Abstract
Background and aims
Online communities provide insights into psychedelic consumption, assisting in identification of trends, informing both harm reduction provisions and clinical research. This study extracts forum data on psychedelic substances, dosages, and administration routes, categorising and analysing self-reported consumption to inform care services and guide clinical work with psychedelics.
Methods
Posts (n = 660) from online psychedelic forums (The Shroomery and DMT Nexus) on 'trip sitting' were analysed. Using a Delphi-style expert panel review facilitated by LE, we created drug weight and intensity charts (threshold, light, common, strong and heavy dosages) for psychedelics discussed in these posts. The psychedelic substance, dosage intensity and route of administration [ROA] (smoked/vaporised, oral, injected, insufflated and undisclosed) frequencies and exploring correlations with perceived need for assistance from a psychedelic carer were mapped and correlated with perceived need for psychedelic care.
Results
Psychedelics appearing in our data were 5-MeO-DMT, ayahuasca, changa, LSA, LSD and psilocybin. There was greater commonality between clinical studies and 'common' doses determined through the Delphi method, for more extensively researched substances like LSD and psilocybin. Many posts indicated opinions that psychedelic care was unnecessary or optional for consumers, particularly for LSD and LSA. 5-MeO-DMT was strongly associated with a perceived need for care. A correlation was identified between greater psychedelic purity, dosage intensity, and a perceived need for care. Oral administration, the most common ROA, showed lower dosage intensity.
Conclusion
More research is needed to understand factors influencing psychedelic care practices. Educational information, emphasizing risk management strategies, should be provided to psychedelic consumers, emphasising psychedelic products and administration methods more likely to be dosed at a strong or heavy intensity.
Introduction
Psychoactive substances have been used by humans for religious, cultural, medicinal and recreational purposes for much of human history, with some of the oldest evidence of psychoactive consumption dating back to 60,000 BC (Crocq, 2007; Guerra-Doce, 2015). Self-experimentation with psychoactive substances by scientists and clinicians emerged in the mid-eighteenth century and is well-documented (Passie & Brandt, 2018). More recently, many popular psychoactive substances have become prohibited, and this criminalisation and stigmatisation of psychoactive cultures and communities have led to them becoming hidden from the public. The evolution of the internet has resulted in relatively anonymous online drug use communities, which has permitted unique insight into such communities, where members often share their experiences with different psychoactive substances, offering each other counsel and circulating harm reduction information (Davey, Schifano, Corazza, Deluca, & Psychonaut Web Mapping Group, 2012; Schifano et al., 2006).
The culture around psychedelics is presently booming as interest steadily increases in the clinical application of psychedelics as adjuncts to psychotherapy (Drozdz et al., 2022; Nayak & Johnson, 2021; Thal, Bright, Sharbanee, Wenge, & Skeffington, 2021) and large numbers of people use psychedelics, in a diverse array of settings (Krebs & Johansen, 2013; United Kingdom Government, 2021; Van Laar & Van Miltenburg, 2020; Yockey & King, 2021; Yockey, Vidourek, & King, 2020). While the prohibition of psychedelic culture is experiencing some liberalisation, criminalisation and stigma has led to a disconnect between cultural and scientific knowledges of psychedelics, with a core issue being uncertainties around psychedelic dosages, and the health implications of variations in these dosages. A classic example of uncertainty of psychedelic dosage can be seen in the case of conflicting information and findings around lysergic acid diethylamide (LSD) dosage (Erowid, 1997; Greiner, Burch, & Edelberg, 1958; MacLean, MacDonald, Byrne, & Hubbard, 1961; Passie, Halpern, Stichtenoth, Emrich, & Hintzen, 2008). An extensive review of LSD analysed by law enforcement found LSD products ranging in potency from 5 to 500 µg, averaging at 53.38 µg (Hidalgo, 2009). One harm reduction platform lists common LSD dosages as starting at 50 µg (Hidalgo, 2009), another lists common LSD dosages as starting at 75 µg (PsychonautWiki, N.D.), while a ‘full LSD reaction’ has been described as requiring 100 µg in clinical settings (Pahnke, Kurland, Goodman, & Richards, 1969; Passie et al., 2008). LSD is typically dosed by absorbing LSD with perforated blotter paper (‘tabs’). The threat of law enforcement is likely the reason for some LSD tabs testing for dosages well above the dosages commonly consumed, as those in possession are more likely to be prosecuted for the number of tabs in their possession, rather than the weight of their LSD in micrograms. Further, many LSD manufacturing procedures leave a substantial amount an inactive LSD isomer (Shulgin & Shulgin, 1997). Finally, different dosages of the same psychedelic are employed for different purposes (e.g., microdosing psilocybin for workplace productivity versus macrodosing psilocybin as part of psychedelic-assisted psychotherapy [PAP]). Drug weight and intensity charts are a popular tool in online harm reduction discussion, estimating the weight of a dosage required to produce either threshold, light, common, strong or heavy subjective effects. Most notably, PsychCombo, Erowid and PsychonautWiki have published these charts for most popular psychoactive substances (Engel, 2023; Erowid, 1998, PsychonautWiki).
