Harm Reduction Guide for Low-5 Pens
The Pattern Project
Harm Reduction Guide for Low Dose 5-MeO-DMT Vape Pens
CONTENTS
DISCLAIMER
BACKGROUND
GENERAL SUMMARY
SCREENING
PREPARATION AND SELF-ADMINISTRATION
MANAGING THE EXPERIENCE
IN CASE OF ADVERSE EVENTS
CONCLUSION
EXPERIENCE SURVEY
GLOSSARY
REFERENCES
APPENDIX
ENDNOTES
Disclaimer
This guide is a starting point for harm reduction education on low dose 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT). It is based on a review of scientific literature, grey literature, which includes a pharmacology safety guide, education materials on 5-MeO-DMT, and case reports, as well as interviews with psychedelic facilitators and science and healthcare professionals on 5-MeO-DMT best practices (see appendix).
It is important to note that there is a limited amount of data on low dose 5-MeO-DMT, and its effects on humans. As such, readers must understand this guide is not exhaustive or conclusive. Anyone who uses 5-MeO-DMT or any psychedelics does so at their own risk. The authors do not recommend using any substance without close medical supervision, and as such, are not responsible for any consequences of the use of psychedelics or substances by readers of this guide or otherwise. Always adhere to your local laws. As new information becomes available, the authors will update this guide periodically.
Background
5-MeO-DMT is a psychedelic compound found in various plants1–3 and the secretions of a toad species.4 It was first synthesized in a lab in 19365 and it belongs to the same class of psychedelics as psilocybin, known as tryptamines.6
5-MeO-DMT is known for its potency and short-lasting effects, and is unique among tryptamines for its strong affinity for serotonin receptors 5-HT1A and 5-HT2A7 and its mild serotonin reuptake inhibiting properties.8 It is also considered an ‘entheogen’, meaning that with the correct set and setting, it can elicit experiences with mystical and non-dual qualities.9–12
The compound is used in retreats internationally,13–15 and is under investigation in several clinical trials to treat mental health conditions, such as treatment-resistant depression, bipolar disorder, and alcohol addiction.16–18 For example, in a recent open-label* trial (n = 16), those with treatment-resistant depression experienced rapid antidepressant effects, with most in remission by day 7.18 In addition, observational studies have noted its use is associated with reduced symptoms of anxiety, depression, trauma, and substance use issues, and can enhance mindfulness and quality of life.9,19
Most retreats and research use doses above 3 milligrams (mg) when smoked or vapourized, requiring close supervision of users for safety. This guide, instead, focuses on harm reduction for vapourized doses well below this threshold — where users can experience enhanced mindfulness and therapeutic insights while remaining grounded and in control.20 This is known as low dose 5-MeO-DMT.
General Summary
A low dose 5-MeO-DMT vape pen is a device that delivers a dose of 2mg or less of 5-MeO-DMT when vapourized. This dose is considerably lower than most 5-MeO-DMT vape pens which deliver a high, potentially hazardous dose of 5-MeO-DMT in the 5mg to 15mg range. A dose that is less than 7% or 20% of these amounts could be considered a microdose or low-dose, and therefore may be safer than a much larger dose.21–23
While the authors recognize that vapourizing compounds can impact physical health,24,25 vape pens have harm reduction benefits that allow users to 1) safely administer 5-MeO-DMT themselves, 2) have less health harms than smoking, and 3) can be calibrated for low-dose use.26–28
These low-dose pens should always be kept out of reach of children and vulnerable individuals. In addition, they should never be shared without someone’s consent and knowledge of potential health risks.
