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Kuiper H, Alley C, Harris Z, Kuiper Rauch C, Robbins M, Rodriguez P, Tomczak P, Urrutia J, Magar V. Psychedelic public health: State of the field and implications for equity. Soc Sci Med 2024; 357:117134. [PMID: 39173415 DOI: 10.1016/j.socscimed.2024.117134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/17/2024] [Accepted: 07/11/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Psychedelic Public Health is an emerging discipline uniting the practices of public health with the potential benefits of psychedelics to reduce harm and promote health, wellness, and equity at community and population levels. Little is known regarding the current state of psychedelic public health despite rising psychedelic usage, evidence of its health efficacy, opening policy environments, and concerns regarding equity and potential harms. METHODS To characterize the current state of psychedelic public health, this survey reviewed relevant webpages from 228 universities housing accredited Schools and Programs in Public Health (SPPHs) and 59 Psychedelic Research Centers (PRCs) in the US and globally. The scan corresponded to the Prisma 2020 checklist, identifying URLs through keyword searches by Beautiful Soup python package and Google search engine web application. Measures were coded through webpage text analysis. FINDINGS Fewer than 10% (9.6%) of SPPHs engaged with psychedelics (2.6% substantially), while half (52.6%) of universities engaged (28.1% substantially). Among PRCs, only 10% indicated a collaboration with SPPHs, and fewer than 3% of PRC personnel held public health degrees. PRCs were preponderantly affiliated with medical schools. Although Indigeneity significantly contributes to Western therapeutic psychedelic protocols, only approximately one-quarter of active universities, SPPHs, or PRCs visibly addressed Indigeneity and only one PRC included Indigenous leadership. 92% of PRCs were led or co-led by people characterized as White-European and 88% by men. Only 20-43% of SPPHs, universities, and PRCs visibly addressed social determinants of health. CONCLUSIONS Public health schools, which train, study, and advise the future of public health, showed limited involvement in the growing psychedelic field, signifying a gap in psychedelic science and practice. The absence of public health's population-level approaches signifies a missed opportunity to maximize benefits and protect against potential harms of psychedelics at community and population levels.
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Affiliation(s)
| | - Chris Alley
- Center for Psychedelic Public Health, USA; New York University, School of Global Public Health, Department of Social and Behavioral Sciences, USA
| | - Zoë Harris
- University of Illinois, Department of Community Health Sciences, Chicago, USA
| | | | - Marlena Robbins
- University of California at Berkeley, School of Public Health, USA; University of California at Berkeley, Center for the Science of Psychedelics, USA
| | | | - Paula Tomczak
- George Washington University, School of Nursing, USA
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2
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Peacock C, Mascaro JS, Brauer E, Zarrabi AJ, Dunlop BW, Maples-Keller JL, Grant GH, Raison CL, Rab F, Palitsky R. Spiritual health practitioners' contributions to psychedelic assisted therapy: A qualitative analysis. PLoS One 2024; 19:e0296071. [PMID: 38166057 PMCID: PMC10760908 DOI: 10.1371/journal.pone.0296071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/29/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Psychedelic-assisted therapies hold early promise for treating multiple psychiatric conditions. However, absent standards for the care, teams providing psychedelic-assisted therapy pose a major roadblock to safe administration. Psychedelics often produce spiritually and existentially meaningful experiences, and spiritual health practitioners have been involved in administering psychedelic-assisted therapies in multiple settings, suggesting important qualifications for delivering these therapies. However, the roles and competencies of spiritual health practitioners in psychedelic-assisted therapies have not been described in research. METHOD This study examined interviews with 15 spiritual health practitioners who have facilitated psychedelic-assisted therapy. Thematic analyses focused on their contributions, application of expertise and professional background, and roles in administering these therapies. RESULTS Seven themes emerged, comprising two domains: unique and general contributions. Unique contributions included: competency to work with spiritual material, awareness of power dynamics, familiarity with non-ordinary states of consciousness, holding space, and offer a counterbalance to biomedical perspectives. General contributions included use of generalizable therapeutic repertoire when conducting PAT, and contributing to interdisciplinary collaboration. IMPLICATIONS Spiritual health practitioners bring unique and specific expertise to psychedelic-assisted therapy based on their training and professional experience. They are skilled at interprofessional collaboration in a way that complements other clinical team members. Psychedelic-assisted therapy teams may benefit from including spiritual health practitioners. In order to ensure rigorous standards and quality care, further efforts to delineate the roles and necessary qualifications and training of spiritual health clinicians for psychedelic-assisted therapy are needed.
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Affiliation(s)
- Caroline Peacock
- Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
| | - Jennifer S. Mascaro
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Erin Brauer
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ali John Zarrabi
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Boadie W. Dunlop
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jessica L. Maples-Keller
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - George H. Grant
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Charles L. Raison
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
| | - Fayzan Rab
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Roman Palitsky
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia, United States of America
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
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3
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Kim A, Suzuki J. Addiction specialists' attitudes toward psychedelics: A National Survey. Am J Addict 2023; 32:606-609. [PMID: 37550848 DOI: 10.1111/ajad.13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In recent years, there has been accelerating scientific and public interest in the use of psychedelics to treat mental health disorders. Our study's objective was to assess the attitudes of addiction specialists regarding therapeutic psychedelics. METHODS Our study utilized an anonymous online survey to assess the opinions of 145 addiction specialists regarding the therapeutic promise, potential risks, and legalization of psychedelics in the treatment of psychiatric illness and substance use disorders. Psychedelics were defined in the survey as inclusive of nonserotonergic hallucinogens such as ketamine or MDMA in addition to "classic" serotonergic psychedelics. RESULTS Most respondents expressed positive attitudes to the therapeutic use of psychedelics, but a sizeable minority expressed concern for their addictive potential. Familiarity with psychedelic scientific literature was the strongest positive predictor of belief in the therapeutic potential of psychedelics, while concern for addictive potential was the strongest negative predictor. DISCUSSION AND CONCLUSIONS Participants overall expressed more positive attitudes to the therapeutic use of psychedelics than we had hypothesized. This may be attributable to the accelerating pace of psychedelics research in recent years. Given the strong influence of concern for addiction risk on attitudes, future study is warranted to explore the findings regarding these concerns. These findings may also represent an opportunity for improved education of physicians regarding the addictive potential, and relative risks/benefits of psychedelics. SCIENTIFIC SIGNIFICANCE Though there have been several prior studies assessing psychiatrist and psychologist attitudes toward psychedelics, we are unaware of any specifically examining the opinions of addiction specialists.
