A new analysis of more than 25,000 calls and text messages to a national psychedelic helpline offers what the authors describe as the largest real-world portrait to date of who reaches out for support during or after a psychoactive drug experience.
The research, published in Science Advances, indicates that among people who contacted the line, distress rates were similar across substances once the timing of the call was taken into account, and that most callers whose setting was recorded were alone. By linking thousands of anonymous support logs with caller feedback surveys, the open-access dataset also provides a new way to study whether individual peer supporters influence caller outcomes.
Bridging the gap between clinical trials and real-world use
Psychedelics are a class of psychoactive substances, such as psilocybin (the active compound in “magic mushrooms”) and LSD, that temporarily alter perception, mood, and thought processes. When people take these substances outside of medical settings, peer support services offer non-clinical assistance from trained volunteers rather than licensed therapists. Through a psychedelic helpline, callers and texters can speak confidentially with a volunteer to calm down during an overwhelming drug experience or to engage in “integration,” the process of making sense of a past psychedelic experience in the days, weeks, or months afterward.
Although clinical trials of psilocybin and MDMA have gained widespread attention, the vast majority of psychedelic use takes place in everyday environments such as private homes, music festivals, and group ceremonies. At the same time, drug policies in the United States are shifting, with states like Oregon and Colorado establishing regulated frameworks for psychedelic use, New Mexico and New Jersey approving limited therapeutic access, and several cities decriminalizing possession. Despite this expansion, public health officials and researchers have had very little systematic data on what happens when non-clinical experiences go awry or what kind of help people actually seek.
Until recently, research on psychedelic safety relied mainly on strictly controlled hospital trials or brief observations from harm-reduction tents at music festivals. Bridging that gap, a 2023 study of the helpline co-authored by Fireside Project founder Joshua White provided initial evidence that peer support over the phone could de-escalate distress for roughly two-thirds of callers and may have helped some callers avoid emergency services.
Still, researchers lacked a large-scale, multi-year dataset capable of tracking broader trends across different drugs or testing whether caller outcomes depend more on specific support techniques or on the interpersonal skills of individual volunteers, a phenomenon well documented in traditional psychotherapy.
To build an empirical foundation for studying community-based care, White and his colleagues compiled and analyzed the Fireside Database. The dataset captures nearly five years of daily operations from the Fireside Project’s Psychedelic Support Line, a free national service operating twelve hours a day via phone and text message, creating a record researchers can use to study who seeks help outside clinical settings and how they rate the support they receive.
“Since our support line launched in April 2021, it has been building exactly that record, one conversation at a time,” White told PsyPost. “This paper turns it into a resource the whole field can use.”
Tracking nearly five years of helpline calls and texts
The researchers examined 25,419 peer-support interactions handled by 220 trained volunteers between April 2021 and February 2026. Of those interactions, 67.5% took place by voice call and 32.5% occurred over text message, with 97.5% initiated by incoming callers. To protect caller privacy during potentially vulnerable moments, the helpline automatically stripped personal identifiers from records, permanently separated phone numbers from conversation records, and gave callers chances to have their anonymized recording deleted, both before the conversation and by text the following day.
The resulting database combines two connected layers of information. First, after each conversation, the responding volunteer filled out a standardized log noting the duration, call type, substances reported, social setting, stage of the drug experience, emotional concerns, and any voluntarily shared demographic or mental health details. Second, callers received a text message the next day inviting them to complete a brief satisfaction survey across five areas: whether they felt heard and supported, the overall quality of the support, how well their needs were met, whether they would call again, and whether they would recommend the helpline. A total of 2,777 surveys were completed, covering 10.9% of interactions.
Across the 57-month period, half of conversations lasted about six minutes or less, though the average was nearly 29 minutes because some ran very long. The most frequent reason for contacting the helpline was active support while under the influence of a substance, which accounted for 40.2% of all interactions, followed closely by post-experience integration support at 32.1%.
Another 11.6% of interactions fell outside the helpline’s scope, such as medical crises redirected to 911 or the 988 suicide and crisis lifeline, while 10.6% were general requests for information, and smaller shares involved helping friends or trip sitters who were looking after someone taking psychedelics. Usage peaked on Saturdays, averaging 18 interactions per day, and reached its highest monthly averages in August (479 interactions) compared to a seasonal low in November (373 interactions).
