How to make psychedelic retreats safer
It can feel like no progress is being made, but those pushing for better standards are cautiously optimistic.
NB: in the article below I mention various retreats. I never recommend any particular retreats and can’t vouch for any of them.
Earlier this year, the US Embassy in Peru issued a warning to American tourists not to use ayahuasca or kambo:
In 2024, several U.S. citizens died or experienced severe illness, including mental health episodes, following consumption of ayahuasca. Aside from the negative health effects, U.S. citizens in Peru have also recently reported being sexually assaulted, injured, or robbed while under the influence of these dangerous substances at “healing” or “retreat” centers.
The announcement provoked surprise from the plant medicine community. Several US citizens died following consumption of ayahuasca last year? If so, these deaths were not reported in the media.
The truth is, we don’t know for sure how many died during or after an ayahuasca retreat, or other psychedelic retreats in unregulated markets. There is little transparency in the global psychedelic retreat industry. If you are plugged into What’s App groups, you might hear word on the grapevine — one person drowned at a retreat in Costa Rica earlier this year, for example, while another person drowned at a retreat in Jamaica. Occasionally, deaths make the news, like the iboga-related death at SoulCentro in 2024, or Aaron Castranova’s death in an ayahuasca-related incident in June 2025.
But many deaths go unreported — I only heard about the death of Diogenes Ianakiara at the Ayahuasca Foundation in January by chance because I happened to be researching the Ayahuasca Foundation at the time. Nor do we know how many people feel worse, or much worse, after attending a psychedelic retreat. I’ve reported on some stories of post-retreat destabilization, including among veterans, but the vast majority of such cases go unreported — people are left in hell and no one is any the wiser. How about sexual assaults or boundary violations at psychedelic retreats, how common are they? We don’t know, although Chacruna published a survey on assault in ayahuasca culture in 2023 (52% had direct or indirect experience of sexual abuse in ayahuasca circles).
People have sometimes compared going on a psychedelic retreat to other forms of adventure tourism like rafting or scuba -diving. But we have some idea of the risks of these activities — professional associations have formed over time, safety protocols have been developed, and deaths have to be reported. So consumers know, more or less, the risks involved in these activities and they know if a company is taking proper steps to mitigate those risks.
The closest thing to this for psychedelic retreats, so far, is a 2023 study by ICEERS, a plant medicine NGO, which spent two years gathering and analysing reports of ayahuasca-related fatalities (not all of which were at retreats). It found 58 credible public reports of ayahuasca-related deaths since records began. ICEERS program director Jeronimo Mazarrasa says:
Not a single one of those 58 deaths could be attributed to ayahuasca toxicity directly. Many were ayahuasca-related accidents. Many were ayahuasca-related accidents. Any fatality is a tragedy but to understand the relative risks of ayahuasca it is necessary to place these 58 fatalities next to the total number of participants - an estimated four million people have taken ayahuasca worldwide
Because we don’t have transparency or an industry-level conversation around harms and deaths at psychedelic retreats, there isn’t much industry-level learning either. In January, Diogenes Ianakiara died of a heart attack during an ayahuasca ceremony. Could his life have been saved if the Ayahuasca Foundation had better screening, or a defibrillator on-site? Should this be a standard at retreats? Should all facilitators be trained in CPR?
There are not yet many places where the psychedelic retreat industry can have these conversations, learn from tragedies, and develop better standards and protocols, although there has been some progress for specific substances, particularly iboga and ayahuasca, and there’s also been some progress in particular countries (more on this below).
Hamilton Souther set up Blue Morpho, an ayahuasca retreat and training centre in Iquitos, back in 2002. He tells me: ‘It’s very rare for retreat centres or facilitators to talk to each other. Everyone is doing their own thing.’
Pascal Tremblay is the co-founder of Nectara, which provides support and infrastructure services to psychedelic retreats. He tells me:
As with any evolving field, the psychedelic retreat space holds growing edges. Primarily - a lack of accountability, founders and facilitators not getting external and professional input, money challenges, lack of business sense, poor screening, a big blindside around adequate preparation and integration, and a general lack of collaboration among retreats.
