How Do I Know if Psychedelics are Safe to Combine With My Medication? 

I’m a 74 year old hippie and am wondering if it’s okay for older psychonauts to trip. Many of us take medications for blood pressure and so on. How can we safely ingest psychedelics when there might be contraindications with medications, especially when your doctor might not have the answers?

As always, the ground zero advice I have for interactions is that every interaction must be explored independently. There are some blanket interactions, like SSRIs generally making MDMA less effective, but you really need to be looking into the specific interactions between two or more specific drugs. 

Unfortunately pharmacology is an extremely complicated science. Very few people are specifically experts in the art of illicit drug pharmacology as a whole. As you said, your doctor will almost certainly not have enough specialized understanding of illicit drugs to be able to give you a practical answer about the risk of certain medication interactions, which is why I always feel fluffy saying “ask your doctor” (and, frankly, usually just say it for liability purposes). They will usually just tell you not to do it on principle. It is, after all, their job to minimize your risks.

The reality is that mixing illicit drugs with medications is often going to involve a lot of risk-benefit analysis, because there are usually quite a few unknowns. Is the interaction very dose-dependent? Is it high-risk in the moment, or something that is more likely to become an issue gradually over time? How predictable is this interaction? How have your prior experiences been with both/all of the substances in question? What are your resources if something goes wrong? Are you willing to take a risk, given the possible payout?

Trying to self-study your own medication interactions is a slippery slope, since people who don’t have an explicit background in pharmacology might not be able to properly interpret scientific journals. Because consumers are put in a position of trying to scrounge up whatever information is available to them, it is typical for people to end up becoming overly confident or certain in how they interpret clinical data. This can lead to surprising and unexpected consequences down the line. 

The two most obvious examples that I use to explain the complexities of interactions are:

1. Downstream effects. This is a term in pharmacology that refers to the flow of information in a signaling pathway in the brain. People sometimes stop at saying, for instance, “it acts on serotonin receptors,” without realizing that this activity at serotonin receptors could also imply modulating, where serotonin is indirectly influencing the activity of other neurotransmitters. Things never happen in a vacuum in neuroscience. It’s helpful to use summarizing statements of the main events that take place when a drug is active, but it’s critical to realize that there is a whole sea of other stuff taking place too.
2. Enzymatic activity. Consuming drugs orally breaks them down in the liver. Everyone has slightly different quantities of various liver enzymes, making your metabolism unique. Enzymes are often inhibited (made less effective) or enhanced (made more effective) by certain medications, which can make you break down drugs faster or process them more slowly. This can get pretty complicated depending on which drugs take priority for processing by the liver, and what chemicals or molecules they’re broken into, and if those smaller components interact with each other.

In addition to these, there are countless other micro-interactions taking place. Hormones, vitamins, electrolytes, every cellular activity you can think of can be implicated in a drug interaction. You can try to get the big picture summary from reading scientific journals, but you are pretty much always going to be missing A LOT of information. Part of consenting to doing drugs is understanding just how many unknowns there are.

Stuff like blood pressure medication is really not straightforward, for example. Mental health medications are often easier to make blanket statements about because they are mostly neurotransmitter-based. A drug such as Warfarin (anti-clotting agent), however, has a totally different pharmacology, making it more difficult to understand how its downstream effects might mix with various psychedelics.

I know this might not be the most directly helpful answer, because ingesting psychedelic substances is about consenting to the unknowns. I’ll end with some more concrete tips that might be useful as you figure this out. 

1. Know your physical and mental health triggers, limits, and no-no’s. If you’re on Warfarin because you’ve had a heart attack, your doctor will probably have given you information about activities and experiences that put you at risk in general. If those risks seem like they could happen while you’re tripping for whatever reason, that’s something to consider. This includes things like very intense emotional experiences, which can trigger arrhythmias, for example.
2. Try to get advice from medical professionals who specifically have experience researching or learning about the drugs you’re thinking of taking. (The Spirit Pharmacist is a great place to start.) It’s much more likely that you’ll get good answers from someone who has elected to learn more about illicit drugs than someone who only specializes in licit ones. 
3. When in doubt, start low and go slow. If you’re only looking into classical psychedelics like LSD and mushrooms, your risk of running into a major interaction is probably WAY lower than with something like ayahuasca, which contains an MAOI. MAOIs are notorious for having a ton of interactions. If you want the DMT experience, look into smoking or vaping it instead. I suggest mushrooms or DMT over LSD if you’re concerned, not only because of the significantly more stimulating nature of LSD but also because of its extremely long duration, should something go wrong.
4. If you’re at risk of certain conditions, make sure you’re aware of the early warning signs and have communicated them to anyone you’re tripping with/being tripsat by. Write down any medical conditions you’re being treated for and have that list available somewhere on your person in case EMS needs to be called. 

