Steve has cops in his family, so he doesn’t tell many people about his work as an underground psychedelic guide. The work takes up a significant amount of his time – around once a week, he’ll meet a client in their home or in a rented home, dose them with MDMA or hallucinogenic psilocybin mushrooms, and sit with them while they trip for up to 10 hours – but he doesn’t tell his siblings, parents or roommates about it, nor his fellow psychology PhD students.

They would probably never guess, either: Steve doesn’t display any signs of involvement with a stigmatized counterculture that many Americans still associate with its flamboyant 1960s figureheads. He’s a bespectacled, soft-spoken former business school student who plays in a brass band and works part-time as an over-the-phone mental health counselor. After one glass of wine, he says: “Whoa, I’m feeling a little drunk.”

But if you probe, he might tell you about the time he took psilocybin and a “snake god” entered his body and left him convulsing on the floor for an hour. (The snake god was benevolent, he says, and the convulsing was cathartic, “a tremendous discharge of anxious energy”.)

In early October, Steve attended a Manhattan conference called Horizons: Perspectives on Psychedelics, which bills itself as the world’s “largest and longest-running annual gathering of the psychedelic community”. I went with my 51-year-old cousin, Temple, a relatively mainstream psychotherapist. She had come to learn more about psychedelic-assisted psychotherapy, which underground guides like Steve facilitate illegally. She hopes to incorporate this type of therapy into her practice if and when substances such as psilocybin, MDMA, LSD and ayahuasca become legal.

Like many attendees, Temple had recently read How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, a bestselling 2018 book by Michael Pollan. It convinced her that psychedelic-assisted psychotherapy “might really be the way of the future”.

Indigenous people are believed to have used plant-based psychedelics for millennia; now, factions of the western medical establishment seem to be catching on. But most psychedelics are still Schedule I controlled substances, in the same category as heroin and cocaine; possession or sale has been punishable by prison sentence since 1971. With rare exceptions, the only way you can legally consume psychedelics in the US is as a participant in one of a few clinical research trials conducted at universities such as New York University and Johns Hopkins.

These studies have yielded astounding results: they suggest that, when administered to carefully screened patients by trained health professionals, psychedelics are safe and potent tools for alleviating PTSD, addictions, cluster headaches, anxiety and depression.

Amid a broken healthcare system and rising rates of opioid addiction and suicide, Americans are searching for alternative paths to healing, which is where underground guides come in. The industry has its share of charlatans, but many guides hold themselves to ethical standards and protocols comparable to those established in clinical settings.

Unlike psychotherapists, however, underground guides have no accredited educational institutions, no licensing and no way to publicly market their services. How, then, does one make a career as a guide?

Steve was one of many guides I spoke to who described feeling spiritually “called” to do this work. Like doctors who provided abortions pre-Roe v Wade, he breaks laws that he believes are unjust; he considers legal violations a risky but necessary part of his quest to alleviate people’s pain. He charges on a sliding scale that ranges from around $15 to $50 an hour.

As is the case with most guides, his own psychedelic experiences convinced him the job was worth the risk.

“During an early guided psilocybin session, I realized I’d never adequately dealt with the pain caused by my parents’ divorce,” Steve says. “There was clearly still this 11-year-old part of myself that was like, ‘I want to be part of a coherent family unit.’ During the experience, I was given this vision – there’s no way to say this that doesn’t sounds silly – but there was this mother figure who was like, half-Vedic goddess, with a million arms and a million eyes, and half-space alien, with gray skin. She was this space mother, surrounded by this space family, and she just beamed to me this incredible welcoming feeling of, this is the divine family that you stem from.”

In addition to keeping quiet about his work, Steve uses an encrypted messaging app to communicate with clients – precautions he takes to avoid the kind of legal trouble that has befallen some underground guides, such as Eric Osborne, a former middle school teacher from Kentucky.

The felon-turned-psilocybin retreat entrepreneur

On a July afternoon in 2015, state troopers showed up at Eric’s gourmet mushroom farm in Indiana with search warrants.

