Is It Safe to Mix Cannabis and Psychedelics?

Photo by Sergey Filimonov

Cannabis might help with a lot of stuff. Sleeplessness. PTSD. Grief. Social anxiety. And once you experience success with cannabis, it becomes easier to understand how other psychedelic medicines could help, too. You might even be inclined to try psychedelic therapies, such as psilocybin-assisted therapy or ketamine infusions. But are cannabis and psychedelics safe to use simultaneously? 

"I don't think we have the faintest idea," says Harvard cannabis specialist Jordan Tishler MD. Combining cannabis with psychedelics will not cause physical harm, but their relationship leaves much to the imagination—at least from a scientific standpoint. The reason for this is the same as it always is when it comes to questions about psychedelics—and cannabis—in general: Due to legal restrictions, we need more research. 

Cannabis is prolific in its purposes. But it certainly isn’t the only tool in the toolkit—especially when it comes to depression. 

Cannabis is prolific in its purposes. But it certainly isn’t the only tool in the toolkit—especially when it comes to depression. And if someone's depression won't dent—even despite using SSRIs or other traditional or non-traditional treatments—they might be a good candidate for psychedelic-assisted therapy. Currently, ketamine is the only FDA-approved psychedelic for treatment-resistant depression.* And though other entheogenic substances, like psilocybin, LSD, DMT, and MDMA, have shown promise in clinical trials, none are legally approved for therapy yet. 

Still, there are reasons to feel hopeful. In 2017, MDMA was granted breakthrough therapy status in 2017 by the FDA due to preliminary therapeutic value evidence for treating PTSD. It's expected to gain approval by 2023. Oregon legalized psilocybin in November of 2020, and it is decriminalized in Oakland, Denver, Ann Arbor, and Washington, D.C. However, it remains a Schedule I drug at the federal level, along with LSD and MDMA. Until the War on Drugs ends, compassionate therapists and facilitators may directly offer psychedelic-enhanced therapy at their own risk. And while psychedelic medicine is ideally used under professional supervision, plenty of people have experienced powerful healing from self-administration.

But back to cannabis: While Dr. Tishler recognizes that plenty of people combine cannabis and psychedelics without issue, he says that it's best to try psychedelic therapy first on its own because we don't know exactly what happens when they mix. "We don't know that much about how [psychedelics} work individually, rather than in combination. So I would be hesitant to recommend to anyone that they use these substances literally at the same time."

"THC, which is an entheogen, brings the heart to the table and your emotions forward."

While doctors tend to feel more comfortable with their patients trying one substance at a time until we have more research, plenty of anecdotal evidence shows that you can combine the two successfully. "THC can exponentiate the psychoactive experience with either ketamine or psilocybin," says Florencia Bollini, founder of NANA, a mental health organization that uses psychoactive integration. "It's a great blend as THC, which is an entheogen, brings the heart to the table and your emotions forward, which you don't necessarily get with ketamine alone." In addition, some patients confirm that cannabis can amplify the experience; however, whether that's positive or negative can depend on the dosage. 

"When macrodosing both psilocybin and LSD, I notice that cannabis can extend or potentiate the trip," says Olivia Alexander, CEO, and founder of Kush Queen. Alexander went viral on TikTok for sharing her psychedelic experiences. She notes that while taking cannabis while macrodosing can heighten visuals, when microdosing—or taking a very small amount of a psychedelic so as not to experience a full-on trip—adding cannabis can be a bit overwhelming. "I notice if I overuse cannabis, specifically THC, it can overshadow the benefits of the microdosing or make the dose stronger. I enjoy using full-spectrum CBD and delta 8 when microdosing as opposed to delta 9 THC," Alexander says. 

Aways approach consumption with responsibility, both for you and for the sake of advancing the psychedelic community. 

Ideally, if you're going to combine cannabis and psychedelics, discuss this decision with your doctor or therapist ahead of time. At the very least, make sure that you have a trusted friend or trip-sitter with you to navigate the process in case paranoia sets in. Psychedelics and cannabis are so riddled with stigma that you should always approach consumption with responsibility, both for you and for the sake of advancing the psychedelic community. 

"Regarding the mixing of medicines, my advice is to get familiar with each medicine individually before you begin combining them," Nicholas Levich, the co-founder and facilitator of Psychedelic Passage. "Try psilocybin therapy alone to see how your mind and body respond before adding in cannabis. While combining cannabis with psychedelics is usually not dangerous, the wide variety of strains of cannabis induce widely different effects that vary from person to person, and this can be hard to navigate." He also notes that high-THC strains can amplify the psychedelic effect and make it last longer, which confirms Olivia's experience. 

While we need more research on the pharmaceutical marriage of cannabis and psychedelics, there is one reality that everyone can get behind: The legalization of cannabis has helped usher in the wave of new research on other psychedelics. "Cannabis paved the way for the psychedelic renaissance that is currently taking place," points out Levich. Early evidence supports this claim. According to a survey conducted by USA Rx, 49% of respondents believe that marijuana provides better treatment options than currently available medications, while one in five say the same about all psychedelics. As research grows, that statistic is likely to skyrocket in the coming months and years. 

*And even FDA-approved ketamine therapy is a bit complicated: Most of the research supporting ketamine for depression is on infusions, which often consist of generic or racemic ketamine, a mixture of two mirror-image molecules, "R" and "S".  However, the only FDA-approved ketamine is in the form of the nasal spray Spravato (esketamine), which only contains the "S" molecule. Using generic ketamine is legal but is often used “off-label,” and patients typically come in for an initial six sessions and then return for boosters as needed.
Sophie Saint Thomas is a freelance writer based in Brooklyn originally from the US Virgin Islands. Her writing is published in GQ, Playboy, VICE, Cosmopolitan, Forbes, Allure, Glamour, Marie Claire, and more.