Your health and wellness may be at risk if you vapourize low dose 5-MeO-DMT and are:
Pregnant or breastfeeding
Have a current or past respiratory condition or negative reactions to vaping products
Not in good physical health (see Screening - Medical history)
Experiencing certain mental health conditions, or have a personal or family history of these conditions (see Screening - Mental health conditions)
Are on certain psychoactive medications, including, but not limited to, Monoamine Oxidase Inhibitors (MAOIs) or Lithium (see Screening - Medications)
Do not use a a low dose 5-MeO-DMT vape pen if:
You do not know the strength of the pen
You do not trust if the pen only contains 5-MeO-DMT, a liquid carrier it is dissolved into, and no other contaminants
Start with a 1 or 2-second dose at first:
To determine if you are sensitive to 5-MeO-DMT
To find the lowest dose where you feel the compound while remaining in control of your mental and emotional faculties
Do not use low dose 5-MeO-DMT:
In combination with alcohol or other drugs
In a “party environment” where others are intoxicated
When operating heavy machinery or a motor vehicle
Screening
The following information is based on Dr. Ben Malcolm’s Five Guide: Pharmacology and Drug Interactions of 5-MeO-DMT.29
1. Medical history
Do not use 5-MeO-DMT if you are pregnant or breastfeeding.
Do not use 5-MeO-DMT if you have any of the following medical conditions:
A respiratory condition that significantly impairs lung function
Allergies or past negative reactions to vape pen ingredients or related products
Cardiovascular disease that is advanced or not well-controlled, such as an irregular heartbeat, heart failure, coronary artery disease, angina, myocardial infarction, stroke, transient ischemic attack, or bleeding and clotting conditions
High blood pressure that is not well-controlled
Liver or kidney disease or failure
Epilepsy or seizures
Traumatic brain injury
Tumours in the central nervous system
Terminal illness
2. Mental health conditions
Do not use a pen if you have a personal or family history (i.e. first-degree relative) with:
Psychosis or a psychotic disorder (e.g., schizophrenia, brief psychotic disorder, schizoaffective disorder, psychotic depression)
Bipolar disorder or recent mania
Do not use the pen if you have a personal history of:
Dissociation
Current or recent suicidal thoughts or a plan to harm yourself or others
Unresolved impulse control issues that cause difficulties in your life
Any other moderate to severe mental health or addiction issue that is not well managed and/or impacting your ability to function in daily life
3. Medications
5-MeO-DMT can be dangerous when taken in combination with certain medications and substances, including, but not limited to, medications that affect the serotonin system in the brain. For example, the risk of serotonin toxicity – a potentially life-threatening condition – increases when 5-MeO-DMT is taken with MAOIs.7,30 Likewise, seizures can occur if 5-MeO-DMT is taken with Lithium. These medications should therefore never be taken with 5-MeO-DMT.
It is important to note that the potential for serotonin toxicity increases when 5-MeO-DMT is combined with multiple serotonergic medications or substances, especially if MAOIs are involved (see table below). However, in most cases, if MAOIs are not involved and only a single serotonergic medication is being used, serotonin toxicity is less likely to occur. Instead, the effects of 5-MeO-DMT may increase or decrease, and/or cardiovascular responses may occur.29
It is strongly recommended that individuals consult with a qualified medical professional before making any decisions related to the concurrent use of medications or substances with 5-MeO-DMT. There is limited research on the topic of 5-MeO-DMT drug interactions and so the information provided below should be considered preliminary and interpreted with caution (for more information on contraindications, pharmacokinetics, and drug interaction management, please see 29,30).
Use of 5-MeO-DMT with the following medications or substances can cause harm. Using a 5-MeO-DMT vape pen with medications or substances in the ‘High’ risk category can be life-threatening.
Lastly, there is limited information on the relationship between 5-MeO-DMT and women’s health. However, consultations with an experienced facilitator note that the intensity of effects, as well as the potential for adverse events, can vary based on a woman’s menstrual cycle.23
Preparation and Self-Adminstration
The following information is based on interviews with experienced facilitators who lead retreats with 5-MeO-DMT27,31 and those who have developed meditation practices using low dose 5-MeO-DMT.28,32
Preparation
1 - Ensure a conducive setting
When planning any session with psychedelics, the setting can contribute to the quality of the experience. Here are some key factors to consider when choosing the ideal location:
Stillness: If you take a low dose in the middle of a busy room, all the external stimulation may distract from connecting with the internal experience of 5-MeO-DMT and could lessen the effects of the compound. In contrast, the same person taking the same dose in a calming environment may feel the effects more strongly.
Privacy: Be sure to select a location where you are unlikely to be interrupted or disturbed. Interruptions can potentially disrupt the flow of the experience and also cause anxiety for first-time users. However, make sure that you can be contacted in case any issues arise and you require support.
