Harm
Reduction

Introduction

Roland Griffiths, PhD

“The preparation before, and the support after psilocybin sessions are believed by many, including me, to be a vital complement to maximizing enduring positive outcomes. And it is precisely this focus of Project New Day’s approach that I find so appealing.”

The Project New Day (PND) Harm Reduction Plan aims to create a cohesive framework designed to promote safety and the best outcomes for its participants. This plan rests on the idea that extensive support should be provided to all participants throughout their coaching and psychedelic sessions*. This support consists of six weekly preparatory life-coaching sessions preceding two psychedelic sessions, which are then followed by six weekly integrative coaching sessions. Additionally, there will be one life-coaching session in between the psychedelic sessions.

After the final integrative session, continued support is offered through an ongoing weekly community support group, designed to ensure that participants are never left without a support system. To guarantee high-quality support, all PND-certified coaches and PND-certified community group facilitators must complete five certificate training courses covering addiction, trauma, coaching techniques, and psilocybin fundamentals. The PND program strives for optimal outcomes by encouraging a compassionate approach from coaches and trainers, emphasizing the importance of unconditional positive regard. This sentiment is underscored by growing support within the psychedelics and wellness community, as reflected in the quotes on this page.

* Project New Day does not provide psychological or medical treatment, or recommend or administer psychedelic therapy to anyone. The responsibility for this falls on other organizations that adopt our model, guided by legal and professional statutes along with individual suitability assessments conducted on a case-by-case basis.

Paul Stamets

“Project New Day brings an important discipline to the therapeutic use of psilocybin mushrooms as powerful medicines. Preparation, set and setting, and most of all having a trusted and skilled team to help maximize success and minimize harm are the pillars that PND brings to those in critical need.”

The Psychedelic Harm Reduction and Integration (PHRI) (Gorman, et al. 2021) framework is a clinical approach to working with participants who are using or considering using psychedelics in any context. This framework incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy and is intended to be used during therapeutic interactions. The framework is the first of its kind in that it is the first cohesive theoretical framework for psychedelic integration in peer-reviewed literature. Consequently, PND’s plan for harm reduction will be largely based on the principles advocated by the PHRI. However, the PHRI framework and the PND Harm Reduction Plan differ in that a PHRI facilitator is not present during the administration of the psychedelic compound, nor are they present during the psychedelic experience.

The PND approach explicitly includes a harm reduction framework for the administration of the psychedelic compound and during the psychedelic experience. While a PND coach will not be present during the administration and experience, the PND plan outlines expectations and best practices for this phase of the overall process. The PND plan will also refer to the Oregon Health Authority (Oregon Health Authority, Public Health Division, Chapter 333) requirements for preparation and administration.

The PND plan for harm reduction is also guided by the harm reduction model for treating addiction, as referenced in the framework of the PHRI. This reflection emphasizes the importance of guiding participants through a very personal journey to healing and self-actualization by allowing them to practice autonomy and develop their own values, goals, and approach to healing. The PND plan rejects outdated practices that shame and stigmatize the addict or traumatized person. Each aspect of the PND plan promotes compassion toward and acceptance of the participant in an effort to reduce the harm caused by substance abuse or psychological trauma. The plan describes best practices for each phase of psychedelic-assisted life coaching: preparation, psychedelic experience, and integration.

Preparation for the Psychedelic Sessions

The PND harm reduction plan follows the guidelines set out by the Oregon Health Authority regarding preparation sessions and also incorporates methods from the PHRI framework. Preparation describes each step occurring prior to the administration of the psychedelic compound, beginning at the first interaction a client has with anyone associated with the provision of a psilocybin service. Interaction with a participant during the preparation phase begins the process of fostering a trusting connection between coach and participant and is integral in ensuring the client is comfortable and safe during the upcoming intervention. Preparation sessions must be conducted privately in person or virtually using video conferencing technology with each client to allow the sharing of personal information.

During preparation, the primary aim should be to seek to understand a participant’s relationship with psychedelics and their motives for use. Addiction and trauma can lend themselves to a variety of experiences and histories, and it is important to understand the participant’s story and how their journey has brought them to a place where they are searching for guidance and support. Preparation also includes identifying and setting goals for the upcoming integration phase. At this point, the coach should aim to outline the following:

  • Why the participant wants to have the psychedelic experience.
  • How the participant plans to achieve the goals motivating the psychedelic experience.
  • What steps they envision to get there.
  • Why their goal is important to them.

