The Biggest Source of Panic Calls on a Psychedelic Line Is Not a Psychedelic
If you ran a crisis line for psychedelics, which drug would generate the most panic? Five years of calls give an answer, and it is not psilocybin, LSD or any psychedelic at all. It is cannabis. That finding drew coverage last week, and it holds up.
Cannabis is not a psychedelic. That is most of what makes the result worth a look. On a line built for psilocybin and LSD, the most distressed callers used a drug that is legal in most of the country.
We downloaded the dataset and ran it ourselves. Cannabis does top the table. But the reason it tops the table is not the one most people will assume. The same quirk that makes cannabis look dangerous makes ketamine look safe.
The callers in this dataset wanted someone to pick up. That is a service, not an expense. HealingMaps’ GPO, the first built for the ketamine industry, gets member clinics 15 to 20 percent off malpractice and liability premiums, 40 percent or more off medical supplies, discounted LegitScript certification, and 20 to 30 percent off HIPAA compliant payment processing. Joining is free with no obligation. See what your clinic qualifies for →
| Key Takeaway | Detail |
|---|---|
| The question | Which substance produces the most distressed calls to a psychedelic support line |
| The answer | Cannabis. 47.2% of the people who called about it were distressed, more than any psychedelic |
| The catch | Cannabis callers phone while still high. 70% of their calls are mid-experience |
| Controlled | Counting only callers still mid-experience, all five land between 45.8% and 49.6% |
| Ketamine’s two numbers | 41% of its callers were distressed, rising to 48% of those still mid-experience |
| What is real | Zero of 433 mid-experience ketamine calls involved 911 or 988 |
| The dataset | 25,419 interactions, April 2021 to February 2026, data released by the authors |
Where the numbers come from
The Fireside Database was published in Science Advances on October 30. It covers every interaction handled by Fireside Project’s Psychedelic Support Line from April 2021 to February 2026.
That is 25,419 conversations, fielded by 220 trained peer supporters, with 2,777 linked surveys. The authors released the de-identified data and their analysis code.
We downloaded both and reproduced their published figures before using anything. The row count, the substance counts and the call type split all match. Everything below is computed with the authors’ own definitions.
One caveat belongs up front. These are people who chose to call a support line. They are not a random sample of anyone, so none of this is a population risk estimate.
Cannabis tops the panic table
One thing to hold onto before reading the table. Everybody counted here already picked up the phone and called a support line. These are not rates among people who use these drugs.
What the numbers show is narrower than that. When a conversation began, the supporter recorded whether the caller was in distress at that moment. The percentages below are the share of each substance’s callers who were.
Read that way, distress is not the default even among people calling a crisis line. Most callers were not in it. Across the five substances that dominate the line, cannabis comes first.
| Substance | Share of its callers in distress | Just the mid-experience callers | Just the integration callers |
|---|---|---|---|
| Cannabis | 47.2% | 49.6% | 38.3% |
| Psilocybin | 42.2% | 45.8% | 35.3% |
| LSD | 41.8% | 47.8% | 32.3% |
| Ketamine | 40.9% | 47.8% | 36.4% |
| MDMA | 40.7% | 46.1% | 38.8% |
Cannabis leads on both measures. Its callers were the most likely to be in distress overall. They stay first when you look only at people who called while still under the influence.
That is worth sitting with. The legal one, the one most people treat as mild, generates more distress calls than any psychedelic on the line.
The gap is mostly about when people call
Look at the first column and cannabis appears five to seven points worse than psilocybin, LSD, ketamine or MDMA. Look at the middle column and that gap shrinks to under four points across all five.
The reason is timing. Cannabis callers overwhelmingly reach out mid-high, with about 70 percent of their calls placed during the experience. That is the highest share of any substance in the set.
Distress is far more common mid-experience than afterward. Across the whole dataset the rate is 45.7 percent during and 33.4 percent after. So a substance whose callers phone while still high will always look worse in a pooled number.
The authors make this point themselves. When someone called predicts distress better than what they took. Cannabis still finishes first either way, but the honest margin is narrow rather than dramatic.
Ketamine’s distress rate depends on which calls you count
This is where it gets useful for anyone running a ketamine practice. Across all its callers, ketamine sits at 40.9 percent, the second lowest of the five. Read that column alone and ketamine looks like the calm one.