Pascal adds:
I do think some retreats do quite well in terms of paying attention to details and trying to offer deep support and care at all levels. But from my experience speaking to so many retreats, some of them have blindsides because they don’t pay attention to details enough; they are too focused on money; they don’t have the time/energy/money to do more; they don’t have enough support; they refuse external help.
A lack of academic research on retreats and churches
While the psychedelic renaissance has been powered by hype from a handful of clinical trials under optimum laboratory conditions, actual psychedelic consumption isn’t happening in those tightly-controlled conditions — it’s happening in homes, at festivals and raves, and at retreats, in unregulated conditions. But very little academic research tracks what actually happens in these unregulated settings.
There are some exceptions, however (below are just some examples, apologies if I left out your paper!)
Baylor University’s psychedelic ethics team published a paper in May 2025 examining the websites of 298 psychedelic retreat centres. One notable finding, from a safety perspective, was that 30% of centres offered more than one substance on retreats.
In June 2025, Rocky Mountain Poison and Drug Safety published a paper on psychedelic tourism, based on a survey of 2,124 Americans who had taken a psychedelic in the past year. A third said they travelled to take psychedelics (probably to a retreat). Those who travelled to take psychedelics were much more likely to have visited an ED or required urgent care in connection with psychedelic-consumption (57-62% of this group) than those who did not travel (9% of this group). RMPDS tell me this may partly be because those who travel to take psychedelics also take psychedelics more often, raising the risk of an ED visit. But they also think travelling for psychedelic-consumption may increase some risks (such as becoming destabilized on the journey back, which I wrote about here).
ICEERS produces a lot of research on ayahuasca, including this paper on adverse events at retreats, based on the Global Ayahuasca Survey. It found 12% of everyone who takes ayahuasca report psychological difficulties afterwards for which they sought professional assistance.
More positively, this 2025 paper from Onaya Science, Heroic Hearts UK and Imperial College found that veterans who attended ayahuasca retreats reported therapeutic benefits.
Oregon Health & Science University (OHSU) is producing a lot of research on the Oregon legal psilocybin market, including through its Open Psychedelic Evaluation Nexus, and the Oregon Health Authority is also publishing data from the programme.
As for the hundreds of psychedelic churches that exist in the US — we only have a guestimate of how many exist, what substances they use, what sorts of safety protocols they have or training for their facilitators.
Our research on this topic
We at CPEP have done some research on retreats. In 2023, Anna Lutkajtis and I published a paper showing 30% of participants at a psilocybin retreat reported short-term integration challenges. More recently, Marta Majer, a CPEP researcher doing a Masters in clinical psychology at the University of Economics and Human Sciences in Warsaw, did an investigation for us into retreat centres’ public information on ethics and risks. Marta built a Python program to analyse the online information of 287 psychedelic retreat centres as listed on Retreat Guru and on their websites.
First, she investigated how many retreat centres mentioned ‘ethics’ on their sites. She tells me:
Of approximately 200 centres who had an accessible website, 92% had no mention of ethics at all on their site. Only 8 (4%) had a clear code of ethics, while another 8 vaguely referenced ethical behaviour.
The eight retreat centres with ethics codes are: Home of Ayahuasca, APL Shamanic Journeys, Beckley Retreats, Coracao Medicina, Hero’s Journey, Shangriballa, Mushroom Awakening, and the Ayahuasca Foundation. But it’s notable that customers have recently complained about boundary violations (facilitators having sex with clients shortly after retreats) at the Ayahuasca Foundation — in other words, a written ethics code is not necessarily a guarantee of optimum ethics in practice.
Marta then looked at how many retreat centres mentioned anything about the risks of psychedelics. She found:
The word “risk” appeared on 21 sites (10%).
