Inclusion of people of color in psychedelic-assisted psychotherapy: a review of the literature

This commentary considers efforts to turn psychedelics into medications that can be administered through healthcare systems as examples of “medicalization.” I draw on ethnographic research both inside and outside of university-based clinical trials from 2014 to date, together with analogous examples from psychiatry and drug research and development. Rather than taking a normative stance on medicalization, I situate it in a wider political, economic, and cultural context to better understand its logics and effects. I begin by suggesting the resurgence of psychedelic science has been concerned with medicalization from the outset, recently prompting a crisis in the “psychedelics community” over its self-identity and values. Next, against the confident public messaging surrounding psychedelics, I consider how attempts to scale up and market psychedelic-assisted therapy could end up undermining the safety and efficacy of the therapy itself. I then outline the movements to decriminalize, legalize, and minimize the harms and risks of using psychedelics in their currently illicit therapeutic and recreational modalities. Finally, I explore how working toward psychedelic medicalization over the coming years may influence the movements toward decriminalizing and legalizing psychedelics use, focusing on the underarticulated ways in which medicalization may disregard or even hinder, rather than help, decriminalization and legalization efforts. I call attention to how the cost of gaining approval for therapies incentivizes the development of diluted-yet-profitable forms of psychedelic-assisted treatments, and how frameworks developed for “proper use” demarcate what counts as “abuse” and enable those with newly sanctioned access to psychedelics to condemn afresh their illicit use.

Section: Making a Medicine: Medicalizationmentioning

confidence: 99%

Making psychedelics into medicines: The politics and paradoxes of medicalization

Noorani

2019

“…A culturally informed approach in psychedelic therapies can and should be used in the research process to ensure equity and diversity in access to the potential benefits of MDMA. Current processes for recruitment and treatment are not sufficient to open the doors of psychedelic therapies to people of color in the US or internationally (Michaels et al, 2018). MAPS has been a leader in conducting research into MDMA-assisted therapy and to our knowledge has been the first to make a deliberate effort to include of people of color in the work.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are still large gaps in the body of knowledge surrounding MDMA. Although many communities of color experience the highest rates of PTSDleading to prolonged suffering, disability, and poor quality of life (e.g., Himle, Baser, Taylor, Campbell, & Jackson, 2009)they are extremely underrepresented in psychedelic research (Michaels, Purdon, Collins, & Williams, 2018;Williams & Leins, 2016). People of color have not been adequately included in previous studies of MDMA-assisted psychotherapy to determine if the treatment is appropriate, safe, or effective for them.…”

Section: Introductionmentioning

confidence: 99%

Culturally informed research design issues in a study for MDMA-assisted psychotherapy for posttraumatic stress disorder

Williams

Reed

Aggarwal

2019

Self Cite

Recent research suggests that psychedelic drugs can be powerful agents of change when utilized in conjunction with psychotherapy. Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy has been studied as a means of helping people overcome posttraumatic stress disorder, believed to work by reducing fear of traumatic memories and increasing feelings of trust and compassion toward others, without inhibiting access to difficult emotions. However, research studies for psychedelic psychotherapies have largely excluded people of color, leaving important questions unaddressed for these populations. At the University of Connecticut, we participated as a study site in a MAPSsponsored, FDA-reviewed Phase 2 open-label multisite study, with a focus on providing culturally informed care to people of color. We discuss the development of a study site focused on the ethnic minority trauma experience, including assessment of racial trauma, design of informed consent documents to improve understanding and acceptability to people of color, diversification of the treatment team, ongoing training for team members, validation of participant experiences of racial oppression at a cultural and individual level, examination of the setting and music used during sessions for cultural congruence, training for the independent rater pool, community outreach, and institutional resistance. We also discuss next steps in ensuring that access to culturally informed care is prioritized as MDMA and other psychedelics move into late phase trials, including the importance of diverse sites and training focused on therapy providers of color.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changesif anyare indicated.

“…However, few studies have adequately examined whether the positive effects of psychedelic experiences in clinical or naturalistic contexts hold for different racial/ethnic subgroups. Although naturalistic studies have included race as a control variable (Hendricks et al, 2015;Johansen & Krebs, 2015;Pisano et al, 2017), clinical trials on psychedelics have been characterized by largely homogeneous samples (Michaels, Purdon, Collins, & Williams, 2018). In nearly all cases, there has not been sufficient comparison between groups regarding patterns of naturalistic use, phenomenology of the experience, impacts on general well-being, or clinical outcomes from controlled experiences.…”

Section: Introductionmentioning

confidence: 99%

Race as a component of set and setting: How experiences of race can influence psychedelic experiences

Neitzke-Spruill

2019

Background and aims Set and setting function both as a concept that guides research and practice with psychedelic drugs and as a meme aimed at reducing harm among psychedelic users. Referring to non-pharmacological factors that shape drug experiences, the concept of set and setting was popularized in the West during the mid-20th century. However, little theoretical development has occurred regarding what falls under the umbrella of set and setting since its conception. Methods By bridging set and setting theory with research from the fields of social psychology and sociology of medicine, this review calls attention to how race can contribute the set and setting for a psychedelic experience. Results I argue that psychosocial factors influencing racial differences in mental health also constitute meaningful differences in set. Furthermore, I suggest that the character of race relations in the United States provides a distinct cultural setting for racialized psychedelic users, both in therapeutic and naturalistic contexts. In turn, racial identification may contribute to the variation in framing and interpretation of psychedelic experiences. Conclusion These considerations have important implications beyond understanding non-pharmacological influences on psychedelic experiences, including developing protocols for clinical applications of psychedelics, educating future practitioners, and meeting the needs of diverse patient populations.