Ethical Complexities and Best Practices in Informed Consent for Psychedelic Services: A Qualitative Study on Expert Perspectives

Background: Informed consent in psychedelic-assisted services is ethically complex, difficult to implement, and remains largely unstudied and unstandardized. Objective: The current study sought expert recommendations from experienced psychedelic facilitators on what constitutes informed consent best practices for supervised psychedelic experiences across various settings. Methods: Participants with expertise in facilitating psilocybin-assisted experiences or other expertise in the psychedelic field were recruited with purposive sampling. Qualitative interviews on informed consent best practices and recommendations were analyzed using Thematic Analysis. Results: Participants (N = 36; 71% white; 56% heterosexual; 53% female) reported facilitating psilocybin services (64%) for a mean of 15.2 (SD = 13.1) years in clinical trial, licensed service center, underground, or ceremonial settings. Participants viewed informed consent as a process (Theme 1), necessitating a strong therapeutic relationship, centering client empowerment, and occurring as an ongoing process. Potential risks and benefits should be comprehensively conveyed (Theme 2), including potential long-term psychological and social changes, and the potential for disappointing experiences. Participants recommended detailed consent processes around touch and boundaries (Theme 3), including explicitly establishing boundaries prior to psychedelic administration, maintaining those boundaries throughout, and recognizing subtle non-verbal cues that may indicate lack of true consent. Within facilitator trainings (Theme 4), participants emphasized cultivating a deep respect for client agency, and experientially learning relational and boundary setting skills. Conclusions: Findings may inform practitioner training, consent practices in varied settings, and policy development for state-regulated psychedelic services.