Communicate: Inform others around you that you will need privacy during your session.
Comfort: Create a cozy and safe environment by including soft lighting, comfortable seating, and cushions or blankets.
Upright seating: To gauge your sensitivity, it is recommended to maintain an upright sitting position. You can arrange a cushion or space on the floor with back support, or use a comfortable chair large enough to support yourself should you slump over.
Safety: Make sure the location is safe and free from potential hazards. Remove any objects that may cause injury or accidents, and ensure easy access to essential items such as water and a restroom. It is recommended to avoid eating before use to limit any potential nausea.
By carefully considering these factors and creating a supportive, interruption-free setting, you will likely be better prepared for a low dose 5-MeO-DMT experience.
2 - Ensure a conducive mindset
According to interviews with participants at a 2022 meditation and low-dose 5-MeO-DMT retreat,15 stillness and mindfulness can play an important part in preparing for low dose 5-MeO-DMT. Engaging in calming and centering activities before taking a low dose may lead to more profound and significant trips.
In addition, breathwork,33 gentle movement,34 and meditation35,36 can help facilitate mental clarity and emotional balance, enhancing the potential for a more immersive and transformative experience.
Some individuals choose to incorporate a combination of these practices, creating a personalized pre-low dose routine that suits their needs and preferences. The intention behind these activities is to cultivate a relaxed and receptive mindset, which may lead to a more meaningful and memorable low dose experience with 5-MeO-DMT. By taking the time to prepare, you can optimize the psychedelic journey and maximize the potential benefits of low dose use.
The following elements may help contribute to a calm state of mind:
Music: Calming instrumental music may enhance the low dose experience by promoting relaxation, guiding emotions, and creating a positive atmosphere. It can encourage mindfulness, provide structure, and facilitate reintegration, making it a valuable aid during 5-MeO-DMT sessions.
Eye mask: Using an eye mask during low dose experiences helps to block out external stimuli, allowing you to focus inward and fully immerse in the 5-MeO-DMT journey. It may promote introspection, enhances visuals, and fosters a deeper sense of relaxation, making it a beneficial accessory for these sessions. However, it is recommended to only use an eye mask after gaining familiarity with the effects of a low-dose experience.
Using pillows, blankets, and cushions can create a comfortable and relaxing environment for low dose 5-MeO-DMT. Soft and supportive cushions can help with body relaxation and reduce physical discomfort during the trip.
Stretch space: Having a space to stretch during a 5-MeO-DMT session can be beneficial if you wish to deepen your mind-body connection.
Self-Adminstration
1. Do not administer to others
A low dose pen is only for the use of its intended user who understands the risks of use. One should not share the pen or administer its content to others.
2. Begin with a pretend run
Exhale completely and deeply.
Pretend to inhale through pursed lips.
Hold for as long as it is comfortable (don’t strain).
Exhale.
Close your eyes and be still. Observe your breathing. Observe the nature of the darkness you see with your eyes closed. Observe how aware you are of your body. Take a mental note of this normal, sober state of consciousness. We will refer to this state as your “baseline”.
Tips:
Remember, most vape pens take at least 1 second to warm up and activate.
After inhaling, breathe normally. Holding the vapour isn't necessary and can disturb your meditation.
If you find it difficult to inhale, adjust the pen's mouthpiece by turning it 90 degrees. This allows some air to flow in from the sides during inhalation, making the process smoother.
3. Determine if you are sensitive to 5-MeO-DMT
It is important to keep in mind that you are using a powerful psychedelic and that the strength of the dose is related to 1) the potency of the pen and 2) how long you inhale from the pen. This is because a fraction of users may be sensitive to 5-MeO-DMT. If you are sensitive, you will require very little 5-MeO-DMT to experience benefits, and could experience a trip that is disorienting if you were to inhale a dose that is too strong on your first try.
