How Do I Help Someone Having a Difficult Trip?

I really want to stay healthy and avoid getting Covid-19 this holiday season. So I’m curious, do some drugs depress your immune system more than others?

I’ll preface this with saying that I am not an immunologist or a medical professional, so I will err on the side of mostly talking about the big picture here.

A drug that depresses your immune system is called an immunosuppressant. This term is actually fairly complicated, since different immunosuppressants suppress different things. ne person, for example, may be prescribed a certain medication for their chronic autoimmune condition, while a different drug may be prescribed to prevent someone’s body from attacking a new organ after a transplant. Immunosuppression can happen in a variety of different ways – direct, indirect, targeted, generalized – so this effect can’t be lumped under one umbrella category too effectively.

A good example of this is MDMA. At the start of COVID there was a swell of discussion about MDMA’s immunosuppressant properties. Could MDMA have certain immunosuppressant effects that make you more vulnerable to infection in the days following? Certainly. I’m not well-versed enough in the specifics to comment on whether these effects are direct or indirect, targeted or general. What I will say, though, is that much of the dialogue around exactly how MDMA suppresses your immune system has been a bit flaky, focusing on statistics about frequency of infection following MDMA use or the ever-popular and non-specific phrase “strain on the system.” 

Which is a valid argument! Putting your body under stress is biologically going to make you more susceptible to infection. Stress is a multi-headed animal that can consist of sleep deprivation, dehydration, hunger, intense emotional experiences, cortisol release (your stress hormone that’s produced in times of fear), etc. The issue with this conversation arises when we entirely attribute immunosuppression to the drug’s biological mechanisms on immune cells, as opposed to the fact that certain drugs can cause your body to enter a state that mimics natural stress and/or causes the release of immunomodulatory (immune-regulating) chemicals.

Cortisol, for example, is a stress hormone which is produced inside your body. It’s also a potent immunosuppressant. Experiences (like some stimulants) or lifestyles (like working multiple jobs) can cause excess cortisol release and suppress your immune system, either temporarily or chronically. 

Then you have drugs like MDMA and alcohol, both of which have more complex effects on immunity (enter the hot phrase “strains the system,” often used gratuitously without further elaboration) that may be partially caused by direct immunosuppression and partially caused by lifestyle-related immunosuppression, and may be targeted to certain parts of the body in ways that may or may not be relevant to, say, COVID.

And finally there are compounds that are more directly immunosuppressive, like levamisole and prednisone. Levamisole is an antiparasitic that’s frequently cut into cocaine and has gained notoriety for causing immunosuppression-related lesions and infections in chronic consumers, and prednisone is a prescribed corticosteroid that causes broader immunosuppression. So I suppose that I could say that doing lots of levamisole-adulterated cocaine would be a pretty high risk activity at this time, but without knowing the exact specifics of what part(s) of the immune system are compromised and how, I can’t be of much further help.

This all to say: What is probably most important here is working to reduce the stressors in your life by taking care of your basic physiological and emotional needs, and engaging in social distancing, masking, and vaccinating. The drug science bit is very complicated, but your body has simple needs that most of us regularly neglect.

I was with friends on a psilocybin journey, and one of us started to have a panic attack.Two of the other friends thought they could sober him up by forcing him to take a cold shower, which didn’t seem to help much. Is there a good way to help someone sober up during a difficult trip?

Panic attacks on mushrooms can edge into the realm of being legendarily terrifying, but attempting to sober someone up is usually not the way I’d recommend responding. Unless you are administering a “trip killer” like Trazodone, nothing you do is going to make this person be less high. (Definitely don’t have them smoke weed, though.) Emphasis on “sobering someone up” takes away from the fact that this person is having a mental health crisis – panic attacks can resemble altered states when someone’s sober. This is a magnified version.

When answering questions like this, there are many things to consider – how much did they take? When? Any medications? Family or personal history of any mental health conditions? Where did the panic start, and why? What is the environment like? And so on.

You’ll also need to consider the more specific interpersonal things: 1) How close is your relationship? Are you in a space where you’re able to truly involve yourself in this person’s process without absorbing it as your own responsibility to fix? Do they want you involved in such a tender part of themselves? 2) Is the person lucid? Are they able (and willing) to actually talk about what they’re experiencing, or are they somewhere else? Is it appropriate to try and work through what is happening on a more substantial level, or is this really a harm reduction moment? 3) Are all parties involved safe? Is there a risk of harm to self or others? 

All of these questions should inform how much you decide to attempt to participate in your friend’s experience, as opposed to merely keeping them safe while they work through it.

Uncontrollable fear can serve as a compass, especially when psychedelics are involved. We can’t face whatever brings us mortal terror unless we actually experience it. Possibly the most common concern that I hear people express when they talk about trying mushrooms is that they are “afraid of being out of control.” In my experience, it is very common for this fear – no matter how primal and deep-seated – to be embodied during difficult trips, and sometimes the source of a sudden swell of terror is a subtle feeling of lost footing or stability. Introducing elements of stability, consistency, friendliness, and familiarity can be very grounding for some people in these moments. For others, changing the scenery or music can be all it takes to end a chapter of a trip.

Remember: You are not there to fix someone else’s trip. Your job, particularly if you are also tripping, is to prioritize physical safety – pad the ground, so to speak. I highly recommend talking with everyone in your group about what to do in this kind of situation BEFORE you dose together. This way you can get a better understanding of what support a person consents to, and what your emergency plan is if someone takes a bit of a tumble. (It happens to all of us.)

If you’d like more info about tripsitting, you can check out my Tripsitting 101 lecture (view it in presentation mode) that’s part of a free drug class that I sometimes teach.

What do you consider a “microdose” of LSD or psilocybin? I hear the term a lot, but I don’t know what dosage is considered standard for this kind of experience?

This really does vary a lot. A word of warning: The phrase “start low, go slow” is very applicable here if you’re trying to microdose on a day where you expect to get anything done at all. I personally recommend starting with 5µg of LSD or 0.1g of psilocybin for a true microdose. Some people decide that they’d prefer 10-15µg of LSD or 0.2-0.3g of psilocybin, so it’s a bit more above threshold. Other people are so sensitive that even 5µg/0.1g is palpable. It comes down to preference and personal sensitivity at the end of the day.

The word “microdosing” has gained quite a bit of buzz in recent years, and with it has come a wave of shoddy dosing practices that categorize a “microdose” as anything under a full tab. I’ve heard folks lament the day that their “buddy” gave them a “microdose” of ⅓ of a tab before work and they had to clock out early because they were too distracted by extra sensory stimulation. I personally refer to those quantities as “macro-micros,” and anything above 30µg or 0.3g I just call… a small dose. 

It is generally agreed that a microdose should be sub-perceptual, meaning that you can go about your whole day having forgotten that you took it because it has so little palpable impact on your perception. Some people, however, find more value in microdoses that you can actually feel – which, again, is preference, but after a certain point I personally just refer to that as a dose. 

If you’re wondering what the point of doing a microdose is if you can’t feel anything, you’re not alone, and there’s actually a bit of contentious science out there about how much of microdosing is just placebo effect and how much is related to minor neural jogging of some circuit or other. It’s possible that both are the case. Regardless, there do not appear to be any deleterious health impacts from microdosing, so if the practice brings additional fulfillment to your life that is what really matters.

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.