Abstract
IMPORTANCE: The availability of psychedelic retreats has grown to meet the demand for access to these substances. Despite centuries of use among Indigenous communities, psychedelics can pose serious risks for some users. OBJECTIVE: To determine safety precautions that retreat organizations that offer psychedelic substances currently use. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study included structured interviews conducted by phone or email with representatives from 49 organizations publicly advertising psychedelic retreat offerings from July to October 2023. Organizations were eligible if they marketed their services in English, offered at least 1 psychedelic substance, and made contact information available online. Organizations were selected using convenience sampling from a broader pool of organizations identified in a prior study. Data were analyzed from March 2024 to November 2025. MAIN OUTCOMES AND MEASURES: The main outcomes of interest included the types of drugs offered and presence of polysubstance use, collaboration with health care professionals, presence of health care professionals during retreats, disqualifying conditions, medication washout procedures, and integration practices. Descriptive statistics were used to characterize organizational practices and locations; content analysis was used to categorize medical exclusion criteria, medication washout protocols, involvement of health care professionals, integration offerings, and training of integration facilitators. RESULTS: Of 48 organizations that reported what substances they offered, all offered either ayahuasca, psilocybin, or both. Nineteen organizations (38.7%) offered more than 1 psychedelic substance. All organizations collected participant medical histories; 36 organizations (73.5%) excluded individuals with certain health conditions. Most (43 organizations [87.8%]) required or recommended medication washout for varying lengths of time, ranging from 1 day to more than 6 weeks. Most (34 organizations [69.4%]) worked with a licensed health care professional or someone with emergency response training, and 32 organizations (65.3%) had someone with those qualifications in attendance at retreats at least some of the time. All organizations offered some sort of integration support. CONCLUSIONS AND RELEVANCE: This qualitative study of the practices implemented by psychedelic retreat organizations found substantial variability in the implementation of safety precautions. Some practices related to medication washout and polysubstance use may pose increased risks to participants. Best practice guidelines are needed and should be codeveloped with Indigenous and nonclinical communities.