Growing fascination with mind-altering drugs has sparked a new industry trend: multi-day psychedelic retreats where participants pay thousands for drug-assisted experiences promising mental health benefits and spiritual growth.
Across the globe, hundreds of companies now operate these retreat centers, but recent research published in JAMA Network Open reveals significant safety gaps in an unregulated industry. Scientists who examined dozens of these operations found they carry “potential for physical, psychological, and interpersonal harms” despite many having safety protocols.
The timing is notable as President Donald Trump recently signed an executive order Saturday directing federal agencies to fast-track reviews of psychedelics for treating conditions like PTSD. The order also instructs law enforcement to reduce restrictions on any psychedelic drugs approved by the FDA.
So far, only MDMA has undergone FDA review, but regulators rejected it as a PTSD treatment in 2024 over safety and effectiveness concerns. Currently, no psychedelic substances have received federal approval in the United States.
“The sheer visibility of psychedelics has led to more demand for these retreats,” explained Brad Burge, who has spent nearly two decades working with psychedelic organizations, pharmaceutical companies and retreat operators. “That growing market has allowed retreats to expand their services, hire more medical and coaching staff and take safety more seriously than we’ve ever seen in the past.”
Dr. John Krystal from Yale School of Medicine, who studies this field, emphasized that psychedelics should be treated as “a serious medical procedure that carries risks that must be carefully managed.”
Most substances offered at these retreats remain federally illegal, including psilocybin mushrooms, ayahuasca, MDMA and LSD. While some retreat operators claim protection under religious exemptions, only select groups like the Native American Church have obtained legitimate legal status for ceremonial peyote use.
Many retreats operate in countries with different drug laws, particularly Peru and Brazil, where Indigenous communities have used ayahuasca – a plant-based psychedelic brew – for hundreds of years.
The lack of industry standards creates challenges for potential participants, according to Joshua White, who founded the Fireside Project, a support hotline for people experiencing difficult psychedelic episodes.
“If there is no regulation, what does that mean about the quality of care you’re going to have?” White questioned. “I certainly fear that there could be a race to the bottom where there is no liability or accountability.”
Amy McGuire, a biomedical ethics expert at Baylor College of Medicine who co-authored the research study, stressed the importance of thorough investigation before attending any retreat.
“It’s really important that somebody interested in a psychedelic retreat do their research, talk to the organizers or facilitators to get more information about what is being offered and how,” McGuire advised.
The research team documented varying practices across retreat centers, with some offering multiple psychedelic substances during single programs. While many employ healthcare professionals, their duties and qualifications often remain unclear. Concerning practices include medical staff participating in drug experiences alongside clients, potentially compromising their ability to handle emergencies.
Essential questions for evaluating retreats include whether staff possess emergency medical training and equipment, proximity to hospitals with reliable transportation, and adequate time devoted to participant preparation and post-experience support.
Medical screening presents another critical safety concern. Over half the surveyed retreats exclude individuals with mental health conditions like schizophrenia, which experts say is appropriate since psychedelics can worsen psychotic symptoms.
“Psychedelic drugs may worsen symptoms of psychotic disorders, such as schizophrenia,” Krystal noted. “It is important that patients are carefully screened to ensure that appropriate patients enter treatment.”
However, all surveyed retreats depend entirely on participants honestly reporting their medical histories and health conditions – a potentially problematic approach.
“When you’re really desperate and hoping to access something that you think could help you, there’s an incentive not to be truthful,” McGuire observed.
Nearly 90% of retreat centers require or suggest participants discontinue certain medications, particularly antidepressants, before psychedelic experiences. These “washout periods” range from one day to six weeks, but medical experts warn that safely reducing antidepressants like Prozac requires six to 12 weeks under professional supervision.
Dr. Jeffrey Lieberman, a Columbia University psychiatrist, cautioned that “the patient needs to realize that by going off their medicine they’re at greater risk of recurrence or exacerbation of their symptoms. They should be monitored regularly to make sure nothing bad happens.”
While retreat operators cite research showing dangerous serotonin interactions between antidepressants and psychedelics, McGuire suggests business motivations may also drive medication discontinuation policies.
“There’s a business rationale for wanting people to have the maximum experience when they show up and they’re paying for these retreats,” she explained.