The increasing popularity of psychedelics makes data collection on psychedelic use an imperative (see Barnett, 2022). Different psychedelic dosages entail different requirements of psychedelic care (e.g. limited everyday care requirements for microdosing versus exhaustive clinical requirements for PAP including therapists, venue, etc.). Information from online communities of people who use psychedelics presents a genuine form of data that may help to identify emerging trends in psychedelic use (Deluca et al., 2012), inform harm reduction services (Engel et al., 2022a–c) and contribute valuable insights for the clinical application of psychedelics (Thal, Engel, & Bright, 2022a, 2022b).
Forum data on psychedelic molecules, products, dosage intensities, and routes of administration (ROA) on psychedelic forums, and the implications of these usage trends can improve provision of psychedelic care. Using data obtained in previous studies, information was extracted regarding participants' perceived need for psychedelic care during the experience of different psychedelic molecules, products, dosages and/or ROA. By comparing self-reported consumption in online blogs with reputable harm reduction and clinical data, harm reduction services and clinical workers responding to clients presenting with situations resulting from psychedelic use and researchers can be better informed.
Methods
Data consisted of posts (N = 660) concerning ‘trip sitting’ appearing in the online psychedelic forums The Shroomery and DMT Nexus (for more detail see Engel et al., 2022a–c) that were identified by LE and ST as representing trip sitting as being either necessary, unnecessary or optional as analysed by previous thematic analysis. Drug weight and intensity dosage charts were used to map substance and dosage category frequencies across posts. Psychedelics, psychedelic products, ROA or dosage intensities were analysed for a correlation with a more commonly perceived need for assistance from a psychedelic carer.
Like dosage weight and intensity charts, the data used in this project exists as peer drug knowledge grounded in online community and lived experience. In keeping with the theme of peer-based harm reduction, information from public, online, harm reduction and related platforms, including PsychCombo, Erowid, PsychonautWiki, DMT Nexus, the Corrobboree, ICEERS, Shroomery and Bluelight, was used to draft a drug weight and intensity chart for each drug appearing in our data set in their fresh, crude or pure product forms. For example, psilocybin may come in a pure powder product, for example, but is mostly commonly consumed in the product forms of extracted, dried or fresh mushrooms. Dosage weights and intensities also vary with ROA, so we produced charts corresponding with these differences, too.
Drug dosage weight was coded by creating a drug dosage chart similar to those used in harm reduction settings. Drugs appearing in the data were attributed the categories threshold, light, common, strong and heavy, based on the prepared dosage charts. Drugs were also coded according to their route of administration (smoked/vaporised, oral, injected, insufflated and undisclosed) and their appearance as pure, crude or raw form. Coding as raw required the use of psychedelic containing plants (or animals, in the case of 5-MeO-DMT and Incillius alvarius venom), crude required use of a simple extract (such as an acidified tea in the case of psilocybin and mushrooms, or an impure resin in the case of DMT and Acacia), while pure required use of an isolated psychedelic (such as LSA produced by refining an acid/base extract made using Argyreia nervosa seeds). For posts relating to drugs in the latter two categories, crude or raw materials were converted to an estimated pure weight and dosage was coded accordingly. For ayahuasca and changa, dosage was coded based on N,N-DMT weight, provided it was deemed sufficient monoamine oxidase inhibition (MAOI) was present. An overview of categorisation of doses can be found in Table 1.
