Psychedelics in Therapy – The Next Generation of Treatment
With dozens of clinical trials underway, psychedelics are now viewed as the next best treatment for mental health disorders like depression, anxiety and PTSD. But at the heart of using psychedelics in therapy are their practitioners. The specialized counselors and therapists capable of leading patients into their healing path with drugs like psilocybin, MDMA or LSD.
The promise behind the therapeutic potential of psychedelics is grand. And many therapists are eager to begin applying these drugs in their practice. As of now, some companies and institutions already offer training courses teaching therapists how to work with psychedelics. But the legal landscape is in development, and possibilities to work legally with these drugs are still limited.
Here’s everything you need to know if you want to use psychedelics in therapy today.
From Ceremonial Plants To Scheduled Substances
Psychedelics are psychoactive drugs capable of producing non-ordinary states of consciousness. Their effect can vary depending on the compound, dosage and the person using them. But in general they’re understood to produce feelings of euphoria, hallucinations and abnormal thinking patterns often leading to introspection.
Archeological research has found evidence for the human use of psychedelic substances that dates back to eight thousand years ago. Psychedelics have returned to the public conversation for their ability to treat a wide array of mental health conditions.
The promise of psychedelic drug’s healing potential has become crucial. Especially as we face a global mental health crisis.
And satisfactory solutions for some ailments (like treatment-resistant depression) are still to be found.
Psychedelics got an early moment of glory for western society between the 1940s and the 1960s. In those two decades psychiatrists began experimenting with the therapeutic potential of these drugs. Mostly due to the chemical discovery of LSD in 1938. And the botanical rediscovery of magic mushrooms (containing the psychedelic compound psilocybin) in 1955.
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And Then…Sitgma Happened
However, these compounds and others became adopted by the youth culture of the 1960s and 1970s. Which gave them more awareness, but also brought along a growing stigma and backlash. They were seen as purely recreational. And only something that “lazy hippies” took. Because of this, governments quickly shut down access to these drugs. And they stopped being studied when they highly prohibited substances whose use or possession could lead to years in prison.
In the early 2000s, researchers from various universities began revisiting the literature. They were looking into the forgotten potential of these substances in the treatment of mental health conditions.
Today, a wide array of clinical trials are underway, exploring the use of psychedelic drugs in various mental health indications. Some forms of psychedelic therapy are already available in certain countries and jurisdictions in North America. But there are varying degrees of legality.
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Are Psychedelics Legal To Be Used in Therapy?
After the 1971 Convention on Psychotropic Substances by the UN, most psychedelic drugs became Schedule 1 substances across the globe. And this status remains active to this day in almost every country on earth.
Except for very specific exemptions, the use and possession of psychedelics like LSD (Lysergic acid diethylamide), psilocybin, DMT (N,N-Dimethyltryptamine), mescaline and MDMA (3,4-Methylenedioxymethamphetamine), as well as many others, is a serious crime. And often punishable with the full extent of the law. This is true in the United States, Canada, the UK, Australia and other English-speaking countries.
Exemptions include:
- Specific countries where some psychedelics have been decriminalized.
- Jamaica or the Netherlands (where possession of certain forms of psilocybe mushrooms are not enforced by the law).
- Brazil and Costa Rica (where DMT-containing ayahuasca is considered legal).
- Some jurisdictions and municipalities within the U.S. where naturally-produced forms of psychedelic compounds have been made a lowest-level law enforcement priority by city councils. These include Oakland and Santa Cruz in California, Denver in Colorado, Ann Arbor and Detroit in Michigan, Seattle in Washington State and the District of Columbia, among others.
- In the context of clinical trials, where these compounds can be used in an authorized therapeutic setting with the goal of obtaining approval by government regulatory bodies like the U.S. Food and Drug Administration and the European Medicines Agency.
Due to the current illegal status of these drugs, psychedelics-assisted therapy is not a widespread practice in mainstream medicine. And it is only offered within these exceptions.
