Psychedelic Safety Checklist: Before, During, and After

A good retreat or licensed session is mostly decided before you arrive. This checklist covers what to check about the provider, yourself, the place and the aftercare. It does not repeat the medical questions: start with the screening checklist, which covers heart, mental health, medicines and pregnancy with the source behind each question, and the interaction checker if you take any medicine. Come back here once you know that a session is medically reasonable for you.

Why you have to check for yourself

In most places nobody inspects a psychedelic ceremony. The Dutch Trimbos Institute notes that no one checks whether ceremony guidance is in order, including intake, aftercare or the number of sober people present. (DRUGSinfo (Drugs Infolijn), Trimbos-instituut) The exceptions are regulated programmes such as Oregon's licensed psilocybin services and Colorado's licensed healing centres. (Oregon Health Authority, current page; Colorado General Assembly, 23 May 2023; Colorado Department of Revenue, Natural Medicine Division, 2 Apr 2025) Where no regulator checks, every item below is your job.

The provider: before you pay a deposit

Licence and legal standing

• Is there a licence, and from whom? In Oregon, facilitators and service centres are licensed by the Oregon Health Authority, and psilocybin may only be taken at a licensed centre under a facilitator. (Oregon Health Authority, current page; Oregon State Legislature, current edition) Colorado licenses facilitators and healing centres separately. (Colorado General Assembly, 23 May 2023; Colorado General Assembly, 23 May 2023; Colorado Lawyer (Colorado Bar Association)) Outside such programmes, ask what legal basis the centre claims, then check it against is it legal where I am?
• Ibogaine: New Zealand treats it as a prescription-only, unapproved medicine. (Medsafe, New Zealand Ministry of Health, 2009; New Zealand Health and Disability Commissioner, 2015) In Mexico no official standard sets ibogaine-specific safety protocols such as cardiac monitoring. (Infobae Mexico, 21 Sep 2026) Read ibogaine clinic safety before booking any clinic.

Medical screening, and who reviews it

• Does screening happen before payment, and who reads it? A form that nobody medically qualified reviews is paperwork, not screening.
• For ibogaine, an ECG, and potassium and magnesium checks are the minimum. The Global Ibogaine Therapy Alliance guidelines exclude a prolonged QTc and say a QTc over 500 ms during treatment requires immediate hospital transfer. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)
• For ayahuasca, ask how the centre handles antidepressants. Combining ayahuasca with an SSRI may cause serotonin syndrome, and stopping a psychiatric medicine is itself risky and should only happen under strict medical supervision. (Journal of Psychoactive Drugs, 1998; ICEERS, 2026; ICEERS, 2018) The details are in ayahuasca and antidepressants. A centre that tells you to stop a medicine on its own timetable is a red flag; that decision belongs to your prescriber.

Staff and training

• Who is trained, in what, and by whom? Oregon facilitators must complete approved training with modules on safety and ethics plus a practicum, pass an exam set by the Oregon Health Authority and pass a background check. (Oregon Health Authority, Public Health Division, May 2025) Elsewhere, ask for names and qualifications.
• How many sober staff are present per participant? Oregon sets minimum client-to-facilitator ratios for group sessions. (Oregon Health Authority, Public Health Division, May 2025) Ask for the number, not a reassurance.
• Is a doctor or nurse on site? For ibogaine this is essential. New Zealand's Health and Disability Commissioner found a clinic in breach after a woman died when her doctor left and monitoring was left to an untrained assistant. (New Zealand Health and Disability Commissioner, 2015)

Emergency plan

• What happens if someone has a medical or psychiatric crisis? In Oregon, facilitators must call emergency services in a medical or behavioural emergency, document it and notify the regulator. (Oregon Health Authority, Public Health Division, May 2025) Emergency services were called 13 times for 5,935 clients in 2025. (Oregon Health Authority, 2026) Rare is not never.
• Where is the nearest hospital, and how would you get there? Remote jungle retreats can be hours away.
• Is there a written plan for you? Oregon requires every client to complete a safety and support plan and a transportation plan. (Oregon Health Authority, Public Health Division, May 2025)

Consent, touch and conduct

• Written consent. The New Zealand ibogaine death involved a clinic that obtained no written consent. (New Zealand Health and Disability Commissioner, 2015)
• A clear touch policy. Oregon's rules limit the kinds of supportive touch allowed and require clients to consent to it before the session. (Oregon Health Authority, Public Health Division, May 2025) Chacruna warns that sessions alone with a healer have been a common setting for sexual abuse, that plant baths and similar practices do not involve touching private parts or require nudity, and that sexual contact between healer and participant during or directly after ceremonies is not acceptable in ayahuasca traditions. (Chacruna Institute for Psychedelic Plant Medicines, 2018)
• A right to stop. You should be able to leave the programme, decline a dose or choose a different facilitator. Oregon's client bill of rights includes choosing your facilitator. (Oregon Health Authority, Public Health Division, May 2025)
• What else is served? Ask for a full list of every substance on the programme. Deaths linked to ayahuasca have involved tobacco preparations and 5-MeO-DMT taken alongside it. (ICEERS, 2023; Journal of Analytical Toxicology, 2005)

Yourself

The screening checklist has the medical questions. Beyond those:

• Tell the provider everything, including supplements and recreational drugs. If they do not ask, that tells you about their screening.
• Do not change any medicine without your prescriber. If a provider says you must, take that conversation to the person who prescribed it.
• Arrange support at home for the days after, and keep the week after free of big commitments.
• Know your reasons. Dutch drug information services say ceremonies advertised as treatment for mental health problems are not therapy and that many people have more complaints afterwards. (DRUGSinfo (Drugs Infolijn), Trimbos-instituut) If you want treatment, look at conditions and clinical trials.