In addition to creating a space where the participant feels safe and supported enough to divulge an intimate retelling of their past, a significant part of the preparation focuses on information sharing. As outlined by the Project New Day knowledge-based coaching process, successful intervention lies in providing participants with an education in topics intimately related to their mental and spiritual well-being. The Project New Day curriculum covers a wide variety of topics including but not limited to:

  • An introduction to brain chemistry
  • Life-improvement strategies
  • Benefits of developing a gratitude practice
  • Determining signature strengths
  • Value clarification
  • Tools to understand life’s meaning
  • Purpose building
  • Trauma healing

The idea is to present a number of possibilities for having a better life. In this way, participants are able to take a holistic approach to their healing, finding paths that are best suited to them.

Finally, engaging the participant in a process of inquiry so that they can make an informed decision as to whether they want to engage in psychedelic-assisted life coaching and how they would like to approach the experience if they do decide to move forward with the intervention is crucial. The coach should neither encourage nor discourage the participant from psychedelic use unless their intended use might result in harm, in which case concerns should be voiced without attaching judgment of the participant’s choice.

In addition to completing the above-mentioned actions, the OHA also requires that the following steps be taken during a preparation session.

  • Completing a Client Information Form – For every client who will participate in an administration session, a facilitator must receive a completed client information form as described in OAR 333-333-5050 by the Oregon Health Authority.
  • Preparing a Transportation Plan – For every client who will participate in an administration session, a facilitator must complete a transportation plan as outlined by the Oregon Health Authority. The transportation plan may not approve a client to operate a motor vehicle, bicycle, or other forms of self-operated transportation following the administration session.
  • Preparing a Safety and Support Plan – Once the client’s motivations have been identified and the participant is sure they would like to move forward, it is important to create a detailed safety plan, as mentioned in the PND A&S procedures. The requirements are also outlined by the OHA.
  • Preparing a Re-entry Plan – Preparing a re-entry plan can help to integrate insights developed during the psychedelic experience. It is extremely critical that participants are equipped with self-regulation tools and daily activities to encourage effective integration into an ordinary state of consciousness and general mental readiness for daily life after the psychedelic experience.

Educating the Participant

It is also important, at this point, to provide the participant with educational materials regarding psychedelics. These materials may also include information regarding alternative therapies or tools that may provide similar outcomes without consuming psychedelics. Managing expectations regarding the psychedelic experience and the potential long-term effects should be handled during this phase. A well-informed participant is better prepared for the intervention and likely to achieve a more positive therapeutic outcome.

Document Review

Under the authority of the OHA, the facilitator must review each of the following documents with the client during the preparation session:

  • Informed consent document
  • Client Bill of Rights
  • Product information document
  • Documentation of fees
  • Documentation of the price charged for the sale of psilocybin products
  • Emergency Plan document
  • Possession of firearms and weapons policy

In addition to the documents listed above, a facilitator must obtain prior written consent from a client during a preparation session for the following activities and circumstances:

  • Participation in a group administration session.
  • Use of supportive touch during an administration session.
  • Participation in a training practicum, including information regarding the training of program students and instructors who will be present during the client’s administration session. The client must have an opportunity to meet any students or instructors who will be present during their administration session prior to the commencement of an administration session.
  • Video or audio recording of an administration session.
  • Presence of an interpreter or client support person.
  • Sharing of identifiable client data.
  • The use of different facilitators to conduct a client’s preparation, administration sessions, or integration session.
  • Consuming secondary doses of psilocybin products during an administration session.
  • Participating in an administration session where licensee representatives of a service center will be present.
  • Disclosure form for de-identified client data.

The documents listed above must be provided to a client prior to a preparation session upon the client’s request. The facilitator must also discuss the process for verification of license status and the process for making complaints to the Authority during or after a preparation session.

Reviewing the Client’s History

Much of the preparation regarding reviewing the participant’s history is covered in the PND Acceptance and Screening Procedures. Interviews and handling of sensitive information require a demeanor and engagement that is open, non-judgmental, and compassionate. It is also helpful to address the participants’ connection to a community of psychedelic users and to understand their corresponding worldviews, the extent to which they subscribe to them, and how to best foster relationships within the context of this perspective.

The Psychedelic Session

The psychedelic session refers to the day on which the psilocybin dose will be consumed at the service center under the supervision of a center licensee or licensee representative. Session facilitators are prohibited from transferring, preparing, or otherwise handling psilocybin products, unless the facilitator is also a licensee representative of a service center, as outlined by the OHA. Below are detailed instructions for this phase of services, including administration and care, therapeutic approach, and discharge.

