[{"data":1,"prerenderedAt":298},["ShallowReactive",2],{"guides":3},[4,121,190],{"id":5,"title":6,"body":7,"date":111,"description":112,"extension":113,"meta":114,"navigation":115,"order":116,"path":117,"seo":118,"stem":119,"__hash__":120},"guides\u002Fguides\u002Fwhat-is-actually-available.md","What is actually available for alcohol and other substance use",{"type":8,"value":9,"toc":104},"minimark",[10,14,19,26,32,38,44,50,54,86,90,98],[11,12,13],"p",{},"If you have read that psychedelics can treat addiction, the first thing to know is that almost none of it is available as a treatment yet. This guide sorts the options by evidence and by legality, because the two do not line up.",[15,16,18],"h2",{"id":17},"the-evidence-briefly","The evidence, briefly",[11,20,21,25],{},[22,23,24],"strong",{},"Psilocybin for alcohol."," The strongest single result in the field. A 2022 randomised trial at NYU gave 93 people with alcohol use disorder two psilocybin sessions inside a course of therapy, against an active placebo. Over the following eight months the psilocybin group had heavy-drinking days about 10 per cent of the time versus about 24 per cent for the comparison group. Larger trials, including several in Canada, are now running to confirm it.",[11,27,28,31],{},[22,29,30],{},"Ketamine for alcohol."," A 2022 UK trial (KARE) gave 96 people three ketamine infusions with or without a structured therapy course. Ketamine plus therapy produced the highest proportion of days abstinent over six months. Earlier small trials from Columbia University found similar signals. The effect is real but modest, and it depends on the therapy.",[11,33,34,37],{},[22,35,36],{},"Ketamine for cocaine and other stimulants."," Small trials, encouraging, not replicated at scale.",[11,39,40,43],{},[22,41,42],{},"Anything for opioids."," Very little controlled evidence for any psychedelic. Medications like buprenorphine and methadone have decades of evidence and remain the standard of care; nothing here replaces them.",[11,45,46,49],{},[22,47,48],{},"Ibogaine."," Widely discussed for opioid withdrawal and used at unregulated clinics abroad. It carries a documented risk of fatal heart rhythm disturbance and has never been through a controlled trial in humans. Some US states have funded research into it; that research has not reported yet. We do not list ibogaine providers.",[15,51,53],{"id":52},"what-you-can-legally-do-today","What you can legally do today",[55,56,57,70,76],"ul",{},[58,59,60,63,64,69],"li",{},[22,61,62],{},"Ketamine, Canada and the US."," Legal, prescribed off-label by a physician, usually in a clinic. A handful of clinics run dedicated alcohol programs modelled on the trials; most treat alcohol use as part of depression care if at all. See our ",[65,66,68],"a",{"href":67},"\u002Fprograms","programs",".",[58,71,72,75],{},[22,73,74],{},"Psilocybin, Oregon and Colorado."," Legal for adults 21+ at licensed centres, without a diagnosis, under a non-medical program. Some centres name addiction among the things they work with. It is a supervised experience, not an addiction treatment: no detox, no medical follow-up.",[58,77,78,81,82,69],{},[22,79,80],{},"Psilocybin, everywhere else."," Illegal outside clinical trials, with narrow exceptions: Canada's Special Access Program lets a physician apply on a patient's behalf, case by case, and Australia allows authorised psychiatrists to prescribe. Trials are the realistic route, and they are free. See our ",[65,83,85],{"href":84},"\u002Ftrials","trials",[15,87,89],{"id":88},"where-that-leaves-you","Where that leaves you",[11,91,92,93,97],{},"If your problem is alcohol, there are more legal options than for any other substance, and the order is: get stable first, then bring ketamine or a psilocybin trial to your treatment team as an addition. If your problem is opioids, nothing on this site should come before medication treatment, and the psychedelic options are years away. If someone is offering you a