Psychedelic-assisted psychotherapy (PAT) shows promise for treating PTSD, depression, and substance use disorders, with potential FDA approval of psilocybin-assisted therapy for depression by 2026. This commentary calls for implementation scientists to collaborate with PAT researchers and practitioners to bring these treatments into routine practice, especially in safety-net settings like Federally Qualified Health Centers and Veterans Affairs health systems that serve historically marginalized populations. Using the RE-AIM Framework, the authors outline how implementation science can contribute tools, methodologies, and approaches to ensure PAT is safe, effective, and accessible for underserved communities.
Psychedelic-assisted therapy (PAT) combines medication with psychotherapy, but many questions remain about how it works, for whom, and in what context. To avoid the typical 17-year delay between research and clinical practice, implementation science can help by simultaneously studying safety, effectiveness, and real-world delivery. Methods like sequential multiple assignment randomized trials (SMART), hybrid study designs, and fidelity measurement can speed implementation while maintaining quality and safety. Substantial changes to regulations, training, and access are needed to accommodate this multimodal therapy outside research settings. The authors advocate proceeding with accelerated caution.
After adjusting for preexisting psychiatric conditions, the link between hallucinogen use and psychosis disappears. Among 273,466 people with substance-related hospital admissions, psychosis diagnoses were more common after hallucinogen-related admissions (16.4%) than after other substance admissions (6.6%). However, once clinical characteristics were accounted for, the increased risk became nonsignificant (hazard ratio 0.97). This suggests that observed associations between hallucinogens and psychosis are largely due to underlying mental health vulnerabilities, not a direct causal effect. The findings inform psychedelic policy by indicating that population-level data on hallucinogen safety may reflect preexisting risk factors.