Slouching towards engagement: interactions between people using psychedelics naturalistically and their healthcare providers
Kasey Cox, Cody Weston, Moss Herberholz, Nicolas G. Glynos, Nicholas Kolbman, Julie Barron, Kevin F. Boehnke, Christopher W Fields, Daniel J. Kruger
Frontiers in Psychiatry August 4, 2023 DOI: 10.3389/fpsyt.2023.1224551 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Cross-sectional survey Peer reviewed |
|---|---|
| Sample size | 1,221 |
| Population | Adults reporting psychedelic use recruited through a psychedelics advocacy event and social media |
| Topics | Psilocybin |
| Keywords | Confidentiality Health care Disconnection Hallucinogen Clinical psychology |
| Key findings | Psychedelic use is largely disconnected from primary and psychiatric clinical care, with low disclosure rates and a gap between desire for and receipt of therapist support. |
Abstract
Introduction: There is substantial public interest in psychedelics as potential treatments for psychiatric conditions. However, most psychedelics are criminalized under federal law in the USA, so it is unclear whether use occurs with clinical support. Our objective was to assess whether naturalistic psychedelic use occurs with clinical support, interactions between those using psychedelics and healthcare providers (psychiatrist, therapist, or primary physicians), and use characteristics.
Methods: We conducted an online, anonymous, confidential, cross-sectional survey of adults reporting psychedelic use ( N = 1221) through a psychedelics advocacy event and social media between 9/18/2022 and 11/5/2022. We assessed participant disclosure of psychedelic use with their psychiatric care provider (PsyCP) and/or primary care provider (PCP), desire for provider support, access to support, and rate of taking prescribed psychoactive medications alongside psychedelics.
Results: Among participants with such care providers, 22% disclosed psychedelic use to their PCP vs. 58% to their PsyCP. Participants were less confident in PCP vs. PsyCP ability to integrate psychedelics into treatment. Common reasons for nondisclosure included stigma, inadequate provider knowledge, and legal concerns. 23% reported taking psychedelics on the same day as potentially interacting psychiatric medications (e.g., anxiolytics, antidepressants). Despite 81% of participants desiring therapist support during psychedelic experiences, only 15% had received such support.
Discussion: Our results show that psychedelic use is generally disconnected from primary and psychiatric clinical care. This disconnection may result in safety issues, including inadequate screening for contraindicated conditions, lack of support during emergent adverse events, and drug interactions. Enhanced clinical education and orienting drug policy towards known harms and benefits of psychedelics is needed.