BUFFALO, N.Y. ­—  As psychedelic drugs such as LSD gain new momentum as a therapeutic treatment for severe post-traumatic stress disorder (PTSD), depression, and even headaches, a University at Buffalo researcher is exploring safety education for recreational users.

Daniel Kruger, PhD, research associate professor in the School of Public Health and Health Professions, looked back more than half a century for best practices on harm reduction.

In the 1960s, when Harvard psychology lecturer and psychedelics proponent Timothy Leary was advising people to “turn on, tune in, and drop out,” a young Radcliffe College graduate was quietly focused on another aspect of hallucinogens — safety.

Lisa Bieberman, who had been a Leary follower, established the Psychedelic Information Center in Cambridge, Mass. In February 1967, she published the $1 pamphlet, “Session Games People Play: A Manual for the Use of LSD,” which recommended best practices for the use of all types of psychedelics, especially for first-timers. She also addressed what might go wrong during an LSD or psilocybin ("magic”) mushroom trip.

“Bieberman highlights a number of games that may be better avoided during a LSD session, such as running away from your companions and believing that you have unlocked the deepest truths of the universe and need to tell the world about them,” Kruger says. “She also recommended that users stay with people they like and trust, avoid going out in public, and clear their minds of negative emotions.”

He launched a study with Paul Gillis-Smith, program lead at the Center for the Study of World Religious Studies at Harvard Divinity School, in which they surveyed almost 600 self-identified psychedelic users. Their findings, which showed that participants agreed with 18 of 19 pieces of Bieberman’s advice, were published in the Aug. 12 edition of the journal Psychedelics.

Other authors on the study are affiliated with the Michigan Psychedelic Center at the University of Michigan; Blue Sage Health Consulting in Ann Arbor, Mich., the Michigan Psychedelic Society; and the Radical Well-Being Center in Southfield, Mich.

When Kruger discovered Bieberman’s pragmatic teachings, which differed from Leary’s esoteric rhetoric, such as “surrender to the void,” he wanted to see if they would hold up today. It’s a timely inquiry, considering that psychedelic use now exceeds that of the counterculture ‘60s, according to Kruger.

Today, these drugs are gaining new momentum through hundreds of clinical trials and legal pathways in states like Oregon and Colorado, Kruger says.

“The idea is to medicalize these psychedelics for psychiatric conditions such as severe PTSD and depression,” he adds. “There really hasn’t been any big innovations in mental health medications since the selective serotonin reuptake inhibitors were introduced in the 1980s, and they don’t work as well as we originally thought.”

Psychedelics have even been used to treat physical conditions such as cluster headaches, which are so painful that some sufferers have reported suicidal ideation.

“The clinical trials show people are getting better for a range of conditions,” he says. “Some report finding more meaning in life, having greater spiritual connections, and improving their relationships.”

While these trials may offer promise to millions of  people, Kruger notes that the majority of those experimenting with psychedelics are doing so outside of a regulated context and with little prevention education.

 “As a public health professional, I believe we need to protect these users,” he says. “When Lisa’s pamphlet was published, there were few resources for novice users. Although the term ‘harm reduction’ was decades from entering the vernacular of drug use education and safety, we propose that ‘Session Games’ and Bieberman’s larger collection of work are precursors to this approach.”

The anonymous survey participants, who were recruited via online advertisements and in-person outreach at a psychedelic advocacy event in Ann Arbor, Mich., reported using LSD and psilocybin mushrooms, mescaline, ayahuasca, ketamine, and MDMA (ecstasy/molly), primarily within the last year. They ranged in age from 18 to 85, with an average age of 43. Some identified as psychedelic guides or educators.

In regard to how to best prepare for a psychedelic experience, the majority of respondents agreed with the statements: “Be with people who know, like, and trust each other,” and “Be aware that, even with a guide, you have to do most of the work yourself.”

For overall advice, the strongest agreement was with the statements: “Recognize that the experience will eventually end,” and “Recognize that you may experience anxiety, which does not mean that something is wrong.”

Participants neither uniformly agreed nor disagreed with the advice to avoid looking in the mirror during a psychedelic trip, which over the decades has proven to be a scary experience for some users.

“Participants strongly endorsed advice emphasizing interpersonal trust, personal responsibility and psychological preparation – principles thought to be foundations to safe and meaningful psychedelic experiences in clinical research,” Kruger says.

Indeed psychedelics were considered a promising therapeutic tool in the mid-20th century when they were used to treat such conditions as neurosis and schizophrenia, along with general psychotherapy. However, by the late 1960s, drugs became criminalized and psychedelic therapy waned.

While classic psychedelic drugs are still illegal in the United States, Colorado and Oregon have established state-regulated frameworks for supervised therapeutic use. New Mexico is not far behind, says Kruger, who predicts that more psychedelics-based medications will enter the marketplace in the not-too-distant future.

“It’s a freight train coming down the tracks,” he says. “So, we better have a train station to safely load passengers onto this train or else they’re just going to try to jump on board while this train is moving.”

Kruger notes that the 2026 Psychedelic Community Survey is now available for anyone to take, regardless if they have experienced psychedelics. While all answers are anonymous, he recommends that participants take the survey on a private computer or device in a private location.