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Affiliation(s)
- Amanda Kim
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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4
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Cordova M. Looking for Ted: black trips, "psychedelic" humanism, and silence. Front Psychol 2023; 14:1198371. [PMID: 37941757 PMCID: PMC10629115 DOI: 10.3389/fpsyg.2023.1198371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Affiliation(s)
- Michael Cordova
- The University of Texas at Austin, Austin, TX, United States
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5
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Lewis BR, Byrne K. A Review of MDMA-Assisted Therapy for Posttraumatic Stress Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:247-256. [PMID: 37404966 PMCID: PMC10316220 DOI: 10.1176/appi.focus.20220088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a common chronic and disabling psychiatric disorder that may develop after exposure to a traumatic life event. There are existing evidence-based psychotherapies and pharmacotherapies for PTSD; however, these treatments have significant limitations. 3,4-methylenedioxymethamphetamine (MDMA) was granted "breakthrough therapy" status by the U.S. Food and Drug Administration (FDA) in 2017 for the treatment of PTSD in conjunction with psychotherapy after preliminary Phase II results. This treatment is currently being investigated in Phase III trials with anticipated FDA approval of MDMA-assisted psychotherapy for PTSD in late 2023. This article reviews the evidence base for MDMA-assisted psychotherapy for PTSD, pharmacology and the proposed causal mechanisms of MDMA, risks and limitations of the current evidence, and challenges and future directions for the field.
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Affiliation(s)
| | - Kevin Byrne
- Department of Psychiatry, University of Utah, Salt Lake City
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6
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Lewis CR, McMurray M, Mennenga SE, Helms Tillery S. Editorial: What is up with psychedelics anyway? Front Neurosci 2023; 17:1161868. [PMID: 36992856 PMCID: PMC10040821 DOI: 10.3389/fnins.2023.1161868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/14/2023] Open
Affiliation(s)
- Candace R. Lewis
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
- Department of Psychology, Behavioral Neuroscience, Arizona State University, Tempe, AZ, United States
- *Correspondence: Candace R. Lewis
| | - Matthew McMurray
- Department of Psychology, Miami University, Oxford, CT, United States
| | - Sarah E. Mennenga
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Steve Helms Tillery
- School for the Future of Innovation in Society, Arizona State University, Tempe, AZ, United States
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7
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Hadar A, David J, Shalit N, Roseman L, Gross R, Sessa B, Lev-Ran S. The Psychedelic Renaissance in Clinical Research: A Bibliometric Analysis of Three Decades of Human Studies with Psychedelics. J Psychoactive Drugs 2023; 55:1-10. [PMID: 35000572 DOI: 10.1080/02791072.2021.2022254] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Psychedelics were used in the treatment of psychiatric conditions prior to their prohibition in the late 1960s. In the past three decades, there is a revived research interest in the therapeutic potential of psychedelic drugs with expected FDA approvals for treatment of various conditions. Given the exponential scientific growth of this field, we sought to characterize, analyze, and visualize trends in its top-cited articles. Bibliometric analyses are quantitative approaches to characterize a scientific field, including evaluation of the impact of academic literature. The bibliometric analysis and visualizations were conducted with R-tools for comprehensive science mapping. The top-cited 100 articles were cited between 82 and 668 times (median 125; mean 158). Fifty-four percent of the T100 articles were produced in the past decade (2010-2020). Network and author impact analysis highlighted key figures and primary collaboration networks within the top 100 publications. UK, USA, Switzerland, Spain, and Brazil lead the field. Results are discussed in terms of research growth, access, diversity, and the distribution of knowledge and experience in the field. These aggregated data and insights on the second wave of psychedelic research facilitate research evaluation, data-driven funding policies, and a practical map for researchers and clinicians entering the field.
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Affiliation(s)
- Aviad Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Shalvata Mental Health Center, Hod HaSharon, Israel
| | - Jonathan David
- Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
| | - Nadav Shalit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center on Addiction, Netanya, Israel.,Lev Hasharon Medical Center, Netanya, Israel
| | - Leor Roseman
- Department of Psychedelic Research, Imperial College London, London, UK
| | - Raz Gross
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychiatry, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ben Sessa
- Department of Psychedelic Research, Imperial College London, London, UK
| | - Shaul Lev-Ran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center on Addiction, Netanya, Israel
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8
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The Safety and Efficacy of Psychedelic-Assisted Therapies for Older Adults: Knowns and Unknowns. Am J Geriatr Psychiatry 2023; 31:44-53. [PMID: 36184377 DOI: 10.1016/j.jagp.2022.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/25/2023]
Abstract
Psychedelics and related compounds have shown efficacy for the treatment of a variety of conditions that are prevalent among older adults, including mood disorders, the psychological distress associated with a serious medical illness, post-traumatic stress disorder (PTSD), and prolonged grief disorder. Psychedelics also have properties that could help provide therapeutic benefits for patients with dementing disorders, as well as promoting personal growth among healthy older adults. This article focuses on psilocybin, a classic psychedelic, and MDMA, a substituted amphetamine with properties similar to classic psychedelics. Both act on the 5HT2A receptor. Psychedelics can be safely administered to healthy adults in controlled conditions. However, both psilocybin and MDMA can increase blood pressure and heart rate, which could be a concern if used in older adults with cardiovascular disease. Very few older adults or patients with serious comorbidities have been included in clinical trials of psychedelics to date, raising the question of how generalizable study results are for the patients that most geropsychiatrists will be treating. Research on the neurophysiologic and mechanistic effects of psychedelics in older adults could also provide insights into the aging brain that could have clinical applications in the future. Given the potential of psychedelic compounds to benefit older adults, more research is needed to establish safety and efficacy among older adults, particularly those with multi-morbidity.
