A case study of difficulties after a high psilocybin dose in Oregon's legal program
Service centres should be more careful with dosage, particularly with young first-time trippers
This is another case study of post-psychedelic difficulties. In this case, a 21-year-old woman went to a legal Oregon psilocybin service centre in November 2024, seeking relief from anxiety and depression. She says she was given a five-gram dose (50mg of psilocybin analyte, the maximum dose allowed in Oregon) and experienced an overwhelming trip with some bewildering (and also some beautiful) transpersonal aspects. She felt depressed in the days afterwards and ‘not right’ for an extended period. About four months later, at college, she smoked marijuana, and this re-activated the trip and gave her anxiety, panic attacks and occasional hallucinations. She submitted herself to an emergency ward where she was given Seroquel. She has subsequently experienced derealization, on occasion so severe she has literally felt she was in a dream, and existential confusion. She had no personal or family history of psychosis. She is managing to take a philosophical and accepting attitude to this adversity, despite the disruption it has caused at this important stage of her life. She did not find much information about post-psychedelic difficulties online but found CPEP through ChatGPT.
The Oregon program measures serious adverse events (which it defines as hospitalisations during the trip) but there’s little data on these kinds of incidents, when people feel worse or much worse in the days, weeks or months after a trip. One study of the Oregon program found many people reported significant improvement in levels of anxiety and depression. Yet data from the 2025 Global Psychedelic Survey suggests around 6% of people who take psychedelics report moderate-to-severe difficulties lasting longer than a month after tripping. Severe cases like Jennifer’s are rarer still, but having experienced such a situation myself, I want to learn as much as I can about them and help people who experience them.
Probably the most useful takeaway for the psychedelic industry and the Oregon program is to be careful with dosage and not to rush to give a second dose, especially if someone is young, female and inexperienced with psychedelics – all of which make challenges during and after psychedelics more likely to occur. Thank you for sharing your story with us, Jennifer.
Jules: Tell me a bit about you.
Jennifer: I’m 21, from North Carolina, but I went to college in Texas. I just graduated. My parents both work in healthcare, and they had been following what was happening with psychedelics for some time. I’ve struggled with depression and anxiety for most of my life. I’ve taken a bunch of medications and was trying to explore different options. I didn’t want to pay a lot of money for it, but my parents were, like, you need to do this in a clinical setting. I tried to qualify for some of the clinical trials, but I couldn’t. I was also in a really bad place, and I was trying to do something quick. I wanted to just get a trip sitter and do it back home in North Carolina. But we ended up going to this place in Oregon that was pretty well-known and recommended. I had a couple meetings with the guide, over zoom, and then traveled to Oregon, and stayed there for a few days. I met the guide the day before the session. I was really excited because I heard psilocybin can help you see things in a different light. I was hoping it would help me be less critical of myself.
Did the guide give you some information about risks?
Not really. She said she trip sits for a bunch of people. And she said ‘everyone’s fine, I’m not worried at all about giving you a high dose’.
How much did it cost out of interest?
Let’s just say it was expensive.
The experience started out really well. I started on three grams of psilocybin. I think it was after an hour or so, before the trip had really kicked in, that the guide brought me more. I didn’t really know what was going on, so I took more, and I think it ended up being over five grams. I had never done any psychedelics before.
Did the guide run that past you beforehand, the possibility that you could take more during the session?
Yes she did. It was briefly mentioned. She said she had given full doses to a bunch of other people. I’m also pretty tall, so I think she thought that [I could handle a full dose] because I know she doesn’t give everyone the full dose.
Anyway, it started getting really intense. I heard my name being called out. And then it got to the point at the peak where I had a complete ego death. I was fully convinced…I don’t know if I can explain this…but I was fully convinced that I was going to be trapped in this hell forever. I was having visions and memories of my old life but I didn’t know who I was, or where I was. It felt like it went on for weeks. It was horrible. I just felt so trapped and, like, I peed my pants, I was nauseous. I remember getting mad at the guide because I didn’t know who she was. I kept asking, what’s happening?
It felt like I was at some point every person I knew in my life. I was my mom, I was my grandma, I was my great-grandma, and I was giving birth to myself. And it was this weird cycle. It was horrible. I never want to give birth. And then I started becoming different animals. At one point I was running through a jungle in Africa or something. It was just crazy. It got to the point where the guide was trying to comfort me. She was like, There’s nothing I can do, this part you just have to ride out. And I was like, what part?
