HOW THE WORLD GETS HIGH Get the Book
Reference

Finding a practitioner.

Five categories, seven questions, six warning signs. Everything the phrase “psychedelic therapist” can actually mean.

The title is unregulated. Anyone can print it on a card. What follows is what is actually behind it, sorted by how much protection you get.

The five categories

1. Ketamine clinics

The only one you can walk into tomorrow. Ketamine has been an FDA-approved anesthetic since 1970, so physicians can prescribe it off-label, and hundreds of clinics now operate across all fifty states. A medical setting, vitals monitored, usually a series of sessions.

Quality swings wildly between a psychiatrist-led clinic with integration support and a storefront running infusions on a conveyor belt. Cost: $400 to $800 per infusion, often six to start. Insurance sometimes covers the nasal spray, rarely the infusions.

2. Licensed facilitators in Oregon, Colorado and New Mexico

A profession that did not exist five years ago. Oregon opened the first service center in 2023 and now has 22 of them and over 100 licensed facilitators. Colorado's healing centers opened in 2025 and already number 76. New Mexico is beginning enrollment.

You travel to the state and consume on site. Nothing goes home with you. The real advantage is unglamorous and large: there is a regulator, a complaints process, and a license to lose. Cost: commonly over $1,000 a session, rarely insured. That is the fairest criticism these programs face.

3. Integration therapists

The category almost nobody has heard of, and probably the most useful one. A licensed therapist who helps you make sense of an experience you had somewhere else. They administer nothing and supply nothing, which is why they are legal in all fifty states.

The experience is rarely the hard part. What comes after is. People describe profound sessions that changed nothing, because nothing was built on top of them. Cost: ordinary therapy rates, sometimes insured, because it is therapy.

4. Retreat centers abroad

Legal where they operate, and enormously variable. Jamaica never scheduled psilocybin. The Netherlands sells truffles openly. Costa Rica, Mexico, Peru, Brazil and Portugal all host retreat industries in various shades of legality.

The absence of regulation is the point of these jurisdictions, and it cuts both ways. Insist on medical screening. A center that does not ask about your medications, your heart and your family psychiatric history before taking your deposit has told you something important about itself. Cost: $2,000 to $8,000 for a week, before flights.

5. Underground guides

Illegal, unregulated, and where the documented harm concentrates. They have existed continuously since 1970 and outnumber every licensed category combined. Some are careful and have been doing this responsibly for decades. Some are not, and a website will not tell you which.

No license, so nothing to revoke. No regulator, so nowhere to complain. No insurance and no recourse. The reported cases of serious misconduct in this field, including sexual misconduct during sessions, come overwhelmingly from settings where the practitioner faced no professional consequence.

Ask these seven questions

  1. What is your license, and in what state?
  2. What is your medical screening process?
  3. What happens if something goes wrong?
  4. What does integration look like, and is it included?
  5. Can I speak to someone who has worked with you?
  6. What is the total cost, in writing?
  7. What are your boundaries around physical contact?

Six warning signs. Any one of them is enough.

  1. No written agreement.
  2. No medical screening.
  3. Discouraging you from telling anyone.
  4. Any romantic or sexual dimension, at any point.
  5. Claims that cannot be true.
  6. Pressure.

Directories that stay current

Maintained by organizations whose job it is to keep them updated, which is why they are here instead of a list of names that would age badly.

Oregon Health Authority
Licensed facilitators and service centers		 oregon.gov/oha
Colorado DORA, Natural Medicine Division
Licensed facilitators and healing centers		 dora.colorado.gov
Your state licensing board
Free lookup for physicians, psychologists, counselors		 search your state plus “license verification”
Psychedelic Support
Licensed therapists offering integration		 psychedelic.support
MAPS
Clinical trials, still a legitimate route to access		maps.org
ClinicalTrials.gov
Search by condition and location. Usually no cost.		 clinicaltrials.gov
Fireside Project
Free, confidential peer support by phone or text		 623-473-7433

And one last thing

Humans have been doing this for ten thousand years, almost always in the presence of somebody who knew what they were doing. A Mazatec curandera singing through the night. A Bwiti initiation the whole village attended. The container was never optional. It was the technology.

What is new is not the substances. It is that a container is being rebuilt in public, with licenses and regulators and complaints procedures, for the first time in the modern West.

Facts first. And your own good judgement always.

This is the practical appendix. How the World Gets High is the nine thousand years that led to it.

Read the book