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9
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Ching THW, Davis AK, Xin Y, Williams MT. Effects of Psychedelic Use on Racial Trauma Symptoms and Ethnic Identity among Asians in North America. J Psychoactive Drugs 2023; 55:19-29. [PMID: 35012425 DOI: 10.1080/02791072.2022.2025960] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a need to understand ways in which Asians in North America attempt to heal from racial trauma, given their well-documented high risk of exposure and associated adverse mental health outcomes. We conducted a secondary analysis of Asians from a survey of people of color in North America who have consumed psychedelics in response to racial discrimination. Ninety-two Asian participants (Mage = 30.25, SD = 6.83) completed online questions assessing demographics, racial discrimination frequency, characteristics and acute effects of their most meaningful psychedelic experience, change in racial trauma symptoms 30 days before and after their psychedelic experience, and current ethnic identity. Participants reported improvements in racial trauma symptoms (d = 0.52). Bootstrapped mediation analyses controlling for racial discrimination frequency and psychedelic dose and duration indicated complete mediation of the link between higher intensity of insightful experiences and stronger ethnic identity, via improvements in racial trauma symptoms (indirect effect = .08, 95% CI = [.004, .19]). There was partial mediation for the independent variable of lower intensity of challenging experiences (indirect effect = -.08, 95% CI = [-.18, -.005]). This study highlights the central role of higher-intensity insightful experiences and both higher- and lower-intensity challenging experiences in alleviating racial trauma symptoms and promoting ethnic identity among Asians in North America who have experienced racial discrimination. Future research should attune to culturally relevant outcomes of psychedelic use in response to racial discrimination among Asians.
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Affiliation(s)
- Terence H W Ching
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Alan K Davis
- College of Social Work, the Ohio State University, Columbus, OH, USA.,Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yitong Xin
- College of Social Work, the Ohio State University, Columbus, OH, USA
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10
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Barber G, Nemeroff CB, Siegel S. A Case of Prolonged Mania, Psychosis, and Severe Depression After Psilocybin Use: Implications of Increased Psychedelic Drug Availability. Am J Psychiatry 2022; 179:892-896. [PMID: 36453037 DOI: 10.1176/appi.ajp.22010073] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Gregory Barber
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Barber); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles (Siegel)
| | - Charles B Nemeroff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Barber); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles (Siegel)
| | - Steven Siegel
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Barber); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles (Siegel)
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11
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CLIFTON JOHNM, BELCHER ANNABELLEM, GREENBLATT AAROND, WELSH CHRISTOPHERM, COLE THOMASO, DAVIS ALANK. Psilocybin use patterns and perception of risk among a cohort of Black individuals with Opioid Use Disorder. JOURNAL OF PSYCHEDELIC STUDIES 2022; 6:80-87. [PMID: 36686617 PMCID: PMC9850635 DOI: 10.1556/2054.2022.00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background and aims There is growing evidence that psilocybin, a serotonergic psychedelic substance, may be useful in the treatment of substance use disorders. However, there is a lack of data on the beliefs and attitudes towards psilocybin amongst Black individuals diagnosed with Opioid Use Disorder (OUD). This study characterized psilocybin use patterns and perception of risk amongst a cohort of Black individuals diagnosed with OUD. Methods Using a convenience sampling approach, patients were recruited from an urban methadone treatment program and paid five dollars to complete an anonymous phone-based survey. Results Twenty-eight patients participated (mean age 53.8; N = 28; 35.7% female). Most (N = 23; 82.1%) had "heard of" psilocybin mushrooms before taking the survey, but only five (N = 5; 17.8%) had ever used them. More than 80% perceived a risk or were "unsure" of the risk for sixteen of the seventeen items queried about psilocybin. Approximately half (N = 15; 53.6%) were willing to try therapy incorporating psilocybin and half (N = 14; 50%) said they would be more likely to try if it were FDA approved for OUD. Most (N = 18; 64.3%) preferred to stay on methadone treatment alone, 32.1% (N = 9) wanted to try treatment with both psilocybin and methadone, and only one participant opted for psilocybin treatment without methadone. Conclusion Many Black individuals with Opioid Use Disorder perceive psilocybin as dangerous and may be hesitant to try psilocybin treatment. Culturally informed treatment models, educational interventions and community outreach programs should be developed to increase racial/ethnic minority representation in psilocybin research and treatment.
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Affiliation(s)
- JOHN M. CLIFTON
- University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author. 2828 Old Hickory Blvd. Nashville, TN 37221. Tel.: +615-414-6997.
| | | | | | | | - THOMAS O. COLE
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - ALAN K. DAVIS
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH 43210, USA,Department of Psychiatry, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA,Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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12
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Ching TH, Williams MT, Wang JB, Jerome L, Yazar-Klosinski B, Emerson A, Doblin R. MDMA-assisted therapy for posttraumatic stress disorder: A pooled analysis of ethnoracial differences in efficacy and safety from two Phase 2 open-label lead-in trials and a Phase 3 randomized, blinded placebo-controlled trial. J Psychopharmacol 2022; 36:974-986. [PMID: 35727042 DOI: 10.1177/02698811221104052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited ethnoracial diversity in previous ±3,4-methylenedioxymethamphetamine-assisted therapy (MDMA-AT) trials for posttraumatic stress disorder (PTSD) has prompted questions concerning whether Black, Indigenous, and People of Color (BIPOC) also benefit from this treatment. METHODS Secondary analysis was conducted using a modified intent-to-treat sample pooled from two Phase 2 open-label trials and a Phase 3 randomized, blinded placebo-controlled trial to compare efficacy and safety of MDMA-AT for PTSD between BIPOC and non-Hispanic White participants. Four subgroups were of interest: MDMA-AT, BIPOC (n = 20); MDMA-AT, non-Hispanic White (n = 63); Placebo-assisted therapy (Placebo-AT), BIPOC (n = 17); and Placebo-AT, non-Hispanic White (n = 27). Planned comparisons tested subgroup differences in changes in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores from baseline to primary endpoint, controlling for study type and baseline scores. Adverse events (AEs) on the day of (day 0) to 2 days post-dosing were reported for each subgroup. RESULTS In the MDMA-AT group, no significant ethnoracial difference in CAPS-5 change scores was observed. In the Placebo-AT group, BIPOC participants trended toward greater reductions in CAPS-5 scores than non-Hispanic Whites. Among non-Hispanic Whites, MDMA-AT was accompanied by significantly greater reductions in CAPS-5 scores than Placebo-AT. No treatment difference emerged among BIPOC participants. AEs were mostly rated as mild or moderate across subgroups. CONCLUSIONS These findings provide preliminary support for the efficacy and safety of MDMA-AT for treating PTSD across ethnoracial groups. There was also a trend toward greater efficacy with Placebo-AT among BIPOC participants. There was an imbalance in subgroups, highlighting the need for culturally responsive recruitment strategies to diversify future studies.
