Bad trip

A "bad trip" (also known as a psychedelic crisis) is a disturbing experience associated with the use of hallucinogens, typically psychedelics like LSD, psilocybin and DMT, but can also refer dissociatives such as ketamine or dextromethorphan. A bad trip can sometimes occur with other substances including cannabis and MDMA. They can manifest as a range of feelings such as anxiety, paranoia, the unshakeable sense of one's inevitable and imminent personal demise or states of unrelieved terror that they believe will persist after the substance's effects have worn off.

Psychedelic specialists in the therapeutic community do not necessarily consider unpleasant experiences as threatening or negative, focusing instead on their potential to greatly benefit the user when properly resolved. Bad trips can be exacerbated by the inexperience or irresponsibility of the user or the lack of proper preparation and environment for the trip and are reflective of unresolved psychological tensions triggered during the course of the experience.^[1]

It is suggested that, at a minimum, such crises can be managed by preventing the individual from harming oneself or others by whatever means necessary up to and including physical restraint, providing the patient with a safe and comfortable space as well as supervising the tripper until all effects of the drug have completely worn off.

A person who supervises the hallucinogenic experiences of others with the intention of harm prevention is commonly referred to as a "trip sitter."

Anchors

An anchor, in the context of hallucinogen usage, can be defined as an activity or physical object which keeps one grounded during heavy suppression and distortion of a person's sense of time, space, language, ego and short/long-term memory. At higher dosages, this can result in extreme disorientation and confusion. Anchors are often used to counteract this and maintain one's concept of the current situation as it is within reality. Examples of anchors include:

• Familiar and uplifting music - An example of this includes our community good vibes portal. However, the creation of a playlist that is comprised of music one associates with being happy is highly recommended.
• An extremely personal and ingrained image or object
• Continuous repetition of a meaningful word or motto as a mantra
• Writing an easily readable reminder onto a large piece of paper and placing it close within one's visual field throughout the experience. - Common reminders include the name of the substance along with its dosage and phrases such as "You are tripping on LSD." The same principle can be used to write reminders on one's hand or other visible body parts.
• An item of clothing or an accessory which is only worn during and therefore associated with the act of tripping.

Aborting trips

If one decides that they want the trip to end, benzodiazepines and other anxiolytics such as some antipsychotics can be considered as an analogous "eject button" of a downhill-headed or extensively long trip. They are very useful tools in preventing panic attacks, paranoia, and possible traumatic experiences. If these are available, be sure to keep them at hand as they are extremely effective tools for mitigating a hallucinogenic crisis. Some other medications such as certain muscle relaxers and antihistamines can also work, provided they work as 5-HT antagonists particularly the 5-HT_2A receptor. Alcohol is widely available and can be used as an anxiolytic if no better-suited medication is available. Make sure that the combination of two or more substances are not dangerous combinations.

Preventative pharmacology

Agonism of the 5HT2a receptor is known to amplify inflammatory pain caused by the COX-2 enzyme. Taking psychedelics while chronically inflamed or sick with something may have the capacity to cause a lot of pain which can be prevented with inhibitors of COX-2 such as common aspirin or white willow bark. The COX-2 enzyme catalyzes the conversion of arachnadonic acid (a metabolite of dietary omega6 PUFAs) into pro-inflammatory and pain inducing prostaglandins, and reducing inflammation via dietary changes could also be a suitable method. THC can increase COX-2 activity, and CBD can reduce it.

Agonism of the 5HT2a receptor is also known to amplify pain caused by nor-epinephrine, and as such, drugs which raise nor-epinephrine such as caffeine may also pre-dispose one to a negative experience.