Association of Entheogenic Practitioners Safety Self-Assessment
This safety self-assessment is required for your participation in an AEP-sanctioned ceremony. Its purpose is to keep you and this sacred work safe. We ask you to collect and share this information so that, together, we may anticipate and prevent negative medical and psychological outcomes.

Notes and recommendations on how to assess an answer are often included as part of the question. In general, we ask that you only share here what you deem necessary and helpful in providing for your safety. The spaceholders will be available prior to the event to hear other considerations and to answer questions about the experience. You can also print this document and bring it with notes and questions to any event.

Entheogenic experiences are generally safe, but they are not for everyone. Many known contraindications (reasons not to participate) are included in the AEP Participation Agreement and below. Contraindications will be taken seriously, and our ceremonies may not be the right fit for you if they represent a significant concern. In general, however, it is unlikely that any one answer will disqualify you from participation.

Please be honest with your answers. Your experience, medical history and mental well-being are all important for our spaceholders to know, in order to ensure a safe and meaningful experience for all. We will treat this information as confidential and private in accordance with your participation agreement and the AEP Code of Ethics.

We are here to support you in making an informed and independent decision about your participation.
   
SACRAMENTS THAT MAY OFFERED AT YOUR EVENT:

Information courtesy The Third Wave (https://thethirdwave.co/psychedelics/)

Psilocybin

A typical trip on a moderate dose of psilocybin mushrooms (1-2.5g) includes an increased intensity of emotional experiences, increased introspection, and altered psychological functioning in the form of “hypnagogic experiences,” which is the transitory state between wakefulness and sleep. Brain imaging studies show that a psilocybin trip is neurologically similar to dreaming, which gives some idea of the mindset you’re entering when undertaking a psychedelic experience.

Strong emotions, both enjoyable and challenging, are common during a journey. When undesirable feelings do arise, it’s best not to resist but rather let the feelings run their course. Many people who have reported the presence of strong negative emotions also report feeling a simultaneous sense of calm acceptance and detachment, especially if they don’t resist and remind themselves that the emotions are temporary. Resisting the emotions can lead to a “bad trip.”

Physical side effects vary from person to person, but they can include a change in heart rate (up or down), change in blood pressure (up or down), nausea, increased tendon reflexes, tremors, dilated pupils, restlessness or arousal, and trouble with coordinated movement. Some also report feeling deeply relaxed and calm.

One study also found that psilocybin can cause headaches that last for up to a day in healthy individuals. None of the subjects reported severe headaches, however, and psilocybin is actually used to treat a clinical condition called cluster headaches.

MDMA

For most clinical trials, researchers administer doses between 80 and 150mg of MDMA. At this dose level, the onset of effects occurs approximately 20 to 60 minutes after taking the drug, and the characteristic effects (euphoria, increased empathy, and energy, enhanced sensations) typically last for three to five hours. The experience is usually characterized by a relaxed, euphoric state, including emotional openness, reduction of negative thoughts, and a decrease in inhibitions. MDMA can make users feel like all is well in the world, and connecting with others becomes easy. Bodily sensations and touch become enhanced, and sounds and colors can appear more intense.

MDMA affects the brain by increasing the activity levels of three neurotransmitters: dopamine, norepinephrine (noradrenaline), and serotonin. Increases in dopamine are what create MDMA’s euphoric effects, as well as the increased energy users feel. Increases in norepinephrine/noradrenaline cause increased heart rate and blood pressure while increases in the serotonin system cause changes in mood, appetite, sexual arousal, and sleep cycles. Spikes in serotonin after taking MDMA likely account for the common feelings of emotional closeness and empathy.

Potentially fatal neurological complications can occur following MDMA ingestion, likely due to short-term hypertension and dehydration that the drug induces. Many fatal cases are due to abnormally high doses, prior health complications, a “bad batch,” or a combination of all of these. In fatal cases, necrosis of the liver and heart tissue have also been reported. It’s often difficult to tell exactly how much of a role MDMA plays in adverse reactions because, in these cases, people are more likely to have used multiple drugs. As with any substance, MDMA should be used in moderation. Frequent use correlates with more complications than occasional use. Clinical studies with pure MDMA have been conducted on more than 1,100 individuals without the occurrence of severe adverse effects.

