A path through a forest in the Ardennes

How to choose a ceremony center: a safety checklist

BySafe Ceremonies

Most ceremony center websites say the same things: experienced facilitators, a safe space, a life-changing week. Those words cost nothing to write. What tells you whether a place is safe is how it handles the dull parts: the health questions, the staffing, the plan for a bad night, and the help it offers once you’re home.

This guide goes through those parts in the order you’ll meet them. It applies to any kind of ceremony or retreat, from an ayahuasca weekend to a breathwork day or a cacao circle, though the stakes rise with the strength of what’s being taken. At the end there’s a checklist you can copy and use on every place you consider.

Start with your own reasons and your own health

Before you compare centers, be clear with yourself about why you want to go and what you hope will happen. Write it down. A place that suits someone curious about a quiet weekend of meditation may be the wrong place for someone dealing with a recent loss, a crisis or a mental health condition.

Then gather the facts a good center will ask you for anyway:

  • Every prescription medicine you take, plus supplements and anything you take now and then.
  • Any heart problem, high blood pressure, history of seizures or other long-term condition.
  • Any personal history of psychosis, bipolar disorder or other serious psychiatric illness, and whether a parent, sibling or other close relative has had one.
  • Whether you are pregnant or could be.

Talk these over with your doctor or prescriber, even if you expect them to disapprove. You don’t need their blessing. You need to know which of your medicines can’t be combined with what you’re considering. Changing or stopping a prescribed medicine is a decision to make with the person who prescribed it, never on a retreat’s say-so.

What good medical screening looks like

Screening is the first real test of a center. Some substances used in ceremonies interact dangerously with common medicines, and some put strain on the heart. A few examples from published research:

  • Ayahuasca brews contain harmala alkaloids, which block an enzyme called monoamine oxidase. Researchers warned in 1998 that combining them with SSRI antidepressants could cause serotonin syndrome, with potentially grave results.
  • In an analysis of 62 online reports from people who took a classic psychedelic such as psilocybin or LSD while on lithium, 47% described seizures.
  • Ibogaine has been followed by reports of life-threatening complications and sudden deaths, which researchers link to its effects on heart rhythm.
  • Kambo can cause a racing heart and swings in blood pressure. A 2025 review of the medical literature found a small number of deaths described after it, and noted that pre-existing risk factors may make such events worse.
  • Classic psychedelics moderately raise pulse and blood pressure, which is one reason research teams screen for heart problems.

Researchers who give these substances to volunteers screen carefully. Safety guidelines published by a Johns Hopkins team in 2008 describe excluding people with a personal or family history of psychotic disorders or bipolar disorder, excluding people whose blood pressure runs high, and checking an ECG before anyone takes part. The reasons behind those rules apply in a ceremony space as much as in a lab.

Look for a center that:

  • Sends a written health questionnaire before your place is confirmed.
  • Asks about medicines, heart health and psychiatric history, including family history.
  • Has a named person, ideally with medical training, who reads your answers and sometimes says no.
  • Tells you plainly which medicines or conditions rule you out, and why.
  • Explains any food or medicine rules it asks you to follow beforehand, and where they come from.

A center that has never turned anyone away should worry you. So should one that skips screening because “the medicine knows what you need.”

Who will be in the room

Ask who leads the ceremony and who else will be there. You want names, not job titles. Find out how long each person has done this work, where they trained and who they trained with. Many groups place weight on lineage and tradition. You can respect that and still ask what it means in practice; our guide to leadership, lineage and cult warning signs goes into this in more detail.

Then ask about numbers. How many participants will there be, and how many staff stay awake and present for the whole ceremony? The Johns Hopkins guidelines call for at least two monitors with each volunteer, so nobody is left alone if one has to step out. Group ceremonies work on very different ratios, but a circle of twenty with one facilitator and no helpers has nobody free when two people need help at once.

Ask whether anyone present is trained in first aid or CPR, and whether a nurse, paramedic or doctor is on site or on call. For substances that affect the heart, ibogaine above all, the answer should be detailed and specific.

The setting and the emergency plan

The most common serious problem in a strong ceremony is psychological: overwhelming fear or confusion. The Hopkins guidelines note that this can lead people to do dangerous things, such as leaving the site. In a survey of nearly 2,000 people about their hardest experience with psilocybin mushrooms, 11% said they had put themselves or others at risk of physical harm. The risk was higher when physical comfort and social support were missing.

That makes the setting a safety question as well as a comfort one. Ask:

  • What happens if someone tries to leave during the ceremony?
  • Is the site near water, cliffs, roads or other hazards, and how are they managed at night?
  • How far is the nearest hospital, how would someone get there, and who would drive?
  • Is there phone signal or another way to call for help?
  • Has the center ever had to call emergency services, and what happened?

