Breaking Ground: First-Ever Guidelines For Psychedelic-Assisted Therapy (Part 2)

This is part 2 of our look into the first-ever guidelines for psychedelic-assisted therapy, published by the American Psychedelic Practitioners Association and BrainFutures in August 2023.

APPA states in the guideline introduction:

“Our mission is to support the integration of psychedelic-assisted therapy into the United States healthcare system. To that end, our work is oriented around creating field infrastructure to support the adoption of best practices for practitioners and to ensure quality training that will enable certification.”

Guidelines Purpose and Audience

The primary intended audience for these guidelines are practitioners who utilize or plan to utilize psychedelic-assisted therapy in their practice.

APPA uses the definition for psychedelic-assisted therapy established by Guss et al., 2020: ““a particular mode of using psychedelic substances in which the effects of the drug, both biological and psychological, play a significant role in facilitating a psychotherapeutic intervention.”

APPA and BrainFutures developed these guidelines anticipating at least one New Drug Application (NDA) to be submitted to the Food and Drug Administration (FDA) for a psychedelic treatment. This model of care – using a psychedelic treatment combined with therapy within the same session – is unlike anything currently utilized in existing psychotherapy (a fancy term for “talk therapy”). Thus, APPA intends for these guidelines to describe the base level expectations for providing this sort of care. These guidelines aren’t describing optimal practice – because we don’t know what that looks like. We’ve still got a long way to go with respect to researching psychedelic-assisted therapy before we’re ready to discuss what “optimal care” looks like. Right now, the focus is on setting the floor – which we have to do before we can start aiming for the ceiling.

Guideline Statements and Summary

There are a total of twelve guideline statements endorsed by APPA. Highlights are included below, along with my short commentary. You can view the full guidelines here.

1. “Psychedelic-assisted therapy practitioners are in good standing with the healthcare licensure and/or certification body of their professional discipline.”

   Commentary: Maintain your professional license and don’t get in trouble with your licensing board. Pretty straightforward!

2. “Psychedelic-assisted therapy practitioners have specialized training in psychedelic-assisted therapy appropriate to their scope of practice and strive to ensure their knowledge of the potential physical, psychological, and spiritual effects of psychedelics and core principles of psychedelic-assisted therapy.”

   Commentary: Physicians should receive training geared towards physicians, pharmacists should receive training geared towards pharmacists, and so on. The knowledge and roles of the therapist conducting the session are different from those needed to verify a psychedelic dose and dispense the medication – the training should be in line with the practitioner’s profession. That said, all psychedelic practitioners should have a good grasp on the fundamentals of psychedelics and their effects on the body and mind. Because this information isn’t currently a part of curriculums, practitioners will need to seek continuing education (which are the classes healthcare providers must take every year to maintain their license) or other training opportunities.

3. “Psychedelic-assisted therapy practitioners obtain and document informed consent before commencing treatment, respect the patient’s right to withdraw consent, and approach consent as an ongoing”

   Commentary: A patient in the midst of a psychedelic-assisted therapy session is in an extremely vulnerable state. Healthcare providers who wish to work in this space must recognize this, and their role in ensuring the patient feels safe and respected. Part of this is not only obtaining consent from the patient before beginning the treatment, but also recognizing that consent is an ongoing process which can be withdrawn at any time the patient decides to do so.

4. “Psychedelic-assisted therapy practitioners specifically address the potential applications of touch in the informed consent process. Such consent includes the patient’s right to refuse touch except in situations where touch is required to prevent serious injury, damage, or harm.”

   Commentary: (TRIGGER WARNING – sexual assault). Physical and sexual abuse in psychedelic therapy has been a known issue since at least the 1970s. People in power can abuse their power. Therapists and psychologists are not exempt from this behavior. To combat this, discussion of appropriate and inappropriate touch, and whether the patient consents to any appropriate touch, must be discussed before initiating treatment.

5. “Psychedelic-assisted therapy practitioners ensure that patients have been comprehensively screened in accordance with existing evidence, guidelines, and clinical judgment.”

   Commentary: not everyone is an appropriate candidate for psychedelic-assisted therapy. I still remember a profound statement from a professor in pharmacy school during one lecture: “It doesn’t take a pharmacist to know when a drug may be used. Pharmacists stand out by knowing when a drug should NOT be used.” Why does this matter? All medical practitioners swear to do no harm. If someone tries psychedelic-assisted therapy and gets no benefit, that’s a bummer, but no harm is caused. On the other hand, if someone with a pre-existing mental condition that shouldn’t receive psychedelics experiences acute worsening psychosis during a psychedelic session, harm has been caused. Responsibility falls on the practitioner to properly screen the patient and refuse to prescribe psychedelic therapy when it’s not appropriate for the patient.

Conclusion

Even if you’re not a medical professional, I highly encourage you to check out the guidelines. These guidelines assist healthcare practitioners interested in learning about the place of psychedelics in therapy, helping them discuss psychedelics with patients and determine who may benefit from treatment.

Moving forward – we wait anxiously for the first-ever clinical practice guidelines that contain specific dosage recommendations for specific psychedelics.