_______________________________________________ Psychedelic Medicine and Interventional Psychiatry
This period also saw research focusing on psilocybin as a probe for brain function and recidivism and as an entheogen used by religious people (divinity students). During this era, psilocybin, LSD, mescaline, and other psyche- delics were used by some individuals with psychiatric diseases, and they were also used extensively by some psychiatrists to treat patients before the drugs were categorized as Schedule I of the U.N. Convention on Drugs in 1967, which preceded the Controlled Substances Act in the United States. Today, the medical value of hallucinogens is being tested in rigorous trials in settings such as Roland Griffith’s Johns Hopkins research program. The experts from the psilocybin research group at Johns Hopkins University have described the importance of trained psychedelic therapists and other components of a psychedelic treatment session to optimize patient safety in hallucinogen research [32]. CONSIDERING PSYCHEDELIC-ASSISTED PSYCHOTHERAPY AS A TREATMENT OPTION For most mental health professionals, the idea of psychedelic- assisted psychotherapy is a major paradigm shift and leap from current practices of providing pharmacotherapy or psy- chotherapy to individuals or groups. At the same time, it may represent a new opportunity to combine the talents and skills of therapists with the proven benefits of a psychedelic drug. Combined psychotherapy/pharmacotherapy is the treatment of choice for most patients with mental health disorders, so interprofessional collaboration is a typical (and vital) part of treatment. Psychedelic medicine requires that diverse disci- plines collaborate closely and communicate to clearly ensure that the therapy is safely and effectively administered. LEGAL AND REGULATORY BARRIERS Today, the federal government has provided limited permission or even grants to study Schedule I drugs and their possible role in the treatment of patients. Outside of these limited cases, researchers find it difficult to obtain the needed drug for testing purposes. To avoid legal and regulatory issues, a good amount of research is performed outside of the United States. “SET” AND “SETTING” IN PSYCHOTHERAPY- ASSISTED PSYCHEDELIC TREATMENT Since the 1960s, therapists have noted that the response to psychedelic drugs is impacted by the patient’s mindset as well as the setting where the psychedelic drug is administered. For example, if the person feels confident that the experience will be a positive one, then this “set” is considered more conducive to a good experience while under the influence of a psychedelic drug compared with when persons are extremely apprehensive and fearful beforehand. By extension, if patients are in an office setting with a therapist or other practitioner with whom they feel safe, the outcome is generally better than in those who feel
unsafe. Research has shown a better outcome with patients receiving psychedelics in a therapeutic setting versus receiving the drug while undergoing a positron emission tomography (PET) scan [33]. These researchers stated [33]: The finding that the PET environment was strongly associated with anxious reactions could be partially explained by the perceived atmosphere. Whereas non-PET experiments were mostly conducted in laboratory rooms that were furnished in an aes- thetically pleasing way, the environment at the PET center was much more clinical and “antiseptic” (i.e., lots of technical equipment, white walls, personnel in white lab coats). Our results are therefore in sup- port of current safety guidelines, which recommend avoiding “cold” and overly clinical environments in human hallucinogen research in order to reduce the risk of anxious reactions. Another element of setting, and one that is also used to enhance set, is the use of music while the patient undergoes therapy with psychedelic medicine. Johns Hopkins has developed a “psilocybin playlist” lasting nearly eight hours that is used for patients who are undergoing treatment with psilocybin [34]. In many cases, psychedelic therapy is administered after a therapeutic session. Psychotherapy is often also provided dur- ing the course of the drug’s effects and at integration sessions that occur after the drug was given to help the patient to give meaning and context for the experience [35]. This provision of multiple hours of psychotherapy over a short period of time can translate to higher costs. This scenario might be less appealing to insurance carriers than traditional therapies (e.g., antidepressants or other drugs), but this is yet to be seen. It should also be noted that in some areas, there are clear manu- alized approaches to treating patients that carefully consider both set and setting; this is particularly the case for MDMA in the treatment of PTSD. However, these approaches are yet to be developed for most other psychedelic drugs. Again, this field offers burgeoning opportunities for psychiatrists, psychologists, primary care providers, and other mental health practitioners. ADVISING PATIENTS CONSIDERING PSYCHEDELIC MEDICINE Some patients will approach their primary care providers to discuss the possibility of seeking care at a ketamine or MDMA (or other) clinic. It is important not to dismiss these treatment options out of hand. Instead, it may be best to ask the patients the following questions to help assess if the option would be helpful and if the facility is set up to provide optimal care: • Who is the expert or experts running this clinic? What experience(s) make this person or team experts? What outcome data are provided?
97
EliteLearning.com/Social-Work
Powered by FlippingBook