Many people who guide, sit with or host others learned what they know from friends, forums, retreats and their own experience. We do not judge that, and we are not here to fight it. We understand why it happens.
We gather what research and documented traditions report, about benefit as well as risk, and give it here for free, with a source and a reliability level on every claim. Pick a question below, and tell us what is missing or where we got something wrong.
Ready now
Twenty-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.
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 reportsAntidepressants 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 reportsWhen 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 reportsAyahuasca 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 reportsIntegration: 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, traditionsConsent, 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 Studies, case reports, retreat interviewsAyahuasca and antidepressants
What have a simulation, a survey, case reports and retreat interviews measured, and what has not been measured?
Read the card Surveys, rules, guidelinesWhat a guide or sitter does, and what they leave alone
What do surveys, one state's rules and laboratory guidelines say a sitter does, and does having one change anything?
Read the card Pooled studies, a preprint, reviewsWomen, men and the life cycle: cycle, menopause, differences in response
Do healthy women and men differ in the acute response, and what is known about the menstrual cycle, contraception and menopause?
Read the card Studies, surveys, registry recordsPreparing and setting an intention
What did studies measure about intention and state of mind before a session, and how is preparation reported?
Read the card Rules, surveys, a traditional studyGetting into the field: apprenticeship, careers, pay
What do official sources and surveys report about licence costs, prices and routes, and what was not located on pay?
Read the card Guidelines, surveys, state rulesScreening before a session: what programs ask and why
What do guidelines, retreat organisations, practitioners and two state programs report asking about health, and does asking change what happens?
Read the card Animal studies, a pharmacology reviewWeight-loss and diabetes medicines (GLP-1)
Do GLP-1 medicines change the effect of a classic psychedelic? What was located, and what was not?
Read the card State rules, a cohort, a survey, a reviewKeeping track: outcomes, follow-up and records
What do state rules and studies report about records, follow-up and adverse event reporting, and what was not located?
Read the card Trials, reviews, a mouse studyHeart and blood pressure: what studies measured
What do trials and reviews report about heart rate and blood pressure in a session, and what is not known about the heart and valves?
Read the card Surveys, health records, a reviewMental health history: what studies measured
Is a history of psychosis, mania or trauma linked to what happens after psychedelic use, and what is not known?
Read the card Surveys, a helpline log, state rulesAlone, at home, or remotely: what has been reported
Does being alone, at home or connected only by video change what happens in a session, and what do licensing rules say?
Read the card Trials, surveys, case reports, retreat interviewsCombining substances and multi-day sequences: what has been reported
What is documented about taking more than one substance in a session or retreat, together or on consecutive days?
Read the card Ethics papers, codes, state textsConsent and agreements: what sources describe
What do ethics papers, published codes and state texts say about consent and written agreements for guided sessions?
Read the card Descriptive study, interviews, fieldworkRetreats: what is offered, promised and charged
What do retreats advertise, what do they list as prices, and has anyone tested their claims?
Read the card Surveys, a helpline log, poison centres, coroners' recordsWhen things go wrong: kinds of harm reported
What kinds of harm do published sources report in connection with natural psychedelics, and how was each one counted?
Read the card Federal rules, court opinion, state and national textsRegulated and unregulated: what legal texts say about Oregon, Colorado and elsewhere
Which places run licensed, supervised programs with natural psychedelics, and what do official texts say about what sits outside them?
Read the card Pilot trials, a systematic review, interviews, state rulesOne-to-one, group, or couples: what has been reported
How are sessions with one facilitator, in a group and with a couple described, and what is known about each?
Read the card Official pages, community lists, surveysChoosing a guide or a retreat: the questions people ask
What do published lists name as questions and warning signs, and is any of it known to relate to outcomes?
Read the card Systematic review, trials, an interview studyMusic in a session: what is played and who chooses
What do published sources report about the music played during a session, and does any of it show a link to outcomes?
Read the card Laboratory study, review, surveysHow common hard experiences are, and how long they last
How often do people report a hard experience, and why can the figures not be compared directly?