Categorisation of doses
| Threshold | Light | Common | Strong | Heavy | |
| Psilocybina | 2 mg | 3–6 mg | 6–15 mg | 15–30 mg | 30 mg + |
| 5-MeO-DMT | 1 mg | 3–6 mg | 6–12 mg | 12–20 mg | 20 mg + |
| N,N-DMT | 2 mg | 10–20 mg | 20–40 mg | 40–60 mg | 60 mg+ |
| Ayahuascab | 2 mg | 10–20 mg | 20–40 mg | 40–60 mg | 60 mg+ |
| Changac | 2 mg | 10–20 mg | 20–40 mg | 40–60 mg | 60 mg+ |
| LSD | 7 ug | 15–30 ug | 30–50 ug | 50–100 ug | 100 ug+ |
| LSA | 300 ug | 1–1.5 mg | 1.5–3 mg | 3–6 mg | 6 mg+ |
a Unless a species was specified, psilocybin mushrooms were assumed to be Psilocybe cubensis.
b Calculated by N,N-DMT weight.
c Calculated by N,N-DMT weight.
Drug, weight, ROA and intensity charts for each drug appearing in our data set in their fresh, crude or pure product were finalised using a Delphi approach (Meyrick, 2003; Okoli & Pawlowski, 2004). As a harm reduction expert with thousands of hours of experience participating in the public, online harm reduction platforms listed, LE facilitated our Delphi method. This facilitation involved sending the draft charts to a panel of five expert reviewers agreed upon by our research team. These reviewers held expertise in pharmacology, chemistry, psychiatry, psychology, ethnobotany and lived experience of psychedelic use. The charts were revised based on the feedback of reviewers until the reviewers were satisfied the charts were sufficiently accurate.
Findings
Substances identified in data
Psychedelics identified in the data presented in this article include N,N-DMT, 5-MeO-DMT, ayahuasca, changa, LSA, LSD and psilocybin (for coding detail see Supplementary material).
5-MeO-DMT is a short acting psychedelic that can be found in a number of plants, fungi and animals (Barker, McIlhenny, & Strassman, 2012; Beaton & Morris, 1984; Erspamer, Vitali, Roseghini, & Cei, 1967; Trout, 2007; Tyler & Gröger, 1964). 5-MeO-DMT is a non-selective serotonin receptor agonist but also evidences affinity to other receptors and to serotonin and norepinephrine transporters (Halberstadt, Nichols, & Geyer, 2012; Ray, 2010). When smoked or vapourised, 5-MeO-DMT has a rapid onset. Its effects peak after 2–5 min and last 15–20 min (Davis, Barsuglia, Lancelotta, Grant, & Renn, 2018). Insufflated, the effects peak after 5–7 min and the experience lasts up to 45 min (Metzner, 2013). 5-MeO-DMT has had very limited administration in completed laboratory trials with humans (Reckweg, 2023). Epidemiological studies and surveys report recreational dose ranges for inhalation around 6 – 20 mg, for intravenous injection around 0.7 – 3.1 mg, for sublingual or intranasal routes around 10 mg, for intramuscular injection around 5 – 10 mg and oral consumption around 10 – 30 mg (Ermakova, Dunbar, Rucker, & Johnson, 2022). Anecdotal reports suggest that 5-MeO-DMT has less distinct subjective visual effects than other tryptamines, such as N,N-DMT (e.g. DMT Nexus, 2009). As can be seen in Table 1, reported dosages of 5-MeO-DMT vary considerably. Dosing studies have not been conducted in human volunteers so data for comparison from clinical studies is not available. Safety studies with human volunteers may be conducted in the future to provide objective dosage ranges for 5-MeO-DMT.
