

Because of how psilocin (the substance that psilocybin breaks down into) acts in the brain, there are some people who should not take moderate to high doses of psilocybin until more clinical research has been completed. There is another segment of people who should get their appropriate medical professional’s support before taking a full dose journey.

People who should not take more than a microdose of psilocybin include:

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.

Psilocybin is contraindicated for people with a personal or parental history of any form of psychosis. This is because psilocin can have unpredictable effects in the brains of those suffering from psychotic disorders. The altered state of consciousness can be disruptive to reality and sensory processing, and can cause symptoms of psychosis to persist well after the journey has been completed and psilocin has been excreted from the body (typically 4-6 hours after ingestion).

For one experience of a woman with schizophrenia who took psilocybin, you can watch the video she put together here. She does discuss doing mushrooms five times – the first two times she describes as wonderful and beautiful experiences. The third time she described as rather ‘meh’. When doing it a fourth time she had hoped it would go back to the great experience but instead turned worse than the third trip. She then tries it a fifth and final time and describes it as very bad – her psychosis was completely triggered. She does not include information about her dosing or time between journeys. The experiences were completed at home with her partner.

Bipolar Disorder

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Symptoms from each phase can potentially last weeks or months.

Psilocybin can worsen symptoms of mania in individuals with Bipolar 1 (Mania present) or other disorders with mania symptoms (including Bipolar II with hypomania, a less severe form of mania). In one survey by Sage Journals of 541 individuals with Bipolar, some form of manic symptoms appeared or increased after psilocybin use in one-third of individuals with both types of Bipolar.

Psilocybin is currently being investigated as a potential treatment for Bipolar, in particular the depressive side of Bipolar. Until we know more about dosing and cadence protocols, we cannot provide full-dose psilocybin therapy to those with diagnosed Bipolar (or who have not been diagnosed but know that they are regularly manic or manic-depressive).

These individuals may do well on micro to low doses of psilocybin to help treat their depression symptoms.

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 or other seizures. We will update our policies as research emerges. You can read more at this article.

In summary, the brains of individuals with psychosis, mania or seizures are physically different than in neurotypical individuals.

Psilocybin does not cause psychotic symptoms in non-psychotic individuals.
It does not cause mania symptoms in non-manic individuals.
And it does not cause seizures in those who do not have a prior 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 blood pressure and/or heart rate during the first 60-90 minutes after ingestion (sometimes due to anxiety). See study here. People with a history of high blood pressure should not take full dose journeys unless they receive approval from their cardiologist or other doctor familiar with their cardiovascular health. People with history of heart transplant, heart surgery, heart attack and stroke should not take a full dose of psilocybin until further research is concluded.

If you are unsure about your current blood pressure, we advise receiving a physical at your doctor, or visiting a free blood pressure machine available at many locations.

Interestingly, use of classic psychedelics has been associated with decreased hypertension in individuals who reported at least one usage of psychedelics in their lifetime. This could be related to the overall stress and mental health easing effects, or the greater effect of self-love and compassion encouraging other healthy lifestyle habits. For more information see this study by the American Heart Association which includes the data chart below. (Note ‘lifetime usage’ does not mean ‘usage throughout all one’s life’ but rather ‘usage at least once in one’s entire lifetime’.)

Anti-Depressant/Anti-Anxiety Medications

If you are on a large dose of serotonin-increasing anti-depressant medication, please get the approval of your prescription provider before taking a full-dose psilocybin therapy session. Very rarely, taking large levels of serotonin-increasing medication along with psilocybin (a molecule that is structurally similar to serotonin) can lead to a rare condition called serotonin syndrome, which is an excess of serotonin in the body. Serotonin syndrome usually presents first with mild symptoms that dissipate when the medication leaves the body, but occasionally it can be serious. MAOI and TCA class medications have a higher risk of serotonin syndrome than do SSRI’s.

Heavy Drinkers

Psilocybin does not pair well with alcohol. It is not physically unsafe or dangerous, but taking a strong dose of both within 24 hours of one another can lead to serotonin receptor down-regulation, a temporary yet unpleasant sensation of emotional emptiness or blankness. This resolves itself within 4-6 hours of psilocybin leaving the body. Please do not consume alcohol within 3 days (at minimum, 1-2 weeks is better) of a therapeutic psilocybin session. Drinking alcohol within 24 hours of your session with almost certainly sabotage the results of your session.

Ironically, high dose psilocybin journeys are excellent at treating or improving heavy drinking syndrome. However, as noted above you MUST be able to go off of alcohol for several days prior to taking the psilocybin therapy. If you drink 5 or more drinks per day currently, please work with your doctor to wean yourself off of alcohol so you do not experience dangerous withdrawal symptoms.

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 clients have about taking psychedelics.

There is much misinformation about psychedelics as a result of the politically-motivated War On Drugs era, from TV advertising to school ‘Drug Education’ programs which made patently false accusations about both psilocybin and LSD (another, far more powerful psychedelic which is a molecule from the ergot fungus).

To help counteract prior decades of misinformation, let us discuss mental-emotional risk, what ‘mental-emotional safety’ means, and what you can do to ensure you have a productive therapy session.