The place and the law

A retreat advertising openly tells you nothing certain about its legal position. Psilocybin is in Schedule I of the 1971 Convention on Psychotropic Substances, and other active ingredients are controlled too. (Transnational Institute (copy of statute), 2001; Instituto Costarricense sobre Drogas, current page; International Narcotics Control Board, Mar 2011) The plants and brews themselves are not under international control, but the International Narcotics Control Board recommends that governments control them nationally where necessary, so international non-control does not mean national legality. (International Narcotics Control Board, Mar 2011) Some examples of how differently countries handle this:

• Portugal makes personal possession an administrative offence, not a crime, but that does not cover a retreat supplying psilocybin to guests. (Diario da Republica, I Serie-A, n.o 276, 29 Nov 2000; Policia Judiciaria, current page)
• Brazil restricts ayahuasca to religious rituals and prohibits selling it. (Ministerio da Justica e Seguranca Publica / Diario Oficial da Uniao, 25 Jan 2010)
• Mexico's non-prosecution rule for mushrooms covers possession tied to Indigenous and Afro-Mexican community ceremonies, not retreats run for visitors. (Camara de Diputados del H. Congreso de la Union, 13 Mar 2026)

The legal status page covers each country. Wild peyote is not on offer here: it is Vulnerable, it is the Native American Church's sacrament, and the site points mescaline interest to cultivated San Pedro instead. See the peyote position. (IUCN Red List, 2017; eCFR, current)

Red flags that should end the conversation

Some answers are enough on their own to walk away:

• A deposit is taken before any medical questions are asked.
• You are told to stop a prescribed medicine, or to taper it on the centre's schedule, without your prescriber.
• Nobody can tell you who is medically responsible during the session, or how they would reach a hospital.
• Ibogaine is offered without an ECG, blood tests and continuous monitoring. A review of 19 deaths after ibogaine found pre-existing heart conditions or other drugs explained or contributed to 12 of the 14 with adequate post-mortem data. (Journal of Forensic Sciences, 2012)
• Ayahuasca is combined in the same programme with toad medicine (5-MeO-DMT), a pairing linked to deaths. (Journal of Analytical Toxicology, 2005; ICEERS, 2023)
• Private sessions alone with a healer, nudity or sexual contact are presented as part of the healing. (Chacruna Institute for Psychedelic Plant Medicines, 2018)
• The programme promises to cure depression, addiction or trauma. No psilocybin medicine is FDA approved, and retreats do not necessarily reproduce the screening and monitoring of clinical trials. (eCFR (Office of the Federal Register), current; U.S. Food and Drug Administration, Jul 2026; Psychiatry Research, 2024)

On the day

• Confirm the screening was read. Ask who reviewed it and whether anything changed.
• Check the room. Oregon requires administration areas to be free of conditions that could pose a risk to clients. (Oregon Health Authority, Public Health Division, May 2025) Look for stairs, water and open fires.
• Drink sensibly. One ayahuasca ceremony death was due to low blood sodium from overhydration. (Nederlands Tijdschrift voor Geneeskunde, 2020; ICEERS, 2023)
• Do not leave alone or drive. Oregon requires a transportation plan for every client. (Oregon Health Authority, Public Health Division, May 2025)

After the session

Integration

Oregon requires facilitators to contact each client within 72 hours of the session to review the safety plan, record any reactions and offer optional integration sessions. (Oregon Health Authority, Public Health Division, May 2025) Ask any provider what follow-up they offer, and who you can call a week later. The integration practices article covers what that work looks like.

Warning signs

Hard days after a session are common. In the Global Ayahuasca Survey, 55.9% reported adverse mental health effects in the following weeks or months; most saw them as part of a positive process, but around 12% sought professional support. (PLOS Global Public Health, 2022) Get help if you notice:

• distress that is not easing after a week or two; in one survey 7.6% of people sought treatment for lasting symptoms after a difficult mushroom experience (Journal of Psychopharmacology, 2016)
• little sleep with racing thoughts or unusual energy; in people with bipolar disorder, mania and sleep problems were the most common new symptoms after psilocybin (Journal of Psychopharmacology, 2023)
• visual effects that keep returning and cause distress, a pattern described as hallucinogen persisting perception disorder (Drug and Alcohol Dependence (Halpern JH, Pope HG), 2003)
• thoughts of harming yourself or anyone else: in the US call or text 988, elsewhere your local emergency number
• after ibogaine for opioid dependence, any plan to use opioids again: tolerance is reset, so a usual dose can be an overdose (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

If any of these apply, see a doctor and tell them what you took.