In a recent episode of Last Week Tonight, John Oliver turned his sardonic attention to patents in the for-profit psychedelic business world. He referenced a Compass Pathways patent application that included claims describing the basic setting of psychedelic therapy, saying, “It’d be like me patenting the concept of wearing a suit while sitting at a desk.”
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.
“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.”
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.
Last month, the Oregon Health Authority issued its first set of draft regulations around training programs for facilitators, setting standards, for example, for the content and hours of training. In the months leading up to these decisions, discussions from advisory board members kept bumping into medical issues, including if it’s possible for licensed mental health professionals to work as practitioners, and to what extent facilitators should ask about a patient’s medical history. National and international psychedelic companies have participated in these conversations.
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.
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.
Iboga plants smuggled out of Gabon provide most of the world’s ibogaine, a drug that can help heal trauma and addiction. As the plant enters fair trade, officials hope regulation ensures equity and sustainability.
Among animals, humans stand out in their consummate propensity to self-induce altered states of mind. Archaeology, history and ethnography show these activities have taken place since the beginnings of civilization, yet their role in the emergence and evolution of the human mind itself remains debatable. The means through which modern humans actively alter their experience of self and reality frequently depend on psychoactive substances, but it is uncertain whether psychedelics or other drugs were part of the ecology or culture of pre-human ancestors. Moreover, (nonhuman) great apes in captivity are currently being retired from medical research, rendering comparative approaches thus far impracticable. Here, we circumvent this limitation by harnessing the breadth of publicly available YouTube data to show that apes engage in rope spinning during solitary play. When spinning, the apes achieved speeds sufficient to alter self-perception and situational awareness that were comparable to those tapped for transcendent experiences in humans (e.g. Sufi whirling), and the number of revolutions spun predicted behavioural evidence for dizziness. Thus, spinning serves as a self-sufficient means of changing body-mind responsiveness in hominids. A proclivity for such experiences is shared between humans and great apes, and provides an entry point for the comparative study of the mechanisms, functions, and adaptive value of altered states of mind in human evolution.
The CIPPres Clinic in London is all Scandi chic, leafy houseplants and psilocybin trials.