Risk screening and exclusion judgment

The manuals converge on the need for careful pre-session screening to identify psychiatric, medical, and substance-related risks before psychedelic administration. Across the extracts, exclusion commonly includes psychotic disorders, bipolar or manic conditions, suicidality, pregnancy, and unstable or significant medical illness, with several manuals also noting the importance of reviewing medications and possible interactions. They also share an emphasis on reassessing eligibility close to dosing, and on treating safety as a matter of recognising when a participant is not an appropriate candidate rather than simply proceeding with the session. The sources differ in the specific exclusions they foreground. The MDMA and mescaline materials place particular weight on structured psychiatric and medical screening, medication review, and pregnancy testing, while the ayahuasca trial adds prior ayahuasca experience, neurological disorders, and substance abuse, as well as day-of-dosing reassessment. The 5-MeO-DMT trial is more specific about excluding OCD, autism spectrum disorder, borderline personality disorder, clinically significant intellectual disability, and prior significant adverse reaction or non-response to psychedelic or dissociative drugs. The guidance on ayahuasca and ibogaine also differs by stressing broader clinical judgement about stability, medication withdrawal risk, and evidence gaps for people with medical comorbidities and many psychiatric conditions.