Not clinically reviewed. Not yet reviewed by a clinician or harm-reduction practitioner. Escalation list, medication interactions and every phone number still need verification.

About 9 min to read · Stay as long as you need

Journey safety and harm reduction

In an emergency, do not read — call. Australia 000 · United States and Canada 911 · United Kingdom 999 · New Zealand 111 · Europe and most of the world 112.

Get help now

If you are worried about someone's body or their safety, call emergency services. You do not need to be sure, and you do not need to know what they took.

Australia 000 · United States 911 · United Kingdom 999 · Europe and most of the world 112

If you do not know your local number, 112 connects to emergency services in most countries, including from a locked phone.

Call now if you or the person you are with has any of these:

  • Thoughts of suicide, or of harming themselves or anyone else — or acting on them.
  • Chest pain, trouble breathing, a very fast or irregular heartbeat, fainting or collapse.
  • A seizure, a very high temperature, rigid muscles, or persistent vomiting.
  • Confusion that is getting worse, an inability to be woken, or loss of consciousness.
  • Agitation or fear severe enough that they cannot be kept safe, or that someone may be injured.
  • Frightening voices, beliefs or perceptions that continue after the effects should have worn off, or that come back later.
  • Any concern about what was taken, or about a reaction with a prescribed medication.

A hard experience and a medical emergency can look similar from the outside, and you are not expected to tell them apart. If anything on this list is present, or you are simply not sure, that is a reason to call rather than to wait.

If they take medication that acts on serotonin

If someone has taken something alongside an antidepressant, lithium, tramadol or a migraine medication, watch for this combination: shivering or shaking they cannot control, muscle twitching or jerking, muscles that feel rigid, heavy sweating, a racing heart, agitation or confusion that is getting worse, and a rising temperature. Together these can indicate a dangerous reaction that gets worse quickly. Call emergency services — do not wait to see whether it settles. Tell them which medications the person takes.

Telling them what happened

Tell emergency services what has been taken, as far as you know it — they need it to treat the person, and it is the most useful thing you can give them. In many places there are legal protections for people who call for help in a drug-related emergency, though these vary from place to place and this guide is not legal advice. Whatever the local situation, a medical emergency is a reason to call.

MediTrip is designed to be a calm, predictable backdrop for altered states — including meditation-induced states and, for people who choose to use psychedelics, those experiences.

We do not encourage drug use. Psychedelics are illegal in many places, the law differs from country to country, and they carry real risks. Nothing on this page is a judgement about what you have done; it is here to help you and the people with you stay safe.

Some people should not do this at all

Risk is much higher, and in some combinations can be life-threatening, if any of these apply:

  • A personal or family history of psychosis, schizophrenia or bipolar disorder, or a previous episode of severe or prolonged distress after an altered state.
  • Heart disease, high blood pressure, an arrhythmia, or any heart condition treated with medication.
  • Epilepsy or a seizure disorder.
  • Pregnancy or breastfeeding.
  • Being alone, with nobody who knows what is happening and can reach help.
  • Taking any medication that acts on serotonin. This includes, and is not limited to, MAOI antidepressants, SSRI and SNRI antidepressants, lithium, tramadol, triptans for migraine, and some over-the-counter cough preparations. Lithium in particular has been associated with seizures in this context. This list is not complete — a pharmacist or doctor can check your actual medications, and can do so without you naming what else you intend to take.

Do not stop or skip a prescribed medication in order to do this. Stopping antidepressants, lithium or anticonvulsants — especially suddenly — carries its own serious risks, including relapse, withdrawal effects and seizures. If you think your medication is a reason not to go ahead, that is a reason not to go ahead; it is not a reason to stop the medication.

