Breaking Ground: First-Ever Guidelines For Psychedelic-Assisted Therapy

Update: This article was updated to add BrainFutures as a co-publisher on 9/30/23.

The American Psychedelic Practitioners Association (APPA) and BrainFutures co-published their “Professional Practice Guidelines For Psychedelic-Assisted Therapy” in August 2023 (that’s this month, in case you’re still half-asleep). These are the first-ever professional practice guidelines for psychedelic-assisted therapy – and I’m going to explain why this has me geeking out.

APPA was founded in 2021. Their 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.”

I want you to keep the “adoption of best practices” part in mind, because this is a key concept to medical guidelines. And that’s a perfect transition into explaining what guidelines are, and why they’re so important to science and medical practice.

What Are Guidelines and Why Do They Exist?

Clinical practice guidelines – or just “clinical guidelines”, or you can shorten it further to “guidelines” – provide recommendations for diagnosing and/or treating a medical condition. Please note that professional practical guidelines are different than clinical guidelines. We dive into recently released guidelines in more details in this article, but today we will be learning about guidelines in general.

Guidelines summarize current medical knowledge and scientific evidence on a condition. The risks and benefits of diagnostics and treatments are used to give specific recommendations for providing care to patients.

Guidelines are not legally binding. Once more – medical guidelines are not legally binding. Healthcare professionals are not required to follow guideline recommendations for every single patient when they believe that the guidelines are not suitable for a particular situation. Guidelines simply are what we call them: guidelines. They provide guidance!

“Why do healthcare professionals need guidelines? Why did you go to school for so long and pay that much in tuition if you can just follow the guidelines?”

I’m tempted to be sassy, but that’s actually a smart, insightful question. Guidelines summarize current medical knowledge and the latest evidence for a given condition. Find a healthcare professional that graduated prior to 2020 and they’d be happy to fill several hours/days of your time detailing how much medical practice has changed in three years – let alone over the course of a 40+ year career.

We’re constantly striving to improve the practice of medicine – and part of that is asking hard questions that require you to fundamentally re-evaluate what you thought were foundational, essential “truths”. Otherwise, we’d still be evaluating your four humors and bleeding you dry to “balance” them.

How Are Medical Guidelines Formed?

(Keep in mind that the following is a general description of how guidelines are developed.)

Guidelines are usually developed by the medical association responsible for the medical condition. For some conditions, more than one association may be involved. For example: the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) work together to create guidelines for treating heart failure. Different associations may create different guidelines. ACC and AHA used to publish their own guidelines on treating heart failure and blood pressure, for example, before deciding to work together on publishing one unified guideline document.

To start: a medical association creates a guideline committee, which includes specialists who have the knowledge and experience needed to cover important questions about the condition. The guideline committee members then work to gather as much information about the condition as possible from a wide range of sources. The members bring this data together and discuss it in order to form consensus opinions on recommendations. This process lasts months, if not years, depending on the condition and how much information is available.

This part is very important: committee members must declare conflicts of interest. For example: a member may work as a consultant to a pharmaceutical company that makes a drug which treats the condition discussed. This isn’t unusual – a cardiology expert has important insight that can help develop effective cardiology drugs. And, experts like to be paid for their expertise. But it’s important to note that this can create a conflict of interest where a member has a financial incentive to back a treatment. Guidelines lose integrity if they are not based on objective evidence. So, committee members must declare all possible conflicts of interest before proceeding to work on the committee.

Why Does This Matter?

This is the first of its kind professional practice guidelines for providing psychedelic-assisted therapy.

Many healthcare practitioners are familiar with psychedelics, but don’t feel comfortable prescribing or recommending them without more evidence and information on what appropriate use looks like. And, we know that patients are asking about psychedelics. In one study, 44% of healthcare providers reported that patients ask them for advice on psychedelics, but 49% of providers stated they did not feel comfortable answering these questions.

Guidelines help bridge the knowledge gap for healthcare providers, providing a resource that can be consulted relatively quickly. This helps healthcare providers educate themselves in a timely manner and properly address the needs of their patients.

Conclusion

The American Psychedelic Practitioners Association just published the first-ever professional practice guidelines for psychedelic-assisted therapy “Professional Practice Guidelines For Psychedelic-Assisted Therapy”. 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. Now that the first guidelines have been published, future work evaluating evidence for psychedelic-assisted therapy has a baseline standard to compare against.