Signs that you are sensitive to 5-MeO-DMT can include:
It is challenging to keep your eyes open after a 1 or 2-second inhalation
It is challenging to sit upright after a 1 or 2-second inhalation
A person that is sensitive to 5-MeO-DMT, with a pen that is too strong and who does not use the low and slow method of administration (listed below), is at risk of:
Purging
Loss of control
Blackout / Loss of consciousness
Other effects associated with macro doses of 5-MeO-DMT that are beyond the scope of this guide. For more information, please see: https://five-meo.education/risks-and-cautions/ 37
Your Choice of Vape Pen Can Influence Your Level of Risk
A concern at The Pattern Project is the strength of 5-MeO-DMT vape pens. Most are three or more times stronger than what is required for mindfulness. Factor in the possibility that an individual could be sensitive to 5-MeO-DMT, and the potential exists that – without a safety-oriented dosing strategy – a sensitive individual is taking an unnecessary risk.
From a safety perspective, consider using a pen that delivers 0.5mg or less of 5-MeO-DMT with each five-second inhale. This dose of pen contains 50mg or less of 5-MeO-DMT in a 0.5mL cartridge.
Go low and slow
Once you are certain of the strength of your pen, start with the smallest possible dose and gradually increase over time, if you are comfortable and feel it is safe. This approach allows you to gauge your body's response, potentially minimizing the potential for overwhelming experiences. It allows for a safer exploration of 5-MeO’s effects by enabling you to find an optimal balance between mindfulness benefits and comfort.
First-time dosing
Avoid pushing the dose higher and higher on your first try. Find a dose where you feel a beneficial effect and yet feel in control throughout.
Start conservatively with a 2-second inhalation of a low dose pen (0.5mg or less per 5-second inhalation). If the dose is strong enough, you will feel an immediate effect. If it is too low, you may feel nothing.
Wait at least 10 minutes. (It takes between 10 to 20 minutes for the majority of the 5-MeO-DMT to clear your bloodstream.)
Decide if the dose you just took was sufficient. If so, take another of the same dose again. Otherwise, if you're comfortable, inhale for an extra second. For example, if last time you inhaled for 2 seconds, this time inhale for 3 seconds.
Stay with your current dose or increase the dose gradually, allowing for at least 10 minutes between doses.
Stop when you reach a dose that feels beneficial and where you continue to feel in control of your mental and emotional faculties. Write down your ideal inhalation time in seconds. This will serve as a helpful benchmark for future use.
Considerations for subsequent use
Do not assume that every experience will be the same at a given dose. Your intention, setting of use, and other internal and external factors can impact what you experience. The battery strength of a pen and the strength of your inhale can also affect the dose. Therefore, always use an approach where you start low and increase slowly.
Frequency of later sessions
At present, there are no conclusive guidelines on how often one can safely take low dose 5-MeO-DMT. As such, this guide is unable to offer any cited guidance or reference to assist users.
What is known is:
Case reports from the 5-MeO-DMT community indicate that with consistent use, sensitivity to 5-MeO-DMT may increase, requiring less of the compound for an effect to be experienced.28,31
Clinical research studies have explored the safety and therapeutic benefits of short-term use of up to 18mg when vapourized with specific clinical populations.17,18
While this may lead one to consider it safe to use low dose 5-MeO-DMT, there has yet to be any low-dose specific safety evaluations, and the effects of long-term use are unknown. Additionally, regular microdosing of some psychedelics (e.g., every few days over several months) may be associated with an increased risk of heart valve disease.39,40** Before considering any use of 5-MeO-DMT, always consult with a qualified healthcare professional knowledgeable about its potential risks and benefits.
Managing the Experience
Once you have found your low dose, you can expect a typical experience to have a 3-minute ascent which may be intense. This may then be followed by a 7 to 15-minute calming descent as the medicine metabolizes and leaves your system.
