Harm reduction & safety

Harm reduction means planning for what could go wrong before it does — not because something will, but because the difference between a hard moment and a dangerous one is almost always preparation. This page is educational, not medical advice. It exists so you can ask your facilitator and your doctor better questions, not to replace either of them.

Medications and health conditions that change the picture

These are the categories every facilitator on this platform is required to screen for before a session is confirmed. None of them automatically rule you out — several just mean a supervised taper, a cardiac check, or a conversation with your prescriber first. What they have in common is that finding out during a session is much worse than finding out before one.

MAOIs

Monoamine oxidase inhibitors (phenelzine, tranylcypromine, moclobemide, selegiline, and some others) combined with many psychedelics or MDMA can cause serotonin syndrome, which can be fatal. This is not a "reduce the dose" situation — it is a hard stop until the medication has fully cleared your system, on a timeline your prescriber sets.

SSRIs, SNRIs, lithium, tramadol

These often blunt or unpredictably alter the effects of classic psychedelics, and combinations with MDMA carry the same serotonin syndrome risk as MAOIs, at lower probability but not zero. Many people taper off under medical supervision before a session — never stop an antidepressant abruptly on your own to "get ready" for something; that carries its own real risks.

Heart conditions

Arrhythmia, long QT syndrome, a pacemaker, a previous heart attack, or uncontrolled blood pressure all matter here. Ibogaine in particular affects heart rhythm directly and is why legitimate ibogaine providers require cardiac monitoring throughout — a facilitator offering it without an ECG on hand is a red flag, not a convenience.

Psychosis and bipolar I — personal or family history

A personal diagnosis of schizophrenia, another psychotic disorder, or bipolar I is a contraindication for most classic psychedelics. A family history in a parent, sibling or child raises the risk even without a personal diagnosis, and is worth a real conversation with a psychiatrist before proceeding, not a box to check quickly.

Pregnancy

Pregnant, trying to conceive, or breastfeeding — the honest answer here is that the research to say any of this is safe simply does not exist yet, so it is treated as a contraindication across the board.

Seizure history, liver or kidney disease

Epilepsy or a seizure history, and liver or kidney disease, change how a substance is metabolised and how safely it clears your system. Your facilitator needs the real answer, not the one that gets you booked.

Recognising a crisis, and what should happen next

If you are currently having thoughts of suicide or self-harm, or are in a mental health crisis right now, this is not the moment to book a session — it is the moment to reach out to a crisis line or emergency services in your area. A responsible facilitator will tell you the same thing, and will not take a booking from someone in acute crisis.

During or after a session, the signs that warrant stopping and getting real medical help — not "waiting it out" — include: chest pain, a racing or irregular heartbeat that does not settle, difficulty breathing, seizure activity, or a level of psychological distress that is not resolving with grounding and reassurance from an experienced sitter. A facilitator who is actually prepared for this has a plan for it before your session starts, not improvised in the moment.

What a facilitator being "medically screened" should actually mean

Every facilitator on TripFacilitator who takes bookings directly is required to screen guests against the categories above before a session is confirmed — that is what the "Medically screened" badge on a profile is standing behind. It is one layer, not the only one: it does not replace a conversation with your own doctor, and it does not replace judgment on the day. Ask any facilitator directly what their emergency plan is, who is present during a session, and what happens if something goes wrong. A facilitator who cannot answer clearly is telling you something.

Integration: the part that actually determines the outcome

The session itself is often the easiest part. What you do in the days and weeks after — rest, avoid rushing back into stress, talk to someone about what came up, keep the insight from evaporating under the weight of ordinary life — is where most of the lasting benefit or lasting difficulty actually gets decided. A facilitator who offers real integration support, not just a goodbye at the end of a retreat, is offering something that measurably matters.

This page does not cover every substance, every interaction, or every medical circumstance. Nothing here replaces a conversation with a doctor who knows your actual history. If you are ever unsure, ask — a facilitator worth booking will never treat that question as an inconvenience.