N,N-DMT is a psychedelic with affinity to serotonin 2A, 2C, and 1A receptors (Nichols, 2016). In addition, it displays affinity and agonist activity at the sigma-1 and trace amine associated receptors (Bunzow et al., 2001; Fontanilla et al., 2009). When administered intravenously effects start almost immediately, peak after 2 min and subsides after 20 min (Strassman, Qualls, Uhlenhuth, & Kellner, 1994). In one study, N,N-DMT was administered intravenously to healthy participants in doses between 0.05 mg/kg and 0.4 mg/kg. Lower doses of 0.05 mg/kg and 0.1 mg/kg were mostly related to somaesthetic effects and hallucinogenic effects were present in after 0.2 mg/kg and 0.4 mg/kg were administered (Strassman et al., 1994). In another study, healthy volunteers received IV doses of N,N-DMT between 7 and 20 mg (∼0.1–0.28 mg/kg) was administered in a dose-related safety, tolerability, and efficacy study in people with major depressive disorder (Timmermann et al., 2019). It was well tolerated in doses of 0.1 mg/kg and 0.3 mg/kg (D’Souza et al., 2022). Outside of research contexts N,N-DMT is typically consumed via smoking or vaporising, as without the addition of a MAOI, oral N,N-DMT is inactive, unless taken in very large ”flood” doses. When smoked or vaporised, Erowid lists threshold and strong dosages as between 2 and 60 mg (∼0.03 – 0.86 mg/kg). Pooled harm reduction resources categorise threshold dosages around 2 mg, light dosages between 10 and 20 mg, common dosages between 20 and 40 mg strong dosages between 40 and 60 mg and heavy dosages above 60 mg for smoked N,N-DMT (see Table 1). Dosage ranges from harm reduction resources are thus higher than those administered in clinical studies. This might be due to clinical studies usually using IV as the ROA for N,N-DMT.
Ayahuasca is usually prepared by combining Psychotria viridis, which contains the serotonin and sigma-1 receptor agonist N,N-DMT (Carbonaro & Gatch, 2016), and Banisteriopsis caapi vine containing harmala alkaloids that act as MAOI (Riba et al., 2003), slowing the metabolic breakdown of DMT permitting it to produce effects when consumed orally. Ayahuasca effects last around 4 h (Riba, 2003). Ayahuasca has mostly been investigated through observational studies in healthy participants. A high dose of ayahuasca has been observed to contain 0.85 mg/kg bodyweight of N,N-DMT, 1.4 mg/kg bodyweight of harmine, 0.09 mg/kg bodyweight of harmaline, and 1.16 mg/kg bodyweight of tetrahydroharmine (Riba et al., 2003). Ayahuasca has been used in one clinical study for the treatment of treatment-refractory depression. The ayahuasca used in this study contained 0.36 mg/mL of N, N-DMT, 1.86 mg/mL of harmine, 0.24 mg/mL of harmaline, and 1.20 mg/mL of tetrahydroharmine. Participants in the study received ayahuasca adjusted to contain 0.36 mg/kg of N,N-DMT (Palhano-Fontes et al., 2019). In a traditional context, ayahuasca refers to the vine plant itself, while contemporary society often uses the word ayahuasca to refer to the combination of N,N,DMT and an MAOI. Neither Erowid nor PsychonautWiki provide their typical dosage summaries for ayahuasca, although they do acknowledge oral ingestion as ayahuasca's ROA. The DMT Nexus Wiki recommends a ayahuasca dosage of a standardised MAOI dosage ∼100 mg, (∼1.4 mg/k) harmaline and a total N,N-DMT dosage of ∼15 mg (∼0.2 mg/kg).
Changa. The inhalation of smoked or vaporised ayahuasca (‘changa’) products is often claimed to be a recent cultural practice appearing in the last few decades, but the precise cultural origins are unclear. Changa's history may be based in the smoking of Australian Acacia resins (The Corroboree, 2006). There have been no studies involving the administration of changa, and of the few studies addressing this drug, fewer still have attended to the unique character of changa as distinct from smoked or vaporised DMT (Lawrence, Carhart-Harris, Griffiths, & Timmerman, 2022; Ona & Troncoso, 2019). There is no changa summary page on Erowid or PsychonautWiki, but changa is widely understood to have a greater intensity and duration of the effect, relative to smoked DMT. A confusing dimension of drug nomenclature and the distinction of ayahuasca and changa are instances in which MAOI material is consumed orally, prior to the inhalation of smoked DMT. The same ayahuasca dosage principle of a baseline MAOI dose combined with a variable DMT dose based on the desired intensity of effect appears to apply.
