What happened when thousands of people who use psychedelic drugs called into a private emergency hotline, instead of 911, when experiencing difficulties? A team of researchers found that callers reported reduced stress, harms and emergency room visits.
The Psychedelic Peer Support Line was created by Fireside Project, fiscally sponsored by Social Good Fund, a California nonprofit. It describes its service as “staffed by rigorously trained, compassionate, supportive volunteers from diverse backgrounds who listen deeply and from a place of non-judgment.” People anywhere in the United States can call or text 62-FIRESIDE, seven days a week from 11 am-11 pm Pacific.
It’s geared towards people who are currently tripping, those helping another person who’s using psychedelic drugs, or those with a past experience they want to discuss. The company says all calls are confidential, and callers aren’t required to provide names or personal information. The volunteers on the other end of the line complete a four-day training course; they can offer emotional support, but do not provide medical care or psychotherapy. Anyone experiencing a medical emergency is still encouraged to call 911, and anyone contemplating suicide is asked to use the 988 Suicide & Crisis Lifeline.
The study of outcomes, just published in the Psychedelic Medicine journal, was led by Dr. Mollie M. Pleet, a psychologist. Its two data sets are an anonymous survey sent to callers 24 hours later, and call logs that volunteers completed. The peer specialists, as volunteers are known, recorded a total of 4,047 calls in the study period from April 2021-September 2022, while 848 callers filled out the survey.
Based on the survey responses, 29.3 percent of respondents said the phone call helped them avoid being physically or emotionally harmed; 12.5 percent said it helped them avoid calling 911; and 10.8 percent said it helped them avoid an emergency room visit.
“To our knowledge, these are the first data suggesting that a lack of support during the process of psychedelic integration may lead to harm.”
There were also reported benefits for people who called the hotline not while tripping, but wanting to make sense of a previous psychedelic experience. This processing and reflection on psychedelic-induced thoughts and emotions is known as “integration.”
According to survey results, 66.4 percent of those respondents who were not currently tripping said the hotline helped them relieve psychological distress; 23.2 percent said the service helped prevent physical or emotional harm; 6.1 percent said they avoided calling 911; and 5.4 percent said they avoided an emergency room visit.
“To our knowledge, these are the first data suggesting that a lack of support during the process of psychedelic integration may lead to harm,” the authors wrote.
The larger data set of call logs completed by volunteers yielded other insights. Of the people who called to discuss a current or past psychedelic experience, 27.4 percent mentioned having a mental health condition. The most common of these were PTSD, depression, anxiety and substance use disorder. Meanwhile, the most common emotions callers expressed were feeling anxious, overwhelmed, fearful or confused.
“Our study implies that people who use psychedelics in nonclinical settings often do so without necessary safety precautions,” the authors wrote. “This creates an ethical imperative to delineate responsible solutions to reduce the risks associated with naturalistic psychedelics use.”
Of course, there are substantial limitations to a study of this kind. One point is that everyone who calls into the hotline chooses to do so—so we can’t apply these findings to the whole population of psychedelics users. And survey participants, a self-selecting subset of that larger group, didn’t all provide explanations for their answers—for example, why exactly they had avoided a hospital visit. Additionally, peer specialists only ask appropriate questions to build trust with callers, so there’s no standardized process, and the volunteers don’t have training to accurately identify medical needs.
“[The service] has a powerful harm reduction effect that is essential at this point in the development of the psychedelic field.”
Despite these significant caveats, the findings contain important indications, and Fireside Project founder Joshua White is encouraged by the research.
“[The service] has a powerful harm reduction effect that is essential at this point in the development of the psychedelic field,” he told Filter. “[It] shows that simply by speaking to a peer, someone with their own psychedelic experiences, who is trained to listen with compassion and non-judgment, it can provide the support people need to reduce the risks of their psychedelic experiences and maybe [increase] the potential of them.”
It’s notable that a significant number of callers reported that they were actually at risk of harm, to the point of considering a hospital visit. Because the service is geared towards people using in nonclinical settings—alone, with friends, or at an event, for example—callers generally lack any trained support, and potential criminalization for their drug use presents another barrier as they consider seeking help. So it’s easy to understand how people might find having a nonjudgmental person to talk to valuable—I wish I had, when I first used psychedelics and my reactions gave my parents the shock of a lifetime.
“It is absolutely imperative that we develop abundant, low-cost, affordable, accessible ways for people to have support during and after their psychedelic experiences,” White said. “Clinical support, as great as it is for some, will not be accessible to very many people because of the status of our mental health care system. People are reading about the powerful curing effects that psychedelics can have, but often the potential risks are not in those articles.”
White said that emergency hotlines are an economical option for governments looking to support vulnerable individuals—certainly when you compare it to seeking immediate medical care for a crisis that might be emotional, rather than medical. In May this year, the federal government allocated $200 million to expand the 988 suicide hotline number. In addition, there is public funding for “peer support specialists” who work with military veterans in recovery from mental health and substance use disorders. And Medicaid funding in many states pays for peer support for people with SUD.
With psychedelics, there are also other forms that support like this can take, as White pointed out: “It could be an integration circle, it could be one-on-one with a peer supporter, it could be conversations with a therapist or social worker, it could be reaching out to people who share aspects of your identity because you really want to talk to someone who’s had similar lived experience.”