You forgot that you were in Oregon, and you’d taken mushrooms.
Yeah, exactly. And then I remembered something she had said in the preparation, that it can be helpful to repeat a mantra, like ‘the mushrooms are working’. So I repeated that while I came down. There were also some really good moments – I learned not to care what other people think, which was good. I literally felt like I met God, more specifically Mother Nature. At one point, I was walking on the most serene beach. I remember looking at my hand, also, and seeing it rapidly age from a baby hand to an old wrinkly hand and then back again. I felt like I understood that everybody’s connected and we all come from the earth, stuff like that.
But after the trip, I actually went into a really bad depression. But then I got out of that on my own, which I’d never been able to do before without medication. So that was interesting. But ever since then, it’s just felt like something was off.
And then fast forward to four or five months later, I smoked weed at college one time, and that reminded me of the trapped feeling during the trip, and it basically caused this psychotic break of sorts. And that’s when I started having panic attacks. And I hallucinated in a way that was reminiscent of the visuals I saw during the trip. So I freaked out. I went to the mental hospital for a few days. It was horrible. And ever since then, I’ve developed black floaters in my left eye that are there constantly. It makes me sad to look up at the clear sky now, because it’s covered in black spots.
I was intrigued that it all came up five months after the trip, not immediately after. It was triggered by something. But at the same time, I didn’t feel normal after the trip. It was building up to it, and then I broke down.
I’ll get flashbacks to the trip. Random things trigger it, like the other morning, my dog was running down the hall, and that somehow reminded me of when I was an animal in the trip, and it completely freaked me out.
And I’ve had really bad derealization, along with these existential questions. Like, nothing makes sense, and I feel like I’m trapped in the world. And there was a day where I was completely convinced that nothing was real. I was very convinced of that. I remember I went to buy shoes, and I thought no one was real, so I was just doing the most random things. I remember I hugged this guy, and I’m usually a very reserved person.
Existential confusion after psychedelic experiences
Before the 18th-century enlightenment, ecstatic experiences enjoyed a central place in Western Christian culture, but they were then increasingly marginalized and pathologized as delusional, stupid and dangerous - a topic I explored in my book The Art of Losing Control
[Here is something I wrote about believing you’re in a dream, or dead, after taking psychedelics)].
And then I have this ongoing fear that I’m still back in Oregon, on the floor, and this is all a dream - even saying that freaks me out. It just feels like everything is fake, and I’m just constantly terrified. I had depression before, but not the panic attacks and this visceral reaction to things. It’s brought up a bunch of questions. I’m just really upset about the hallucinations in my vision, and there’s a lot of guilt and regret, I guess. It’s just frustrating because I was trying to help myself.
Had you smoked weed before?
Yeah, and I never had this reaction. I don’t think I can smoke weed or do psychedelics again, which sucks, because I could see it being really interesting and cool, not taking a big dose.
Did you contact the Oregon guide afterwards?
Yeah, I did reach out recently just to share what happened. She dismissed what I said. It was a bit frustrating, but I don’t think she wanted to get into legal trouble, not that I was gonna sue her or anything.
How do you feel she dismissed it?
Jennifer
She just said ‘a trip can bring up challenging insights’. I explained that I literally received a diagnosis for PTSD and HPPD.
She might not have even learned about it. I mean, there’s limited knowledge in the field at the moment. There’s one paper published on traumatic psychedelic experiences, and it was only published three months ago.
Yeah, for sure. And it’s frustrating because I’ve been trying to look up PTSD from psychedelics, or trauma from psychedelics. And what comes up is how psychedelics can help heal trauma.
Do you notice the symptoms get better or worse under certain conditions?
The eye floater things are always the same, but the hallucinations are worse when I’m stressed, or like, if I’ve gotten really drunk. Usually the visuals will be colorful fractal patterns, but other times I’ve seen hundreds of faces or winding staircases. It’s been hard to fall asleep sometimes because it’s worse when I close my eyes. So I think, yeah, substances or anxiety make it worse, for sure. I’m also on medicine now, SSRIs.
I actually went to the ophthalmologist because I was really confused when the black spots appeared. And apparently, my right eye is fine, but I have a birthmark on the back of my left eye, and I think it’s causing me to see start seeing that. So I don’t think they’re actually floaters. I think they’re like parts of the back of my eye that I’m seeing now, for some reason.