LSD is derived from alkaloids produced by a group of fungi named ergot (Nichols, 2004). Its subjective effects are thought to mainly result from its action as serotonergic agonist. In addition, LSD may affect dopaminergic and adrenergic receptors (Nichols, 2004). Its effects may last up to 12 h (Schmid et al., 2015). LSD has been used in controlled studies with healthy adults. Data suppose that 100 µg may be considered a ‘intermediate’ or ‘good effect’ dose (indicated by a good combination of positive subjective, minimal negative subjective effects and medium levels of ego-dissolution) while 200 µg may be considered a ‘high’ or ‘ego-dissolution’ dose (i.e., similar positive subjective effects but increased negative subjective effects and substantial ego dissolution; Holze et al., 2020). In healthy participants, neither sex nor bodyweight have effects on the plasma concentration or subjective strength of effects of LSD (Holze et al., 2019, 2020). LSD has been used in a recent clinical study to treat anxiety related to life-threatening diseases (Gasser et al., 2014). In older clinical investigations doses could range from 20 µg (Greiner et al., 1958) to 1,500 µg (MacLean et al., 1961). In comparison, a recent clinical trial administered a dose of 200 µg (Gasser et al., 2014). Optimal therapeutic effects may be evident for doses of 100–200 µg (Passie et al., 2008). While Erowid lists LSD dosages as between 10 and 400 µg (Erowid, 1997), common LSD dosages are likely lower than this range. Based on harm reduction resources threshold dosages start around 15 µg, light dosages range between 50 and 75 µg, common dosages range between 75 and 150 µg, strong dosages range between 150 and 300 µg and heavy dosages start above 300 µg (see Table 1).
LSA has a similar structure and activity relationship to LSD yet receives comparably limited attention in the research literature. Most LSA in circulation is in the form of Convolvulaceae seed from Ipomea tricolor, A. nervosa and Rivea corymbosa, in which the LSA is produced via symbiotic fungus (Jones, Steen, & Panaccione, 2021). Discussion of LSA appears primarily in biochemical studies (e.g. Jones, et al., 2021) and concerns around toxicity to livestock (e.g. Miles et al., 1996), with limited investigation of administration to humans. Erowid does not offer their usual drug weight intensity chart for LSA and instead suggests potency of ∼3–10% of LSD, quoting Hofmann's bioassays and claims of an effective 1 – 2 mg oral dose (Erowid, 2000). Anecdotal reports tend to calculate dose by the number of seeds ingested but varies incredibly widely from one to hundreds of seeds of the same species (Shroomery, 2009 [R. corymbosa]). Qualitative effects are described as lasting up to seven hours and have been described as more sedating and less stimulating than LSD (Erowid, 2012). Based on harm reduction resources threshold oral dosages start around 0.3 mg, light dosages range between 1 and 1.5 mg, common dosages range between 1.5 and 3 mg, strong dosages range between 3 and 6 mg and heavy dosages start above 6 mg (see Table 1). The absence of laboratory studies with human volunteers means there is no objective method of comparison. Future studies should investigate safe doses in laboratory settings.
