Assessing contraindications is a complex process, given the regulated and unregulated health professionals working in the field and the populations undergoing altered states.
Clients will often either not report nor have a formal diagnosis of a mental disorder, or if they do, it may not be accurate, or they may deny its validity.
It is important to recognize that there are those for whom it may never be suitable to work with psychedelic medicines due to psychiatric and medical conditions that would put them at risk. It is essential to have a medical professional with whom you or your client can consult.
Contraindications can vary and depend upon individual factors (both mental and physical health), their social circumstances, the medicine, set, and setting. Formal and structured assessments are more likely to yield useful information and help the health professional avoid missing areas of risk.
The following key categories accrue to risk, falling within the area of mental health and addictions in order to determine suitability for PHRI and psychedelic-assisted therapy (Silveira & Rockman, 2021).
If a client reports any of these symptoms, functional impairments, conditions, or risks, this should trigger a deeper evaluation. If any of the items are a concern, they should be considered a potential contraindication, and if you are a regulated professional, ensure that you document that you asked about these domains.
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May lead to risk to self/other, intentionally, or unintentionally
Decreased function may enhance risk
Consider acuity and history
Concrete potential repercussions
Ingesting any psychoactive substance will have some degree of risk, and it is essential that the client is informed of this.
The following are considered absolute contraindications for MDMA, psilocybin, and ketamine (Mitchell et al., 2021). There are absolute contraindications associated with other compounds and it is beyond the scope of this document to address these. Please refer to the literature for further information.
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The Little Book of Psychedelic Substances is also a great beginners guide to learn more about the properties and brief history of each psychedelic medicine.
For a deeper dive into the subjective effects, adverse effects, and contraindications of the various psychedelic medicines covered in Numinus' training programs, consider registering for Molecular Foundations.