They searched his house, then trawled through his mushroom fruiting chambers, inspecting racks of shiitakes, turkey tails and reishis, which he sold to upscale local restaurants. Eric was confident the police would find nothing incriminating there – he grew his psilocybin mushrooms far from his restaurant-bound crops – but when he saw them heading towards the woods on his property, he panicked.

Two nights earlier, Eric and his then fiancee had sat around a campfire with a new friend, all tripping. A self-described “recovering Catholic” with a southern drawl who, in 2009, became Indiana’s first state-certified wild mushroom expert, he had been offering underground psilocybin therapy sessions for years. (He has no formal training in psychology; he says the mushrooms, which he’s consumed at high doses around 500 times, are his teachers.)

The friend had hoped a session might help resolve a years-old trauma. After the mushrooms took effect, she went to lie down in her tent. Minutes later, Eric saw a glow of headlights through the trees. As a safety precaution, he had hidden the woman’s car keys in the house, but now, her car was speeding down his driveway.

“My heart just dropped,” Eric says. “I was sure she was going to die.”

Eric and his fiancee spent 14 hours searching for her before she texted, saying she was safe. She had crashed into a ditch near the farm after retrieving a spare key hidden under her car’s transom. No one was hurt, but after police found her, disheveled, she told them everything about Eric’s psilocybin operation to avoid being charged with drug possession.

“I knew the cops were coming for me,” Eric says. Before they arrived, he stashed a pound of dried ‘Mr E’ psilocybin mushrooms – a unique strain he had bred and named himself and didn’t want to lose – inside a hollow log in the woods.

Somehow, the police managed to find it: “That was the end, there.”

He spent a week in jail contemplating the effects of the drug war on the mental healthcare system. “The horrible irony was, I sat in this cell with people who had drug addictions that psilocybin can help remedy,” he says. After being released, he was put on house arrest with an ankle monitor for eight weeks, forbidden from speaking to his fiancee, whose parents had bailed her out of jail after a day. He was facing a minimum of 10 years in prison for each of three B-felony charges – Schedule I substance manufacturing, distribution and possession.

“The night our friend drove off was the most terrifying, gut-wrenching moment of my life, but in the eight weeks that followed, when I sat on those 87 acres alone, there were moments of complete despair. I had to take my shotguns to a neighbor,” he says. “I have uncles who were cannabis growers who spent years in prison. I was certain I’d follow in their path.”

The judge at his trial was mercifully liberal, however. The B-felonies were pleaded down. Eric was convicted of “maintaining a common nuisance” and sentenced to two and a half years probation.

“Yeah, that’s what I do – ‘maintaining a common nuisance’,” he says. “I’ve turned it into a career now.”

He’s not joking: in October 2015, instead of quitting the mushroom world, he founded MycoMeditations, an above-board psilocybin-assisted therapy retreat center in Jamaica, one of the few countries where psilocybin is legal.

“I felt I had no other option,” he says. “The landlord kicked me off the farm, I was working in a Louisville restaurant – I couldn’t go back to teaching with a felony – so I just pushed full speed into this. I felt like the medicine was so needed that I couldn’t not do it.”

In the three years since, about 400 people from around the world have attended MycoMeditations’ seven- to 10-day group retreats in Treasure Beach, on Jamaica’s remote southern coast. Guests trip on psilocybin every other day in a fenced-in field surrounded by mango and coconut trees. “All I do is just sit there with people, supporting them silently, sometimes holding their hands,” Eric says.

While every guide has a unique approach, above-board and underground psychedelic-assisted therapy tends to follow a similar structure. Before a trip, clients have preparatory therapy sessions with guides, discussing their mental health issues and intentions for treatment. (Some guides won’t work with people who take psychiatric medications; they caution that prescription antidepressants can have potentially dangerous interactions with certain psychedelics, especially ayahuasca.)

