I was referring to those with long-lasting negative effects that persist for weeks, months, or even years after the trip.
These negative effects are frequently downplayed (or downvoted) in online discussions. They tend to be dismissed through victim blaming, such as suggesting that the person was unprepared, had latent psychiatric issues, or had improper set and setting.
The definition of "correct" preparation and set and setting seems to be defined as an impossibly high bar that few people actually follow. The impossibly high bar makes it easy to dismiss, ignore, or victim-blame the negative outcomes.
For example:
> All indications are that it is such an approach is what is responsible for the overwhelming positive outcomes of these studies, as opposed to the "acid casualties" that happen in informal, usually uninformed or even self-destructive casual use.
How many of the people reading this article or this comment section will be following the MAPS therapeutic protocol with trained professional supervision? Realistically, that number is zero. How many HN readers do you think are searching the darknet right now to buy some 5-MeO-DMT or Psilocybin for ad-hoc personal drug use under the belief that they are self-medicating? Probably quite a few.
Interested people are going to use these substances regardless, as the abject failure of the War on Drugs has shown, and in the internet age there's no effective way of keeping people from finding out about these substances. If anything, the information about them is going to get out way more effectively and faster than ever before.
We need to inform users of the risks of these substances along with their benefits, and safe ways to use them. If they then choose to ignore those ways, that's going to be their choice.
Right now there are ayahuasca circles and peyote ceremonies people could join, and underground psychedelic therapists they could go to.
Hopefully, when these substances are legalized there'll be more safe places where people could go and have their experience with trained, caring people.
I can state with complete certainty that trained, professional guides and clients in this kind of work are reading this article and this comment thread.
On the other hand, just because someone has a difficult experience it doesn't mean that on the whole the experience was detrimental. A lot depends on who the person is, what kind of help they have, and how they react to and integrate the experience.
This is much like reactions to difficult experiences in ordinary waking consciousness. One could go through an illness, for example, and come out of it stronger and with a greater value for the simple things in life you had taken for granted before. Or one could come out thinking "why me?", feeling sorry for yourself, feeling bitter at the world and life, or feeling persecuted.
In the MAPS therapeutic protocol that you mention (which is based on the work of Stanislav Grof), people are prepared for such difficult experiences, and if they happen are urged to stay with them instead of fightng them and trying to run away from them, to go deeper in to them, and afterwards are helped by trained therapists to deal with them integrate them.
All indications are that it is such an approach is what is responsible for the overwhelming positive outcomes of these studies, as opposed to the "acid casualties" that happen in informal, usually uninformed or even self-destructive casual use.