Psilocybin can be found in more than 200 species of mushrooms and occurs in mycelium and sclerotium, as well as fruiting bodies. Psilocybin is a biologically inactive prodrug. Upon ingestion, it is converted in the body by a dephosphorylation reaction mediated by alkaline phosphatase enzymes into the pharmacologically active compound psilocin (Gilbert & Senyuva, 2008). Psilocin's 5-HT2A-agonism is thought to be responsible for its main subjective effects (Vollenweider, Vollenweider-Scherpenhuyzen, Bäbler, Vogel, & Hell, 1998). After ingestion, effects are commonly noticeable for 10–40 min and, depending on the dose and individual metabolism, may last 2–6 h (Passie, Seifert, Schneider, & Emrich, 2002). Psilocybin has been administered to healthy participants in numerous studies in various doses up to 0.6 mg/kg with dose being the strongest predictor for subjective effects (see e.g., Nicholas et al., 2018; Studerus, Gamma, Kometer, & Vollenweider, 2012). Psilocybin has been used in the treatment of demoralized long-term AIDS survivors (Anderson et al., 2020), treatment-resistant depression (Carhart-Harris et al., 2016), major depressive disorder (Carhart-Harris et al., 2021; Davis et al., 2021; Goodwin et al., 2022), anxiety and depression related to cancer (Griffiths et al., 2016; Grob et al., 2011; Ross et al., 2016), alcohol-use disorder (Bogenschutz et al., 2015, 2022), smoking cessation (Johnson, Garcia-Romeu, Cosimano, & Griffiths, 2014), and obsessive-compulsive disorder (OCD; Moreno, Wiegand, Keolani Taitano, & Delgado, 2006). Doses of psilocybin in these trials ranged from 1.75 to 30 mg (median: 21 mg; based on an average body weight of 70 kg; see Thal et al., 2022). A post hoc analysis of 10 studies with 288 participants indicated that adjusting the dosing of psilocybin to the bodyweight of participants was not advantageous compared to fixed dosing (Garcia-Romeu, Barrett, Carbonaro, Johnson, & Griffiths, 2021). Most psilocybin use occurs outside of clinical contexts and involves the consumption of psilocybin-containing mushrooms, sclerotium and related products. The most commonly used mushroom is Psilocybe cubensis, which proliferates alongside cattle farming and spread using simple home cultivation techniques. These mushrooms tend to contain psilocin, as well as psilocybin, and are normally dosed according to the dry weight of mushroom fruiting bodies or sclerotium. Erowid lists oral P. cubensis fruiting body dosages as between 0.25 and 5 g. Harm reduction resources indicate oral threshold dosages of pure psilocybin to start around 0.250 mg, light dosages range between 3 and 6 mg, common dosages range between 6 and 15 mg, strong dosages range between 15 and 30 mg and heavy dosages start above 30 mg (see Table 1). This aligns well with information from clinical studies with humans which usually apply higher doses (e.g., 30 mg, see Thal et al., 2022) for therapeutic purposes. Interestingly, doses of psilocybin in clinical settings tend to be slightly stronger/higher than doses of LSD (30 mg psilocybin vs. 200 µg LSD) when compared to harm reduction resources (see Table 1).
Psychedelics and care requirements
Of the total posts (N = 228) representing psychedelics as associated with an ideal form of psychedelic care, 20.18% (46 posts) were understood to imply psychedelic care was a necessity, 42.11% (96 posts) to imply psychedelic care was optional and 37.72% (86 posts) to imply psychedelic care was unnecessary (see Table 2).
Frequency of form of psychedelic care across psychedelics (see Thal et al., 2022; 2022a; Engel et al., 2022a–c for detail on data, method and psychedelic care)
| Psychedelic | Care necessary | Care optional | Care unnecessary |
| 5-MeO-DMT | 7.46% (17 posts) | 3.07% (7 posts) | 1.32% (3 posts) |
| Changa | 0% (0 posts) | 0.44% (1 post) | 0.44% (1 post) |
| Ayahuasca | 1.75% (4 posts) | 1.32% (3 posts) | 1.32% (3 posts) |
| DMT | 4.82% (11 posts) | 14.47% (33 posts) | 1.75% (4 posts) |
| LSA | 0% (0 posts) | 0.44% (1 post) | 9.21% (21 posts) |
| LSD | 2.19% (5 posts) | 1.75% (4 posts) | 4.39% (10 posts) |
| Psilocybin | 3.95% (9 posts) | 20.61% (47 posts) | 19.3% (44 posts) |
| Total | 20.18% (46 posts) | 42.11% (96 posts) | 37.72% (86 posts) |
Routes of administration
In total, 71 posts specified ROA. Of these, 6 concerned 5-MeO-DMT (one insufflated, seven smoked/vaporised), 17 concerned N,N-DMT (11 smoked/vaporised, two insufflated, three IV, one oral), 19 concerned LSA (all oral), 20 concerned psilocybin (all oral), and nine concerned LSD (seven oral, two smoked/vaporised). Of these, smoked/vaporised N,N-DMT was the only psychedelic ROA frequently reported (i.e., associated with more than three posts) as necessitating psychedelic care (five posts; 29.41% of N,N-DMT ROA posts). Psychedelic care was portrayed as unnecessary for oral LSA (19 posts, 100% of LSA ROA posts), oral LSD (five posts, 71.43% LSD ROA posts) and oral psilocybin (20 posts, 100% psilocybin ROA posts). No psychedelic ROA was frequently portrayed as permitting optional psychedelic care.