Cannabis

Common effects of cannabis include mood enhancement and euphoria, accompanied by laughter and relaxation, as well as an increased enjoyment of music, food, tactile sensations, and activities you may normally find dull. Thoughts tend to flow more freely, often leading to creative, philosophical, or spiritual insights. At higher doses, the flow of ideas can even become overwhelming.

Cannabis is a mild psychedelic, so visual effects tend to be limited to color enhancement, moderate closed-eye patterns, and increased sensitivity to light. At very high doses, however, cannabis can induce psychedelic hallucinations—especially if you’re in the dark.

More negative cannabis experiences may include panic attacks, confusion, memory loss, and depersonalization or derealization, as well as dream suppression.

Lethargic, slow movements are especially common with cannabis, even though the substance elevates the heart rate. Many also report cottonmouth and bloodshot eyes. Nausea (if any) tends to fade after the initial onset and may be replaced by an insatiable appetite—famously known as the “munchies.”
 
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We encourage you to do your own research; the below link from Third Wave includes the above information and more, and Erowid is an excellent resource for learning about subjective individual experiences.


https://thethirdwave.co/psychedelics/

https://www.erowid.org/plants/mushrooms/mushrooms.shtml
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Email *
Name *
Dietary restrictions *
Please write a bit about why you are interested in having an intentional entheogenic experience, describing any intentions, goals, or expectations that you may have for it. *
If you have used entheogens before, please select which ones. Check all that apply, *
Required
In what setting did you use entheogens? Check all that apply. *
Required
How would describe your relationship with entheogens? *
If you have had experiences, what are some general trends? For example, do you often experience elevated heart rate, anxiety, euphoria, etc.? *
Have you had any experiences with any entheogens or other powerful psychoactive substances in the past thirty days? If so, with which substances? *
Are you planning on having any other experiences with entheogens or other powerful psychoactive substances within the next month or few months? If so, with which substances? *
Are you pregnant or breastfeeding? *
Please describe any physical health condition, disease, or complication you have, or have had, if applicable. (Some important examples: Low Blood Pressure, High Blood Pressure, Heart Surgery, Heart Transplant, Heart Attack, Circulatory Problems (Arteriosclerosis, dysrhythmia, etc.), Diabetes, Meningitis, Migraine, Epilepsy, Hyperthyroidism, Cancer or Tumour, HIV/AIDS, Ulcer, Obesity, Physical Disability/ Injury, Chest Pain (Angina or otherwise)Asthma, Aneurysm, Chronic Pain, Fibromyalgia, Arthritis, Stroke, Head Injury, Any infectious or contagious diseases, Gynecological Condition, Glaucoma, Displaced Retina, Osteoporosis) *
Many of the sacraments we offer have known contraindications and pharmaceutical interactions. Please list any and all medications you are taking, how recently you used them, what you are taking them for, and your dosage. The following medications are ones we want to be especially aware of: [(Amitryptiline (Elavil) - TCA, Aripiprazole (Abilify), Bupropion (Wellbutrin, Zyban) - NDRI, Citalopram (Celexa, Cipramil) - SSRI, Duloxetine (Cymbalta) - SNRI, Escitalopram (Cipralex, Lexapro) - SSRI, Fluoxetine (Prozac, Sarafem, Adofen) - SSRI, Fluvoxamine (Luvox, Faverin) - SSRI, Lithium, Mirtazapine (Remeron) - TeCA, Nortryptyline (Allegron, Aventyl, Noritren) - -TCA, Paroxetine (Paxil, Seroxat, Pexeva) - SSRI, Phenelzine (Nardil, Nardelzine) - MAOi, Sertraline (Zoloft) - SSRI, Trazodone - SARI, Venlafaxine (Effexor) - SNRI, Vilazodone (Viibryd) - SSRI, Clonazepam (Klonopin) - Benzodiazepine, Lorazepam (Ativan) - Benzodiazepine, Diazepam (Valium) - Benzodiazepine, Clorazepate (Tranxene) - Benzodiazepine, Oxazepam (Serax) - Benzodiazepine, Alprazolam (Xanax) - Benzodiazepine, Midazolam (Versed) - Benzodiazepine, Triazolam (Halcion) - Benzodiazepine, Estazolam (Prosom) - Benzodiazepine, Temazepam (Restoril) - Benzodiazepine, Chlordiazepoxide (Librium) - Benzodiazepine, Flurazepam (Dalmane) - Benzodiazepine, Quetiapine (Seroquel), Orlistat (Xenical), Cannabis (Medicinal or self-medication), I receive TMS)] *