We define ‘mental-emotional safety’ as a state of being and environment which allows you to express and process your whole self including grief, trauma and rage, while knowing that nothing harmful is going to happen to either your body or your mind when you emerge on the other side; and further, that no one will harm you, judge/criticize/shame you, pressure you, or take advantage of you while you are in a vulnerable state.

It is akin to a feeling of being ‘held safe’ throughout a difficult experience.

What mental-emotional safety does not mean is that the journey is guaranteed to be full of only warm, happy, fuzzy feelings. You should fully anticipate a ‘Shadow’ portion of your journey, especially if this is your first or second time doing a full dose and no prior trauma has yet been cleared.

Instead, providing mental-emotional safety means that if the medicine invites you to journey through this emotional darkness, that you will emerge from the other side safe and whole and that you are not in any danger whatsoever while you are in your altered state. You will be protected, guided and supported by your facilitator when you need it.

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, and welcome the medicine. 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 do your very best to let go if/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.

PROPER DOSING

As with everything in life, the more you take or do 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 barely perceive a microdose of psilocybin, while a 2-2.5g dose will make your anxiety, fears and superficial world completely crumble away so you can explore your 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. A ‘full’ psilocybin dose is 2 grams, or 20mg of pure psilocybin. A stronger therapeutic dose of 2.5 or 3 grams may be warranted in certain individuals. Fractal Soul does not administer sessions larger than 3 grams, even in a 1:1 setting.

What’s a Hero’s Dose?

Much has been discussed of the so-called ‘Heroic Dose’, involving consumption of 5-6 grams of dried psilocybe mushrooms. We think it’s unfortunate this dosage was dubbed a hero’s dose, as it can encourage inexperienced psychonauts to consider themselves heroes or in some elite club if they take it. This can play into ego and the Daredevil persona, chasing adrenaline or other extreme experiences. What this strong of a dose will do in the brain is 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. It is not, of course, but taking too large of a dose for egoic purposes + having no idea what to expect + not being in a psychologically or physically safe environment is a reliable recipe for having what is considered ‘a bad trip’.

As mentioned throughout this article, we counteract this and help ensure this does not happen to our clients by:

– Dosing them properly based on their individual goals and past medical/prescription history
– Educating them thoroughly on how psilocybin works in the mind and what to expect at each phase of a journey
– Embedding the client in a physically and emotionally safe and warm/snuggly environment for their session, and
– Having the session attended by an experienced facilitator who is trauma-informed, has hands-on psychedelic experience, has done their own Shadow/healing work, and upholds the highest rigor of ethics before, during and after sessions, understanding the client’s vulnerability and never taking advantage of it.

To be clear, there may be a time and a place for certain individuals to take these heroic doses – however, they are for experienced psychonauts only, and due to their overwhelming nature, we find they go past the therapeutic window and actually become less helpful, in particular for someone new to psilocybin or who has a lot of grief and trauma to unpack. As one of our mentors once said, ‘at some point you stop bringing messages back’.

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:

#1: Supporting the journey versus leading it, and

#2: The knowledge and competency required to lead safe sessions and to keep clients physically and emotionally safe, which includes the ability to discern true medical emergencies from perceived ones, and pre-discussed client touch preferences.

You can read our full Code of Ethics, the standards by which we hold all facilitators to, as well as foundational expected behavior by our clients to remain safe and respectful for all.

WHAT HAPPENS IF I EXPERIENCE EMOTIONAL CHALLENGES DURING A TRIP

As Michael Pollan defines, a ‘bad trip’ is really the mind and ego’s response to the suggestion of letting go, the giving-up of engrained thought patterns that have turned into deep ruts. Such resistance is a little like taking medicine to exorcise demons and then refusing to exorcise them. Usually this happens for two reasons:

#1: These ‘demons’ are embedded deeply in the individual’s Identity of Self, such that unconsciously they may not be willing or ready to give up that part of themselves, or

#2: The individual is afraid of experiencing or re-experiencing the pain associated with releasing things like prior traumas and griefs

We won’t sugar coat it: If you have repressed emotions (like stored trauma), you may very well need to cry pretty hard, or yell pretty hard, or punch something soft and safe, to get them released. We offer a safe environment for you to do so and will be right by your side during the whole time. As well, self-consciousness and self-criticism pretty much disappears once psilocin is fully engaged in the brain, which makes the entire process easier. It is during the ~45 minutes of uptake, while you are shifting from normal state to altered state, that you may experience struggle as the medicine comes upon you, in particular your first time. We will coach and soothe you through this, if it happens.

But here’s the real question: If you had the option to sob for an hour straight and then be healed of a particular trauma and its effects for the rest of your life, would you do it?

If you do experience high anxiety or panic during a session, we are well prepared to guide you through that. But ultimately, the choice to embrace the journey and let go, is up to you.

Even if you experience frightening thoughts or images during a journey (which is fairly uncommon at 2-2.5 grams), you can speak those to us, process them, and get curious about them. This curiosity and opening up often leads to some of the most profound revelations of your lifetime.

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So there you have it! More information on the physical and emotional safety of taking psilocybin. As a reminder, the information provided falls within the context of full dose journeys, defined as 2 to 3 grams. Taking microdoses of .1 gram to low doses of .5 grams is going to have sub-perceptual to subtle/mild effects.

Pending no contraindications listed above, you can feel confident that you will be safe and held, even as you go through a full dose journey.