Psychedelic medicines hold great promise in the treatment of mental illness. We are just now seeing the introduction of legal psychedelic treatment with MDMA and psilocybin in Australia. The FDA has already approved a ketamine nasal spray for treatment-resistant depression and both MDMA and psilocybin are soon to be releases for standard use in the USA. It is time to start thinking about practical issues in psychedelic therapy. It is a genuine concern that all of current excitement will turn to disappointment when psychedelic therapy in the US becomes a reality.
What Will Psychedelic Therapy Be Like?
Conditions for which psychedelic medicines are being tested include post-traumatic stress disorder, depression, and substance abuse disorders. Treatment with both MDMA and psilocybin is used in addition to psychotherapy or coaching sessions. Although the psychedelic medicine may only be given once of twice the therapy sessions commonly continue beyond the visits when the medicine is given.
In the case of ketamine for depression, a person needs to make a substantial commitment to this approach. Standard treatments are twice a week for four weeks, once a week for four weeks, and as often as weekly or monthly thereafter. Treatment may be for a person’s life. Patients need someone to drive them to and from treatment sessions which last two to two and a half hours each. As with psilocybin and MDMA, patients may end up having therapy or coaching sessions as well.
The point of all this is that psychedelics are not a “take one pill and get better” sort of treatment. As a rule a physician will not prescribe this sort of treatment unless standard therapies including antidepressants have not worked. And here we may be talking about months or years of therapy. All of this may be very disappointing for people who expected a single, life-changing experience.
Psychedelics Will Not Be a Quick Fix for Most Folks
We all have heard stories about folks who went to a weekend retreat where they took a psychedelic medicine. We have written about ayahuasca ceremonies that last one night. Although people with the financial ability to fly to Mexico or the Amazon to get treatment may tell wonderful stories, most folks cannot afford such approaches and will have to rely on their insurance coverage for payment. This means they will be paying part of the bill and will be investing a substantial amount of time over months in an attempt to treat their depression, PTSD, or substance abuse disorder. Treatment in the VA system will be available for those who qualify but services may well be overwhelmed by the need for these treatments.
Psychedelic Treatment May Be Expensive
In Australia where psychedelics just became legal the estimated cost of therapy is about $25,000. As a point of comparison, going to a family doctor and getting a prescription for a standard antidepressant like Zoloft costs about $10 a month for a medicine and whatever the person pays out of pocket for the office call. For a mild case of depression that may be all a person needs. There may be a great temptation to get some MDMA or psilocybin and just take it thus bypassing of the professional rigamarole. Unfortunately, evidence to date shows that psychedelics work to make therapy more effective. When taken in non-therapeutic settings there is a chance that a person would get worse.
Where Will Psychedelics Fit into the Treatment Picture?
If the US follows Australia’s example, prescription of psychedelics will be limited to those professionals who are also providing the necessary therapy. People with mild cases of depression will not be getting psychedelics. Individuals with severe cases of depression will need to go through the steps of trying standard medicines and therapeutic approaches before psychedelics are used.
Finding a professional with the experience and skill to treat patients with psychedelics will be difficult at first. Only when enough professionals have been trained in the specifics of psychedelic therapy will the likely bottlenecks be opened up. Thus, we expect those with the financial ability to jump the line, pay for top drawer treatment, go out of the country where regulations are less strict. We expect the rest of the folks who need help to have to stand in line and wait their turn in order to get the treatment that might save their lives. This will create a backlash after all of the current excitement about psychedelic treatment.