Ethnoracial health disparities and the ethnopsychopharmacology of psychedelic-assisted psychotherapies

Emerging evidence from randomized, double-blind, placebo-controlled clinical trials suggests psychedelic compounds such as 3,4-methylenedioxymethamphetamine (MDMA), psilocybin, and lysergic acid diethylamide (LSD), when administered as an adjunct to psychotherapy, that is, psychedelic-assisted psychotherapy (PAP), may be beneficial for treating substance use disorders, posttraumatic stress disorder (PTSD), depression, anxiety, and other psychiatric conditions. Previous ethnopsychopharmacological research has identified ethnoracial differences in the metabolism, safety, and efficacy of psychotropic drugs, yet no studies have directly investigated the impact of ethnoracially based differences in psychedelic drug pharmacology. Although there is an extensive global history of psychedelic use among peoples of various cultures, ethnicities, and intersectional identities, psychedelic research has been conducted almost exclusively on White populations in North America and Western Europe. The failure to include Black, Indigenous, and People of Color (BIPOC) in psychedelic research trials neglects the ethnic, racial, and cultural factors that may impact individual responses to PAP and thereby prevents generalizability of findings. This article investigates the impact of biological and social factors related to culture, ethnicity, and race on pharmacological responses to PAP, as well as clinical outcomes. The limitations of ethnopsychopharmacology are discussed, and the authors present expected cultural, clinical, and public health benefits of expanding funding for this area. This work will draw attention to the unique and individualized needs of ethnoracially diverse clients in therapeutic settings and is intended to inform future PAP trials.

Psychedelic Medicine’s Future Depends on Proactive Development of a Robust Medical Billing and Coding Strategy

Background: Although still investigational, psychedelic therapies appear poised to begin securing regulatory approval as medical treatments in the United States within the next 2 years. If approved, one of the most daunting barriers to equitable patient access to these novel treatments is their incorporation into the medical billing and coding system. Since specific billing codes for psychedelic therapy delivery do not exist, modification of existing codes or development of de novo codes will be necessary. This reality has created uncertainty about reimbursement and the financial future of psychedelic medicine.

Opinion: We argue that development of de novo billing codes in conjunction with the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel is the best approach for addressing psychedelic therapy reimbursement concerns. However, with no similar existing medical services to guide development, the potential need for multiple providers during dosing sessions, limited mental health care representation on the CPT Editorial Panel, and a number of misconceptions surrounding psychedelic therapy among critics, psychedelic therapy is particularly vulnerable to development of billing codes that undervalue the complexity of its delivery. With an industry-sponsored application for new CPT codes for “psychedelic drug monitoring services” soon to be reviewed by the CPT Editorial Panel, a critical step toward maximizing psychedelic therapy’s societal impact has been taken. However, many questions remain about whether these proposed codes will provide adequate flexibility for a treatment modality involving various drugs, therapeutic approaches, and patient monitoring strategies, as well as which types of providers will qualify to use them. Whether these proposed codes ultimately become the bedrock of billing for psychedelic therapy or future codes are developed to augment or replace them is not known, but it is a promising sign that efforts to create a robust medical billing and coding strategy for psychedelic medicine are now underway.

Personal Psychedelic Use Is Common Among a Sample of Psychedelic Therapists: Implications for Research and Practice

Background: An emerging controversy in psychedelic therapy regards the appropriateness or necessity of psychedelic therapists having personal experience using psychedelics themselves. Although there are a number of potential advantages and disadvantages to personal use among psychedelic therapists, no studies to date have measured their use or other aspects of their training.

Materials and Methods: First, we broadly review the literature on experiential learning in psychotherapy and psychiatry as well as the history of personal use of psychedelics by professionals. We then report on the results of a survey that was sent to all 145 therapists associated with Usona Institute’s Phase II clinical trial of psilocybin for major depressive disorder. Thirty-two of these individuals (22% response rate) participated in the survey.

Results: We found that experiential learning is common in psychotherapy but not in psychiatry, meaning psychedelic therapy straddles two different traditions. In our survey, the majority of psychedelic therapists identified as white, female, and having doctoral degrees. Most of the sample had personal experience with at least one serotonergic psychedelic (28/32; 88%), with psilocybin being most common (26/32; 81%; median number of uses = 2–10; median last use 6–12 months before survey). Participants had myriad intentions for using psychedelics (e.g., personal development, spiritual growth, fun, curiosity). All respondents endorsed favorable views regarding the efficacy of psilocybin therapy.

Conclusion: Personal experience with psychedelics was notably common in this sample of psychedelic therapists, but the study was limited by a low response rate and a lack of diversity among participants. Future research is needed to address these limitations as well as to identify whether personal experience with psychedelics contributes to therapists’ competency or introduces bias to the field. Nonetheless, these findings are the first to delineate the personal use of psychedelics among professionals and can inform a pressing debate for the field.

Dreams and Psychedelics: Neurophenomenological Comparison and Therapeutic Implications

Background: A resurgence of neurobiological and clinical research is currently under-way into the therapeutic potential of serotonergic or ‘classical’ psychedelics, such as the prototypical psychedelic drug lysergic acid diethylamide (LSD), psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine), and ayahuasca – a betacarboline- and dimethyltryptamine (DMT)-containing Amazonian beverage. The aim of this review is to introduce readers to the similarities and dissimilarities between psychedelic states and night dreams, and to draw conclusions related to therapeutic applications of psychedelics in psychiatry. Methods: Research literature related to psychedelics and dreaming is reviewed, and these two states of consciousness are systematically compared. Relevant conclusions with regard to psychedelic-assisted therapy will be provided. Results: Common features between psychedelic states and night dreams include perception, mental imagery, emotion activation, fear memory extinction, and sense of self and body. Differences between these two states are related to differential perceptual input from the environment, clarity of consciousness and meta-cognitive abilities. Therefore, psychedelic states are closest to lucid dreaming which is characterized by a mixed state of dreaming and waking consciousness. Conclusion: The broad overlap between dreaming and psychedelic states supports the notion that psychedelics acutely induce dreamlike subjective experiences which may have long-term beneficial effects on psychosocial functioning and well-being. Future clinical studies should examine howtherapeutic outcome is related to the acute dreamlike effects of psychedelics.

