How Psychedelics Are Entering the Mainstream
New treatment models aim to make psychedelics increasingly common.
Posted Sep 15, 2020
Signs of progress in the field of psychedelics are easy to come by. You needn't look far to notice the increasingly robust research emerging on their ability to aid multiple mental health conditions. And as such, many are starting to wonder where they can access the treatment.
Psychedelics have shown particular promise in treating depression, with psilocybin (the psychoactive compound in magic mushrooms) having achieved "Breakthrough Therapy" status by the FDA for the condition. Despite this, though, a standardized treatment model for delivering psilocybin-assisted therapy outside of research settings does not currently exist.
That means, for the most part, people can only legally access the treatment by qualifying for a clinical trial, and there is no way for patients to continue the therapy afterward. This leaves them without proper support.
"It's difficult seeing people in our studies who are really helped by psychedelic-assisted psychotherapy only to be desperate for it again so they can continue treatment," says Dr. Rosalind Watts, the former clinical lead of the Psilocybin for Depression Study at the Centre for Psychedelic Research at Imperial College London.
"I'm in contact with someone from the first study who, five years later, is still contacting me saying he really needs another session but doesn't know where to go as he can't access this care anywhere."
Watts has first-hand experience treating patients with psilocybin as a session guide in two studies investigating the compound on depression. She has also conducted research on how participants regard the treatment. From her work, she now feels the therapy is both safe and promising enough to become more widely available to those who meet the same inclusion criteria used in the studies.
Moreover, current models of psychedelic-assisted psychotherapy are prohibitively expensive. So far, studies investigating the therapy for depression require each patient to be accompanied by two therapists for a whole day, not counting additional hours for regular psychotherapy to integrate their experiences. Although shown to be effective, due to its high cost, the treatment in its current state is unlikely to become mainstream.
To change this, different centers are experimenting with different models for psychedelic-assisted psychotherapy.
New York-based Ember Health, for example, a clinic specializing in treating depression with ketamine, works with patients and their care teams to develop treatment plans involving intravenous infusions of the drug for 40 minutes, followed by 20 minutes of resting time before discharge.
Patients are advised to have four infusions over two weeks as a foundation, and then "top-ups" according to their specific needs. Taking an hour per session, Ember Health's model minimizes costs and makes it easier to integrate their treatment with existing treatments and everyday life.
Synthesis, on the other hand, has a group approach. In their therapy program, each attendee receives six weeks of preparation therapy, leading up to a week-long truffle-assisted group therapy retreat. Following aftercare and follow-up, attendees then begin a 12-month online integration program.
Although more resource-heavy than Ember Health's offering, Synthesis is still able to keep costs lower than the model used in the Imperial studies as each participant has just one personal facilitator throughout their psilocybin experience, as opposed to two.
Regardless of the model though, for now, psychedelic-assisted therapy is still prohibitively expensive to most and generally not covered by health insurance. Prices generally range from hundreds of dollars per session to thousands of dollars per treatment plan.
Given that many in the field are motivated by widening access to psychedelic medicine, these cost barriers are far from ideal. But at the same time, many recognize that it may be a necessary evil for now. Watts, for example, likens the development of psychedelic treatment models to that of the Tesla car: starting by targeting high-end consumers to cover the costs of developing a proper, scalable model that is both accessible and affordable to the masses.
But this doesn't mean that those with less financial means will not be able to gain access to psychedelic-assisted psychotherapy. Ember Health, for example, has committed to providing reduced infusion fees for up to 20% of their patients at any given time. Meanwhile, Synthesis has opened a scholarship fund, which has so far enabled 16 people who took part in the Imperial studies to enroll in their program.
As more people receive various forms of psychedelic-assisted therapy, those at the forefront of the treatment hope that healthcare providers will soon start to understand its value and eventually refer people for the treatment. Ultimately, they hope to see psychedelic-assisted therapy become a gold-standard treatment option, and for it to be covered by insurance companies.
For this to happen, though, more work is needed from researchers, healthcare providers, and retreat centers alike to develop effective and scalable models for the treatment. When asked what the most important aspect of this psychedelic-assisted therapy model is, Watts answered with one word: trust.
"The most important thing in psychedelic therapy is that people trust you, trust the medicine you're providing, and trust the team that they're working with," says Watts. "This then allows them to trust themselves, something that is crucial going in, especially as psilocybin experiences can be so incredibly intense."
Despite the hurdles, there is a widespread sentiment in the field of psychedelics that it's just a matter of time before they become mainstream. In this sense, the "what" has already been established. What's left now is the "how." And with the research behind these drugs gaining more acclaim, it is now up to treatment providers to play their part in seeing them leave novelty and enter convention.