The Current Psychedelic Therapy Landscape

The field of psychedelic therapy is undergoing significant developments, with optimism surrounding the potential legalization of MDMA-assisted therapy for the treatment of PTSD. The Multidisciplinary Association for Psychedelic Studies (MAPS) predicts that the FDA will approve this groundbreaking treatment on August 11, 2024. However, several subsequent steps are necessary before clinicians can offer MDMA-assisted therapy to patients. These steps include DEA rescheduling MDMA from Schedule 1 to Schedule 3, the formulation of high-level guidance by different states, and the development of policies and procedures by medical and clinical colleges. Realistically, clinicians may begin offering this therapy sometime during 2025. As we anticipate this change, therapists must navigate the evolving legal landscape.

The Hurdles of the Clinical Trial Path

Existing therapies for PTSD and other mental health challenges often come with drawbacks, such as time-consuming implementation, unpleasant side effects, and low efficacy rates. In contrast, psychedelic treatments offer hope for breakthroughs to those who have been unsatisfied with existing treatments. The resurgence of interest in psychedelic therapy has sparked hope for a mental health revolution, but the clinical trials needed to legalize these treatments can take years and sometimes decades. The prolonged process of clinical trial development has prevented legal access and frustrated patients seeking effective mental health treatments. Consequently, some individuals turn to underground therapists who have stepped in to fill this void.

Competition for Licensed Therapists

As MDMA becomes available through prescription, licensed therapists face a unique challenge. Their competition won’t be limited to other licensed professionals; they’ll also contend with the established underground therapeutic community. How will legal aboveground therapy and underground practice be seen by potential clients? The clandestine underground practitioners have honed their skills and built trust with clients. It is reasonable to predict that accessibility will play a crucial role: underground sessions often occur in comfortable settings like homes or local hotel rooms. Cost-effectiveness favors underground therapy due to the absence of facility fees and insurance. Moreover, the flexibility to use a diverse range of psychedelics, including LSD, psilocybin, and 5-MeO-DMT, provides more treatment options. Some underground therapists draw from ancient ayahuasca ceremonies, incorporating indigenous wisdom into their practices that may be attractive to potential clients. Licensed therapists must recognize this competitive landscape and position themselves accordingly.

Licensed therapists would be wise to counter these perceived benefits, as underground therapy poses significant risks. The lack of medical oversight in underground therapy means that patients may face serious health risks. Engaging in illegal therapy can lead to legal consequences for both therapists and patients. Quality control issues arise as the purity and quality of substances used in underground therapy cannot be guaranteed. Additionally, patients have no insurance or legal recourse if something goes wrong. Variability in ethical standards and practices among underground therapists can also lead to abuse and harm.

Aboveground Safety

Legal therapy practices offer structured oversight and recourse, ensuring safer and more regulated experiences. Patients benefit from rigorous physical, psychological, and psychiatric screenings that ensure suitability, reducing risks from underlying physical and mental health conditions. Legal safeguards provide protection and recourse for any issues during treatment. Purpose-built spaces and regulated active molecules ensure quality and purity. Financial protection through insurance coverage is also available for harm or injury during treatment. Collaborative interdisciplinary care teams can provide balanced, holistic care, and patients navigate a transparent landscape with access to online resources and firsthand inspections.

Currently, aboveground clinics mostly offer ketamine therapy, which is legal, short-acting (60 min), and relatively easy to manage. In Canada, the Special Access Program (SAP) is available for critically ill patients who have exhausted other options and wish to access experimental treatments like MDMA. SAP applications are complex, time-consuming, and subject to Health Canada’s approval.

Conclusion

As we stand on the cusp of a potential transformation in mental health treatment, the introduction of MDMA-assisted therapy offers hope to many who have found traditional therapies insufficient. However, the journey from clinical trials to widespread therapeutic use is fraught with challenges. Licensed therapists must prepare to navigate the evolving legal landscape, ensuring they can offer these groundbreaking treatments safely and effectively. They must also recognize and address the competition posed by underground practitioners, emphasizing the safety, regulation, and comprehensive care provided by legal therapeutic practices. The future of psychedelic therapy holds promise, but it requires careful, informed, and ethical implementation to truly benefit those in need.