Administration and Care

On the day of the psychedelic session, the client will arrive at the service center where the psilocybin product will be sold and transferred to the participant by the licensee representative of the service center, following these guidelines:

  • The sale of psilocybin will not exceed a total amount of 50 mg.
  • The facilitator will not take part in the sale or administration of any psychedelic compound.
  • All purchases of psilocybin products must be completed prior to the start of the administration session.
  • The psilocybin product will be transferred to and consumed by the participant immediately after transfer within a designated administration area under the supervision of the licensee representative.
  • It is an option to allow the client to consume a secondary dose of psilocybin during their administration session as long as the total amount does not exceed 50 mg.

For a participant to consume a secondary dose the following requirements must be met, as outlined by the Oregon Health Authority:

  • Receive written consent from the client prior to the beginning of their administration session.
  • Require the client to purchase and take possession of the secondary dose prior to beginning their administration session.
  • Require the client to store the secondary dose at a designated secured location within the service center’s licensed premises.
  • Require the client to retrieve the secondary dose from the designated location and consume it without assistance if they choose to consume the secondary dose.
  • Require the client to return the secondary dose to the service center at the conclusion of their administration if they do not consume it during their administration session.

Following the administration of the psychedelic compound, the participant will be brought into the designated space for the psychedelic experience. Throughout the duration of the session, a facilitator must always be present. The facilitator must be in direct contact with the participant, monitoring for signs of physical and emotional distress.

Under the Oregon Health Authority Guidelines, the facilitator is allowed to take restroom breaks of approximately five minutes or less during an administration session if the facilitator remains on the licensed premises and a service center licensee representative is available to monitor clients. During the administration session, it is only appropriate for the provider to provide supportive touch if requested by the client and authorized by prior written consent. Under these circumstances, supportive touch is limited to hugs or placing hands on a client’s hands, feet, or shoulders. No other forms of touch are permitted.

While a PND-trained coach will not be present during the administration session, the PND Program model encourages working with facilitators whose approach is non-judgmental, non-authoritative, open, and curious about whatever the participant experiences during their session. On the other hand, the use of mindfulness techniques may be used during the psychedelic session, as the use of these modalities offers attentional and attitudinal shifts, improving how people relate to the causes of their distress and allowing them to develop insights that can then be applied to alleviate feelings of distress.

The therapeutic approach used in preparatory and integrative sessions will reflect many of the same ideals as those expressed previously with the inclusion of some directive coaching. PND-certified coaches will engage in knowledge-based coaching, where an emphasis is placed on offering participants the knowledge and tools to support the processing of past experiences. The skill learned during coaching sessions will explore positive psychology methods for improving well-being and creating a clear sense of meaning and purpose. Project New Days brand of knowledge-based coaching utilizes both directive knowledge-based coaching and non-directive work to support the participants’ exploration of self.

Non-Directive Approach

Non-directive refers to an approach that encourages coaches to provide patience and guidance rather than instruction. This approach allows participants to self-direct their integration session and encourages them to adopt an uncritical reflection of their psychedelic experience. It is the role of the coach to remain present and engaged with the client, respond to client insights with support and warmth, maintain connection, and build trust.

Inner-Directed Approach

Inner-Directed refers to an approach in which the coach encourages the participant to produce insights and solutions by looking into their inner experiences. An emphasis is placed on the client’s ability to tap into their inner healing intelligence as described in the following quote:

“Our system is inner-directed. … Once we give someone MDMA, they are the ones who produce the content. We follow and support where they are going. Our hypothesis is there is an inner healing intelligence. We all know that’s true for our bodies. If you get a scratch or break bones, your body has a mechanism to heal itself. … There is this wisdom of the body to try to sustain itself. We think similarly there is something like that for the psyche.” Rick Doblin, PhD, founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), speaking at the Psych Congress 2020 preconference.

Knowledge-Based Coaching

Life coaching is the process of engaging an individual in work that will support their ability to maximize their potential and reach their goals. Knowledge-based coaching specifies the process of synthesizing theory, knowledge, and traditions from a wide variety of resources and implementing them into the coaching process to develop a deeper ability to explore and understand the self.

Handling Negative Experiences

There is always the possibility that a participant will have a negative experience after consuming psychedelics. The intensity of these experiences can be mitigated by discussing these possibilities prior to the session. Implementing techniques during the session that promote a feeling of safety and comfort for the client can also help the client to manage difficult feelings and experiences during the session. It is important to remember that the role of the coach is simply to receive and respond to what the client is producing. If pain is rising to the surface of the session, it is only the responsibility of the coach to reflect a supportive, non-judgmental presence back to the client to encourage their intuitive progress.

