By Jason Luoma and Brian Pilecki.

The use of psychedelics in the USA has rapidly increased over the last decade, not only for recreational purposes but also for therapeutic purposes. For example, rates of Google searches on microdosing have skyrocketed since 2015 demonstrating strong interest in using psychedelics for improving personal well-being among the public. This trend, coupled with the progressive movement towards the legalization of some psychedelics, suggests that healthcare providers will be increasingly encountering patients who engage in the use of these substances outside of legally sanctioned frameworks, often without any intention to cease their use. In addition, a growing evidence-base supports the generally benign and even beneficial effects of some of the most common psychedelic drugs, especially when taken in supportive, safe contexts.

Much of clinical practice in relation to psychedelic substances use outside of clinical trials has been framed in terms of a harm reduction model. Harm reduction, in the context of mental health care and medicine, refers to attempts to minimize the negative impacts of drug use without necessarily requiring cessation or reduction of use. Harm reduction psychotherapy is an alternative to the more traditional abstinence-only models often used in working with clients with substance use disorders. Harm reduction has been applied to working with clients using psychedelics given its advantages in providing a framework for substance use and because clients are often engaged in illegal activities when they are using psychedelics. While “preparation” sessions are conducted in legal contexts such as research trials, using a similar prescriptive approach in non-legal contexts potentially increases risk for therapists as it can be viewed as condoning an illegal act.

However, applying a harm reduction perspective to psychedelic use has some shortcomings. First, it may inadvertently overlook crucial ethical considerations when individuals use drugs in a manner that is not only low risk but beneficial to their mental and physical well-being. Second, it may perpetuate unhelpful stigma that psychedelics are dangerous and reducing risk is the preferred way to orient therapy.

We advocate for a more comprehensive approach to therapy with people using psychedelics that encompasses both harm reduction and benefit enhancement. While it is essential to mitigate risks, especially when psychedelics are used in uncontrolled settings, it is also important to acknowledge and support the positive outcomes that can emerge from their use in conducive environments, such as supported use settings in states like Oregon or Colorado, in ceremonial settings, or other supportive retreats. The concept of “benefit enhancement” aims to enrich the conversation around psychedelic use by emphasizing the importance of maximizing the positive aspects of these experiences for individuals who choose to engage with them.

This expanded perspective is grounded in the core bioethical principles of beneficence and autonomy. The principle of beneficence obliges healthcare professionals not only to minimize harm but also to promote well-being. According to this principle, the role of clinicians should extend beyond safeguarding patients from potential dangers to assisting them in maximizing the benefits of behaviors they are engaging in, including the use of psychedelic substances. Autonomy, another foundational ethical principle, underscores the importance of respecting patients’ decisions, including the use psychedelics for health and mental health promotion. If patients seek guidance on how to use psychedelics constructively, it becomes a professional responsibility to support these goals.

Certainly, there are risks to using psychedelics. For example, some psychedelics should be avoided by individuals with a history of cardiac conditions and can have harmful interactions with other substances. Psychedelics can also create mental health risks. However, much of the harm that occurs in public psychedelic use is due to the illegal status of many psychedelics, which paradoxically increases risk by promoting the use of unregulated substances (e.g. “street drugs”) and unsafe consumption practices. A harm reduction lens is important to mitigate these risks and help clients avoid common mistakes when using psychedelics so that they maximize safety.

However, psychedelics such as psilocybin and LSD are also judged to be relatively medically safe compared to most other controlled substances, and there is a growing body of research that demonstrates that when psychedelics are used in supportive settings, such as in clinical trials or at a supportive retreat, they can be used safely and with substantial benefit. Thus, the term “benefit enhancement” was coined to capture the idea it is important to consider helping clients increase the benefit of their psychedelic use, should they choose to use, in addition to minimizing harm.

Acknowledging the dual nature of psychedelics is essential—they carry risks but also offer significant benefits under the right circumstances. A focus solely on harm reduction might not only neglect patient autonomy but also overlook the unique properties of many psychedelics, such as low potential for addiction and relative medical safety when used responsibly. Psychedelics are often portrayed as one of two extremes: a magic bullet that will cure mental health problems or a dangerous drug that can make you go “crazy.” A balanced approach of harm reduction and benefit enhancement, rooted in accurate information and research about the actual risks and benefits, is a better option for healthcare providers working with clients who are using psychedelics on their own. We therefore advocate that harm reduction and benefit enhancement strategies should be used together by health care professionals going forward.

As the landscape of psychedelic use evolves, so must the approach of healthcare professionals. By integrating the principles of benefit enhancement with harm reduction, clinicians can more ethically and effectively meet the needs of those who turn to psychedelics, not just for exploration but for healing and personal growth.

Authors: Jason Luoma and Brian Pilecki.

Affiliations: Portland Institute for Psychedelic Science

Competing interests: Dr. Luoma is co-owner of and Dr. Pilecki works for Portland Institute of Psychedelic Science, which provides psychedelic-related mental health services, conducts clinical trials, and provides training related to psychedelics.

Social media accounts of post authors: Jason Luoma – @jasonluoma.bsky.social, Facebook, LinkedIn