Substance information was recorded for 15,596 interactions, while the remaining 38.6% did not specify a drug. Among the interactions with substance data, psilocybin was by far the most common at 59.9%, followed by LSD at 14.4%, cannabis at 12.8%, ketamine at 7.7%, MDMA at 4.4%, and the plant brew ayahuasca at 3.2%. Callers also reported a variety of less common substances, including dimethyltryptamine (DMT) compounds, San Pedro cactus, Amanita muscaria mushrooms, and ibogaine. When callers combined multiple substances, the pairing of MDMA and LSD occurred 1.8 times more often than would be expected by chance alone.
Distress tracked timing more closely than the drug
When the authors looked at raw totals across all call types, the share of interactions in which callers reported distress, as recorded by volunteers, was highest for cannabis at 47.2%, compared to 42.2% for psilocybin, 41.8% for LSD, 40.9% for ketamine, and 40.7% for MDMA. However, this difference largely reflected when people decided to reach out: 70.2% of cannabis interactions occurred while the caller was actively high, whereas the majority of interactions involving MDMA (66.3%) and ketamine (59.0%) took place afterward for integration support.
Once the researchers separated active-trip calls from integration calls, distress rates during active drug experiences clustered near 47% across all major substances (ranging from 45.8% for psilocybin to 49.6% for cannabis), while distress rates during integration calls clustered near 36% (ranging from 32.3% for LSD to 38.8% for MDMA). Within either category, the differences between substances were not statistically significant, which the authors take as a sign that the stage of the experience is a stronger predictor of distress than the specific drug.
“When people struggle with psychedelics, timing matters more than the substance,” White said. Pointing to the broader role of the helpline, he added, “The other takeaway is simpler: a trained, compassionate person on the other end of the line is real safety infrastructure, and it can be available to anyone, anywhere.”
Even so, White noted that seeing cannabis top the initial distress rankings was unexpected. “Much of that turned out to be about timing, since about 70% of cannabis callers reached out while still in the experience, but it’s a reminder that a substance many people don’t think of as a psychedelic can produce intensely difficult experiences,” he said.
Caller contexts, mental health, and reports of facilitator abuse
The logs also shed light on the circumstances surrounding difficult experiences, though volunteers were only able to record these details when they came up during a conversation. Among the 6,998 interactions where social context was recorded, representing a little over a quarter of the database, 66.3% of callers were entirely alone, while 26.4% were with one or a few close companions, and 5.0% were in ceremonial or large group settings. In the 6,388 active-trip interactions with known timing, 43.9% occurred after the peak effects had passed, 33.3% during the peak, and 22.8% as the drug was starting to take effect. Anxiety and feeling overwhelmed were the most common emotional struggles across the dataset, and escalations to 911 or 988 stayed below 1% for every major substance, from 0.08% for ketamine to 0.65% for cannabis.
In the subset of 7,826 interactions where mental health history was recorded, 60.5% involved at least one self-reported psychiatric diagnosis. PTSD was the most common condition at 18.5%, followed by major depression at 16.7% and generalized anxiety disorder at 8.8%. Notably, 2.4% of these interactions (185 cases) involved callers who reported having schizophrenia, a population that is routinely excluded from clinical psychedelic trials for safety reasons. Among survey respondents who provided demographic information, 46.8% identified as male, 39.4% as female, and 13.8% as nonbinary or another gender, while 68.4% identified as white.
A small fraction of the database, totaling 43 interactions (0.2%), involved caller reports of abuse by psychedelic guides or facilitators, in which case volunteers directed callers to survivor peer-support resources without collecting identifying details about the facilitators. In descriptive comparisons based on small subsets of these interactions, reports clustered heavily around ceremonial settings and traditional plant medicines: ayahuasca, 5-MeO-DMT, San Pedro, and iboga or ibogaine made up 40.7% of the 27 abuse reports that listed a substance (11 cases), compared to 4.4% of substance-coded interactions overall.
Similarly, 41.2% of abuse interactions with known social context (7 of 17) took place in ceremonial gatherings, compared to 2.7% across all helpline interactions with social context data. Among the 15 abuse reports with recorded emotional concerns, 10 (66.7%) involved trauma processing, compared to a 6.5% base rate across the database, and 8 of the 23 cases with diagnosis data (34.8%) included self-reported PTSD, nearly double the 18.5% overall rate.
White described the concentration of abuse reports in ceremonial and plant medicine contexts as troubling, while noting how those records are collected. “The facilitator abuse reports are callers’ own accounts,” he explained. “We did not independently investigate or verify them, but they are a signal that deserves serious study.”