A well-run center will have worked through these questions long before you ask them, and may have a written emergency plan it will show you. Vague reassurance (“we’ve never had a problem” or “the space is protected”) is not a plan.

Consent, touch and boundaries

You should know before the ceremony what will be done to you and what will be asked of you. Will facilitators touch you, and if so, how and when? Will there be bodywork, tobacco, extra substances or other practices you haven’t agreed to? Can you say no to one part and still take part in the rest?

The Council on Spiritual Practices, in its code of ethics for spiritual guides, says people should agree to a practice in advance, in an ordinary state of mind, after hearing its physical and psychological risks. That’s a sensible standard to hold any center to. Agreement given in the middle of a ceremony, when you may be confused or easily swayed, counts for much less.

Sexual contact between a facilitator and a participant has no place in a ceremony. The Chacruna Institute’s community guide on sexual abuse in ayahuasca settings compares it to sex between a doctor and a patient, and questions whether anyone can truly consent while under the influence of a psychedelic. It’s worth reading whatever kind of ceremony you’re considering.

Aftercare and integration

Ask about what happens after the ceremony before you book. Most people come home without lasting problems, but not everyone does. In a study of 608 people who reported difficulties after a psychedelic experience, such as anxiety, a sense of unreality or feeling cut off from others, about a third said the problems went on for more than a year. The study only looked at people who had difficulties, so it can’t say how common they are. It does show they can last.

Find out what support the center offers after you leave: follow-up calls, integration circles, referrals to therapists who understand this kind of experience. Ask who you contact if you’re struggling a month later, and whether that costs extra. A center whose responsibility ends at the gate on the last morning is leaving out part of the job.

Know your outside options too. Fireside Project runs a free, confidential psychedelic peer support line on 62-FIRESIDE (623-473-7433), by call or text, from 11 a.m. to 11 p.m. Pacific time every day. In the US, the 988 Suicide & Crisis Lifeline answers calls and texts at 988. In an emergency, call your local emergency number.

Money and paperwork

  • Get the full price in writing, including anything charged on arrival.
  • Read the cancellation and refund policy, especially what happens if the screening rules you out after you’ve paid.
  • Be wary of discounts for paying today, or pressure to commit before you’ve been screened.
  • Read any waiver at home, before you travel, rather than on the night.

The law

The legal status of these substances differs by country, by state and sometimes by city, and in some places it is changing quickly. This guide can’t tell you what’s legal where you are, and a center’s own account of its legal standing isn’t independent advice. For the United States, the psychedelic law and policy tracker run by Psychedelic Alpha with UC Berkeley’s Center for the Science of Psychedelics gives an overview. For your own situation, ask a lawyer.

Reading reviews well

Reviews are most useful when you read them for specifics. “Amazing, life-changing” tells you how someone felt. “They called me twice before the retreat to go over my medicines” or “one facilitator for eighteen of us” tells you how the place runs. Look for:

  • How screening, preparation and aftercare were handled.
  • How staff responded when someone had a hard night.
  • Whether the place matched what its website promised.
  • How the center replies to critical reviews: defensively, or by explaining what it changed.

A run of perfect reviews posted in the same week, all in the same voice, deserves a second look.

Your checklist

Copy this and fill it in for each place you’re considering. If you can’t tick an item, ask the center about it directly.

  1. I know why I want to go and what I’m hoping for.
  2. I’ve talked to my doctor or prescriber about my medicines and health.
  3. The center sent a written health questionnaire covering medicines, heart health and psychiatric history.
  4. A named person reviews my answers and can turn me down.
  5. I know the names, experience and training of the people leading.
  6. I know how many participants there will be and how many staff stay present throughout.
  7. Someone trained in first aid is present, and medical help is on site or on call.
  8. I know how far the nearest hospital is and how I’d get there.
  9. I know what will happen in the ceremony, including any touch, and I can opt out of parts of it.
  10. There’s follow-up support after I leave, and I know who to contact.
  11. I have the price, the refund policy and any waiver in writing.
  12. I’ve read reviews from past participants and seen how the center answers criticism.
  13. I understand the legal situation where the ceremony takes place.
  14. I can leave at any point without penalty or pressure.

More guides

Safe Ceremonies is a free directory of ceremony centers with reviews from people who have attended them. You can search the listings by place and by type of ceremony, such as ayahuasca or breathwork, and read what past participants say before you contact anyone. If you’ve been to a ceremony yourself, your review helps the next person choose.

Sources

Photo: Forest Path in the Ardennes by *rboed*, CC BY 2.0.

Safe Ceremonies
Author: Safe Ceremonies

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