PATHS – Psychedelics as Therapeutics: Harm Reduction and Safety (360G-Wellcome-340985_Z_25_Z)

We are world leaders in researching substance use development, psychedelic pharmacology, and drug stigma, but we do not yet know precisely how millions of vulnerable people worldwide are using psychedelics as medicines outside formal medical systems — nor how to make this safer. This is urgent: individuals experiencing mental health crises are using psychedelics in unregulated settings lacking therapeutic support and safeguards, facing risks from uncertain supply, criminal networks, exploitation, and poorly-processed difficult experiences. Marginalised populations bear disproportionate risks. For many, the choice is understood as ‘legally dead or illegally alive’. This UK-focused discovery programme, through unprecedented partnerships with hard- to-reach communities — cluster headache patients, police using psychedelics for occupational trauma, festival crisis intervention providers — will investigate emergent, informal therapeutic psychedelic use outside legal and medical jurisdictions during the critical transitional period before anticipated approval. We will deliver a paradigmatic step-change in psychedelic harm reduction scholarship by shifting focus from institutional clinical trials to lay therapeutic practices. We will discover what harms users encounter, and evaluate which community-led innovations work or fail. Understanding these practices and consolidating fragmented grassroots knowledge will have transformative potential for the lives, health, and wellbeing of those driven to engage in therapeutic psychedelic use.