There remain significant gaps in knowledge about best practices for facilitated psychedelic care and psychedelic-assisted therapy. To inform the development of service models that support safe and beneficial experiences, this qualitative study explored expert perspectives on current and ideal standards of care, including key practices (e.g., screening, adapting care to diverse contexts) and regulatory and research challenges that influence service delivery. Online focus groups (n = 8) were conducted with a purposive U.S. sample of people with psychedelic content knowledge expertise, including providers (psychiatrists, clinical psychologists, addiction medicine experts, and licensed/unlicensed practitioners) and harm reduction specialists. Transcripts were analyzed through Thematic Analysis team-based coding using a combined inductive-deductive approach within a semantic framework. Participants (N = 38, mean age 47 (SD = 10) years, 53 % women, 84 % white) had an average of 10 years of psychedelic service experience (SD = 11) across diverse settings, including festivals/events, service centers, and clinical, research, ceremonial, community and ‘underground’ contexts. Five key themes emerged: (1) ‘Strengthening Safety through Credibility and Accountability’; (2) ‘Advancing Culturally Responsive and Inclusive Psychedelic Care’; (3) ‘Healing in Community: The Crucial Role of Ongoing Support and Integration’; (4) ‘Ensuring Safe Psychedelic Use: Preparation, Screening, Vulnerability, and Medication Management’; and (5) ‘Providing Informed Guidance and Navigating Legal and Informational Gray Areas.’ Overall, results underscore the need for stronger provider accountability structures, culturally inclusive practices, accessible and integrated community support, robust safety and screening protocols, and clearer guidelines to help providers navigate legal complexities, ensure safety, and optimize outcomes across diverse populations.
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