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Affiliation(s)
- Terence Hw Ching
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Department of Psychological Sciences, University of Connecticut, Mansfield, CT, USA
| | | | - Julie B Wang
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Lisa Jerome
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | | | - Amy Emerson
- MAPS Public Benefit Corporation, Santa Cruz, CA, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, CA, USA
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13
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Plesa P, Petranker R. Manifest your desires: Psychedelics and the self-help industry. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103704. [DOI: 10.1016/j.drugpo.2022.103704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
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14
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McCartney AM, McGovern HT, De Foe A. Psychedelic assisted therapy for major depressive disorder: Recent work and clinical directions. JOURNAL OF PSYCHEDELIC STUDIES 2022. [DOI: 10.1556/2054.2022.00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Psychedelic substances such as psilocybin and ketamine may represent the future of antidepressant treatment, due to their rapid and prolonged effects on mood and cognition. The current body of psychedelic research has focused on administration and treatment within a psychiatric context. Here, instead, we put to the test the contention that it is necessary to evaluate the current state of this literature from a broader biopsychosocial perspective. Examining these arguably neglected social and psychological aspects of psychedelic treatment can provide a more holistic understanding of the interplay between the interconnected domains. This review of six major clinical trials applies a biopsychosocial model to evaluate the antidepressant effects of psilocybin and ketamine assisted therapy. We conclude that combination psychedelic treatment and psychotherapy facilitate more enduring and profound antidepressant effects than produced by ketamine or psilocybin alone. Emphasising the advantages of therapeutic intervention will encourage those who may attempt to self-medicate with psychedelics to instead seek a framework of psychological support, minimising associated risks of unregulated use.
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Affiliation(s)
| | | | - Alexander De Foe
- The Royal Melbourne Institute of Technology, Melbourne, Australia
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15
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Argento E, Goldenberg S, Deering K, Lavalley J, Braschel M, Bingham B, Shannon K. Interest in receiving psychedelic-assisted therapy among marginalized women: Implications and findings from a community-based study in Canada. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100044. [PMID: 36845985 PMCID: PMC9948919 DOI: 10.1016/j.dadr.2022.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Background Psychedelic-assisted therapies are receiving mounting attention for their therapeutic potential. However, little is known about interest among women who experience elevated risk of mental health and substance use disorders. This study examined interest in receiving psychedelic-assisted therapy and socio-structural factors associated with interest among marginalized women. Methods Data (2016-2017) were drawn from two community-based, prospective open cohorts of >1000 marginalized women in Metro Vancouver, Canada. Bivariate and multivariable logistic regression examined associations with interest in receiving psychedelic-assisted therapy. Among women who used psychedelics, additional data were collected to describe ratings of personal meaningfulness, sense of wellbeing, and spiritual significance. Results Of 486 eligible participants (aged 20-67 years), 43% (n = 211) were interested in receiving psychedelic-assisted therapy. Over half identified as Indigenous (First Nations, Métis or Inuit). Factors independently associated with interest in psychedelic-assisted therapy in multivariable analysis included: daily crystal methamphetamine use in the last six months (Adjusted Odds Ratio [AOR] 3.02; 95%Confidence Interval (CI) 1.37-6.65), lifetime mental health conditions (depression, anxiety, post-traumatic stress disorder) (AOR 2.13; 95%CI 1.27-3.59), childhood abuse (AOR 1.99; 95%CI 1.02-3.88), lifetime psychedelic use (AOR 1.97; 95%CI 1.14-3.38), and younger age (AOR 0.97 per year older; 95%CI 0.95-0.99). Conclusions Several mental health and substance use-related variables that have been demonstrated to be amenable to psychedelic-assisted therapy were associated with interest in receiving psychedelic-assisted therapy among women in this setting. As access to psychedelic-assisted therapies continues to expand, any future approaches to extend psychedelic medicine to marginalized women should integrate trauma-informed care and broader socio-structural supports.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- BC Centre on Substance Use, 1045 Howe Street, Vancouver V6Z 1Y6, BC, Canada
| | - Shira Goldenberg
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Kathleen Deering
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
| | - Jennifer Lavalley
- BC Centre on Substance Use, 1045 Howe Street, Vancouver V6Z 1Y6, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver V6T 1Z4, BC, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
- Vancouver Coastal Health, Aboriginal Health, 2750 East Hastings Street, Vancouver V5K 1Z9, BC, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver V6T 1Z3 BC, Canada
- Centre for Gender & Sexual Health Equity, 1081 Burrard, Vancouver V6Z 1Y6, BC, Canada
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Aday JS, Heifets BD, Pratscher SD, Bradley E, Rosen R, Woolley JD. Great Expectations: recommendations for improving the methodological rigor of psychedelic clinical trials. Psychopharmacology (Berl) 2022; 239:1989-2010. [PMID: 35359159 PMCID: PMC10184717 DOI: 10.1007/s00213-022-06123-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE Psychedelic research continues to garner significant public and scientific interest with a growing number of clinical studies examining a wide range of conditions and disorders. However, expectancy effects and effective condition masking have been raised as critical limitations to the interpretability of the research. OBJECTIVE In this article, we review the many methodological challenges of conducting psychedelic clinical trials and provide recommendations for improving the rigor of future research. RESULTS Although some challenges are shared with psychotherapy and pharmacology trials more broadly, psychedelic clinical trials have to contend with several unique sources of potential bias. The subjective effects of a high-dose psychedelic are often so pronounced that it is difficult to mask participants to their treatment condition; the significant hype from positive media coverage on the clinical potential of psychedelics influences participants' expectations for treatment benefit; and participant unmasking and treatment expectations can interact in such a way that makes psychedelic therapy highly susceptible to large placebo and nocebo effects. Specific recommendations to increase the success of masking procedures and reduce the influence of participant expectancies are discussed in the context of study development, participant recruitment and selection, incomplete disclosure of the study design, choice of active placebo condition, as well as the measurement of participant expectations and masking efficacy. CONCLUSION Incorporating the recommended design elements is intended to reduce the risk of bias in psychedelic clinical trials and thereby increases the ability to discern treatment-specific effects of psychedelic therapy.