Functional neuroimaging of psychedelic experience: An overview of psychological and neural effects and their relevance to research on creativity, daydreaming, and dreaming

The neural correlates of the psychedelic experience are increasingly being investigated with noninvasive functional neuroimaging methods. This research has now provided a preliminary understanding of the neural substrates of various stages and contents of psychedelic experience, elucidating how various stages differ from one another, and also relate to kindred “altered” states of consciousness such as dreaming and creative thinking. Several conclusions can be gleaned from this review. First, psychedelic experiences involving strong visual hallucinatory components activate the same brain areas as “natural” altered states involving high rates of visual imagery, most notably daydreaming and nighttime dreaming. Second, peak psychedelic experiences involving loss of the sense of the self or “ego-dissolution” involve deactivation or disintegration of brain networks, most notably the default mode network, that are widely thought to maintain and subserve an internal stream of thoughts and a coherent sense of self.

The costs and benefits of psychedelics on cognition and mood

Anecdotal evidence has indicated that psychedelic substances may acutely enhance creative task performance, although empirical support for this claim is mixed at best. Clinical research has shown that psychedelics might have enduring effects on mood and well-being. However, there is no neurocognitive framework that ties acute changes in cognition to long-term effects in mood. In this review, we operationalize creativity within an emerging cognitive control framework and assess the current empirical evidence of the effects of psychedelics on creativity. Next, we leverage insights about the mechanisms and computations by which other psychoactive drugs act to enhance versus impair cognition, in particular to those that act on catecholamines, the neurophysiological consequences of which are relatively well understood. Finally, we use the same framework to link the suggested psychedelic-induced improvements in creativity with enduring psychedelic-induced improvements in mood.

God on Psychedelics: Tripping Across the Rubble of Old-time Religion

In God on Psychedelics, veteran journalist Don Lattin trains his eye on some previously unexamined questions. Why do relatively few people in the burgeoning psychedelic renaissance connect chemically induced mystical states with their own religious traditions? Can sacred plant medicines be a source of renewal for Christians, Jews and other people of faith?

God on Psychedelics takes the reader on a magical mystery tour across the nation’s changing religious landscape, exploring a new kind of trinity that blends psychedelic insight, psychological healing and spiritual revival.

Bicycle Day and other Psychedelic Essays

“What are the roots of psychedelic culture? Why are psychedelics seen as transgressive? How was Albert Hofmann’s discovery of LSD’s effects entwined with a world at war? In Bicycle Day and other Psychedelic Essays, Alan Piper explores the often forgotten or ignored early histories of psychoactive drugs that helped shape psychedelia.

Falling between the eighteenth century, the Club des Hashischins and the psychedelic sixties, the less explored interwar period has a surprisingly rich culture of drug-induced mind states, which are intimately connected with the birth of modernism. From the literature of Hope Mirrlees, David Lindsay and Ernst Jünger, to Harvard peyote experiments, Hofmann’s occultic network and the relationship of Sandoz pharmaceuticals with Nazi Germany, Alan Piper’s collection is a rich tapestry of literary and social drug history.”

The need for establishing best practices and gold standards in psychedelic medicine

Psychedelic substances are under investigation in several drug development programs. Controlled clinical trials are providing evidence for safe and effective use of psychedelic therapies for treating mental health conditions. With the anticipated FDA approval of MDMA-assisted therapy for posttraumatic stress disorder in 2023 and psilocybin therapy for depression disorders soon after, now is the time for the medical community to become informed on best practices and to actively participate in developing standards of care for these new treatments. Given the emergence of numerous drug sponsors and other companies developing therapeutic modalities for combination with psychedelic medications, it is essential that the medical professional field is at the forefront of communicating unbiased information related to safety and effectiveness. Gold standards have long been a part of medicine and serve to distinguish treatments and assessments as the highest quality by which all others can be compared to. For a treatment to be established as a gold standard, several factors are considered including the quantity and quality of the supporting data, the rigor of trials, and the safety and efficacy compared to other treatments. In this article, we review the origins of psychedelic-assisted therapy (PAT), minimum requirements for safe use of psychedelics, criteria for gold standards in mental health, and the nuances regarding how to establish gold standards in psychedelic medicine and guide clinical decision making.

Studying Harms Is Key to Improving Psychedelic-Assisted Therapy—Participants Call for Changes to Research Landscape

Although psychedelic drugs generally have good safety profiles, a recent systematic review concluded that adverse events in psychedelic trials are poorly defined, not systematically assessed, and likely underreported. In the past year there have been multiple reports of serious adverse events (SAEs), and long-lasting harms to participants in clinical trials of psychedelic-assisted therapy (PAT) have emerged. We draw attention to a unique and overlooked category of risk in PAT stemming from the interactions between therapists and patients receiving high doses of psychedelics. In our view, the understudied therapeutic component of PAT presents the most serious risks. Addressing it requires interdisciplinary approaches by researchers free from conflicts of interests.