Possible range of experiences
To prevent any unnecessary anxiety, here is a list of what you might expect during a low dose 5-MeO-DMT experience.20,22,23
Commonly experienced:
Feeling a sense of calm, relief, and being present in the moment
Feeling absorbed in whatever is catching your attention, such as sounds, sights, smells, your breath, or your heartbeat
Experiencing vivid daydreams or memories
Seeing geometric shapes, light, or fractal patterns that could include mystical qualities
Heightened awareness of your body, such as hearing your heartbeat loudly or feeling like you are inside of your breathing
Feeling less sensation in your body, such as experiencing numbness in your hands or feeling like your breathing is far away
Less common experiences:
A feeling of falling away, which can be unsettling or anxiety-inducing
Feeling the desire to move your body for movement's sake. This could include autonomous expression or movement, such as tearing eyes or a smiling mouth
Coughing or burping
Passing headache
A metallic taste or feeling in one’s mouth
Slight clenching or chattering of the teeth
Mild nausea that is short-lasting
Strong psychological and emotional experiences can also surface during the experience. These can be insightful and beneficial, however, they can also be challenging if unexpected, and even overwhelming for some. For example, some individuals have reported a heightened awareness of their anxiety, and although the sensations were challenging, this led to gaining a new perspective on their mental health.
If you are prone to nausea, it is recommended to fast for at least 2 hours before use.
As detailed above, a person who is sensitive to 5-MeO-DMT, with a pen that is too strong and who does not use the low and slow method of administration, is at risk of:
Purging
Loss of control
Blackout / loss of consciousness
Reactivations***
Grounding anxiety
Some individuals are prone to anxiety attacks. If you are too, it is important to have a routine in place to ground yourself, if needed. As 5-MeO-DMT can become more potent with stillness, one way to reduce the intensity of the experience is to stimulate yourself by opening your eyes, moving, or speaking out loud. If you don’t have a routine to deal with anxiety, try using the 5-4-3-2-1 method.42
The 5-4-3-2-1 method
Identify five things you can see around you. Say them out loud.
Find four things you can touch. Say them out loud.
Find three things you can hear. Say them out loud.
Find two things you can smell. Say them out loud.
Find one thing you can taste. Say that out loud.
This process can help you focus on the present moment by engaging with your senses, potentially dampening the effects of the 5-MeO-DMT and redirecting your attention away from anxiety.
It's important to keep in mind that the effects of low dose 5-MeO-DMT are most intense for the first couple of minutes before gradually easing off.
In Case of Adverse Events
The authors, in reviewing research for this guide, are not aware at the time of writing, of any reported serious adverse events requiring medical attention or hospitalization from the self-administration of low dose 5-MeO-DMT.9,17,18,22,27,28,31,32,43–45 However, a lack of reported serious adverse events does not guarantee safety. It is possible there are instances of serious adverse events of which the authors are unaware or have not been publicly disclosed. Therefore, it is recommend to exercise an abundance of caution:
Have an emergency contact available before trying 5-MeO-DMT.
If an emergency occurs, call 9-1-1 (or the local emergency phone line in your area) and go to a hospital or emergency department for medical support as soon as possible. Don’t be afraid to explain what you have taken.
Notify a healthcare provider if any adverse events persist.
In case of an experience involving anxiety:
Open your eyes to dampen the effects.
Use relaxation techniques to calm your mind and body (e.g., slow, deep breathing, the 5-4-3-2-1 method).42
Contact someone you trust (e.g., family, friends) for support.
You can find support specific to those seeking help integrating a 5-MeO-DMT experience at https://five-meo.education/46
Conclusion
The information provided throughout this guide is intended to enhance safety and knowledge regarding low dose 5-MeO-DMT. By emphasizing responsible practices, informed decision-making, and a thorough understanding of potential risks, the authors aim to empower individuals to learn about low-dose use of this compound in a mindful and harm-reducing manner. Always prioritize your well-being, adhere to local laws, and consider seeking professional guidance when needed. A comprehensive understanding of harm reduction is key to fostering a positive and intentional relationship with psychedelics. May your explorations be informed, safe, and transformative.
If you have any advice for improving this guide, or an interest in contributing a low dose 5-MeO-DMT article for The Pattern Project, please email hello@patternproject.ca.
Experience Survey
Due to the limited amount of research on low dose 5-MeO-DMT, the authors are collecting data on individuals’ experiences. If you have tried low dose 5-MeO-DMT, please fill out the brief survey linked below.
Click Here For Experience Survey
The survey is anonymous and confidential. All data collected will be used to understand subjective experiences, safety, and potential applications of this compound.