What dietary supplements are you taking? Check all that apply. Some may be contraindicated for the days surrounding a ceremony. *
Required
Have you or anyone in your family been diagnosed with any of the following conditions? Check all that apply. *
Required
Who received the diagnosis or diagnoses in the previous question? Choose the first answer that applies. *
Have you ever been hospitalized due to mental health issues? If so, when and for what? *
Have you ever experienced psychosis, delusion, or hallucinations? If so, how frequently and under what circumstances?       *
Have you ever attempted suicide? If so, how recently and under what circumstances?       *
Optional - Wellbeing
The questions below are optional. Feel free to give as much or as little detail as you deem necessary and helpful to your own safety and the safety of others. Your comfort with sharing matters most.
Please write a bit about your relationship with your inner world. For example, do you have therapy/have you ever had therapy? Do you meditate/have you ever meditated?
How would you describe your mental health over time and more recently? Feel free to use or not use diagnoses-- you can just speak in terms of how you think/feel about it.
On a scale of 0-10, how in control of your emotions do you typically feel throughout any given day?
Clear selection
Please describe any history of addiction, if applicable, and how much of what substance/activities you partook in, and how often. E.g., what is your relationship with alcohol?
Are you currently going through a "spiritual emergence" process? (Please search online if you are unsure what this is.)
If you haven’t already addressed this in another response: what does spirituality mean to you?
Interpersonal Trust Questions
1-5 rating system, 1 = strongly disagree, 5 = strongly agree
1. It's not wise to let people know your secrets.
Strongly disagree
Strongly agree
Clear selection
2. Whatever it takes, you must get the important people on your side.
Clear selection
3. Avoid direct conflict with others because they may be useful in the future.
Clear selection
4. Keep a low profile if you want to get your way.
Clear selection
5. Manipulating the situation takes planning.
Clear selection
6. Flattery is a good way to get people on your side.
Clear selection
7. I love it when a tricky plan succeeds.
Clear selection
8. People see me as a natural leader.
Clear selection
9. I have a unique talent for persuading people.
Clear selection
10. Group activities tend to be dull without me.
Clear selection
11. I know that I am special because people keep telling me so.
Clear selection
12. I have some exceptional qualities.
Clear selection
13. I'm likely to become a future star in some area.
Clear selection
14. I like to show off every now and then.
Clear selection
15. People often say I'm out of control.
Clear selection
16. I tend to fight against authorities and their rules.
Clear selection
17. I’ve been in more fights than most people of my age and gender.
Clear selection
18. I tend to dive in, then ask questions later.
Clear selection
19. I've been in trouble with the law.
Clear selection
20. I sometimes get into dangerous situations.
Clear selection
21. People who mess with me always regret it.
Clear selection
22. Watching a fist-fight excites me.
Clear selection
23. I really enjoy violent films and video games.
Clear selection
24. It's funny when idiots fall at on their face.
Clear selection
25. I enjoy watching violent sports.
Clear selection
26. Some people deserve to suffer.
Clear selection
27. Just for kicks, I’ve said mean things on social media.
Clear selection
28. I know how to hurt someone with words alone.
Clear selection
IMPORTANT: IF THERE IS AN ISSUE THAT YOU FEEL CANNOT BE DISCLOSED COMFORTABLY ON THIS FORM, PLEASE CHECK THIS BOX.
I certify that all the information above is true and correct to the best of my knowledge. *
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