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Affiliation(s)
- Jacob S Aday
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA.
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Steven D Pratscher
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Ellen Bradley
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Raymond Rosen
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Joshua D Woolley
- Department of Psychiatry and Behavioral Sciences, San Francisco VA Medical Center, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
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Stein CA, Penn A, Van Hope S, Dorsen CG, Mangini M. The Pharmacology and Clinical Applications of Psychedelic Medicines Within Midwifery Practice. J Midwifery Womens Health 2022; 67:373-383. [PMID: 35522087 PMCID: PMC9322528 DOI: 10.1111/jmwh.13371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
The research and use of psychedelic medicines to treat common mental health disorders has increased substantially in the past 2 decades. At the same time, knowledge is relatively uncommon among midwives regarding (1) the relative benefits of psychedelic-assisted therapy, (2) best practices associated with the delivery of psychedelic-assisted therapy, and (3) responsible integration of this potentially useful intervention into mental health treatment plans. The purpose of this review is to describe current applications of psychedelic medicines to treat common mental health disorders, to describe the current legal status of these medicines used in this context, and to explore the potential for midwifery practice in this area with further training. This article also addresses the disparities regarding LGBTQIA+ and BIPOC populations in relation to this topic and their historical exclusion from research and treatment access in this field.
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Affiliation(s)
- Cindy A Stein
- California State University Monterey Bay School of Nursing, Seaside, California
| | - Andrew Penn
- University of California at San Francisco School of Nursing, San Francisco, California
| | | | - Caroline G Dorsen
- Division of Advanced Nursing Practice, Rutgers School of Nursing, Newark, New Jersey
| | - Mariavittoria Mangini
- Integral and Transpersonal Psychology Department, California Institute of Integral Studies, San Francisco, California
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18
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Murphy R, Kettner H, Zeifman R, Giribaldi B, Kartner L, Martell J, Read T, Murphy-Beiner A, Baker-Jones M, Nutt D, Erritzoe D, Watts R, Carhart-Harris R. Therapeutic Alliance and Rapport Modulate Responses to Psilocybin Assisted Therapy for Depression. Front Pharmacol 2022; 12:788155. [PMID: 35431912 PMCID: PMC9009076 DOI: 10.3389/fphar.2021.788155] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/07/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Across psychotherapeutic frameworks, the strength of the therapeutic alliance has been found to correlate with treatment outcomes; however, its role has never been formally assessed in a trial of psychedelic-assisted therapy. We aimed to investigate the relationships between therapeutic alliance and rapport, the quality of the acute psychedelic experience and treatment outcomes. Methods: This 2-arm double-blind randomized controlled trial compared escitalopram with psychedelic-assisted therapy for moderate-severe depressive disorder (N = 59). This analysis focused on the psilocybin condition (n = 30), who received two oral doses of 25 mg psilocybin, 3-weeks apart, with psychological preparation, in-session support, and integration therapy. A new psychedelic therapy model, called “Accept-Connect-Embody” (ACE), was developed in this trial. The primary outcome was depression severity 6 weeks post treatment (Quick Inventory of Depressive Symptomatology, QIDS-SR-16). Path analyses tested the hypothesis that therapeutic alliance (Scale To Assess the Therapeutic Relationship Patient Version, STAR-P) would predict depression outcomes via its influence on the acute psychedelic experience, specifically emotional-breakthrough (EBI) and mystical-type experiences (MEQ). The same analysis was performed on the escitalopram arm to test specificity. Results: The strength of therapeutic alliance predicted pre-session rapport, greater emotional-breakthrough and mystical-type experience (maximum EBI and MEQ scores across the two psilocybin sessions) and final QIDS scores (β = −0.22, R2 = 0.42 for EBIMax; β = −0.19, R2 = 0.32 for MEQMax). Exploratory path models revealed that final depression outcomes were more strongly affected by emotional breakthrough during the first, and mystical experience during the second session. Emotional breakthrough, but not mystical experience, during the first session had a positive effect on therapeutic alliance ahead of the second session (β = 0.79, p < 0.0001). Therapeutic alliance ahead of the second session had a direct impact on final depression scores, not mediated by the acute experience, with a weaker alliance ahead of the second psilocybin session predicting higher absolute depression scores at endpoint (β = −0.49, p < 0.001) Discussion: Future research could consider therapist training and characteristics; specific participant factors, e.g., attachment style or interpersonal trauma, which may underlie the quality of the therapeutic relationship, the psychedelic experience and clinical outcomes; and consider how therapeutic approaches might adapt in cases of weaker therapeutic alliance. Clinical Trial Registration: This trial is registered at http://clinicaltrials.gov, identifier (NCT03429075).
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Affiliation(s)
- Roberta Murphy
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Medical Psychotherapy, South West London and St. Georges NHS Trust, London, United Kingdom
- *Correspondence: Roberta Murphy,
| | - Hannes Kettner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Rick Zeifman
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Bruna Giribaldi
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Laura Kartner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Jonny Martell
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Medical Psychotherapy and General Adult Psychiatry, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Tim Read
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Ashleigh Murphy-Beiner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Department of Psychology, Royal Holloway University, Surrey, United Kingdom
| | - Michelle Baker-Jones
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - David Nutt
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - David Erritzoe
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Rosalind Watts
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Robin Carhart-Harris
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Psychedelics Division Neuroscape, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
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Ching THW, Williams MT, Reed SJ, Kisicki MD, Wang JB, Yazar-Klosinski B, Emerson A, Doblin R. MDMA-Assisted Therapy for Posttraumatic Stress Disorder: A Mixed-Methods Case Study of a Participant of Color From an Open-Label Trial. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221076993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
MDMA (±3,4-methylenedioxymethamphetamine)-assisted therapy (MDMA-AT) was shown in previous clinical trials to have promising efficacy and safety for alleviating treatment-resistant posttraumatic stress disorder (PTSD). However, due to low ethnoracial diversity, the question remains as to whether ethnoracial minority participants would benefit similarly. Thus, a mixed-methods case study was conducted on a participant of color from an open-label trial of MDMA-AT for PTSD to provide a culturally informed lens on symptom recovery with this treatment approach. An additional aim was to elucidate mechanisms of change underlying this treatment for the participant. A case profile was provided, documenting quantitative improvement in PTSD symptoms. This was followed by an interpretative phenomenological analysis (IPA) of effects and mechanisms of action for this participant, based on integration session transcripts. Results of IPA indicated recurrent themes related to psychological mechanisms of symptom change, reduced PTSD symptoms, and additional effects (positive and negative) beyond PTSD symptom reduction. These themes were discussed and recommendations for attuning to culturally relevant material during MDMA-AT were provided.