During the trip, guides sit with the client, ensuring their safety, and, if necessary, helping them navigate what researchers call “difficult struggle experiences”.

“What we find in talking with patients is that this ‘difficult struggle’ is not a bug in the experience, but actually a feature,” says Dr Alex Belser, who co-founded the psychedelic research team at NYU in 2006. “When they take these medicines, people go into difficult places – they deal with past grief, trauma and suffering, and feel those feelings intensely, for a time … Without a strong sense of safety and trust with a therapist, that may lead to what’s been called a ‘bad trip’. But if there’s enough intention put into supporting that experience, it’s the beginning of an arc of healing that can lead to something extraordinary.”

After a trip, guides facilitate “integration” sessions, in which the client strives to incorporate lessons from the experience into their everyday lives. At MycoMeditations, after integration sessions, guests get massages and swim among sea turtles and coral reefs.

One attendee, a stage four cancer patient, felt so healed by the retreat that she donated a year’s salary to Eric, which allowed him to quit his job at the Louisville restaurant – he had been splitting his time between Jamaica and Kentucky – to focus full-time on the center. “Now she’s in remission, traveling the country fly-fishing in her Mercedes Winnebago,” Eric says. “Miracles are becoming – not mundane, but pretty normal around here.”

The social worker-turned-medicine woman

I meet Hummingbird at Alice’s Tea Cup, an Alice in Wonderland-themed cafe in Manhattan. Wearing a lavender shawl and a gold turtle-shaped brooch, Hummingbird matches the decor. One of six children of Cuban immigrant parents, she calls herself a “medicine woman”; her approach to guiding is ceremonial rather than clinical.

As a teenager in New Jersey in the 1980s, she was a star cheerleader and an enthusiastic participant in the Drug Abuse Resistance Education (Dare) program. Since age 10, she’d dreamed of becoming a social worker; after getting her master’s, she “tried basically every social work job” she could find, including working at a methadone clinic and as a family therapist in the Bronx. “I was very googly-eyed,” she says. “Quite the idealist. I wanted to change the system.”

After several years, though, “apathy was building”, she says. “I was very dissatisfied with the system, getting burnt out, very ill – constant bronchial infections, flus.”

During one such illness, while she was managing a program aimed at reducing psychiatric hospital recidivism, she tried treating herself with herbs – elderberry root and slippery elm – instead of visiting a doctor. This induced a fever dream of sorts, she says: “I’m having cold sweats and chills, and I feel this weight on me – this being, making this purring noise, in a language I now understand a lot better. It was calling me. I wake up and say: ‘OK, I’m leaving my job.’”

Shortly after she quit, a friend took her to a ceremony in Upstate New York and introduced her to “abuela”, as many devotees call ayahuasca, a plant-based tea containing the natural hallucinogen DMT. “By then, I’d tried everything – mushrooms, LSD, ecstasy, cocaine – but this was different,” Hummingbird says. “The sky opened up. At the end of a walkway of stars was this feeling, like, you’re home. I was flooded with tears of gratitude. And I started talking in this other language, chirping away, talking to birds in the woods.”

On sabbatical, she backpacked through Guatemala, where she attended eight more ayahuasca ceremonies led by indigenous curanderas. “When I came back to my luxurious home, I was shocked at the US way of life,” she says. “I couldn’t believe I’d let myself become part of this system.”

Instead of returning to social work, she studied indigenous healing traditions with a New York-based shaman, Irma StarSpirit Turtle Woman. In 2015, after adopting a “medicine name” – Hummingbird, translated from Zunzún, her Cuban grandmother’s nickname – she began leading ayahuasca ceremonies herself.

At ceremonies, which cost $230 a night, Hummingbird blows a tobacco snuff called rapé up the noses of her guests, then serves ayahuasca and sings icaros – medicine songs – while they purge. “There’s a lot of crying, laughing, vomiting, urinating, sweating – [what I call] ‘getting well’,” she says.