In 2 cases, it referred to unrelated topics (e.g., cancellations, mosquito bites).
Only 19 websites out of 200 (9.5%) addressed substance-related risks.
Only one retreat centre — Alalaho — mentioned that there was any fatality risk of attending a psychedelic retreat
Only two retreat centres — Mushroom Awakening and Alalaho — mentioned the risk of any long-term adverse effects.
We get people coming to CPEP reporting serious harms after retreats -—insomnia, terrible anxiety, HPPD, new-onset bipolar, psychosis, hospitalizations. None of these people say the retreat centre had any clue how to support them or where to refer them for professional support. How rare or how common are such cases? We don’t yet know. Hopefully they’re very rare, and we also come across very positive stories of people’s retreat experiences.
The challenges to sector-wide collaboration
It’s proven very hard for the psychedelic retreat ecosystem to evolve an agreed set of standards. The field has existed for at least 25 years, and there have been previous efforts to develop standards and certificates, such as the Ethnobotanical Stewardship Council (ESC). This was an initiative launched in 2013 to try and improve the safety of ayahuasca ceremonies and the sustainability of the industry. It gathered a fair amount of support and raised $90,000 in crowd-funding, but the initiative fizzled out after it was publicly denounced by Bia Labate, executive director of the plant medicine NGO Chacruna.
One reason such initiatives are hard — and this seems to have been Labate’s principal complaint against the ESC -—is that psychedelic retreats include both western-run and indigenous-run centres, and they use substances like ayahuasca that have been used by indigenous tribes for a long time. But it’s impossible to imagine a western-run association telling indigenous groups how they should or shouldn’t provide their own ancestral medicines. In addition, it’s quite diverse — different companies offering different substances in different jurisdictions all over the world.
Another big stumbling block is the illegality of most of the field. The industry largely exists in the grey or black economy, so retreat centres (or churches) don’t want to join public associations of the sort that exist in other wellness or leisure industries. Many operators are tiny and don’t even have a website, never mind professional safety protocols.
Robert Heffernan, co-founder of the Sacred Plant Alliance (an NGO that promotes safety among entheogenic churches) tells me:
A major part of the problem with trying to address safety issues within the psychedelic community is that most sacred medicines are considered to be controlled substances. This makes it difficult to gather information and call out individuals or groups who may be causing harm. It also limits how much any group that engages in best practices are willing to publicly discuss their safeguards openly and explicitly. The best case scenario might be for sacred medicines to be decriminalized. We would be safer, better educated, and freer to have honest discussions about all the issues at hand.
Reasons to be cheerful
Saying all that, there are some positive initiatives, and people trying to push for positive change are both exhausted, but also cautiously optimistic things are slowly getting better.
The legal US psychedelic retreat industry is small but growing
In the last few years, guided psychedelic sessions have been legalized in Oregon, Colorado and (recently) New Mexico. These states have introduced, or are in the process of introducing, a legal framework for psychedelic experiences — legal standards for screening, facilitator training and emergency medical support,; approved ethics; adverse event reporting,; complaints procedures and so on. It’s true that, because of the price and bureaucracy involved, most psychedelic consumption still happens in the unregulated market in these states, but some think the legal market is the future.
Gabe Charalambides founded Odyssey, which is one of two companies to offer legal psilocybin retreats in Oregon. He tells me:
I do feel the state models solve some of these problems and present a pretty safe way of doing this. You’re going to see a significantly smaller number of incidents in those frameworks. My guess is, over time, you’ll see a shift towards more and more domestic retreats, to the point where, in ten years time, most of the psychedelic retreats happening in the world are going to be happening in the US.
There are promising self-regulation initiatives underway
There are self-regulation associations formed or forming in particular countries.
In Spain, for example, where a Madrid high court just confirmed that ayahuasca is not illegal, there is Red Micelio Federation (FERM), a federion of organisations working with and studying entheogens.
In Holland, there is the Guild of Guides Netherlands.
In Costa Rica, there are early conversations around an association for plant medicine retreat centres.