Products
In total 107 posts specified the form of the psychedelic consumed. Of these, 5 concerned 5-MeO-DMT (2 crude, 3 pure), 3 concerned N,N-DMT (1 raw, 1 crude, 1 pure), 20 concerned LSA (19 raw, 1 pure), and 79 concerned psilocybin (24 fresh, 55 crude). Of these, crude psilocybin was sometimes portrayed as necessitating psychedelic care (4 posts, 5.06% psilocybin product posts), although psychedelic care was more often portrayed as optional (31 posts, 39.24% psilocybin product posts) or unnecessary (24 posts, 30.38% psilocybin product posts) for crude psilocybin. No 5-MeO-DMT or N,N-DMT product was associated with three or more posts portraying perceived need for a particular type of psychedelic care.
Dosage intensities
A total of 113 posts specified the dosage of a consumed psychedelic. Of these posts, 10 concerned 5-MeO-DMT (4 light, 2 common, 3 strong, 1 heavy), 4 concerned ayahuasca (2 light, 1 common, 1 strong), 4 concerned DMT (3 light, 1 heavy), 3 concerned LSA (3 strong), 13 concerned LSD (2 common, 3 strong, 8 heavy) and 79 concerned psilocybin (2 light, 24 common, 35 strong, 18 heavy). Of these posts, psychedelic care was only portrayed as necessary for a heavy dose of LSD (4 posts, 30.77% of LSD dosage posts) and for a heavy dose of psilocybin (4 posts, 5.06% of psilocybin dosage posts. However, psychedelic care was also frequently portrayed as optional (11 posts, 13.92% of psilocybin dosage posts) and unnecessary (3 posts, 3.79% of psilocybin dosage posts) for heavy psilocybin doses. Psychedelic care was also frequently portrayed as optional for common (4 posts, 5.06% of psilocybin dosage posts) and strong (14 posts, 17.72% of psilocybin dosage posts) doses of psilocybin, while psychedelic care was also portrayed as unnecessary for common (20 posts, 25.31% of psilocybin dosage posts) and strong (21 posts, 26.58% of psilocybin dosage posts) doses of psilocybin. The only other psychedelic dosage portrayed as related to a particular preference of psychedelic care was N,N-DMT, for which care was portrayed as optional for heavy doses (4 posts, 100% of N,N-DMT dosage posts).
Discussion
There was disparity in how some psychedelic substances were dosed in clinical studies and ‘common’ doses determined by our Delphi method. Substances subjected to extensive clinical research, such as LSD and psilocybin, tended to have greater consistency in dosage. Interestingly, doses of psilocybin in clinical settings tend to be slightly stronger/higher (30 mg psilocybin vs. 200 µg LSD) than the common dose of LSD determined through our Delphi method. We anticipate the dosage chart produced via our Delphi method (Fig. 1) to be a useful and valued harm reduction information tool for communities surrounding psychedelics and have made this publicly available via The Mescaline Garden website and will be distributed amongst online psychedelic networks including DMT Nexus, Shroomery, PsychCombo, Entheogenesis Australis, Erowid, Bluelight and related social media platforms.
Building on the dosage information obtained via our Delphi method, Engel (2024) created this poster, with the aim of contributing to harm reduction. The poster can be downloaded at https://www.themescalinegarden.com/psychedelic-dosage
Citation: Journal of Psychedelic Studies 8, 3; 10.1556/2054.2024.00377
We coded posts according to psychedelic consumed and perceived importance of psychedelic care, aiming to consider which factors of psychedelic use (chemical, ROA, dosage intensity) were most likely to require human intervention. Overall, more posts portrayed psychedelic care as unnecessary or optional than portrayed psychedelic care as essential. A notable preference for carer absence has been identified in our previous analyses of this same data (Thal et al., 2022; 2022a; Engel et al., 2022a–c). An aversion to carers amongst people who use psychedelics provokes consideration of how education could support consumers to care for themselves under the influence of psychedelics, improving their understanding of subjective effects and the relationship of these effects with dosage and other biological factors, such as staying hydrated when drinking alcohol. In contrast to clinical settings where preliminary evidence suggests that therapeutic care is highly appreciated and may be important for therapeutic effects (Murphy, et al., 2022; Thal, et al., 2022), people who use psychedelics in other settings/recreationally seem to appreciate psychedelic independence. This preference may be because this population does not necessarily take psychedelics to treat psychiatric disorders but, for instance, to engage in self-exploration, increase creativity, or to increase existential awareness (Pestana, Beccaria, & Petrilli, 2021).
