Psychedelic Doctors: The MD as an Asset in Psychedelic Medicine

As MDMA and psilocybin move towards commercialization, we’re getting down to the brass tax of delivering psychedelic medicine to the masses. Who will be key players in the interdisciplinary psychedelic team? Let’s talk about Psychedelic Doctors: the MD as an asset in psychedelic medicine. 

At Psychedelic Support, we’re looking forward to a new mental health paradigm. Applying psychedelics in the form of psychedelic therapy means creating a whole new system for delivering medicine. We can’t know exactly what the different roles in this field will look like, but we have a pretty good idea. 

Physicians will be leaders in implementing psychedelic medicine on the patient level. They’ll use evidence-based treatment plans, diagnose patients, prescribe therapy, and evaluate outcomes. Here’s how physicians will help bring psychedelic medicine to patients seeking mental health treatments. 

Structuring the Future of Psychedelic Medicine 

To deliver psychedelic medicine, we’ll need to create a new care team with specific and designated roles. 

Physicians will act as the head of this team. They will make the decision to incorporate psychedelic therapy into a patient’s care plan. As the prescriber, the MD will also diagnose and evaluate patients for appropriateness in therapy. The MD may prescribe psychedelics, but will not necessarily be present for active psychedelic sessions. 

Nurses will likely have important roles in patient safety and advocacy. They’ll provide a detailed assessment, assist in patient care and education, and act as the MD’s eyes during active sessions. Some nurses will even prescribe psychedelics as advanced-practice RNs. 

Psychedelic therapists can also help patients with their decision to choose psychedelic therapy. They may have a background in counseling or social work – which will help with the emotional aspect of the psychedelic experience. They’ll establish a baseline for patient mental health and build rapport with patients before their active session. It’s also likely they’ll be in the room to supervise sessions and help patients integrate their experiences. 

Psychedelic facilitators will likely fill gaps in the care team. Neither a licensed therapist or medical personnel, this person will help assist the patient through what can be an emotional experience. Psychedelic facilitators will have specific training and certifications. Utilizing these professionals may increase patient access despite a deficit in licensed personnel.   

MDs Role as Psychedelic Health Team Leaders

Psychiatrists will be leaders in bringing psychedelic medicine into their practices. As detailed symptom assessors and diagnosticians, they may be the first touch-point for new patients seeking mental health treatment. As psychedelics are commercialized, their guidance may help long-suffering patients receive the help they deserve. 

Palliative care physicians and hospice care doctors will also be important diagnosticians in determining a patient’s candidacy for treatment. Psychedelics could offer new relief for patients suffering from anxiety and depression during their last days. Palliative care physicians will have the power to help patients get the relief they need. 

Detailed Symptoms Assessment and Diagnosis

Doctors can help put together the clues from patient assessments to form the full picture of an accurate diagnosis. This skill will be especially critical when determining if a patient could benefit from psychedelic therapy. 

Specific diagnoses have shown promise in psychedelic medicine. PTSD specifically has shown positive responsiveness to MDMA. Many patients in trials experienced a remission of symptoms even months after treatment [1]. Accurately assessing and diagnosing patients is the first step in determining whether psychedelics can help them heal. 

Implementing and Managing Treatment Plans

As leaders in developing patient treatment plans, physicians will be the deciders on whether a patient should be offered psychedelic medicine. They’ll decide what a holistic treatment plan should look like for each patient and evaluate patients throughout the process. 

Physicians will have an important role in managing medications around patients’ active sessions. Certain meds that change serotonin could impact a patient’s experiences. For instance, there’s evidence that MDMA treatment may not be as effective for patients on SSRIs [1]. Physicians will have the training and expertise to make informed decisions about medications and treatment plans. 

Monitoring and Documenting Outcomes

Doctors will monitor patient status and outcomes after psychedelic therapy. This may look like monitoring a patient through their nurse. It may also take the form of outpatient appointments. 

Measuring outcomes is especially important in psychedelic medicine since these treatments are being newly understood in the context of mental health. Physicians will be responsible for documenting their patient outcomes and bringing important findings to medical associations.  

