23 October 2025
On October 1st, a one-day symposium took place at the Champalimaud Foundation that brought together clinicians, researchers, patient representatives, policymakers and ethicists to explore the landscape of psychedelic-assisted care through the lens of the four pillars of medical ethics: beneficence, non-maleficence, justice, and autonomy.
“I was a psychedelic teenager. Then, at 18, I had a bad trip with LSD, and became very paranoid”, explained Jules Evans to his audience at the event that took place at Champalimaud Foundation, at the beginning of the month, under the title “Psychedelic Therapy: From Evidence to Equity”. Today, Evans is the founder and Director of the Challenging Psychedelic Experiences Project, the leading resource for post-psychedelic difficulties and what helps people recover from them.
The effects of the bad trip, Evans recalled – a high level of anxiety and nightmares – lasted for weeks. Would he ever recover, he asked himself time and again. In the 1990’s, there was hardly any information about this kind of situation.
He consulted a psychiatrist, who told him he suffered from PTSD and social anxiety. He joined an informal cognitive-behavioural therapy support group and this eventually led to his recovery. It was a slow process, he admits. “For a long time, I had no romantic life – I got married just four months ago!”
“Fifty percent of ‘psychonauts’ [people who experiment with mind-altering substances] have had one bad experience with un psychedelics, maybe the worst challenging experience in their lives”, says Evans. According to a survey promoted by the Challenging Psychedelic Experiences Project, for 10% of the individuals with a bad experience, the difficulties last for more than a year and are moderate to severe.
They report “serious extended difficulties” such as anxiety, trauma, phobias, social disconnection, depersonalisation, visual hallucinations, existential confusion (how to make sense of the experience?), depression, psychotic/manic episodes, diminished sense of self. “And their main question is ‘how long will it last?’”, Evans points out once more.
These traumatic experiences happen in non-medical, suboptimal settings, in parties or when people are alone, and because of “excessive dosage or the lack of competent support after the event”, he adds. They are really life-wrecking.
So, how do you recover? Evans’ NGO has five published papers on this, he said. Social support, family and friends are paramount; self-care, acceptance, self-compassion are helpful; and medication such as SSRIs (antidepressants) are useful when needed. “Learn, communicate, seek support, don’t hide it or minimize it”, he advises.
But the lack of public information, of evidence-based support and protocols makes desperate people try to recover through any available alternative, including practices such as acupuncture and shamanism. “Doctors don’t know about these difficulties”, says Evans. “And more research is needed on particular psychedelic difficulties, more studies on how to recover”.
“Beyond just understanding whether a substance is good, there are critical ethical issues”, said Albino J. Oliveira-Maia, psychiatrist and director of Neuropsychiatry Unit and of the newly created Digital Neurotherapeutics Clinic – integrated in the Centre for Restorative Neurotechnology at the Champalimaud Foundation –, when he introduced the event of which he was also the organiser. “The four pillars of ethics are: beneficence, non-maleficence (prescribed use), justice and autonomy (individual use)”, he explained. Those were the four aspects the symposium would be about.
Even the regulated, medical use of psychedelics poses several ethical conundrums, as was stressed a few months ago, also at the Champalimaud Foundation, during the presentation of multidisciplinary recommendations to guide the evidence-based integration of psychedelics into clinical practice in Portugal. In particular, careful consideration of the specificities of informed consent when using psychedelic substances with patients was considered of the utmost importance.
On the other hand, non-regulated, individual use – that is, mainly recreational drug use, including psychedelics, is growing in Europe, bringing with it a cohort of risks for users. Thomas Clausen, Chief Scientist of the European Union Drug Agency (EUDA), described the methods used to measure and understand drug use trends. “A small subgroup uses the drugs for medication”, he explained. “But more than 75% of users take ketamine, MDMA (ecstasy), cocaine, to get high, to have fun.”
However, the frequency of psychedelics use is still very low in the EU. According to an ESPAD 2024 report (the world’s largest research project on adolescent substance use, with research teams in over 40 European countries), 95% of students only consume cannabis, with MDMA and LSD representing only 2% of that total population. Nonetheless, even if only 1% of total recreational drug consumption concerned ketamine in 2016, he adds, “there is an illicit market for ketamine in the EU. And with growing ketamine availability, the risks of harm are also on the rise.”
The demand for “Psychedelic Retreats”, which of a “pseudo-clinical, neo-shamanic or religious” nature, has increased five-fold in five to six years in Europe, Clausen pointed out. “Prohibition fails – and causes a lot of harm”, said João Taborda da Gama, a Public Law Lawyer and Academic Specialised in the Regulation of Controlled Substances and Drug Policy, during his talk.
Some reportedly more scientific therapy models have been put in question. In her talk, Neşe Devenot, from Johns Hopkins University – who has been a psychedelic humanities researcher since 2010 and helped found Psychedelic Studies as an interdisciplinary field – questioned a model used by Multidisciplinary Association for Psychedelic Studies (MAPS, an American ONG).
In the US, MAPS guidelines are some of the most commonly used in psychedelic-assisted therapy – namely, its manual for using MDMA to treat PTSD.
Devenot and co-authors wrote an opinion piece in JAMA Psychiatry, in 2023, warning that the therapy component of this psychedelic-assisted therapy wasn’t being studied enough and could pose serious risks to patients. She also reported her concern in a written analysis she submitted to the FDA, also in 2023.
But the future can be brighter.
Today, psychedelics such as MDMA, ketamine and esketamine, as well as psilocybin (mushrooms) are gaining traction as real treatments for severe depression, with some of them being authorised, both in the US and Europe (including Portugal) for this medical indication. And science-based clinical trials are on the way.
“There is accumulating evidence for the benefits of psilocybin treatment against end-of-life distress”, said in his talk Robert Schoevers, Principal Investigator of the PsyPal Consortium, the first ever European partnership to receive an EU grant to do clinical research into psychedelic-assisted therapy.
Large, precise and well-controlled clinical trials are critical steps for patients to have access to psychedelic treatments in “real-world” settings.
Psypal will perform a clinical trial of psilocybin therapy in the context of palliative care. The consortium recently started recruiting participants.
The rationale behind Psypal is that many individuals with life-limiting conditions face existential problems and distress – and that innovative solutions are urgently needed to meet their spiritual and emotional needs while receiving palliative care.
PsyPal's aim is to explore whether psilocybin-assisted therapy in palliative care settings could help to alleviate experiences of existential distress for individuals with the following life-limiting conditions: Chronic Obstructive Pulmonary Disease (COPD); Multiple Sclerosis (MS); Amyotrophic Lateral Sclerosis (ALS); and
Advanced Parkinson’s Disease and Atypical Parkinsonisms (APD).
It will treat over one hundred patients across four distinct clinical sites, with each site focusing on a specific condition: COPD at the University Medical Centre Groningen (UMCG), in the Netherlands; APD at the Champalimaud Foundation, in Portugal; MS at the National Institute of Mental Health, in the Czech Republic; and ALS, jointly at the University of Copenhagen and the Bispebjerg Hospital in Denmark.
“Europe is already a leader in psychedelic safety research”, Evans had stressed in his talk. “And Portugal could become a leader, maximising benefits while reducing harm.”
