A study published in Science Advances on Friday examined 25,419 anonymized interactions from the Fireside Project, a nonprofit hotline run by trained volunteers.
The dataset covers calls and text exchanges made between April 2021 and February 2026. It exceeds the combined sample sizes of all published psychedelic clinical trials by an order of magnitude.
Researchers led by Félix Schoeller, a senior scientist at the Institute for Advanced Consciousness Studies, say this trove of data offers a rare look at how people experience psilocybin, ketamine, MDMA, LSD, and ayahuasca outside of clinical settings.
Most psychedelics are consumed in homes, festivals, or uncontrolled environments rather than hospitals. The Fireside Project fills a gap by connecting callers during bad trips or seeking information with confidential peer support.
Distress is common across substances
About 40.2 percent of the 25,419 interactions involved people actively tripping. A further 32.1 percent occurred during the integration period after a trip. The remaining calls were informational inquiries, requests to prepare or buy drugs, or assistance from trip-sitters.
Psilocybin was the most reported substance with 9,348 callers. LSD accounted for 2,247, cannabis for 2,004, ketamine for 1,194, and MDMA for 682.
Surprisingly, cannabis users reported the highest distress rate. Forty-seven point two percent of those callers had bad experiences. This challenges the reputation of cannabis as a low-stakes substance and highlights a need for harm reduction.
Distress rates for other commonly used psychedelics were slightly lower, ranging between 40 and 42 percent.
Abuse in ceremonial settings
The study identified 43 rare but disturbing instances of facilitator abuse. These occurred at remote retreats or ceremonial gatherings involving ayahuasca.
Callers reported that facilitators deliberately gave them extra doses without consent. The study notes these reports cluster in ceremonial settings involving plant medicines and often involve callers with prior PTSD diagnoses.
This provides the first quantitative documentation of this phenomenon in a community help-seeking sample. It suggests that even modest surveillance through peer support can detect harm in unregulated psychedelic settings.
Empathy predicts success
The study outlines limitations, including sample bias. People who call a hotline are not representative of all psychedelic consumers. Self-reported accounts of doses are impossible to verify.
Despite the noise, the data offers clear clues. Success on a call was strongly linked to the perception that the volunteer showed genuine care and empathy.
Using 2,777 post-interaction satisfaction surveys, the team found negative experiences stemmed from volunteers appearing dismissive or uncaring.
Schoeller noted that the number one predictor of a failed support call is the volunteer being perceived as genuine. This poses a problem for the biomedical system where centralized hospitals can lead to clinician burnout.
For this reason, Schoeller and his colleagues plan to follow up on the role of perceived care and empathy in treatment. They intend to emphasize this factor in guidance for community-based peer support for people in crisis.
The Fireside Project hotline provides a safe and confidential service for those reluctant to contact emergency services due to criminalization or fear of medical debt.
“For many people, they have experiences with psychedelics, and they may not be required to go to the ER, but they still need someone to help them navigate the difficult experience,” Schoeller concluded. “The hotline can truly be a lifeline for them.”
