Ethical and legal issues in psychedelic harm reduction and integration therapy

Abstract

Psychedelic-assisted therapy may represent an upcoming paradigm shift in the treatment of mental health problems as recent clinical trials have demonstrated strong evidence of their therapeutic benefits. While psychedelics are currently prohibited substances in most countries, the growing popularity of their therapeutic potential is leading many people to use psychedelics on their own rather than waiting for legal medical access. Therapists therefore have an ethical duty to meet this need by providing support for clients using psychedelics. However, incorporating psychedelics into traditional psychotherapy poses some risk given their prohibited status and many therapists are unsure of how they might practice in this area. This paper explicates such risks and describes ways in which therapists can mitigate them and strive to practice within legal and ethical boundaries. A harm reduction approach will be emphasized as a useful framework for conducting therapy around clients' use of psychedelics. It is argued that therapists can meet with clients before and after their own personal psychedelic experiences in order to help clients minimize risk and maximize benefit. Common clinical scenarios in this growing clinical area will also be discussed.

Translating Psychedelic Therapies From Clinical Trials to Community Clinics: Building Bridges and Addressing Potential Challenges Ahead

“…Transgression of ethical boundaries is an ever-present risk for clinicians and subjects when working with altered states of consciousness, given therapist-patient power imbalances and potentially traumatic states in vulnerable patients (21)(22)(23)(24).…”

“…Transgression of ethical boundaries is an ever-present risk for clinicians and subjects when working with altered states of consciousness, given therapist-patient power imbalances and potentially traumatic states in vulnerable patients ( 21 – 24 ). Research protocols specify male-female therapist dyads, ongoing supervision by experienced therapists, transparent practices, and ultimately oversight by Ethics Committees and Review Boards.…”

Predictors of Psychedelic Experience: A Thematic Analysis

“…Yet, this current framework does not generalise to important populations who, for various reasons, will continue to self-medicate without clinical guidance even after psychedelic therapy is legally accessible (Pilecki et al, 2021). A major ethical concern is that once this treatment becomes publicly available, its financial cost may render it inaccessible to groups that it would benefit most (a phenomenon known as 'inverse care'; Rea & Wallace, 2021).…”

“…Public awareness of the importance of preparation, understanding, motivation and mindset during psychedelic use, becomes even more crucial in light of current trends. The prevalence of people using psychedelics for self-therapeutic purposes, and without clinical supervision, is predicted to rise (Pilecki et 2021). According to a recent global study, public use of ketamine, MDMA, psilocybin and LSD has increased substantially.…”

“…To address this concern, a more nuanced understanding of predictive variables is crucial to progressing the therapeutic application of psychedelics . Furthermore, given the highly publicised return of psychedelic research and widespread coverage of their health benefits, the prevalence of people using psychedelics for self-therapeutic purposes is predicted to rise (Pilecki et al, 2021). As this unsupervised use becomes more prevalent, better knowledge of factors that predict adverse experiences in particular, could inform the development of public harm reduction frameworks.…”