Glossary
5-MeO-DMT: A potent psychoactive compound found in certain plants and the venom of the Colorado River toad. It is chemically similar to DMT but has its own unique effects and safety profile.
Baseline: A term used to describe a person's normal state of being without the influence of any substances.
Harm reduction: Strategies, policies, and practices designed to minimize the negative impacts and harms associated with substance use.
Lithium: A type of medication commonly used to treat bipolar disorder. It is contraindicated with 5-MeO-DMT use.
Low dose: A quantity of a substance that is smaller than a typical recreational or therapeutic dose, intended to produce milder effects. In the context of 5-MeO-DMT, this refers to 2mg or less when vapourized.
Microdose: A dose of a substance that is small enough to provide benefits without a perceptual, psychedelic experience.
Monoamine Oxidase Inhibitors (MAOIs): A class of drugs that inhibit an enzyme that breaks down certain neurotransmitters. They are commonly used as antidepressants and are contraindicated with 5-MeO-DMT use.
Pen (or vape pen): A device used to vapourize substances for inhalation.
Psychedelic: A class of substances that produce changes in perception, mood, and various cognitive processes.
Serotonin: A neurotransmitter in the brain that affects mood, emotion, and sleep, among other functions.
Serotonin toxicity: A potentially life-threatening condition caused by an excess of serotonin in the brain. It can be caused by the use of certain drugs, including some antidepressants and psychedelics. Symptoms can be mild (e.g. nausea, shivering) to severe (e.g. seizures, high fever).
SNRIs (Selective Serotonin-Norepinephrine Reuptake Inhibitors): A class of drugs commonly used as antidepressants. They work by increasing levels of serotonin and norepinephrine in the brain.
SSRIs (Selective Serotonin Reuptake Inhibitors): A class of drugs commonly used as antidepressants. They work by increasing levels of serotonin in the brain.
Trip: A term commonly used to describe the experience of being under the influence of a psychedelic substance.
Tryptamines: A family of compounds that includes 5-MeO-DMT, psilocybin, and others. They share a common molecular structure and often have psychedelic properties.
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Appendix
Quality assessments
Due to limited research on low dose 5-MeO-DMT, the authors consulted with, and cited, communications on best practices with experienced psychedelic facilitators and science and healthcare professionals who work with psychedelics.
To assess the quality of the information obtained, the authors independently rated the likelihood of the information having a risk of bias. If there were disagreements between raters’ scores, they were resolved through discussion until a consensus was achieved. Only communications that were rated as having a low risk of bias were cited.
1) Quality criteria for psychedelic facilitators were based on:
Relevant professional background for working with psychedelics (0-2 points)
The number of years worked with 5-MeO-DMT (0-2 points)
The number of clients served with 5-MeO-DMT (0-2 points)
Whether they have training on psychedelic harm reduction and safety (0-1 point)
The credibility of the information provided and the ethics of their practice (0-2 points)
These quality ratings provided a maximum score of 9 (see table 1). Scores of 0-3 indicated a high risk of bias, scores of 4-6 indicated a medium risk of bias, and scores of 7+ indicated a low risk of bias.
2) Quality criteria for science and healthcare professional who work with psychedelics were based on:
Relevant professional background for working with psychedelics (0-2 points)
Whether they have training on psychedelic harm reduction and safety (0-1 point)
Whether they have training in pharmacology (0-1 point)
If relevant, whether they have they published peer-reviewed literature or community-respected education materials on 5-MeO-DMT (0-1 point)
The credibility of the information provided and the ethics of their practice (0-2 points)
These quality ratings provided a maximum score of 7 (see table 2). Scores of 0-3 indicated a high risk of bias, scores of 4-6 indicated a medium risk of bias, and scores of 7+ indicated a low risk of bias.
Endnotes
*Open-label refers to both participants and researchers knowing what study medication is administered.
** The risk of heart valve disease is associated with the activation of serotonin receptor 5-HT2B.38
*** Reactivations are re-experiences of 5-MeO-DMT’s perceptual, emotional, or sensory effects. Individuals have reported their occurrence as positive, neutral, or negative. They are associated with macro doses,41 and to the authors’ knowledge, have not been reported with low-dose use.