psychedelic for addiction outside these routes, our ",[65,94,96],{"href":95},"\u002Fguides\u002Fquestions-to-ask","questions guide"," is written for that conversation.",[11,99,100],{},[101,102,103],"em",{},"This is general information, not medical advice.",{"title":105,"searchDepth":106,"depth":106,"links":107},"",2,[108,109,110],{"id":17,"depth":106,"text":18},{"id":52,"depth":106,"text":53},{"id":88,"depth":106,"text":89},"2026-09-19","Ketamine, psilocybin, trials, and the things that are still illegal, sorted by how much evidence stands behind them and how you can legally get them in Canada and the US.","md",{},true,1,"\u002Fguides\u002Fwhat-is-actually-available",{"title":6,"description":112},"guides\u002Fwhat-is-actually-available","p031qO0_SzCA2loPPNAqTLVml4lpO3mvRmTz3Ben-RQ",{"id":122,"title":123,"body":124,"date":111,"description":184,"extension":113,"meta":185,"navigation":115,"order":106,"path":186,"seo":187,"stem":188,"__hash__":189},"guides\u002Fguides\u002Fwithdrawal-first.md","Withdrawal first: why the order matters",{"type":8,"value":125,"toc":178},[126,129,133,136,139,143,157,160,164,167,171,174],[11,127,128],{},"Almost every conversation about psychedelics and addiction skips a step. The trials that produced the promising results did not enrol people in active withdrawal. They enrolled people who had been assessed, were medically stable, and in most cases had already stopped or reduced. The medicine came after.",[15,130,132],{"id":131},"why-this-is-not-a-formality","Why this is not a formality",[11,134,135],{},"Alcohol and benzodiazepine withdrawal can cause seizures and, in severe cases, death. Opioid withdrawal is rarely fatal on its own but drives relapse and overdose, and it changes how other drugs act on you. Ketamine raises heart rate and blood pressure; psilocybin can produce hours of intense distress. Neither is something to layer on top of a nervous system in withdrawal, and no responsible clinician will.",[11,137,138],{},"So the order is: assessment, then withdrawal management if you need it (medically supervised, at home or in a program, depending on severity), then a period of stability, and only then a ketamine course or a trial. Some programs say this on their site. Avesta, in the Washington DC area, states \"full detox before treatment\" as a condition. Others assume it. Ask directly.",[15,140,142],{"id":141},"what-a-good-program-asks-you","What a good program asks you",[55,144,145,148,151,154],{},[58,146,147],{},"How much you are using now, and when you last used.",[58,149,150],{},"Whether you have ever had a withdrawal seizure, delirium tremens, or a hospital admission for withdrawal.",[58,152,153],{},"What medications you take, including naltrexone, acamprosate, disulfiram, buprenorphine or methadone, and any benzodiazepines.",[58,155,156],{},"Who else is involved in your care and whether they can share information.",[11,158,159],{},"If a program does not ask these before quoting a price, that is the answer.",[15,161,163],{"id":162},"medication-interactions-worth-knowing","Medication interactions worth knowing",[11,165,166],{},"Naltrexone does not interact dangerously with ketamine or psilocybin but may blunt some effects; programs handle this differently. Buprenorphine and methadone are usually continued. Benzodiazepines reduce the effect of psilocybin and are sometimes used to end a difficult session. SSRIs are commonly held before psilocybin in trials. None of this is advice to change anything yourself; it is a list of the things your prescriber and the program need to talk about with each other.",[15,168,170],{"id":169},"if-you-are-in-withdrawal-now","If you are in withdrawal now",[11,172,173],{},"Contact a doctor, a detox service or emergency services, depending on how bad it is. Shaking, sweating and anxiety after stopping alcohol can progress to seizures within a day or two. This site can