5 Ways Clinicians Can Work With Patients Interested in Psychedelics

If your patients aren’t yet asking about psychedelics, they most likely will be in the very near future, Saundra Jain, MA, PsyD, LPC, told clinicians attending the Sana Symposium on Sunday.

For now, most psychedelics remain illegal in the United States, although they are rapidly becoming a curiosity for many patients, especially those who aren’t responding to traditional treatment. Practitioners, therefore, must be ready to chart a path forward that balances helping patients while protecting both those patients and clinicians themselves, said Jain, an adjust clinical affiliate School of Nursing at the University of Texas.

Clinicians and patients alike can approach psychedelics through 1 of 3 mindsets or “windows,” Jain said.

“We, as clinicians, approach the conversation about psychedelics the same way our patients do,” she said. “We either come to it from a place of support or a place of opposition. Some uncertainty is possible too. Whether we come to the table from support or opposition, don’t forget that third window: curiosity. If we approach the conversation, no matter what our position, just interested in what our patients bring to the conversation, we are in a better place.

“If we, as clinicians, come to the conversation not really certain, but leaning towards opposition, we may inadvertently convey some judgment when patients ask about psychedelics … If we open that window of curiosity, we can listen openly, learn together, and grow together.”

Broadly, caution should be the rule when it comes to psychedelics, Jain said. Clinicians should consider how they will handle conversations with patients before they happen and know the amount of risk they are willing to take.

As the field waits for FDA approval for the use of additional psychedelics in therapy, what can clinicians offer in the meantime? Jain said there are 5 options:

Join a clinical trial. Familiarize yourself with current trials that are being conducted or supported by organizations such as MAPS, the Johns Hopkins Center for Psychedelic & Consciousness Research, NYU Langone Health Center for Psychedelic Medicine, and several European research hubs. Most researchers are registering their ongoing clinical trials at clinicaltrials.gov, and additional information on current trials is available at the psychedelic database found on Psychedelic.Support.

Psychedelic integration. “Many of us believe through the psychedelic integration process, cementing of the psychedelic experience occurs,” Jain said. Psychedelic integration provides a safe space to work with someone else to create meaning out of individual pieces, she said. Psychedelic.Support, MAPS, and the KRIYA Ketamine Research Institute offer resources and provider databases for integration.

Harm reduction. Harm reduction is about more than reducing negative consequences associated with drug use, Jain said. It is also a social justice movement built on belief in and respect for rights of people who use drugs. Organizations such as the not-for-profit DanceSafe, which promotes health and safety within the nightlife and electronic music communities, peer support resource Fireside Project, and the Zendo Project offer ways to get involved with harm reduction activities related to psychedelics. Jain said clinicians should also do the following:

• Know applicable laws
• Consult an attorney
• Know your licensing board’s position
• Know your context in which you practice. For example, are you located in a conservative or liberal area?
• Make your best decision
• Be educated and prepared by staying current on developments in the field

Legal psychedelics. While not a classic psychedelic, ketamine is an MNDA receptor agonist that can provide mystical experiences. It is FDA approved for treatment-resistant depression and has off-label uses for other mental health conditions. Many organizations offer training and education for ketamine-assisted psychotherapy certification.

If “work in the psychedelic space speaks to you and you want to do it in a legal setting outside of clinical trials, ketamine is the path forward at this point,” Jain said.

Jain also recommends exercising caution with regard to psychedelic tourism, the practice in which patients seek out practices offering psychedelic-assisted therapy in other countries where psychedelics are legal.

“Be fully aware of how much risk you are willing to shoulder,” she said. “The worry is that if we make a recommendation or are supportive of our patient following the route of psychedelic tourism, what happens if something bad happens when they are at the retreat center? What is our liability? We do want to help our patients, particularly those who are really suffering, but this one we may want to step back and reconsider.”

In addition to legality and liability, uncertainty over the potency of medicines administered at such retreats and the threat of sexual assault are among other risks associated with psychedelic tourism.

Other paths to nonordinary states of consciousness (NSOC). Until the FDA makes a ruling about psychedelics, the field remains in a holding pattern, Jain said. Be aware there are other paths and consider exploring options such as breathwork and meditation.

Ultimately, Jain said that no matter which window into psychedelics they approach these patient conversations from—support, opposition, or curiosity—clinicians should keep 3 guidelines in mind: Know where you stand, be clear on your previous experiences, and know what you bring to the table for this conversation.

Reference

Jain S. Working with patients who use psychedelics outside the clinical setting. Presented at: Sana Symposium; September 17-19, 2021; Virtual.