MDs as Prescribers in Psychedelic Medicine

A key role of the physician will be to evaluate if patients are candidates and prescribe psychedelic therapy. This will mean evaluating a patient’s appropriateness for therapy and exploring any risk factors for abuse and poor outcomes. 

Certain patient histories may be “red flags” for the psychedelic physician. Psychedelic physicians will be specifically trained to understand the risks of psychedelics, as well as specific scenarios that may be harmful for patients. 

A history of psychosis may rule a patient out for psychedelic therapy because psychedelics may exacerbate hallucinations – doing more harm than good. Assessing for past mental health history will be key in determining a patient’s readiness for psychedelic intervention. 

Another contraindication for psychedelic therapy may be a recent or ongoing history of substance abuse. This may seem counterintuitive, since some psychedelics have been found to help with addiction recovery. It’s important that patients have been able to fully stabilize and detox before administering any psychedelic interventions. 

What Psychedelics Can Doctors Currently Prescribe?

Some doctors are already taking up the prescriber role in psychedelic medicine. For instance, ketamine is prescribed by psychiatrists and anesthesiologists. Ketamine infusions and therapy for mental health conditions are described as “off-label” uses – while it’s technical use is as an anesthetic. Ketamine has been remarkably helpful for people with anxiety, depression, and other mental health conditions. 

Through ketamine therapy, physicians have seen how commercialization has had an impact on the treatment process. Ketamine research has included therapy integration alongside infusions. The “off-label” usage means that clinicians can offer ketamine infusions as stand-alone treatment, without the ongoing support of therapy. 

We don’t yet know how this affects outcomes for patients – but we hope that other psychedelic prescriptions will require therapy alongside substance sessions. MDs will have a key role in leading evidence-based psychedelic medicine and implementing standard treatment plans that link therapy with psychedelic experiences. 

Canada’s Special Access Policy (SAP) allows doctors to request access to experimental therapeutic substances on behalf of their patients. This use is restricted to cases of terminal illness or treatment-resistant ailments. Late last year, the SAP expanded to include MDMA and psilocybin. 

In the research setting, psychedelic doctors are responsible for evaluating patients’ candidacy for treatment. They also help to structure, measure, and report research findings. By leading research in psychedelic therapies, doctors are expanding our consciousness of psychedelic medicine while creating evidence-based standards of care. 

Oregon will allow people to access psilocybin under a new bill as early as 2023. Requests for psilocybin will not require MD oversight, and we’re not sure how this bill will play out in the real world. We hope that this new access process will use evidence-based treatment practices to  avoid a “watered down” commercialization similar to ketamine.

One of the few places that doctors can implement psychedelic medicine today is in the Netherlands. The Psychedelic Society is an organization at the forefront of bringing psilocybin retreats to Europe. They also vet safe environments and psychedelic facilitators. These retreats are not necessarily evidence-based and are not under safety-enforcing regulations like we have in the states. 

Next Steps for Future Psychedelic Docs

If you’re a physician interested in offering cutting-edge mental health care, we’d love to have you in the psychedelic medicine field. In this exciting new medical frontier, you’ll not only be a leader in diagnosing and prescribing, but in implementing a new framework for how we treat mental health. You can be a part of a revolution in psychiatric and therapeutic medicine. 

Psychedelic medicine needs you to help patients access these new treatments as they become available. We’ll need thousands of trained psychedelic physicians to fulfill the goal of offering broad access to treatment. You could be part of this exciting movement and a key leader in bringing better mental health treatment to folks who need it most. 

Psychedelic Support offers educational resources and community support for physicians who are interested in psychedelic medicine. We offer a variety of courses for prescribers; our Self Paced Ketamine Module offers insight and guidance for physician prescribers and you can earn CME credit. In it, you’ll learn about patient safety and advocacy in ketamine therapy. At the end of this module, you’ll have the skills to offer ketamine treatment to patients with depression, anxiety, PTSD, and more. 

If you want to connect with therapists who need a doctor for prescription referrals, join our free network and use Professional Connect to find those therapists in need of your services. 

References:

1. Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 27, 1025–1033 (2021). https://doi.org/10.1038/s41591-021-01336-3