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In this episode of the Psychedelic Medicine Podcast, Christian Jurlando, PhD, joins to unpack the topic of extended difficulties following psychedelic experiences. Dr. Jurlando is a humanities professor at Stevens Institute of Technology in Hoboken, NJ, and a researcher and advocate focused on psychedelic safety and extended post-psychedelic difficulties (EPPD). Drawing in part on his own lived experience of prolonged difficulties following psilocybin use, his work focuses on improving recognition, care, and support for people experiencing adverse psychedelic outcomes.
In this conversation, Dr. Jurlando discusses extended post-psychedelic difficulties, drawing on both research and his own experience of EPPD following a low dose of psilocybin. He explains that these difficulties can take many forms, may occur even after relatively small doses, and can persist long after the acute psychedelic experience has ended. The conversation explores how to distinguish acute crises and shorter-term difficulties from extended post-psychedelic difficulties, as well as the importance of recognizing when someone needs professional support. Dr. Jurlando also discusses the emerging infrastructure for supporting people who experience adverse psychedelic outcomes, including peer support, harm-reduction services, specialized clinics, and the development of clearer pathways for escalation and referral. Throughout, he emphasizes the importance of acknowledging these experiences within the psychedelic field, developing more nuanced approaches to risk and informed consent, and recognizing that recovery can take time and may involve different approaches for different people.
In this episode, you'll hear:
What extended post-psychedelic difficulties can look like and how they may differ from psychosis or other acute psychedelic complications
Four questions for assessing whether someone experiencing post-psychedelic difficulties may need additional support
How peer-support and harm-reduction services can identify when someone may need to be referred for more specialized care
What is currently known about risk factors, set and setting, and the prevalence of extended post-psychedelic difficulties
Why psychedelic risk needs to be considered in relation to the potential benefits and the individual circumstances of each patient
Quotes:
"In my research, I found that back in the late 50s, that was kind of the rule of thumb: that smaller doses were more dangerous because people didn't process what was coming up and could get stuck in a negative state." [5:16]
"The best estimate [of extended post-psychedelic difficulties] that we have right now is from the Global Psychedelic Survey… over 6400 people were surveyed and 8% reported difficulties lasting a month or longer that meaningfully disrupted their daily functioning." [10:43]
"It's very difficult when something presents so fast to realize that the remedy or getting better takes time. It takes, in fact, sometimes a lot of time. And there can be a lot of resistance to that because you think 'hey, if I just took some mushrooms and then suddenly felt this way, surely I can just take something else and suddenly feel better, right?' It doesn't work that way. And so I think that that's sort of an added level of distress, and it's maybe unique." [13:59]
"What we're finding is that what people really need is just acknowledgment that these sorts of things happen. That's the first thing that would have been really helpful for me—because when you're in that state and you think that you've broken your brain or something, then it can just start snowballing." [17:37]
"It does seem like there's a wide variety of treatments [for extended post-psychedelic difficulties] and some work for some [people] and some work for others." [32:05]
Links:
Challenging Psychedelic Experiences Project website
Previous episode: The Challenging Psychedelic Experiences Project with Jules Evans
Previous episode: Who Is a Good Candidate for Ibogaine? with Fernando Rivas, MD