I do think time is gonna be the best thing for this. My parents actually had a colleague at Johns Hopkins, who does a lot of psychedelic research. And I talked to someone there who worked with people with HPPD, and they said, you just learn to live with it, or you get used to it. Mine’s definitely on the milder end of the spectrum.
The weirdest part is the derealization. This is maybe a strange question, but I was wondering - the whole existential derealization thing made me think a lot about religion. Did it affect your worldview?
The whole thing did because it was the hardest thing I’d ever gone through in my life [I’m talking about the PTSD I developed in my late teens after a bad trip]. I had to find something to believe in. It was so shocking to me, my life was so turned upside down, and I was so different to how I used to be, that I had to find something spiritual to believe in. I got into Stoic philosophy – it was just a thing that helped me get through tough times.
With derealization, you can get philosophical about it, like Hinduism and Buddhism talk about how we are in an illusion. These kinds of experiences can make us question the illusion or dream we’re in, like the computer game of life. But you don’t want to start thinking, ‘therefore it’s meaningless’, or ‘nothing I do matters’, because you can still die in the computer game, and that has real effects on the people you know. And you can still hurt yourself, you can still get arrested. We did a paper interviewing people who had post-psychedelic existential confusion, or ontological shock. And in that paper, people said what was helpful for them is often grounding, it’s not something you necessarily solve cognitively. It’s more like, right now, you’re this particular human being in this reality, experiencing this lifetime. And when you’re doing this life, do this life, so like ground back into your body and into this reality and into your relationships. You know what I mean?
This quote helped me when I was feeling derealization: ‘I think, therefore than I am’, like, we don’t know everything, we don’t know how anything started, but all that we do know is what we are experiencing now.
Yeah, sure, I agree. I thought of exactly the same quote when I wasn’t sure if I was in a dream, coming back from the Galapagos Islands after an ayahuasca retreat. I remembered that quote from Descartes. The one thing I’m sure of is I’m conscious. I can’t tell whether I’m in the afterlife or not, but I’m still conscious, and I can try and navigate this reality.
Yeah, I’m almost scared of death - this sounds morbid, but there was a comfort in death, like it’s all over. But now I’m afraid death will mean another endless trap or endless torture for whatever reason. I grew up Catholic, but right now it’s comforting to think just scientifically, and assume that there’s nothing after death.
Yeah, well, that’s, that’s something I’ve heard from other people. It can be helpful to think that what you experience on a psychedelic trip isn’t necessarily or probably the ultimate cosmic truth – it’s just a state of mind amplified. So you were in a hellish state of mind. But nothing is permanent, that’s not the ultimate cosmic truth you’re going to be stuck in forever. It’s a passing state of mind.
So have you found anything to be helpful in recovering?
I have been going to therapy. I did a little bit of EMDR, it kind of helped. It’s definitely not as bad as it was.
What about the depression? How is that now?
Same as it was – managed, with medication.
Is the therapist helpful?
I think so. I was going to her twice a week. Now I’m going once every two or three weeks, because, in a way, like me being busy has been a good distraction. So I think it’s been a little bit better recently. The reason I reached out is because I think it’s really helpful hearing other people’s stories [of post-psychedelic challenges]. It’s very comforting. I’ve been talking to a lot of people who were trying to give me advice, but I don’t think they knew exactly what I was referring to. It’s different if you’ve gone through it.
How did you hear about us?
It may have been Chat GPT. I think I looked up something like ‘New York in person psychedelic difficulties groups’. And they’re like, there’s not a lot, but it mentioned CPEP.
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This is a great example of one of the flaws in the Oregon and now the Colorado experiments. Not enough time is allowed for proper intake and prep, especially with a younger first time client being given the highest allowed dose of psilocybin. I know a number of very experienced underground practitioners that, given her background with depression etc, would have spend a significant amount of time with intake and prep and most likely would never start with psilocybin. Most would opt to start with a lower dose of MDMA. It's best to start with a really experience facilitator to learn the art and science of navigating non-ordinary states of consciousness. Unfortunately a legal environment for this does not exist.
Super interesting to read. I hadn’t heard before that young women with little psychedelic exposure are more likely to have this kind of experience. I was a bit younger than your subject here when I had a super challenging trip and started having weed-induced flashbacks… exactly the same trip, for hours! Best wishes to her, that’s so tough.