Extrapharmacological safety topics in psychedelic-assisted psychotherapy

The Swiss authors of this JAMA Psychiatry article write: "The increasing popularity of psychedelic-assisted psychotherapy (PAP) has generated important discussions about the safety of psychedelic drugs. However, arguably the most important safety concerns arise from extrapharmacological factors. Treatment effects of these drugs notoriously depend on context, and they put patients in an unusually vulnerable state. Furthermore, the recent hyperbole surrounding psychedelic therapies has led to great expectations in both patients and therapists. These circumstances can make patients more vulnerable to therapist ineptitude or misconduct, as well as to disappointment due to unrealistic expectations.  In our view, these problems can be mitigated. Switzerland has a uniquely long history of legal PAP with lysergic acid diethylamide (LSD), psilocybin, and 3,4-methylenedioxy-methamphetamine (MDMA) through a restricted medical use program dating to 1988.1 Licensed psychiatrists can apply for permission to practice PAP, then request allowances to use psychedelic agents for patients who do not respond to standard treatments on a case-by-case basis given at least preliminary evidence that the agent is effective in treating the patient’s diagnosis. By describing the state of PAP in Switzerland, we hope to highlight some underdiscussed topics and provide insights into what future guidelines for safe PAP could look like. To further contextualize our comments, one of us (G.H.) has practiced PAP with ketamine since 2013 and with LSD, psilocybin, and MDMA since 2019, having treated 120 patients for mood disorders, posttraumatic stress disorder, and other indications. Both of us are members of the Swiss Medical Society for Psycholytic Therapy (SÄPT) and have experience with safely administering LSD to dozens of clinical study volunteers."

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