Also on offer is sananga, a psychoactive eye drop that burns like habanero chilis, and Kambo, a drug made from the venom of the Amazonian giant monkey frog.

Hummingbird’s work with the psychiatric healthcare system left her concerned that the millennia-old spiritual traditions surrounding psychedelics risk being sidelined in the process of medicalization. Despite psychedelic researchers’ attempts to quantify results with tools like the “Mystical Experience Questionnaire”, trip experiences – such as encounters with “snake-gods” – tend to fall outside the realm of contemporary scientific understanding.

“Abuela is an ever-evolving quantity,” Hummingbird says. “There are no final end results, which science loves to have.”

The former labor nurse who helps people ‘give birth to themselves’

Since his book’s publication, Pollan’s readers have bombarded him with requests for referrals to underground guides – requests he turns down to protect his sources.

“The demand [for psychedelic therapy] far outweighs the supply and care we have, whether in clinical trials or in the underground,” Pollan said at Horizons. “I was struck by how many people are really suffering. I wish people could just go to 1-800-Underground Guide.

Steve’s schedule is at capacity; he finds himself turning away roughly three-quarters of referrals he gets, some of which come from licensed psychotherapists, who may risk losing their licenses by pursuing interests in illegal substances.

But many are optimistic about the future of legalization for medicinal use. In 2017, the Food and Drug Administration (FDA) granted “breakthrough therapy designation” to MDMA-assisted psychotherapy for PTSD, acknowledging that it “may demonstrate substantial improvement over existing therapies” and agreeing to expedite its development and review. In October, researchers from Johns Hopkins University recommended that psilocybin be reclassified to a schedule IV drug, with accepted medical use.

The push for legalization has received bipartisan support: Rebekah Mercer, the billionaire Republican and co-owner of Breitbart, recently donated $1m to the Multidisciplinary Association of Psychedelic Studies (Maps), a not-for-profit organization conducting much of today’s psychedelic research.

In anticipation of expanded access, the California Institute for Integral Studies, in San Francisco, offers a training and certification program for medical and mental health professionals who hope to eventually facilitate legal psychedelic-assisted therapy.

‘I’m a super joyful person now’

While underground guides tend to fiercely support decriminalization, a few, such as Jackie, say that even if psychedelics were to be legalized medically, they would continue to work underground.

“I don’t want to work under the medical model,” Jackie says. “It’s too regimented for me.”

Before she became a guide, Jackie worked as a birth doula and a registered labor and delivery nurse. “I used to sit with people as they gave birth to humans,” she says. “Now I sit with people as they give birth to themselves.”

After leaving her “tumultuous, fucked-up family” at 17, she tried LSD for the first time with the man she would later marry. While raising her kids in the 1980s, she suffered from “persistent emotional pain” and tried everything to treat it: decades of psychotherapy, yoga, meditation, neurofeedback, self-help workshops. Nothing worked.

In 2016, on the recommendation of her 30-year-old daughter, she attended a shaman-led ayahuasca retreat in Costa Rica. “Even as I was throwing up on the jungle floor, I was like: ‘Thank you. This is why I came here,’” she says. “Afterward, I felt like all the trauma stuck inside my body had been released.”

Upon returning home, she broke up with her psychotherapist. “I haven’t felt a need to go back,” she says. “I’m a super joyful person now.” She began attending Horizons and training as a guide with several mentors.

Now, at 57, she works full-time as a guide for two to four clients a month, either in her New England home or an Airbnb, charging several thousand dollars for 48-hour sessions and “unlimited post-trip integration”.

Many of her clients are “genius entrepreneurs”; most, she says, have little experience with drugs. She gets word-of-mouth referrals from all over the world and also mentors newbie guides.

“As underground therapists, we have to think, what if the worst thing happened and we went to jail?” she says. “But if I went to jail, I think I’d still find a way to serve. And I know it sounds woo-woo, but I somehow feel protected by the mushrooms.”

• Steve and Jackie’s names have been changed to protect their anonymity