Non-profits have also developed safety protocols or guidance for specific substances / plant medicines. The Global Ibogaine Therapy Alliance (GITA) created safety protocols for ibogaine, while ICEERS created an AyaSafety course for facilitators.
And there are non-profits working in particular sectors, for example, the Sacred Plant Alliance is working to develop ethics and safety guidance for US psychedelic churches.
There’s also the Psychedelic Safety Institute, which launched this year and held its first gathering — where improving retreat safety was one topic of discussion. Nectara also hopes to provide retreat centres with educational resources around topics like ethics, screening and integration. Pascal Tremblay of Nectara says:
Nectara hopes to serve as a thoughtful, purpose-led partner offering tools, self-assessment frameworks, and compassionate support to help retreats thrive, not just as businesses but as spaces of true and lasting transformation.
There seems to be an appetite for more sector-wide collaboration at the moment. Hamilton Souther of Blue Morpho says he is reaching out to people in the retreat industry to try and coalesce around shared values and standards. Neil Markey, CEO of Beckley Retreats, tells me:
I think many in our field, including us, have been focusing on their own orgs these last few years, but there is certainly the beginnings of conversations on how to collaborate. I took part in a panel at Psychedelic Science with leaders from Beond, Soltara and Tandava Retreats, all great people leading values-aligned orgs and there’s an appetite to keep that conversation going. We’d certainly be stronger together.
Gabe Charalambides of Odyssey says:
I haven't seen any initiatives of retreat leaders reaching out to one another and saying, ‘Hey let's form a group together’. That would be cool. I would certainly join.
It would also be very useful if someone started an online group where retreat facilitators could meet and compare notes — these are often young idealistic people working in extremely demanding, if not outright exploitative, conditions. They often want to provide good care and end up with moral burnout when they aren’t able to do that. Facilitators have no way to talk to each other but could potentially be a collective catalyst for change in the sector. CPEP is willing to help with this if there is demand.
More public awareness / media reporting
One of the things that has driven the boom in psychedelic tourism in the last five years is media hype. There have been too many uncritical articles whooping about psychedelic retreats in the last few years without much mention of risks.
But that’s changed. There are now more articles on problems at retreat centres — deaths, rapes, post-retreat destabilization. I have debates with industry figures over whether such articles do any good — some people say that bad actors will continue to do bad even after they have been called out for their behaviour. I don’t think media articles about risks and harms are enough to bring improvement in the field on their own, but they could be one factor in the mix, along with self-regulation and legislative changes like legalization.
I also think pressure from consumers could be a bigger factor pushing for change. Last week’s Ayahuasca Foundation story, for example, was basically pissed-off clients publicly complaining about an unsafe product. At the moment, annoyed retreat customers can complain on Retreat Guru, Google Reviews, Reddit or Facebook, and this can have an impact. I wonder if there could be a more formal Psychedelic Consumers Association to push for changes (maybe the Global Psychedelic Society could do that, but I don’t see it doing it yet).
So there are positive signs. Progress is very slow. But it does seem to be happening. Jeronimo Mazarassa of ICEERS says:
At this point of the expansion of psychedelics and indigenous plant medicines I don't think the genie can be put back into the bottle anymore. They will continue to expand, and one day they will be accepted legal practices in global north countries. I don't know if that’s going to take 10 years, 20 years or 100 years, but there's no doubt in my mind that it is not going backwards. That's what keeps me doing my work. I would have given up if I wasn't sure that the way people do this 20 years from now will be much safer than it is now.
Don't sleep on bestretreats.co
Sarah, Many of us think that instead of full legalization it would be safer and more viable to decriminalize them including for sharing and group use. And allowing facilitators to be compensated for harm reduction.
While this wouldn't address all possible issues it would mean they couldn't be marketed and sold in dispensaries and other outlets. It would also mean that education and information could be freely shared including about which groups/individuals were engaged in best practices and those that may be creating harm.