That reading is an artifact of who calls. Most ketamine contacts are not crisis calls at all. They are integration calls placed afterward, once people have come down, and those run 36.4 percent.
Those calmer conversations pull the average down. Count only the people who called while the experience was still happening and ketamine runs 47.8 percent. That puts it level with LSD and under two points behind cannabis.
So ketamine is not the calm outlier the first column suggests. Compared with callers in the same situation, it looks like everything else on the line.
That is a statement about callers, not about patients. Nothing here estimates how often somebody in a clinic chair becomes distressed. Everyone counted in this dataset reached for a phone first.
One ketamine advantage survives the test
We applied the same control to emergency escalation, and here ketamine holds up.
Across all ketamine interactions, 1 of 1,180 involved a call to 911 or 988. Among mid-experience ketamine calls specifically, the count was zero out of 433.
The comparable mid-experience rates were 0.29 percent for psilocybin, 0.46 for LSD, 0.51 for cannabis and 1.05 for MDMA. These are small counts and should be read as such, but the direction is consistent.
So the picture is specific rather than flattering or damning. Ketamine callers in the middle of an experience were distressed about as often as LSD callers. That distress resolved on the phone without becoming an emergency.
Ketamine callers reverse the pattern
The other thing that separates ketamine in this dataset is when its callers turn up at all. Ketamine appears in 1,194 interactions, fourth behind psilocybin at 9,348, LSD at 2,247 and cannabis at 2,004.
Across the whole dataset, 10,208 calls came in mid-experience and 8,155 came afterward. For the classic psychedelics the split leans hard toward mid-experience. Ketamine goes the other way.
| Substance | Interactions | Called mid-experience | Called afterward |
|---|---|---|---|
| Psilocybin | 9,348 | 59.5% | 33.7% |
| LSD | 2,247 | 58.9% | 35.6% |
| Cannabis | 2,004 | 70.2% | 24.7% |
| Ketamine | 1,194 | 36.3% | 59.0% |
| MDMA | 682 | 28.2% | 66.3% |
Ketamine integration calls outnumber ketamine crisis calls by roughly two to one. Only MDMA shows the same shape. A separate field backs it up, with 230 of the 358 phase-coded ketamine interactions logged as post-peak.
Ketamine’s share of the line also grew faster than anything else. It went from 4.6 percent of substance-coded calls in 2021 to 10.8 percent in 2025. The 2026 window covers January and February only, so we left it out of that comparison.
Who these ketamine callers are
The coded detail is partial, since supporters record these fields only when a caller volunteers them. Where it exists it points one direction.
Of the 446 ketamine interactions with a social context recorded, 302 callers were alone. That is 67.7 percent. We found a similar signal last month. Survey data showed unsupervised users rating ketamine just as effective, with far higher hallucination odds.
These are not novices. Of the 920 who answered, 885 said it was not their first time with psychedelics, or 96.2 percent. In 1,017 of the 1,194 interactions ketamine was the only substance listed.
Most were already in care. Of the 516 who disclosed it, 51.9 percent were seeing a therapist. Others named a psychiatrist or an integration specialist. They had clinicians and still called a volunteer line.
Fireside also codes a category for facilitator abuse. It covers callers who said a provider dosed them without consent or otherwise crossed a line. There were 43 across five years, concentrated in ceremonial and retreat settings. Five involved ketamine. Fireside did not independently verify individual reports.
What a clinic should take from this
Three things, in order of how actionable they are.
First, read numbers like these with the denominator in view. A figure that pools people mid-experience with people calling days later is not describing either group. That caution applies to any dataset built on who happened to make contact.
Second, the escalation record is genuinely good and worth knowing. Distress during ketamine experiences was common and almost never became a 911 call. What those callers needed was someone to answer.
Third, 8,155 people called a volunteer line for help processing an experience after it ended. Of those, 705 were ketamine calls. That is demand for a service almost nobody sells on its own.
The people generating it are experienced users, mostly alone, already paying somebody for mental health care. We have written that integration work is moving into the home as clinical models get leaner. This dataset shows where it lands. It lands on volunteers.
Fireside published its first data on that gap in 2023. Three years and roughly six times the data later, it is measured rather than estimated. Ketamine is a larger part of it every year.
Patients looking for supervised care can start with our directory of verified ketamine clinics.
This article is for informational purposes and is not medical or clinical advice. The Fireside Project Psychedelic Support Line can be reached at 62 FIRESIDE.