Of all psychedelic substances discussed, 5-MeO-DMT was the substance most strongly associated with a perceived need for care. This association was likely due to 5-MeO-DMT's elevated risk of contraindications, with MAOI combinations being a notable concern. While both 5-MeO-DMT and N,N-DMT drastically reduce physical capabilities whilst under the influence (Erowid, 2000, 2010), DMT has also been used by humans far more widely than 5-MeO-DMT. Posts concerning N,N-DMT were more likely to be portray care as optional than for any other psychedelic. Psychedelic care was less likely to be portrayed as important for LSA than for any other psychedelic. Perhaps this is due to LSA having a reduced duration and a sedating, rather than stimulating action (Erowid, 2012). After LSA, LSD was the next substance least likely to be represented as requiring psychedelic care. While there was a lack data on diverse psychedelic products, there did seem to be a broad correlation between greater psychedelic purity and dosage and a perceived need for care. The greater the purity of a psychedelic product, and the more potent a psychedelic molecule by weight, the easier it is to overdose on the psychedelic, which presumably increases the importance of psychedelic care as a response to the overdose.
For the psychedelics discussed in this paper, dosage intensity for the same weight is significantly lower when consumed orally than consumed via other ROA (e.g. smoking and IV). The most common route of administration in this data set was oral. The reduced intensity of oral administration of psychedelics (e.g. Barker, 2022) may have impacted this data set, i.e. psychedelic care may be less important for this population than for populations engaged in more intense psychedelic dosages.
Limitations include a lack of demographic information available for posters and no way of relating their psychedelic care preferences to their level of experience and knowledge, although the technological barriers for participation in this study likely limit the diversity of participant posters. Various dosages of some of the substances identified in this study have been investigated in clinical studies. In most cases, clinical studies show that the dosage of the substance that is administered moderates the strength of the subjective effects of the experience (Liechti & Holze, 2021). It is worth mentioning, that diverse people have been underrepresented in current clinical investigations (Michaels, Purdon, Collins, & Williams, 2018). The consideration of genetic and cultural differences regarding the metabolism, safety, and efficacy of particular doses of these substances is thus an important factor (Fogg, Michaels, de la Salle, Jahn, & Williams, 2021) we were unable to address.
Conclusion
We interpreted data as implying concentrated, lesser-known psychedelic products consumed via routes other than oral administration were seen as more requiring of psychedelic care, but factors influencing practices of psychedelic care and harm reduction require further exploration. Specifically, educational resources should be focused on different types of psychedelic products and care strategies relating to higher risk psychedelics e.g. distinguishing psilocybin effects from 5-MeO-DMT effects and encouraging 5-MeO-DMT consumers to inhale this psychedelic when seated, opt for electric rather than flame combustion and avoid coadministration with ayahuasca, changa and MAOI containing compounds. Strategies should address psychedelic consumption without a carer. Capacities for psychedelic self-care and remote care services like Fireside are in limited supply but appear be in high demand as non-clinical users value safety and also independence. As the use of psychedelics expands in clinical settings, the safety of administering psychedelic interventions is, but more research is required to improve psychedelic safety outside of acute care.
Authors' contributions
Liam Engel: coding, analysis, writing up; Sascha Thal: coding, analysis, writing up; Stephen Bright: analysis, writing up; Mitchell Low: writing up.
Disclosures
The authors have received no funding relating to this article. The authors report no conflict of interest relating to this article.
Supplementary materials
Supplementary data to this article can be found online at https://doi.org/10.1556/2054.2024.00377.
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