Withdrawal first: why the order matters

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.

Why this is not a formality

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.

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.

What a good program asks you

• How much you are using now, and when you last used.
• Whether you have ever had a withdrawal seizure, delirium tremens, or a hospital admission for withdrawal.
• What medications you take, including naltrexone, acamprosate, disulfiram, buprenorphine or methadone, and any benzodiazepines.
• Who else is involved in your care and whether they can share information.

If a program does not ask these before quoting a price, that is the answer.

Medication interactions worth knowing

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.

If you are in withdrawal now

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.

This is general information, not medical advice.