Is Therapeutic Use of Psychedelic Medication Influenced by Bias?

Abstract

The use of psychedelic medications to treat the brain disorders associated with psychiatric illness has re-emerged in recent years as a viable treatment option (Grieco et al., 2022). Historically there is evidence of hallucinogenic use in religious and spiritual rituals dating back to 500 B.C. (Begola & Dowben, 2018). The discovery of LSD (lysergic acid diethylamine-25) in Switzerland in 1943 marked the beginning of its use in managing psychiatric disorders (Begola & Dowben, 2018). The widespread abuse of substances and their illegal status halted the research and subsequent discussion about therapeutic use by 1970 (Begola & Dowben, 2018). Nichols (2016) noted that research on psychedelics diminished after Congress passed the Controlled Substance Act in 1970. The renewed interest in legitimizing these substances as therapeutic likely occurred with the Federal Drug Administration’s designation of “breakthrough therapy,” a new classification of drugs, allowing the development and review of drugs to be expedited to maximize the potential use of psychedelics as useful in treating various neuropsychiatric disorders (Nichols & Walter, 2021). Although interest in the use of hallucinogens or psychedelics has markedly increased in recent years, they still remain a controversial option with legal and cultural implications for psychiatric treatment (Garcia-Romeu & Richards, 2018). This editorial will examine the consideration of psychedelic medication (excluding marijuana) in nursing practice where nurses are likely to encounter patients requesting or needing clinical management of their psychedelic medication regime. Patients may ask a nurse practitioner to consider prescribing these agents or nurses may encounter patients receiving psychedelic agents as part of routine inpatient or outpatient care. While some sources might characterize these agents as hallucinogenic, for purposes of this discussion, the term psychedelic medication is used to refer to a broad range of medication including psilocybin, LSD, ayahuasca, ketamine, and 3,4-methylenedioxymethamphetamine (ecstasy; Begola & Schillerstrom, 2019). Psilocybin has been studied for tobacco cessation, alcohol dependence, and depression/ anxiety while methylenedioxymethamphetamine (MDMA) has been used to treat patients with post-traumatic stress disorder. Positive results suggest the need for further research and consideration (Penn et al., 2021). Extensive information on the specific properties of psychedelic drugs not detailed here is available in the literature (Grieco et al., 2022). Barnett et al. (2022) noted that the United States National Institutes of Health (NIH) had not provided direct grant support for psychedelic-assisted therapy clinical trials. The National Library of Medicine National Center for Biotechnology Information website (n.d.), clinicaltrials.gov, shows that there are currently 209 registered studies noted as treating psychiatric disorders with psychedelics. Seventy-six of these studies involved the use of psilocybin for depression or PTSD. In the remaining studies, other identified agents included cannabis, ketamine, and MDMA. A disclaimer notes that the United States government does not review or approve safety and science of studies listed on the website (clinicaltrials.gov). In the United States, a number of states in recent years have legalized the use of psychedelics (Smith & Appelbaum, 2021). Smith and Appelbaum (2021) note that overly rapid legalization and commercialization of psychedelics could potentially influence prudent legal reforms. They note an ongoing debate about decriminalization, addressing a mental health crisis, and adding a new psychiatric intervention with potential to be effective. Smith and Appelbaum (2021) cautiously emphasized the need to approach legalization and clinical use with prudence, evidence-based research, and regulatory policy. Mocanu et al. (2022) advocated for shifts in drug policies that emphasize safe access and evidence-based compassionate care. Heal et al. (2023) advocated for considering state and local legislation of psychedelics from the following categories: decriminalization, supported adult use, medical use, clinical research, and policy analysis. How does the historical stigma of psychedelic use inhibit the rational consideration of these agents as legitimate for treatment? State-specific prescriptive authority determines if nurse practitioners are able to legally prescribe Schedule I drugs. Preuss et al. (2023) noted that psychedelic medication requires prescribers in the United States to have a Schedule I prescribing certificate. Examples of Schedule 1191467 JAPXXX10.1177/10783903231191467Journal of the American Psychiatric Nurses AssociationEditorial editorial2023