Outside of clinical trials, the use of psychedelics is not supervised by any regulatory body. This “legal grey area” can sometimes lead to informal or ceremonial applications that lack the medical protocols. And these medical protocols can sometimes be necessary to guarantee a safe and responsible use in psychiatry.
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Ketamine: The Exemption To The Rule
Ketamine is a dissociative drug first synthesized in 1956 and approved by the FDA as an anesthetic. It has gained traction in recent years for its potential in treating some mental health conditions like depression and acute suicidality.
Scientists discovered that patients that received ketamine in their surgical treatments experienced a drop in depression symptoms. As a result, some doctors in the 1990s began prescribing ketamine in an off-label capacity to patients with depression.
In the last decade the practice became widespread. Dozens of clinics opening up in the U.S., offering ketamine in IV, sublingual or intranasal form, with or without psychotherapy.
Scientists don’t yet know if the beneficial effects of ketamine are linked to its psychedelic-like properties. Or if it is purely related to the neurological modulations that the drug is able to produce in the brain. Ketamine’s antidepressant effects usually only last a few weeks. And some clinics and physicians are using the drug in psychotherapy as part of a more holistic approach to healing. Which is called “ketamine-assisted psychotherapy,” or KAP for short.
The use of ketamine in this context is considered legal if prescribed by an MD. Although the drug is prescribed off-label, which are indications that lay outside of the ones officially approved by the FDA.
Which Psychedelics Are Being Studied For Use Therapy?
Psilocybin and MDMA are the two most widely researched psychedelic compounds to this date. Psilocybin is the active ingredient in so-called “magic mushrooms.” And MDMA is known in the party scene as ecstasy or molly.
MDMA has undergone extensive clinical research in a program lead by The Multidisciplinary Association For Psychedelic Studies. They are currently leading the last tranche of a phase 3 clinical trial for the treatment of post-traumatic stress disorder (or PTSD). And so far have seen very promising results.
After analyzing data from the first tranche of their phase 3 trial, The Multidisciplinary Association For Psychedelic Studies researchers found that 67 percent of participants who received three MDMA-assisted therapy sessions for severe PTSD no longer qualified for a PTSD diagnosis by the end of the trial.
This program is generally expected to receive approval by the FDA in 2023.
Psilocybin is expected to follow a similar path, possibly gaining approval by around 2025. A phase 3 trial with the drug is in its early stages after Compass Pathways. Compass is a biotech company that completed a phase 2 trial for treatment-resistant depression.
A plethora of other psychedelic molecules are also being studied in similar clinical trials. These include chemically modified versions of the compounds mentioned above, as well as LSD, DMT, ibogaine and mescaline. And have been studied for indications that include alcohol use disorder, substance abuse, major depression and various forms of anxiety.
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What are the Benefits of Psychedelics in Therapy?
Psychedelics have the capacity to induce altered states of consciousness. And those altered states can be leveraged therapeutically through different protocols that vary depending on the compound.
While these protocols are still undergoing clinical research, evidence gathered so far is compelling. And much of it points to an amazing potential to treat a wide array of mental health conditions.
The therapeutic mechanism of action of psychedelics is currently still a bone of contention in the field of psychedelic science. Many theories point to these drugs’ ability to disrupt the brain’s “default mode network.”
How do Psychedelics in Therapy Work
“The way that the brain is communicating with itself when these experiences are happening, is kind of a disintegration and then a more chaotic state of communication,” says Dr. Albert Garcia-Romeu, a Johns Hopkins assistant professor and member of the university’s Center for Psychedelic and Consciousness Research.
“This controlling, repressive mechanism, which enables one to control one’s behavior, is turned down. And when that happens, all the centers of the brain tend to communicate more with each other. So you have a little lighting up,” says Amanda Feilding. Fielding is the founder and director of the Beckley Foundation, an NGO that has been studying psychedelics since 1998.
“What happens is that there’s all these new interconnections in terms of communication from one part of the brain to another,” adds Garcia-Romeu.
