Psychedelic Medicine and Interventional Psychiatry ________________________________________________
CONSUMER INTEREST At the same time that the federal government has somewhat loosened its tight reins on psychedelic medicine and research- ers and medical professionals have begun to explore the use of these agents, there has been a dramatic increase in interest among consumers in Schedule I drugs, particularly in canna- bis, but also in psilocybin and other psychedelic drugs. As of 2022, 37 states as well as the District of Columbia and four U.S. territories allow the medical use of cannabis (“medical marijuana”) [16]. (Note that medical use of cannabis is a bit of a misnomer, as prescribers generally have little or no involvement with patients who take the drug and it has not attained FDA approval for any condition.) In addition, the U.S. House of Representatives passed a bill to decriminalize cannabis use in 2022 [17]. In addition, 18 states, the District of Columbia, and 2 U.S. territories have legalized the recreational use of cannabis for adults [18]. This followed several years of decriminalization at the local and state levels. While cannabis is not considered a psychedelic drug, its shift toward decriminalization and medici- nal use is a sign that a similar path may be beginning for other Schedule I drugs with potential psychiatric benefit. Further, in states that allow medical or recreational use of cannabis for adults, the federal government has largely backed away from taking any punitive measures against individuals who use the drug, even though cannabis remains illegal at a federal level. This movement may already be advancing with psychedelic drugs. This began with the decriminalization of psilocybin in Denver, Colorado, in 2019, followed by Oakland and Santa Cruz, California. In 2021, the city of Cambridge, Massachu- setts, passed a law decriminalizing all “entheogenic plants,” which includes the drugs ayahuasca, ibogaine, and psilocybin [19]. As of 2022, the largest city to decriminalize psilocybin is Seattle, Washington [19]. In 2020, the state of Oregon approved the use of psilocybin by consumers [20]. Also in 2020, the District of Columbia decriminalized the use of psilocybin mushrooms as well as other substances found in peyote and ayahuasca [20]. Other states are considering taking similar actions. In 2021, Health Canada, the premier health agency in Canada, approved trials of MDMA-assisted therapy for the treatment of PTSD [15]. It is important to note that it can be dangerous for psilocybin and other psychedelic drugs to be used by individuals who do not understand its risks. As popular- ity and interest in the medical use of these agents increases, clinicians have a responsibility to educate themselves and their patients about the safe and appropriate use of psychedelics. A major factor in the popularity of psychedelic drugs is frustra- tion resulting from unrelenting depression, anxiety, chronic pain, or other health and mental health conditions. Some patients may have already tried cannabis to address these conditions, with varying levels of success.
GROWING BODY OF RESEARCH FROM RESPECTED ACADEMIC AND PHYSICIAN LEADERS Although researchers have historically chosen to avoid or been blocked from researching psychedelics because of bans by the federal government, this has changed in the past few decades. For example, in 2006, Johns Hopkins Medicine began their research on psychedelic medicine, subsequently producing more than 80 peer-reviewed clinical studies by 2020 [21]. A new home for the Center for Psychedelic and Consciousness Research was created in 2020, the first such establishment in the United States [21]. Private donors provided funding to launch the Center, and since its opening, the Center has also received federal funding for research. In addition, Yale, Mas- sachusetts General Hospital/Harvard, and other psychiatric and research excellence centers are studying psychedelic medi- cations as treatment options for serious psychiatric disorders. In addition, training programs focusing on psychedelic psychia- try are being established ( Table 2 ). Johns Hopkins, New York University, and Yale are collaborating to create a psychedelics- psychiatrist program funded by a grant facilitated by Heffter Research Institute [22]. PSYCHEDELIC PSYCHIATRY TRAINING PROGRAMS Hopkins-Yale-NYU https://medicine.yale.edu/news-article/grant-supports- development-of-training-for-psychiatrists-in-psychedelic- medicine MAPS https://mapspublicbenefit.com/training Mount Sinai https://icahn.mssm.edu/research/center-psychedelic- psychotherapy-trauma-research/training-education
Source: Compiled by Author
Table 2
DEFINITIONS Clear definitions of the concepts related to psychedelic drugs and interventional psychiatry are helpful. The following is a glossary of terms used throughout this course. Classic psychedelic : Refers to older hallucinogenic drugs, such as psilocybin and LSD. These agents are often derived from natural sources. Deep brain stimulation : With the use of implanted electrodes, the brain is stimulated to treat such psychiatric problems as treatment-resistant depression. Electroconvulsive therapy (ECT) : Stimulation of the brain causing a seizure. This therapy is administered under sedation and is used to help patients with severe psychiatric diagnoses.
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