Discharge

The minimum duration of an administration session shall be dependent on the total amount of psilocybin a client consumes during that session, including any secondary dose consumed. The minimum length for any administration session is one hour and the longest, consuming the maximum allowed dose of psilocybin analyte at 50 mg, has a minimum length of 6 hours. While this may be the range of duration, the average psilocybin dose used in a psychedelic session is between 20 to 30 milligrams, creating a window for a 4-5 hour session on average. The exact dosage will vary depending on various factors such as weight, height, age, and medical history. Below is the recommended duration for a session and the corresponding dose of psilocybin analyte.
  • Less than 2.5 mg of psilocybin analyte, the minimum duration of the administration session is one hour for the client’s initial administration session at a service center. After completing an initial administration session at the service center, the minimum duration is 30 minutes when the client participates in any subsequent administration session at the same service center within a period of 12 months following the initial administration session.
  • Between 2.5 mg and 4.9 mg of psilocybin analyte, the minimum duration of the administration session is one hour.
  • Between 5 mg and 9.9 mg of psilocybin analyte, the minimum duration of the administration session is two hours.
  • Between 10 mg and 24.9 mg of psilocybin analyte, the minimum duration of the administration session is four hours.
  • Between 25 mg and 34.9 mg of psilocybin analyte, the minimum duration of the administration session is five hours.
  • Between 35 mg and 50 mg of psilocybin analyte, the minimum duration of the administration session is six hours.
Upon or after the conclusion of the minimum duration period, a facilitator, in consultation with the client, will determine whether the administration session should be concluded. If the facilitator and client determine that continuing the administration session is not required to ensure the safety of the client and the public, the administration session may be concluded. It is the responsibility of the facilitator to record and retain the time and date that each administration session began and concluded as well as notifying the Authority if the administration session goes beyond 11:59 PM local time. Before concluding sessions, facilitators will require clients to sign a release document stating they agree to end their administration session and follow the terms of their transportation agreement. Within the 72 hours following the conclusion of the administration session, the facilitator will attempt to contact the participant to confirm the client’s upcoming integration sessions.

Integration

Psychedelic integration refers to the process in which the participant integrates the insights of their experience into their life. The PND Plan for Harm Reduction emphasizes the importance of providing the client with support via coaching integration sessions while arming clients with the tools and strategies that will allow them to continue integration outside of those settings. The psychedelic service centers may offer some form of integration but, in general, participants will partake in six coaching integration sessions with a PND coach. Following psychedelic sessions with meaningful integration and support is a cornerstone of the PND model. Successful integration is reflected in the client’s ability to successfully process insights and adopt them into their day-to-day lives.

Challenges

Handling feelings of distress following a psychedelic session requires patience and support. Symptoms of anxiety, panic, and depressed mood are not necessarily indications that the participant is suffering or has developed a mental illness or the loss of orientation to reality as a result of the psychedelic experience. It is important that in the face of these potential outcomes, the coach reassures the participant that their reaction is within the realm of what is expected following an intervention, that these feelings will not persist for the remainder of their lives, and help the participant to avoid unhelpful reactions to temporary distress. If these symptoms do persist beyond the psychedelic’s pharmacological duration of action, this may indicate a participant may need further psychotherapeutic support and they should be encouraged to seek out these additional supports.

Positive Experiences

To increase the likelihood of lasting positive experiences, it is important to refer to the initial outline regarding goals and motivations created in the preparatory sessions by the client. This is necessary to ensure that the client and coach are moving forward in a focused and productive manner. Reassessing what the client’s goals were and how they described an ideal integration process can help to guide this phase. Goal setting and monitoring are essential.

Maintenance

The process of constructing meaning out of psychedelic experiences is not isolated to the therapeutic setting. It is the coach’s responsibility to encourage the participant to pursue activities that help sustain focus on the psychedelic experience and any resulting insights. Tools for maintaining the benefits gained through psychedelic intervention can be taught during proceeding integration sessions. Resources for maintenance will be suggested in subsequent integrative coaching sessions and encouraged in PND group community sessions. These tools may include:

  • Mindfulness practice
  • Yoga
  • Reflection
  • Journaling
  • Connecting with nature
  • Guided meditation
  • Art practices
  • Grounding practices
  • Self-care
  • Continued Education

It is always the goal of the Project New Day framework to provide participants with an experience that is safe and meaningful. By adhering to the structures outlined in the PND Harm Reduction Plan, facilitators can significantly increase the likelihood that participants will complete a psychedelic intervention with the feeling that their lives have been impacted in a uniquely positive way.