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Affiliation(s)
- Terence H. W. Ching
- University of Connecticut, Storrs, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - Sara J. Reed
- Minds iHealth Solutions, Inc., Louisville, KY, USA
| | | | | | | | - Amy Emerson
- MAPS Public Benefit Corporation, San Jose, CA, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, USA
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20
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Psychedelic use is associated with reduced daily opioid use among people who use illicit drugs in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103518. [PMID: 34758431 PMCID: PMC8890776 DOI: 10.1016/j.drugpo.2021.103518] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Research into the therapeutic and naturalistic uses of psychedelics for improving outcomes related to mental health disorders has generated increasing interest in recent years. While controlled clinical trials of psychedelics have signaled benefits for treating substance use disorders, this area has not been well studied in the context of naturalistic psychedelic use. This study sought to investigate the possible relationship between recent naturalistic psychedelic use and subsequent daily illicit opioid use among people who use drugs (PWUD). METHODS Data (2006-2018) were drawn from three harmonized prospective cohorts of community-recruited PWUD in Vancouver, Canada. We used multivariable generalized linear mixed-effects modeling (GLMM) to estimate the independent association between psychedelic use and subsequent daily illicit opioid use. RESULTS Among 3813 PWUD at baseline, 1093 (29%) reported daily use of illicit opioids and 229 (6%) reported psychedelic use in the past six months. Over study follow-up after adjusting for a range of potential confounders, psychedelic use remained independently associated with a significantly reduced odds of subsequent daily opioid use (Adjusted Odds Ratio: 0.45; 95% Confidence Interval: 0.29 to 0.70). CONCLUSION While confirmation in other settings is required, these findings align with growing evidence that psychedelic use may be associated with detectable reductions in subsequent substance use including illicit opioid use.
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21
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Smith DT, Faber SC, Buchanan NT, Foster D, Green L. The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision. Front Psychiatry 2022; 12:774736. [PMID: 35126196 PMCID: PMC8811257 DOI: 10.3389/fpsyt.2021.774736] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Psychedelic medicine is an emerging field that examines entheogens, psychoactive substances that produce non-ordinary states of consciousness (NOSC). 3,4-methylenedioxymethamphetamine (MDMA) is currently in phase-3 FDA clinical trials in the United States (US) and Canada to treat the symptoms of posttraumatic stress disorder (PTSD). MDMA is used in conjunction with manualized therapy, because of its effectiveness in reducing fear-driven stimuli that contribute to trauma and anxiety symptoms. In 2017, the FDA designated MDMA as a "breakthrough therapy," signaling that it has advantages in safety, efficacy, and compliance over available medication for the treatment of trauma-, stress-, and anxiety-related disorders such as PTSD. In the US and Canada, historical and contemporary racial mistreatment is frequently experienced by Black people via a variety of macro and micro insults. Such experiences trigger physiological responses of anxiety and fear, which are associated with chronically elevated stress hormone levels (e.g., cortisol and epinephrine), similar to levels documented among those diagnosed with an anxiety disorder. This paper will explore the benefits of entheogens within psychedelic assisted-therapy and their potential benefits in addressing the sequelae of pervasive and frequent negative race-based experiences and promoting healing and thriving among Black, Indigenous and other People of Color (BIPOC). The author(s) discuss the ethical responsibility for providing psychedelic-assisted therapy within a culturally competent provider framework and the importance of psychedelic researchers to recruit and retain BIPOC populations in research and clinical training.
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Affiliation(s)
- Darron T. Smith
- Department of Sociology, The University of Memphis, Memphis, TN, United States
| | | | - NiCole T. Buchanan
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Lilith Green
- Department of Sociology, The University of Memphis, Memphis, TN, United States
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Walsh Z, Mollaahmetoglu OM, Rootman J, Golsof S, Keeler J, Marsh B, Nutt DJ, Morgan CJA. Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych Open 2021; 8:e19. [PMID: 35048815 PMCID: PMC8715255 DOI: 10.1192/bjo.2021.1061] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In the past two decades, subanaesthetic doses of ketamine have been demonstrated to have rapid and sustained antidepressant effects, and accumulating research has demonstrated ketamine's therapeutic effects for a range of psychiatric conditions. AIMS In light of these findings surrounding ketamine's psychotherapeutic potential, we systematically review the extant evidence on ketamine's effects in treating mental health disorders. METHOD The systematic review protocol was registered in PROSPERO (identifier CRD42019130636). Human studies investigating the therapeutic effects of ketamine in the treatment of mental health disorders were included. Because of the extensive research in depression, bipolar disorder and suicidal ideation, only systematic reviews and meta-analyses were included. We searched Medline and PsycINFO on 21 October 2020. Risk-of-bias analysis was assessed with the Cochrane Risk of Bias tools and A Measurement Tool to Assess Systematic Reviews (AMSTAR) Checklist. RESULTS We included 83 published reports in the final review: 33 systematic reviews, 29 randomised controlled trials, two randomised trials without placebo, three non-randomised trials with controls, six open-label trials and ten retrospective reviews. The results were presented via narrative synthesis. CONCLUSIONS Systematic reviews and meta-analyses provide support for robust, rapid and transient antidepressant and anti-suicidal effects of ketamine. Evidence for other indications is less robust, but suggests similarly positive and short-lived effects. The conclusions should be interpreted with caution because of the high risk of bias of included studies. Optimal dosing, modes of administration and the most effective forms of adjunctive psychotherapeutic support should be examined further.
