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Hippie flips, candy flips, kitty flips, jedi flips... With names that sound more like skateboard tricks than psychedelic protocols, the world of medicine “stacking" can be as intriguing as it is intimidating. But is it really wise to be mixing such powerful substances like some kind of pharmacological cocktail?

For this issue of "Ask a Guide Anything," we posed this question to our network of practitioners: When, if ever, does it make sense to combine or "stack" different medicines?

Here's what they had to say.

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Intention over intensity

Multiple practitioners said stacking should be purposeful, not simply about intensifying effects. Joanne DeGarimore puts it plainly: "I feel stacking is about intentions, not about intensity. The medicine responds to purpose." Similarly, Gv Freeman only combines medicines "when I can help a client relax their psychological defenses to soften the path for the actual medicine to start working."

The classic combination mentioned by several guides is MDMA with psilocybin (i.e., the aforementioned “hippie flip”). John Moos explains why it works: "This combination is great because it's safe, predictable, and when timed correctly, can mute the unpleasant onset of psilocybin so that the safe, secure, heart-centric space you find yourself in with MDMA can seamlessly crossfade into the deeply introspective, visual, and spiritual side of the psilocybin."

Jill Sitnick shares a powerful personal example: "In healing my own PTSD from childhood trauma using MDMA, my therapist and guide suggested adding psilocybin to the journey. When my inner child was unable to leave her mental childhood home of abuse, my guide gave me a low dose of psilocybin. It made all the difference."

Relationships and respect

Several practitioners stressed the importance of understanding each medicine individually before combining them. Azalea Montaño-Kemp offers a beautiful perspective from Indigenous traditions: "Every plant and every medicine has its own spirit—its own energy, its own personality. Before taking different medicines together, we must get to know their spirits first."

This relational perspective shifts the question entirely. As Azalea suggests, we should ask "do these medicines want to commune together in my body?" rather than "should I take both medicines?". This approach honors the medicines as teachers rather than simply substances.

Carla Detchon explains the practical reasons for this approach: "Stacking medicines allows access to different neurotransmitters and different somatic centers in the body. MDMA, for example, is felt in the heart center. LSD, with its visioning capabilities, often opens access to the upper energy centers. Mushrooms, because they live underground, often target the lower energy centers."

Wallace Murray reminds us that "most Indigenous entheogenic traditions prize relational depth with a single plant at a time," so keep in mind that contemporary stacking is a recent phenomenon.

Caution and expertise

Nearly every practitioner pressed for caution, expertise, and support when stacking medicines. Ben Askins warns: "Stack if you must, but remember that you're juggling grenades, not glowsticks. Do it to deepen the excavation, not decorate the walls of your cell."

Karl Christopher stresses that "the health and well-being of the client is paramount" and advises that stacking should only be done "when a practitioner has a thorough experiential knowledge of the individual medicines, and has researched and consulted others about the effects."

Oxana Kirsanova offers a firm reminder: "This should never be casual. Mixing substances without deep knowledge and guidance can pose serious risk. Plant medicines are already powerful on their own." And Kala Hall takes an even more conservative stance: "As ayahuasca facilitators, we honor Mama Aya as a sacred sacrament and believe the deepest healing happens when the spirit of each plant is engaged purely."

Our take

When it comes to stacking medicines, we're in the "less is more" camp, unless you really know what you're doing (or are working with someone who does). Non-psychedelic medicines count, too, by the way. It’s important to understand any interactions or contraindications with your existing medications. (Here’s a 100% HIPAA compliant and confidential tool you can use to do your diligence.)

That said, stacking can clearly be valuable in the right context. Whether you're working with one medicine or ten, just remember that these are potent substances deserving of respect, caution, and proper preparation and integration.

Thanks to Stephen T. for submitting this week’s question. 🫠

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.