02
Who should pause before anything else
Psilocybin is not considered safe for people with schizophrenia, schizoaffective disorder, or severe forms of bipolar disorder. Anyone with current thoughts of harming themselves or others needs immediate professional support, not a psychedelic experience. Cardiovascular disease, uncontrolled blood pressure, seizure history, significant kidney or liver disease, pregnancy, breastfeeding, and serious mental-health conditions call for individualized medical advice.
Whole mushrooms can also trigger allergies. Wild mushroom misidentification can cause fatal poisoning. A smartphone photo, trade nickname, or seller assurance is not a safety test.
- Choose a physically safe, familiar environment away from traffic, open water, heights, weapons, fire, and crowds.
- Arrange transportation and child or pet care before impairment begins.
- Do not mix alcohol, cannabis, stimulants, or other psychoactive substances.
- Make a plan for medical help, crisis support, and Poison Help.
03
Medication interactions are not fully understood
Lithium
Treat this as a high-risk combination. Oregon’s regulated services exclude recent lithium use, and an observational analysis of online reports found a strong seizure signal. That study cannot establish a precise rate, but the concern is serious enough to avoid casual experimentation.
Antidepressants
SSRIs and SNRIs may blunt or change effects for some people, but research does not support a universal rule. Do not compensate with a larger psychedelic amount. MAOIs, tramadol, stimulants, antipsychotics, mood stabilizers, and other serotonergic or cardiac medicines require individualized review.
04
What sober support should look like
A support person should remain sober, be trusted, understand consent and boundaries, know relevant health information, and have an emergency plan. Their job is to protect safety and offer calm presence, not to steer emotions or act like an unlicensed therapist.
Discuss touch in advance. “No” remains no while someone is impaired. A sitter should never pressure, isolate, exploit, record without consent, or initiate sexual contact.
05
During intense fear or confusion
- Lower stimulation.Reduce noise, bright light, crowds, and competing conversation.
- Orient simply.Say who you are, where the person is, and that you will stay nearby.
- Protect without force.Move hazards away. Do not restrain unless trained emergency personnel decide it is necessary.
- Watch for medical signs.Breathing trouble, seizure, chest pain, unconsciousness, or immediate danger means 911.
- Use the right support.Fireside offers nonclinical peer support for a difficult psychedelic experience; 988 is for suicidal thoughts or emotional crisis.
06
When to get help now
Call 911 immediately
If someone is unconscious or unresponsive, has trouble breathing, is having a seizure, reports chest pain, or presents an immediate risk of physical harm.
Call Poison Help · 1-800-222-1222
For suspected poisoning, dangerous interaction, accidental ingestion, or uncertain mushroom identity. Do not wait for symptoms and do not try to make someone vomit.
Call or text 62-FIRESIDE
For intense fear, confusion, or panic without signs of a medical emergency. Fireside is nonclinical peer support, not emergency care or a suicide hotline.
FAQ
Common questions
When should someone call 911?+
Call for unconsciousness or unresponsiveness, trouble breathing, seizure, chest pain, or immediate risk of physical harm.
What should a trip sitter do during panic?+
Reduce stimulation, speak calmly, offer simple orientation and reassurance, and protect the person from hazards. Do not restrain, shame, interrogate, or initiate sexual contact.
Can someone take psilocybin with lithium?+
Treat lithium as a high-risk combination. Do not use psilocybin or change lithium without individualized medical guidance.
What if the mushroom identity is uncertain?+
Do not consume it. For suspected poisoning or accidental ingestion, call Poison Help at 1-800-222-1222 immediately and do not wait for symptoms.
Sources