Exploring the Therapeutic Potential of Psychedelic Treatments in Psychiatry

In part 2 of this exclusive Q&A, Cape Cod Symposium faculty members Raghu Appasani, MD, PC, Gaetano Vaccaro, PhD, CSAT, and Kaci Hohmann, JD, dive even deeper into some of the key topics from their session "Psychedelics—Ethical Concerns and Efficacy for Modern Psychiatry" including the most promising therapeutic benefits of psychedelics, how psychedelics function as adjunctive therapies, and the key legal challenges and considerations.

Part 1 of this Q&A discussed the barriers and opportunities of psychedelic therapy in conventional medicine and addiction recovery. They offer insight into the potential benefits, ethical considerations, and the evolving perceptions and impact of psychedelic therapy.

For more coverage on the 2024 Cape Cod Symposium on Addictive Disorders, visit the newsroom. 

Editor’s note: This interview has been edited for length and clarity.

Thistle: What are the most promising therapeutic benefits of psychedelics? Are there any particular patient populations that you believe could benefit most from these treatments?

Dr. Appasani: There have been positive research and benefits shown in clinical research and through Indigenous cultures for the use of psychedelics. For example, MDMA has been shown through phase III clinical trials to benefit in the treatment and remission of posttraumatic stress disorder (PTSD). For terminally ill patients facing existential distress, psychedelics like psilocybin can help alleviate anxiety and provide a greater sense of peace and acceptance. Psychedelics, including ayahuasca and ibogaine, have shown potential in treating substance use disorders (SUDs).

Therefore, treatment with psychedelics, along with psychotherapy, may be beneficial for those suffering from addiction, treatment-resistant depression, anxiety, obsessive-compulsive disorder (OCD), PTSD, and those at the end of life and/or struggling with terminal illness.

Thistle: In your view, how do psychedelics function as adjunctive therapies in a clinical setting? Could you share any insights on how they complement existing psychiatric treatments?

Dr Vaccaro: Ketamine is the most-studied psychedelic drug for mental health therapy. In low doses, it has been shown in clinical trials to be beneficial in treating depression, and it is now in common usage as an adjunctive therapy.  Additionally, significant research has been done on MDMA and psilocybin, which have been designated by the FDA as “breakthrough therapies” for PTSD and TRD. The best efficacy seems to be the use of these treatments in clinical settings, in combination with traditional talk therapy and the appropriate use of psychiatric medications.  

When a patient enters into a state of expanded consciousness, whether it is through conventional therapies such as guided visualizations, eye movement desensitization and reprocessing (EMDR), brainspotting, etc., or through adjunctive treatments using plant-based medicines, there are a number of caveats and risks. These treatments may involve a myriad of emotional, psychological, and physical manifestations that can feel very unsettling and require continual reintegration and resourcing. The most common of these manifestations being disorientation, emotional flooding, reentry shock, and the spontaneous reemergence of the experience (flashbacks). Also, paradoxically, these treatments sometimes result in a magnification of the anxiety, panic, or depressive symptoms they were intended to alleviate. 

Therefore, it is vital to prepare clients for this type of deep therapy through a process of preparation sessions prior to the deep-process/journeying session, followed by one or more integration sessions. The preparation sessions are intended to assist the client in developing internal psychological resources (e.g., self-awareness, self-regulating, self-soothing) and establishing how to access external resources (e.g., psychiatrists, therapists, guides, and trained practitioners) when they are having difficulty adjusting to the experience. 
Integration sessions are intended to help clients integrate the new insights and awareness they have gained through the treatments to shift emotional patterns and promote psychological and spiritual development.

Thistle: With Oregon Measure 109 paving the way for legal psilocybin services, what do you see as the key legal challenges and considerations for other states looking to implement similar measures?

Hohmann: Implementing state-regulated programs in the psychedelics space comes with a host of challenges that requires a great balancing act.  Currently, one of the primary concerns relates to access and affordability. One-on-one single-day sessions with a licensed Oregon facilitator can cost anywhere from $1,000 to $3,000. The federally illegal nature of these substances means participants in state-regulated programs are forced to pay out-of-pocket for services as there is no health insurance. Businesses are also struggling to stay afloat due to the high cost of navigating complex state regulations and implementing necessary liability measures. 

There are numerous other issues states must consider when developing these programs, including dosing limits, contraindications, and location of services, as well as whether licensed facilitators should be able to practice their other licensed professions (e.g. psychiatry) while simultaneously providing psychedelic services. There is no uniform approach that will work for every state but looking to Oregon and soon, Colorado, to determine what is or is not working in those programs is a good starting point for developing laws and regulations in other states.

Thistle: Is there anything else you would like to share for the audience from a legal perspective outside of Oregon Measure 109?

Hohmann: Given the surging interest in psychedelics for the treatment of mental health disorders, I would remind licensed medical and mental health practitioners interested in working in this space to fully weigh the risks and take steps to protect themselves. Even when working with federally illegal substances, implementing best practices, familiarizing yourself with your licensing board’s position on psychedelic treatment, and developing appropriate legal strategies and documentation can help mitigate liability.

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Raghu Appasani, MD, PC, is an Integrative & Addiction psychiatrist, psychotherapist, impact media producer, entrepreneur, and author who combines psychotherapy, pharmacology, nutrition, and holistic methods to provide personalized care. Dr. Appasani is also a neuroscientist, exploring the clinical applications of non-ordinary states of consciousness and delving into the human experience, and is a clinical professor at UCSF and Mount Sinai New York. He founded The MINDS Foundation, a mental health NGO in India, and serves as the CEO at PYM Health. He is currently launching a new venture, Rooted, focused on helping families build healthier relationships with technology. He is also the Program Director of Nutrition/Youth/Metabolic Mental Health & Psychedelics at the California Institute for Stress & Resilience.

Gaetano Vaccaro, PhD, is a Licensed Clinical Psychologist and Certified Sex Addiction Therapist (CSAT), as well as an expert in Organizational Psychology and Optimal Performance. Dr Vaccaro is the creator of RISC-Relationships, Intimacy and Sexual Compulsivity - a multi-modal treatment program for substance abuse, sexual compulsivity, and process addictions, workshop facilitator for SOAR- Survivors of Abuse in Recovery – for survivors of sexual trauma.
Dr Vaccaro is currently the National Clinical Advisor with Constellation Behavioral Health for Alta Mira Recovery Program and Bridges to Recovery in Beverly Hills, CA. Dr Vaccaro previously served as Clinical Director for the Sexual Addiction Program at Blue Tiger Recovery; Clinical Director at The Meadows - Gay Men’s Institute in Palm Springs; Interim Executive Director at Alta Mira Recovery Programs in Sausalito; Program Director and Clinical Director at Moonview Sanctuary in Santa Monica. Dr Vaccaro began his Clinical career at the LAGLC Jeffrey Goodman Clinic in Los Angeles and is currently in private practice in Palm Springs.

Kaci Hohmann, JD, is a business attorney at Emerge Law Group, headquartered in Portland, Oregon. She is licensed to practice law in Oregon, Colorado, and New Jersey. Kaci has extensive experience advising clients on a variety of business-related matters in cannabis, psychedelics, and traditional markets. She was a member of the drafting team for Oregon Measure 109, which legalized psilocybin services in Oregon. Kaci is co-chair of Emerge Law Group’s psychedelics practice group and chair of the Oregon State Bar’s Cannabis and Psychedelics Law Section.