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Affiliation(s)
- Zach Walsh
- Department of Psychology, University of British Columbia, Canada
| | | | - Joseph Rootman
- Department of Psychology, University of British Columbia, Canada
| | - Shannon Golsof
- Department of Psychology, University of British Columbia, Canada
| | - Johanna Keeler
- Eating Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK
| | - Beth Marsh
- Psychopharmacology and Addiction Research Centre, Department of Psychology, University of Exeter, UK; and Clinical Psychopharmacology Unit, Department of Clinical, Educational and Health Psychology, University College London, UK
| | - David J Nutt
- Drug Science, UK; and Neuropsychopharmacology Unit, Division of Psychiatry, Department of Brain Sciences, Imperial College London, UK
| | - Celia J A Morgan
- Psychopharmacology and Addiction Research Centre, Department of Psychology, University of Exeter, UK
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Beating Pain with Psychedelics: Matter over Mind? Neurosci Biobehav Rev 2021; 134:104482. [PMID: 34922987 DOI: 10.1016/j.neubiorev.2021.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [[we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics' potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dentritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics' pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics' inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric condition associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
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Wallace B, Rea K. Enhancing equity-oriented care in psychedelic medicine: Utilizing the EQUIP framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103429. [PMID: 34461409 DOI: 10.1016/j.drugpo.2021.103429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Psychedelic-assisted therapies are experiencing a re-emergence in mainstream medicine and mental health contexts. A wide variety of psychedelic-assisted therapy modalities are being utilized to address mental health issues such as substance use disorders, end of life anxiety, treatment-resistant depression, suicidality, PTSD and other conditions. The novel and inchoate acceptance of psychedelic-assisted therapies into mainstream medical and therapeutic realms raises questions of equity. Concerns have been raised that individuals and communities facing structural inequities are perhaps least able to access these treatments including Black, Indigenous and people of colour (BIPOC) as well as people who use drugs. Psychedelic-assisted therapies may exemplify the inverse law of care whereby services are most inaccessible to communities with the most need, especially if these therapies are regulated into the private sector. As legalization and wider implementation of these therapies appears to be imminent, now is a critical time to consider how health equity may be promoted within psychedelic medicine. This paper examines how the EQUIP Health Care approach (https://equiphealthcare.ca) may inform the development and provision of equity-oriented psychedelic-assisted therapies. The EQUIP approach seeks to reduce the effects of structural inequities on people's health, the impacts of discrimination and stigma, and the mismatches between usual approaches to care and the needs of people most affected by health and social inequities. Key dimensions of the EQUIP intervention include cultural safety, harm reduction, trauma and violence-informed care, and contextual tailoring.
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Affiliation(s)
- Bruce Wallace
- UVIC School of Social Work, Scientist, Canadian Institute for Substance Use Research (CISUR), University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Kerri Rea
- University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada
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Lukačovič M, Masaryk R. Use of hallucinogens in Slovakia: Does it differ from global trends? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103385. [PMID: 34364200 DOI: 10.1016/j.drugpo.2021.103385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People have been using hallucinogens for thousands of years and interest in these substances has grown in recent years. The aim of this study was to determine the basic socio-demographic data, preferences, experiences, and attitudes associated with hallucinogen use in Slovakia. METHODS A cross-sectional research design was used whereby an online survey included participants who had had at least one experience with hallucinogens (N = 422, age M = 27.78; SD = 7.84; SE = 0.38; 35.1% females). Due to the illegal, intimate, and minority nature of the phenomena studied, data was collected using the snowball sampling method via an online social network in groups that declared a drug focus. RESULTS Users of hallucinogens were mostly employed (61,8%) and in some form of partnership (57,6%); they usually have a high school diploma (46,68%) or a university degree (45,41%). They most often use psilocybin mushrooms, while the age of initial use (M = 19,61; SD = 5,39) as well as lifetime frequency use (M = 18,26; SD = 24,21; Median = 10) are similar to global trends. Free use without rituals was preferred to ceremonial use. In general, our sample of hallucinogen users considered the integration of psychedelic experiences to be simple rather than challenging. Concurrently, they tended to see hallucinogens as useful to humans, but realised that they are not without risk and can be somewhat dangerous. Males used hallucinogens for the first time at a younger age (p < .05, r = -.12), used more hallucinogens during their lifetime (p <.001, r = -.23), and demanded decriminalisation and legalisation more (p <.01, r = -.13) than females. CONCLUSION Slovak users of hallucinogens in our sample showed similar usage trends as users abroad. Even though both males and females perceive and evaluate hallucinogens very similarly, females are significantly more careful in using these substances.
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Affiliation(s)
- Marek Lukačovič
- Institute of Applied Psychology, Faculty of social and economic sciences, Comenius University, Mlynské luhy 4, 821 05 Bratislava, Slovakia.
| | - Radomír Masaryk
- Institute of Applied Psychology, Faculty of social and economic sciences, Comenius University, Mlynské luhy 4, 821 05 Bratislava, Slovakia
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Strauss D, de la Salle S, Sloshower J, Williams MT. Research abuses against people of colour and other vulnerable groups in early psychedelic research. JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107262. [PMID: 34253622 DOI: 10.1136/medethics-2021-107262] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
There is a growing resurgence in the study of psychedelic medicines for the treatment of mental health and substance use disorders. However, certain early investigations are marred by questionable research methods, abuses against research participants, and covert Central Intelligence Agency financial involvement. The purpose of this study was to understand how and to what extent people of colour and other vulnerable populations, specifically, individuals who were incarcerated or incapacitated due to mental health issues (inpatients with psychotic disorders), were exploited during the first wave of psychedelic research in the USA (1950-1980). To do so, we reviewed available empirical publications according to current ethical standards. Variables of interest included race and ethnicity of participants, population vulnerability, drug administration conditions, informed consent and undue influence. Our findings draw attention to the history of research abuses against people of colour in Western psychedelic research. In light of these findings, we urge a call-to-action to current psychedelic researchers to prioritise culturally inclusive and socially responsible research methods in current and future studies.
