Anticipating Access Obstacles for Psychedelic-Assisted Therapies

As the prospect of widespread use of psychedelic-assisted mental health therapies moves closer toward a clinical reality, many wonder how and to whom these therapies will be made available.

On Saturday, October 15, at the second annual Sana Symposium, Rick Doblin, PhD, founder and executive director of Multidisciplinary Association for Psychedelic Studies (MAPS), talked as a panelist for the session entitled “Addressing Access Challenges for Psychedelic Treatments,” before a virtual audience of mental healthcare professionals, including doctors, nurse practitioners, care advocates, and non-profit representatives.

Ahead of his presentation, Dr Doblin spoke with Psych Congress Network about what clinicians should be thinking about in regard to accessibility for psychedelic therapies, when access should be limited, and common misconceptions that need to be cleared up.

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Editor’s note: Responses have been lightly edited for clarity.

Brionna Mendoza, Associate Digital Editor, Psych Congress Network: What are 3 main takeaways from your session regarding patient access to psychedelic treatments that clinicians need to know?

Rick Doblin, PhD: First, clinicians should know that the first Phase 3 study was exceptionally successful. Second, therapists who want to work with patients, if FDA approval is indeed obtained, will need to learn the therapeutic method used in Phase 3, as taught by the Multidisciplinary Association for Psychedelic Studies (MAPS), or groups that MAPS has authorized. Finally, MDMA is a tool that can be used with many different therapeutic approaches.  

Mendoza: As psychedelics move towards FDA approval, what should clinicians be thinking about now in regards to patient access of these therapies? 

Dr Doblin: The key issue will be insurance coverage, but we think there’s a good chance we’ll be able to obtain that.  

Mendoza: Are there any reasons why access should be limited? Why or why not?

Dr Doblin: People on SSRIs will need to taper off to be eligible for psychedelic treatments. If they don’t want to, currently access is limited to them. People with uncontrolled hypertension are not allowed into the study unless they get hypertension control. Access is currently denied by FDA to people that have post-traumatic stress disorder (PTSD) and active substance use disorders, but that should change. We should be able to treat people simultaneously for PTSD and substance use disorder. There are other exclusion criteria to the study in addition to those mentioned above.

Mendoza: In regards to access challenges, what lessons can we learn from the exploration of psychedelic applications during the 1960s and 1970s? What about lessons from similar explorations of other illicit psychoactive substances for medicinal application, such as cannabis?

Dr Doblin: That psychedelics can be used to treat substance use disorder and that we should be able to treat people for PTSD and substance use disorder simultaneously. We should also keep in mind that there need to be periods for preparation and integration; the psychedelic experience by itself is not sufficient. With psychedelics, we are seeking approval for administration under supervision, not as a take-home medication.  

Mendoza: Which misconceptions about this topic would you like to clarify for our audience?

Dr Doblin: People think that the drug is the primary healing agent, when it’s actually the therapy that the drug makes more effective. Additionally, the dangers of MDMA neurotoxicity have been vastly exaggerated and do not apply to the doses used in MDMA-assisted therapy. 

Mendoza: Any final thoughts pertaining to this topic?

Dr Doblin: Drug policy reform and drug development are mutually supportive.

Rick Doblin, PhD, is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He received his doctorate in Public Policy from Harvard’s Kennedy School of Government, where he wrote his dissertation on the regulation of the medical uses of psychedelics and marijuana and his Master’s thesis on a survey of oncologists about smoked marijuana vs. the oral THC pill in nausea control for cancer patients. His undergraduate thesis at New College of Florida was a 25-year follow-up to the classic Good Friday Experiment, which evaluated the potential of psychedelic drugs to catalyze religious experiences. He also conducted a 34-year follow-up study to Timothy Leary’s Concord Prison Experiment. Rick studied with Dr Stanislav Grof and was among the first to be certified as a Holotropic Breathwork practitioner. His professional goal is to help develop legal contexts for the beneficial uses of psychedelics and marijuana, primarily as prescription medicines but also for personal growth for otherwise healthy people, and eventually to become a legally licensed psychedelic therapist. He founded MAPS in 1986, and currently resides in Boston with his wife and puppy, with three empty rooms from his children who have all graduated college and begun their life journeys.