The consent problem
Informed consent requires that a person understand what they are agreeing to. The characteristic feature of this experience is that it cannot be adequately described in advance, and that the people who have had it routinely say language fails them.
That does not make consent impossible. It does mean consent has to be constructed carefully and honestly. At minimum a person should be told: what is known and unknown about the risks; that they may believe they are dying; that they may lose control of their body; that they may have no memory of parts of it; that they may be destabilised for weeks; that no particular outcome can be promised; and exactly what substance they are being offered, synthetic or toad-derived, and what is known about its composition.
Consent given under emotional pressure, in a group setting where everyone else has already agreed, or after money has changed hands and is non-refundable, is compromised consent. Those conditions are extremely common.
Power asymmetry
The asymmetry here is unusually large. One person is entirely without defences for a period. The other is in full possession of themselves, holds the substance, holds the room, and frequently holds a role that the first person regards as spiritual authority.
That combination has produced abuse in every tradition where it has existed, and this field is not an exception to human nature. Anyone who believes their own good intentions make them an exception is precisely the person to worry about.
The practical answers are unglamorous: more than one person present, clear agreements made in advance and in writing, recording where consented to, external supervision, and a real route for complaint that does not depend on the goodwill of the person being complained about.
Touch
Touch should be agreed in advance, specifically, with the forms and locations named, and it should be revocable. A person in this state cannot meaningfully consent in the moment, which means whatever was agreed beforehand is the whole of the permission.
Any sexual contact is abuse. There is no framing, no lineage, and no explanation that makes it something else.
Money
Money is not disqualifying. Teaching, hosting, and holding a space competently is work and work is paid for. The ethical issues are elsewhere: pricing that pressures people into decisions, non-refundable payments taken before screening is complete, screening conducted by the person whose income depends on the answer, and upselling to people in an open and suggestible state afterwards.
Screening should be structurally separate from sales wherever that is achievable. Where it is not, the conflict should at least be named out loud.
Dual relationships
Practitioner and therapist. Practitioner and friend. Practitioner and business partner. Practitioner and romantic partner. Each of these compromises judgment in a direction that is hard to see from inside.
Clinical professions developed rules about this over a century of learning the hard way. This field has largely started from scratch and is relearning the same lessons at the expense of the same people.
Accountability
There is no licensing body, no register, and no mandatory adverse event reporting. That absence is the central structural problem in the field, and it will not be solved by individuals being sincere.
What individuals can do: work within a named scope of competence, keep records, seek supervision from someone willing to disagree with them, publish their screening and consent practices, refer out early, and treat a complaint as information rather than as an attack.