#110 On providers, patients, and death at psychedelic retreats

I want to think about a sensitive topic: death. What conclusions can/should we make if someone dies at a psychedelic retreat?

The retreat in the Netherlands where I first took iboga closed three years ago after someone died there. To my knowledge, the guides didn’t go to jail, but they had to close the retreat and it’s safe to say they can never work with psychedelics again, at least in the Netherlands. I reached out to them when I learned about this tragedy—still no answer, perhaps because they feel shame or embarrassment, or they can’t disclose details of the event for legal reasons. For the record, the guides are great people and appeared knowledgeable about giving psychedelics in therapeutic contexts. You might be thinking, well, not as knowledgeable as one thinks. That may be true. In this post I want to think about both sides of the argument regarding death at a psychedelic retreat.

The Provider

Let’s take the provider’s side first. If someone dies in their care, does this automatically make this person bad or unqualified to administer psychedelic “medicine”? It would seem that way, but I disagree. Sure, the provider might be bad: cutting corners wherever possible; offering poor therapies and techniques to heal their patients’ traumas; overpromising and underdelivering by touting falsehoods about themselves or their retreat. People like this exist in all fields and industries, the proverbial snake oil salesman. And we should expect these characters and unfortunate incidents such as death in the early days of the psychedelic renaissance. As the quip goes in academia: we need more research. Some psychedelics are lethal and most of them can leave one’s psychological state rattled for weeks or months depending on the substance, experience, and person. Providers should know as much as possible about the substance they administer to others. With that said, the reemergence of psychedelics in Western society means that we know very little about these substances at present. We’re mostly blind until more research happens and further conclusions can be made on the best way to prepare for, consume, and integrate psychedelics.

In playing devil’s advocate, we can empathize with good people that make mistakes, albeit life-or-death ones. I think most people in society are good and strive to be better. I consider myself a good person who made stupid mistakes. You’re probably the same. Does this mean that you or I should be banished to the outskirts of society like a leper thousands of years ago for one mistake? The death of a patient might not even be the provider’s fault: the drug addict or person taking prescription pharmaceutical medicine might have lied or forgotten about when they took their last hit; they might be physically compromised in ways neither the patient nor provider are aware of; or any number of reasons.

The Patient/Customer

As an ill patient or “healthy normal” customer wanting to attend a retreat, I’m putting my body and mind in the provider’s hands. I’m trusting that they know what they’re doing because what they and their psychedelic tools do to me is serious. The patient might not even have a choice in the matter. They might be so desperate after trying everything else, conventionally speaking, that they’ll put some psychoactive, perhaps purgative, drug into their body to rid them of an addiction or mental illness. The patient takes a leap of faith regarding whether the provider knows what they’re doing, which is not always the case. After all, it’s the patient’s choice to attend a provider’s retreat, but the patient likely expects that the provider has the credentials to back up their practice.

What rights does the patient have? I don’t know, that’s not my field of expertise. I would appreciate learning more about what others know about patients’ rights at a psychedelic retreat. Until then, patients should be looking for cues that the provider knows what they’re doing; has been trained academically and/or by indigenous people that know how to administer/handle the substance; has the (if necessary) hospital equipment or medical personnel on hand; etc.

In Sum

Someone dying at a psychedelic retreat is sad, especially while under someone else’s care. And who is to blame for this? Blame can be one’s person sole fault or can be shared. In my opinion, since the provider provides an experience that can potentially induce harm to the patient, they are more to blame because they should know what to do, what to ask for, and what to test prior to giving someone a drug. If the provider turns out to be faulty for someone’s death, however, some positive outcomes are realizable.

First, everyone in the community, particularly concerning that drug, learns what not to do. The death of one may save the lives of countless others. Such occurrences establish the need for protocols to anticipate what could happen before, during, and after the experience. Because something happened in the past, all sorts of protocols exist in society today to decrease the chances of that event happening again. For example, commercial aviation has never been safer because of what we learned from many mistakes over decades. These mistakes cost thousands of lives, a lot of money, devastation, on so on. That doesn’t mean we scrapped aviation. Rather, we persisted until many of those kinks were ironed out. Space tourism and space exploration will play out in much the same way, not to mention any new technology we think relatively safe while at the same time acknowledging that all possible scenarios that can happen can’t be anticipated in advance. We (humans) learn by doing.

Second, the provider has experiential knowledge regarding the death of a patient, and we should value this knowledge. Not everyone has had such experiences. We can learn from their experience, whether it was their mistake or not. More importantly, the provider will probably never make that mistake again and will be more judicious in dealing with patients than his or her colleagues because of their experience. For example, if we sacked every doctor that lost a patient, we’d have a shortage of doctors. Death is part of the medical profession. As unfortunate as death is, doctors become experts in dealing with it because it has happened before while patients were under their care.

I think everyone can agree that a recurring pattern of death at someone’s retreat should result in this provider not giving drugs to anyone ever again. A single death however, coupled with (ideally) their education and experience with a particular psychedelic substance, should not result in total ostracization of this individual. We learn more from our mistakes than our successes. I propose giving said provider a second chance to redeem themself. I don’t see this individual or retreat as a threat to society unless a pattern emerges.

Doctors have a mandate to do whatever necessary to save someone’s life. They normally don’t go to jail if their patient dies under normal or expected circumstances. Why? Because they have the education and years of experience to back up their decisions. The same should apply to psychedelic retreats and their providers. I think what we need are basic governmental regulations, hoops one must jump through, if they want to engage in this line of work. (But not too cumbersome or bureaucratic.) Are we there yet? No, but I’m confident we will develop these regulations one day to minimize risk to providers, patients, and society.

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