Wouldn’t it be great if we had illicit drug pharmacology experts – or well-informed medical professionals – available to talk to?

To help my depression I decided to go for it and eat 6g of mushrooms. It was the best, most helpful experience of my life. Since then, I have taken the same mushrooms seven more times over a 16 month period, but I have not had the same depression-lifting, spiritual experience as before. I’ve even been upping the doses. Am I doing something wrong or did I build a tolerance?

Well, you’re definitely not building a physical tolerance. Tolerance to mushrooms only happens over the course of a few days of repeat use. The question of mental/psychological tolerance, however, is less straightforward, and something I don’t necessarily have the answers for. 

I’ll start by saying that 6 grams is an earth-shatteringly huge dose of mushrooms, unless they are weak. It is possible that the ones you took were, indeed, weak. I’d have to ask a lot more questions here, like whether you’ve been on any medications during any of the experiences, how much your consequent doses were, what the specific nature of the trip was like (how intense, how long, etc.), and how the shrooms were stored thereafter. Without access to that information, what I can offer is general input on why I personally think stuff like this happens. 

It’s becoming increasingly common for people to turn towards psychedelics as a last ditch effort to make things better in their lives. Sometimes this ends really, really badly, and sometimes it ends with stories like yours, where the experience is pivotal and mystical. The adage “you get the trip you need, not the one you want” is usually applicable here. It can be easy to set an immediate elevated expectation when you get something so powerful out of your first large dose experience. 

The truth is, no psychedelic is singularly responsible for changing your life. Drugs are tools, not cures. There seem to be some basic underlying mechanisms for how mushrooms can influence things like depression – chemical and neurological changes that may happen regardless of how you, personally, interact with the experience – but I do believe that those changes also occur in a sort of dance with the set and setting of the trip.

When you went into your first experience, it was probably with a whole range of emotions. It’s possible that some of those emotions involved hoping, desperately, that this trip would change you and give you what you needed to be happy. Maybe it involved humility, fear, reverence, or resignation. No matter what that magic mixture was, it will never happen exactly the same way again. 

So my guess about what’s happened here is pretty simple: You have been approaching mushrooms with an expectation, returning to the well with your hands open and ready to receive, and continuing to chase the glory of being cracked wide open for the first time. I’ll pass on my most cherished advice about psychedelics (and, really everything in general) to you: You will not find what you seek. You will get what you receive, and your lesson is responding to it. Mushrooms really don’t give a shit about your expectations for your trip.

It’s possible that you are receiving a lesson right now without even realizing it, but you have to look for it. There is value to be had at EVERY tier in psychedelia, from a sub-perceptual microdose, to a social trip where you end up nonverbal, to a catastrophic trainwreck meltdown dumpster fire where you end up naked in someone’s yard. These lessons are buried treasures in otherwise unremarkable psychedelic experience. You are ultimately learning who you are, and how to work with yourself, not against yourself, through tripping. Otherwise psychedelic experiences would just be a series of explosive trips with periods of anticipation in between.

One of my favorite things about mushrooms is how they help you remember the small wonders. These mystical experiences are great and all, but enjoying being alive is in the details. It’s a day-to-day love for being human, constant warmth instead of lustful heat. Mushrooms are probably just trying to teach you how to sustainably enjoy the human experience, one tiny flower at a time.

How quickly does LSD lose potency? I’ve had some strips for about two years now that I forgot about, but when I tried a tab recently, it didn’t really do much but relax me.

It really does seem to depend. Usually I tell people that tabs will last 50+ years in a freezer (which has been true on many occasions), but I’ve also encountered a lot of bunk tabs that were probably just stored poorly. Leaving your stash in a hot car or on a sunny windowsill for too long can gradually degrade LSD’s potency.

For best results, I suggest storing your tabs in a cool, dry place in an airtight container of some sort. There have been tabs and vials that literally lasted 50 years or more in the right settings. 

About Your Psychedelic Auntie

When we have questions about psychedelics, we often consult our Auntie. An Auntie can be a person of any gender who offers wise advice about psychedelic substances and how to effectively use them. Lucid News is asking a collection of well-informed people to step in as Auntie and answer your questions about psychedelics. Some of the best peer-based, accurate information about psychedelic substances and harm reduction comes from DanceSafe, a nonprofit educational organization founded in 1998. DanceSafe provides health and safety services at festivals and events. This month, our Psychedelic Auntie is DanceSafe Programs and Communications Coordinator Rachel Clark. Send your questions to the Psychedelic Auntie via the Lucid News contact page and watch this space for the answers.