Psychedelics are classified in science and harm reduction as “relatively physically safe” — that’s evidence-based. But it does not follow that no emergencies can arise.
Real emergency situations with psychedelics:
- Bad trip with danger to yourself or others — jumping out of a window, walking into traffic, self-harm
- Psychotic episode — persistent, even after the effects have worn off
- Fall injury, traffic accident from distorted perception
- Hyperthermia with DOI/DOC and some NBOMes
- Serotonin syndrome with mixed use of MAO inhibitors
- Seizure with mixed use of lithium
Practical consequences:
- Set & setting is not “nice to have” — it’s the central safety measure
- Trip-sitting by an experienced, sober person is essential at higher doses
- Low starting doses with an unknown substance or a new setting
- Drug checking — especially with tablets or powders sold as “LSD” (often they’re actually NBOMes or DO substances with a different profile)
In an acute mental health crisis: see emergency scenarios panic-crisis and psychotic-episode. If there’s danger to yourself or others: 112 or the Berlin crisis service (Berliner Krisendienst).