Caller satisfaction and variation among supporters
Feedback from the 2,777 post-call surveys was predominantly favorable: 76.1% of respondents strongly agreed that they felt supported, 78.2% rated the support quality as excellent, 66.8% reported that almost all of their needs were met, and over 86% said they would definitely call again and recommend the service. Still, 3.2% of respondents disagreed that they felt supported, and 2.1% rated the quality as poor. Among the 30 negative survey responses that included written explanations, the most common complaints were an impersonal or judgmental tone (40.0%), a poor conversational fit (26.7%), or technical interruptions and delays (23.3%).
In traditional psychotherapy, differences between individual therapists account for roughly 5% to 10% of the variation in client outcomes, and the database’s structure, which includes 50 volunteers who completed at least 10 surveyed interactions each, allows researchers to investigate whether a similar pattern holds in peer support. Comparing supporters with at least three surveyed conversations, the researchers found an average rating of 4.66 out of 5, with visible variation from one supporter to the next. The authors stress that this is a descriptive pattern, not a formal test of whether individual supporters affect outcomes.
“This paper is best understood as a resource rather than a single finding,” White said. The team has posted the anonymized records and the code behind its analyses for other researchers to use. “Because 50 of our supporters each have 10 or more surveyed conversations, researchers can now ask a question the field has rarely been able to test at scale: does who supports you change how you fare?” he added.
“This paper and the people at Fireside step into two critical gaps, providing care for those in community settings who need support while using psychedelics or cannabis and providing rich, experiential data about what distressing experiences may result,” Joshua C. Black, a senior research scientist at Rocky Mountain Poison & Drug Safety, a division of Denver Health, who was not involved in the study, told PsyPost. “Fireside meets a care need, and may escalate to 911/988 if needed. I think the finding that distress rates didn’t vary much by substance is important, which gives the public health field good information on how to meet the needs of people in distress from psychedelic and cannabis experiences.”
Study limitations and future research directions
There are a few things to keep in mind when interpreting these findings. The study was funded by Fireside Project and conducted by its founder, its research division, and a paid consultant, so the satisfaction findings reflect an organization evaluating its own service. Because the data come from a single organization, the results may not generalize to other peer-support lines or harm-reduction services, and because caller satisfaction was the only outcome measured, the study cannot show whether the helpline prevented harm.
In addition, the database only captures people who actively chose to contact a support line, meaning the distress rates for substances like psilocybin or cannabis reflect the experiences of help-seekers rather than the general public. Because cannabis is used by a vastly larger share of the American public than psychedelics, even a low rate of adverse reactions in the broader population can generate thousands of helpline calls.
“Our distress rates describe our callers, not the population-level risk of any drug, so please don’t read them as ‘47% of cannabis users have a bad trip,’” White emphasized.
Black also pointed to that distinction as a key caveat when evaluating the numbers. “These data are inherently from those who may be in a crisis moment, and therefore high distress is expected,” Black said. “They likely don’t represent overall distress rates of everyone using these substances. The authors acknowledge this, and it’s a common limitation of any call support data.”
Additionally, only 10.9% of interactions resulted in a completed follow-up survey, so callers who had particularly positive or frustrating conversations may be overrepresented in the satisfaction numbers.
The current analyses are descriptive. In future work, the authors plan to use multilevel statistical modeling, a technique that separates the influence of an individual supporter from the difficulty of the calls they take, alongside computer analysis of written feedback to identify which interpersonal skills make peer support most effective.
“The question I care most about is what makes support actually work: which skills and qualities in a supporter predict better outcomes for the person they’re helping,” White said. “Answering that could change how we train peer supporters, facilitators, and therapists across the field. We also hope outside researchers will dig into the data and ask questions we haven’t thought of, and they can reach us at info@firesideproject.org.”
“Every data point in this paper is a real person at a vulnerable moment who trusted a stranger enough to reach out, and I’m deeply grateful to them and to the volunteers who answered,” White added. “If any of your readers ever need support during or after a psychedelic experience, our line is free and confidential. Download our free mobile app, or call or text 623-473-7433, every day from 11 a.m. to 11 p.m. Pacific.”
The study, “The Fireside Database: Large-scale evidence from 25,419 psychedelic support interactions,” was authored by Felix Schoeller, Marc Santolini, Dana Xiadani, Mickael Eskinazi, Ashwin Murali, David Esselman, Wyatt Houtz, Wesley Bellanca, and Joshua White.