Before

  • Set — your mindset. If you are acutely distressed, grieving or under pressure, this is not a good time. If you are already in it, that is not a failure — skip to If it gets hard.
  • Setting — a safe, familiar space, comfortable temperature, water nearby, phone on silent, nothing you need to do for the rest of the day.
  • Sitter — having a sober, trusted person present is one of the most important things you can do, especially for a first or high-intensity experience.
  • You cannot tell what a substance is by looking at it. Things sold as one substance are often something else, and a test — where drug-checking services are legally available — can suggest what is present but cannot tell you the strength, the purity, or that nothing dangerous has been added. An expected result is not a safety guarantee.
  • Don't mix. Combining substances — including alcohol, cannabis and prescription medications — is where many bad outcomes come from. See the medication list above.
  • This guide gives no dosing guidance. MediTrip does not tell you what to take, how much, or how often, and nothing here should be read as an indication that any amount is safe. A harm-reduction service or a doctor is the place to ask, not this page.

If you are sitting with someone

  • Stay. Do not leave them alone and do not go to sleep. If you need a break, hand over to another sober person first.
  • Stay sober yourself. The whole value of your role is that your judgement is intact.
  • You are not there to guide the experience. You do not need to say the right thing, interpret anything, or fix it. Calm company is the job.
  • Offer, don't impose. "Would you like water?" "Would you like the light on?" "Would you like me closer, or would you like space?" Accept no as an answer.
  • Do not physically restrain someone unless they are about to come to immediate harm — and if it reaches that point, call for help.
  • If they vomit or become drowsy, turn them onto their side so they cannot choke, and keep watching their breathing.
  • Keep them away from roads, water, balconies, stairs and windows. Do not let them drive, and do not drive them yourself unless you are certain of your own state — call an ambulance instead.
  • Write down what was taken, and when, as best you know it. If help is needed, that is the first thing you will be asked.
  • Calling for help is not an overreaction and not a betrayal of their trust. If you are frightened, that is information. Call.

If it gets hard

  • Change something small. Move rooms, change the music, lie down. Sip some water — sips, not litres. Get fresh air at an open window, or step outside with someone.
  • Press Ground me at any time. It stops the motion and the sound, pauses any video, and stays on until you turn it off yourself. It works with no internet connection and it is always free.
  • Breathe out longer than you breathe in.
  • Remind yourself, out loud if it helps: "I took something. This is the substance. I am in my room and someone is with me."
  • Don't drive or swim. Stay away from roads, water, balconies and stairs. Leave big decisions and big conversations for another day.
  • If you have taken more than you meant to, that is a reason to get someone sober with you and to read Get help now above — not a reason to ride it out alone.

Support lines

Every number below should be confirmed against its current published source at expert review.

Australia

  • Emergency: 000
  • Poisons Information Centre: 13 11 26 (24 hours)
  • Lifeline: 13 11 14 (24 hours)
  • DanceWize (Harm Reduction Victoria) and Directions (ACT) publish peer harm-reduction information. These are information services, not crisis lines.

United States

  • Emergency: 911
  • Poison Help: 1-800-222-1222
  • Suicide & Crisis Lifeline: 988
  • Fireside Project peer support line: 62-FIRESIDE (623-473-7433) — check their site for current operating hours. A peer support line, not an emergency service.

United Kingdom and Ireland

  • Emergency: 999 (112 also works)

Elsewhere in Europe

  • Emergency: 112

Poison information services can advise on substance emergencies and are the right call when somebody has taken something unknown.

Integration

See the Integration guide. What you do in the days after matters too.

What this guide does not do

No dosing information, no advice on obtaining anything, no promises about how an experience will go or how it will end, and no medical advice. Nothing here replaces a doctor, and nothing here should be read as a reason to delay contacting one.

Sources

Written from the general classes of source below. Specific references — titles, authors, DOIs and links — are to be added at expert review; none are cited here because none have been verified for this draft.

  • Published guidance from established harm-reduction organisations, including their material on sitting with someone through a difficult experience and on when to seek medical help.
  • General emergency-medicine guidance on symptoms that warrant urgent assessment, and on serotonin toxicity in particular.
  • Peer-reviewed psychedelic-science and psychiatric literature on challenging experiences, acute adverse effects and contraindications.
  • Published national emergency, poison-information and crisis-line directories for the numbers listed above.

Reviewers: please check the escalation list, the medication-interaction list, the serotonin-toxicity signs and every phone number against current clinical guidance and current published sources. Please also confirm that nothing here promises a safe outcome, prescribes how a person should respond to their own experience, or reads as encouragement to use.