ARC: a framework for access, reciprocity and conduct in psychedelic therapies

Abstract

The field of psychedelic assisted therapy (PAT) is growing at an unprecedented pace. The immense pressures this places on those working in this burgeoning field have already begun to raise important questions about risk and responsibility. It is imperative that the development of an ethical and equitable infrastructure for psychedelic care is prioritized to support this rapid expansion of PAT in research and clinical settings. Here we present Access, Reciprocity and Conduct (ARC); a framework for a culturally informed ethical infrastructure for ARC in psychedelic therapies. These three parallel yet interdependent pillars of ARC provide the bedrock for a sustainable psychedelic infrastructure which prioritized equal access to PAT for those in need of mental health treatment (Access), promotes the safety of those delivering and receiving PAT in clinical contexts (Conduct), and respects the traditional and spiritual uses of psychedelic medicines which often precede their clinical use (Reciprocity). In the development of ARC, we are taking a novel dual-phase co-design approach. The first phase involves co-development of an ethics statement for each arm with stakeholders from research, industry, therapy, community, and indigenous settings. A second phase will further disseminate the statements for collaborative review to a wider audience from these different stakeholder communities within the psychedelic therapy field to invite feedback and further refinement. By presenting ARC at this early stage, we hope to draw upon the collective wisdom of the wider psychedelic community and inspire the open dialogue and collaboration upon which the process of co-design depends. We aim to offer a framework through which psychedelic researchers, therapists and other stakeholders, may begin tackling the complex ethical questions arising within their own organizations and individual practice of PAT.

Commentary: ARC: a framework for access, reciprocity and conduct in psychedelic therapies

“…The authors present the Access, Reciprocity, and Conduct (ARC) framework for guiding ethics related to psychedelic-assisted therapy (P-AT). Resting on the foundations of ARC are three pillars dedicated to “representing a commitment to equitable access to psychedelic therapies (Access), a respect for traditional and spiritual uses of psychedelics (Reciprocity), and the safe and ethical delivery of P-AT in clinical settings (Conduct)” (Spriggs et al, 2023 ). ARC offers the field both a clinical and community-based approach rooted in ethics (Spriggs et al, 2023 ).…”

“…Resting on the foundations of ARC are three pillars dedicated to “representing a commitment to equitable access to psychedelic therapies (Access), a respect for traditional and spiritual uses of psychedelics (Reciprocity), and the safe and ethical delivery of P-AT in clinical settings (Conduct)” (Spriggs et al, 2023 ). ARC offers the field both a clinical and community-based approach rooted in ethics (Spriggs et al, 2023 ). Different stakeholders are relevant to each pillar, with ARC aiming to highlight their interdependence within as imperative for robustly supporting the future growth of practice, policy, industry, and research.…”

“…Different stakeholders are relevant to each pillar, with ARC aiming to highlight their interdependence within as imperative for robustly supporting the future growth of practice, policy, industry, and research. Background for each of the pillars and the development process for ARC are discussed in detail throughout (Spriggs et al, 2023 ).…”

“…While the authors clearly note that this is a starting point for developing the criteria across stakeholders (Spriggs et al, 2023 ), future scholarship could benefit by the inclusion of information about the process for choosing representatives from each sector of the psychedelic community. The authors write that “The stakeholders have been identified to be representative of the actors most closely implicated in the ARC pillar in question, and come from research, industry, community, anthropological, policy, and indigenous contexts” (Spriggs et al, 2023 ). This is helpful insofar as it goes, but how are the authors judging who is most “closely implicated” with P-AT?…”

“…The authors introducing the ARC framework for access, reciprocity, and conduct in psychedelic therapies offer a comprehensive and thoughtful methodology for creating a more unified framework of conduct within the realm of psychedelic therapies. As a clinician, bioethicist, and researcher committed to culturally responsive practice, it is encouraging to see more literature exploring ethical and equitable infrastructures for psychedelic care to support the rapid expansion of P-AT in research and clinical settings (Spriggs et al, 2023 ).…”