Read the cardEach 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 whyReady
- Mental health history: what studies measuredReady
- Heart and blood pressure: what studies measuredReady
- Antidepressants and other psychiatric medicinesReady
- Weight-loss and diabetes medicines (GLP-1)Ready
- Ayahuasca and antidepressantsReady
- Pregnancy, breastfeeding and hormonesIn preparation
- Women, men and the life cycle: cycle, menopause, differences in responseReady
- Age: younger and older peopleIn preparation
- Everyday substances around a session: cannabis, alcohol, nicotine, caffeineIn preparation
Preparing the session
- Preparing and setting an intentionReady
- Diet, fasting and preparing the bodyIn preparation
- The room and its safety set-upIn preparation
- MusicReady
- One-to-one, group, or couplesReady
- Alone, at home, or remotely: what has been reportedReady
During the session
- What a guide or sitter does, and what they leave aloneReady
- A friend, a partner, a therapist or a remote “witness”In preparation
- Do guides take the substance too?Short section on the boundaries card
- When it gets hard: what helpers do in the momentReady
- Calming medicines in a crisisIn preparation, held for extra review
- How common hard experiences are, and how long they lastReady
- Physical risk and getting medical helpIn preparation
- Touch and massageIn preparation
- Amounts, top-ups and step-ups, as reported in studiesIn preparation, held for extra review
Substances and combinations
- What is in it: identity, testing, variabilityIn preparation
- Combining substances and multi-day sequences: what has been reportedReady
- 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
- Consent and agreementsReady
- Power and sexual boundariesReady
- When things go wrong: kinds of harm reportedReady
- Regulated and unregulated: Oregon, Colorado and elsewhereReady
- Legal risk for people who sit or hostIn preparation
Getting into the work and running it
- Training and certificates for guidesReady
- Getting into the field: apprenticeship, careers, payReady
- Retreats: what is offered, promised and chargedReady
- Choosing a guide or a retreat: the questions people askReady
- 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 recordsReady
No topic matches. Try a shorter word, or clear the filters. A topic you do not see may still be on our list, and you can tell us what is missing by writing to main@metanoia-ca.org.
Upcoming topics
These 22 topics are on our list and not yet written up. They are in no promised order and no date is promised, because a topic goes up only after its sources have been read in full. Two of them, marked on the list above as held for extra review, wait for a second check before they go up. If a question you ask is missing, write to main@metanoia-ca.org and we will add it to the list.
- Pregnancy, breastfeeding and hormones
- Age: younger and older people
- Everyday substances around a session: cannabis, alcohol, nicotine, caffeine
- Diet, fasting and preparing the body
- The room and its safety set-up
- A friend, a partner, a therapist or a remote “witness”
- Calming medicines in a crisis
- Physical risk and getting medical help
- Touch and massage
- Amounts, top-ups and step-ups, as reported in studies
- What is in it: identity, testing, variability
- 5-MeO-DMT and bufo
- Ketamine
- Microdosing
- Other substances: iboga and ibogaine, LSD, mescaline, kambo and peyote
- Lasting difficulties: sleep, feeling unreal, feeling cut off
- Repeated sessions and changing response
- Support lines, peers and supervision
- Legal risk for people who sit or host
- The sacred, “the medicine”, the dieta: spiritual and traditional framing
- Using AI as a helper
- What is claimed about benefit, and what has actually been measured
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.
Forms to download
These four documents already exist and are published with the data element set. They are version 1.1, dated 25 September 2026, released under CC BY 4.0. They are for reading and printing and are not interactive forms. The record form is a paper or on-screen layout of the 23 elements. It records what a source reported. It is not guidance on use and not a clinical, screening or diagnostic tool, and anyone who uses it is responsible for their own consent, privacy and legal review.
- Exposure record form (PDF)Follows the record model field by field, with the permitted values and the five missing-data codes.
- Completion guide (PDF)Plain-language instructions for each of the six element groups. No clinical background assumed.
- Data dictionary (PDF)Every element broken into its sub-fields, with a working identifier, definition and data type for each.
- Full minimum data element set (PDF)The complete document, with the element tables, the sources, and the verification note.
Send us reports
What happens in sessions, retreats and centers outside supervised programs mostly goes unrecorded. We want to hear it. Metanoia runs an anonymous research channel for these accounts. It asks for roles and never for names, and we take no position on the legal status of anything a report describes. The channel is open, and its privacy terms and publication policy are on the form page.
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. Accounts of what happened in a session belong in the field reports channel, not in email. Please leave out names and anything that identifies a person or a place. If we have reported something wrongly, tell us. We read every comment.