When patients undergo this process, which can be modulated to different intensities depending on the dosage, they can experience very positive psychological progress. This is often manifested in the form insight into one’s personal life and life history, relationships. “As well as just biological factors like feelings of increased mood and energy and reduced negative affect,” says Garcia-Romeu.
In higher doses, psychedelics can trigger “a feeling of unity with nature or the universe,” often described as a state of awe. This can lead patients into deep realizations about themselves and their place in the world. Which can be then translated into positive psychological progress.
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How Do Therapists Work With Psychedelics?
The role of the therapist in psychedelics-assisted psychotherapy is usually divided into three stages: preparation, guidance and integration.
During the preparation phase, the therapist will introduce the patient onto the type of experience they’ll have with the drug. This will help them get ready for the experience. This process can last several weeks or months. A it’s crucial that patients understand how to navigate the effect of a psychedelic.
In many protocols, there’s no active psychological exchange done between the therapist and the patient during the actual psychedelic experience. Patients are normally directed to go inwards and let the substance take them to wherever the thoughts, ideas or hallucinations may go. The therapist’s role during this process is to “hold space.” Which is to take care of whatever needs the patient might have. And make sure that all the conditions are given for the best experience possible, by creating the right set and setting.
After the psychedelic journey is over and the effects of the drug were off, patients go into the integration phase. This involves discussing the experience in order to make sense of it and come up with insights that can be applied in their healing process. This phase can also go on for many sessions after the psychedelic experience.
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Certificates Needed to Use Psychedelics in Therapy
Currently, as psychedelics continue to be illegal substances, there aren’t any certifications that can legally qualify a therapist to apply drugs like LSD, psilocybin or MDMA in their practice. In the case of ketamine, while the drug can be legally prescribed off-label, it continues to be considered an anesthetic by the FDA and Health Canada.
However, several companies today offer courses and training programs. Some of which are necessary to conduct therapy with psychedelics in clinical trials. While others are chosen by therapists who want to apply psychedelics in treatment in decriminalized jurisdictions.
“The The Multidisciplinary Association For Psychedelic Studies training for MDMA practitioners will be a requirement for therapists who would like to access legal MDMA after Health Canada approves this medication,” says Mark Haden, a member of Clearmind’s Scientific Advisory Board.
Some universities like Vancouver Island University, are now offering psychedelic training within the context of their own programming, adds Haden.
Other institutions, like Fluence, offer training for psychedelics therapy. On its site, the company describes their certificate program as designed to prepare licensed clinicians to provide Psychedelic-assisted Therapy or Psychedelic Integration Therapy.
However, they clarify that “The certificate is not a license or authorization to practice therapy in itself, but a course of study covering key elements and experiences, providing exposure to mentors and leaders in the field, and introducing participants to a peer group for ongoing professional support and development.”
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Psychedelics in Therapy – Integration Certificates
Dr. Alex Camargo is Fluence’s program director for the integration certificate. And he says that the most immediate use of certificate training programs in psychedelic assisted therapy is for FDA-approved clinical trials.
“Receiving a certificate will not guarantee employment as a study therapist, but it indicates a level of competency to study sponsors. Additionally, many therapists say they want to pursue training in anticipation of either state-specific or nationwide legalization of specific psychedelic treatments,” he adds.
Lastly, Camargo says that psychedelic integration therapy can be a good option for therapists wanting a certificate with a current concrete legal use. As integration therapy occurs after the drug has been taken. Which relieves the therapist of any legal relationship to the drug consumption itself.
The Center for Psychedelic Therapies and Research at the California Institute of Integral Studies also offers a Psychedelic-Assisted Therapies and Research Certificate Program.
The Institute makes sure to point out that “at no time does the program promote or require the use of psychedelic drugs in any manner. Students taking the certificate will learn about the competencies required of therapist guides in federally approved medical treatment and psychedelic research.”
While no current certificates can grant the legal authorization to use psychedelic drugs in medical practice today, these training programs will become the backbone of psychedelics therapy delivery once compounds like MDMA and psilocybin become FDA-approved.
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