wait.",[11,175,176],{},[101,177,103],{},{"title":105,"searchDepth":106,"depth":106,"links":179},[180,181,182,183],{"id":131,"depth":106,"text":132},{"id":141,"depth":106,"text":142},{"id":162,"depth":106,"text":163},{"id":169,"depth":106,"text":170},"Alcohol, benzodiazepine and opioid withdrawal can be medically dangerous. Every credible ketamine or psilocybin program expects you to be past it before you start, and the ones that don't say so are the ones to ask about.",{},"\u002Fguides\u002Fwithdrawal-first",{"title":123,"description":184},"guides\u002Fwithdrawal-first","u48jRkbiLwn2CtMClqv2xYj5v8WEFRTBNOVk56ympqU",{"id":191,"title":192,"body":193,"date":111,"description":292,"extension":113,"meta":293,"navigation":115,"order":294,"path":95,"seo":295,"stem":296,"__hash__":297},"guides\u002Fguides\u002Fquestions-to-ask.md","Questions to ask any program before you pay",{"type":8,"value":194,"toc":289},[195,198,264,268,285],[11,196,197],{},"Addiction treatment has always attracted operators who sell hope by the week, and psychedelics have given them a new vocabulary. These questions are meant to be asked out loud, and the point is as much how they are answered as what is said.",[199,200,201,207,216,222,228,234,240,246,252,258],"ol",{},[58,202,203,206],{},[22,204,205],{},"Is what you offer legal here, and under what licence?"," A good answer names the licence: a medical practice prescribing ketamine off-label, a state-licensed psilocybin service, a registered trial. A bad answer talks about a legal grey area.",[58,208,209,212,213,69],{},[22,210,211],{},"Do you require detox or a period of stability before starting, and who assesses that?"," Yes, and a clinician, are the right answers. See ",[65,214,215],{"href":186},"withdrawal first",[58,217,218,221],{},[22,219,220],{},"Who is medically responsible during a session?"," A name and a credential. Not \"our trained team\".",[58,223,224,227],{},[22,225,226],{},"What therapy is included, who delivers it, and how many sessions before and after the medicine?"," The trials that worked used structured therapy. A program that is medicine plus a waiting room is not following the evidence.",[58,229,230,233],{},[22,231,232],{},"What happens if I have a frightening experience, or if I relapse afterward?"," Both happen. A program that has not thought about either has not run many sessions.",[58,235,236,239],{},[22,237,238],{},"Will you talk to my doctor, counsellor or treatment program?"," If not, why not.",[58,241,242,245],{},[22,243,244],{},"What does it cost in total, including therapy and follow-up, and what is refundable?"," Written down.",[58,247,248,251],{},[22,249,250],{},"What are your outcomes, and how do you know?"," Honest programs say the evidence comes from trials and they track their own results informally. Dishonest ones quote a success rate.",[58,253,254,257],{},[22,255,256],{},"Do you guarantee anything?"," No is the only acceptable answer.",[58,259,260,263],{},[22,261,262],{},"Can you point me to the study your protocol is based on?"," They should be able to name it. For ketamine and alcohol it is usually the KARE trial; for psilocybin and alcohol, the NYU trial.",[15,265,267],{"id":266},"red-flags-that-end-the-conversation","Red flags that end the conversation",[55,269,270,273,276,279,282],{},[58,271,272],{},"Any offer of psilocybin, MDMA, ibogaine or ayahuasca outside a licensed program or a registered trial.",[58,274,275],{},"Pressure to pay a deposit before screening.",[58,277,278],{},"Discouraging you from involving your own doctor or your existing recovery supports.",[58,280,281],{},"Testimonials in place of a description of the protocol.",[58,283,284],{},"A success rate.",[11,286,287],{},[101,288,103],{},{"title":105,"searchDepth":106,"depth":106,"links":290},[291],{"id":266,"depth":106,"text":267},"Ten questions that separate a program built on the evidence from one built on the marketing, and what a good answer sounds like.",{},3,{"title":192,"description":292},"guides\u002Fquestions-to-ask","3SoHJYk-VIaIPwyUP6P972TtcPCXNiOTXrxDZsi8GOY",1791062337062]