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Affiliation(s)
- Dana Strauss
- Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jordan Sloshower
- Psychiatry, Yale University, New Haven, Connecticut, USA
- Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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Kettner H, Rosas FE, Timmermann C, Kärtner L, Carhart-Harris RL, Roseman L. Psychedelic Communitas: Intersubjective Experience During Psychedelic Group Sessions Predicts Enduring Changes in Psychological Wellbeing and Social Connectedness. Front Pharmacol 2021; 12:623985. [PMID: 33995022 PMCID: PMC8114773 DOI: 10.3389/fphar.2021.623985] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Recent years have seen a resurgence of research on the potential of psychedelic substances to treat addictive and mood disorders. Historically and contemporarily, psychedelic studies have emphasized the importance of contextual elements ('set and setting') in modulating acute drug effects, and ultimately, influencing long-term outcomes. Nevertheless, current small-scale clinical and laboratory studies have tended to bypass a ubiquitous contextual feature of naturalistic psychedelic use: its social dimension. This study introduces and psychometrically validates an adapted Communitas Scale, assessing acute relational experiences of perceived togetherness and shared humanity, in order to investigate psychosocial mechanisms pertinent to psychedelic ceremonies and retreats. Methods: In this observational, web-based survey study, participants (N = 886) were measured across five successive time-points: 2 weeks before, hours before, and the day after a psychedelic ceremony; as well as the day after, and 4 weeks after leaving the ceremony location. Demographics, psychological traits and state variables were assessed pre-ceremony, in addition to changes in psychological wellbeing and social connectedness from before to after the retreat, as primary outcomes. Using correlational and multiple regression (path) analyses, predictive relationships between psychosocial 'set and setting' variables, communitas, and long-term outcomes were explored. Results: The adapted Communitas Scale demonstrated substantial internal consistency (Cronbach's alpha = 0.92) and construct validity in comparison with validated measures of intra-subjective (visual, mystical, challenging experiences questionnaires) and inter-subjective (perceived emotional synchrony, identity fusion) experiences. Furthermore, communitas during ceremony was significantly correlated with increases in psychological wellbeing (r = 0.22), social connectedness (r = 0.25), and other salient mental health outcomes. Path analyses revealed that the effect of ceremony-communitas on long-term outcomes was fully mediated by communitas experienced in reference to the retreat overall, and that the extent of personal sharing or 'self-disclosure' contributed to this process. A positive relationship between participants and facilitators, and the perceived impact of emotional support, facilitated the emergence of communitas. Conclusion: Highlighting the importance of intersubjective experience, rapport, and emotional support for long-term outcomes of psychedelic use, this first quantitative examination of psychosocial factors in guided psychedelic settings is a significant step toward evidence-based benefit-maximization guidelines for collective psychedelic use.
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Affiliation(s)
- H. Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - F. E. Rosas
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
- Data Science Institute, Imperial College London, London, United Kingdom
- Centre for Complexity Science, Imperial College London, London, United Kingdom
| | - C. Timmermann
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - L. Kärtner
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - R. L. Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - L. Roseman
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Buchanan NT. Ensuring the psychedelic renaissance and radical healing reach the Black community: Commentary on Culture and Psychedelic Psychotherapy. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2020.00145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AbstractSimilar to much of the mental health field, psychedelic-assisted psychotherapy has failed to center the needs of people of color. Monnica Williams and colleagues demonstrate the harm faced by Black women and other people of color when working with psychedelic-assisted psychotherapists that are unaware of and ill-equipped to address sensitive topics related to race. Here I discuss the benefits and limitations of Functional Analytic Psychotherapy training for therapists that have not engaged in deep and reflective processes to understand their personal engagement in racism, privilege, and oppression. I call on leaders in the field of psychedelic-assisted psychotherapy to adhere to a new standard of intersectional cultural humility for anyone preparing to provide these services. Finally, I highlight the need to significantly increase the number of therapists of color trained to offer psychedelic-assisted psychotherapy to begin to address racial disparities to access to these radical treatments for trauma.
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Affiliation(s)
- Nicole T. Buchanan
- Department of Psychology, Michigan State University, 316 Physics Rd, East Lansing, MI, 48824, USA
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Williams MT, Bartlett A, Michaels T, Sevelius J, George JR. Dr. Valentina Wasson: Questioning what we think we know about the foundations of psychedelic science. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2020.00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractEquity and diversity are essential to the development of inclusive psychedelic research. However, oversights and misattributions are common, particularly when it comes to accounts of important psychedelic moments and key figures. Dr. Valentina Pavlovna Wasson is an important early contributor to the growth of Western psychedelic science but remains under-recognized. Psychedelic researchers must continue to address the glaring need to ask questions and examine the foundations of what we think we know about psychedelic studies—to question our assumptions with a critical and intersectional eye to resist replicating social and cultural inequalities in psychedelic research and history.
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Affiliation(s)
| | - Amy Bartlett
- 2Department of Classics and Religious Studies, University of Ottawa, Ottawa, ON, Canada
| | - Tim Michaels
- 3Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 4Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Jae Sevelius
- 5Department of Medicine, University of California, San Francisco, CA, USA
| | - Jamilah R. George
- 3Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Williams MT, Reed S, George J. Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2020.00137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractPsychedelic medicine is an emerging field of research and practice that examines the psychotherapeutic effects of substances classified as hallucinogens on the human mind, body, and spirit. Current research explores the safety and efficacy of these substances for mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although current studies explore psychotherapeutic effects from a biomedical perspective, gaps in awareness around cultural issues in the therapeutic process are prominent. African Americans have been absent from psychedelic research as both participants and researchers, and little attention has been paid to the potential of psychedelics to address traumas caused by racialization. This paper examines cultural themes and clinical applications from the one-time use of 3,4-methylenedioxymethamphetamine (MDMA) as part of an US Food and Drug Administration (FDA)-approved clinical trial and training exercise for three African American female therapists. The primary themes that emerged across the varied experiences centered on strength, safety, connection, and managing oppression/racialization. The participants' experiences were found to be personally meaningful and instructive for how Western models of psychedelic-assisted psychotherapy could be more effective and accessible to the Black community. Included is a discussion of the importance of facilitator training to make best use of emerging material when it includes cultural, racial, and spiritual themes. A lack of knowledge and epistemic humility can create barriers to treatment for underserved populations. Implications for future research and practice for marginalized cultural groups are also discussed, including consideration of Functional Analytic Psychotherapy (FAP) as an adjunct to the psychedelic-therapy approaches currently advanced. As women of color are among the most stigmatized groups of people, it is essential to incorporate their perspectives into the literature to expand conversations about health equity.
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Affiliation(s)
- Monnica T. Williams
- 1Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 2Behavioral Wellness Clinic, LLC, Tolland, CT, USA
- 3School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Sara Reed
- 1Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 2Behavioral Wellness Clinic, LLC, Tolland, CT, USA
| | - Jamilah George
- 1Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Close JB, Bornemann J, Piggin M, Jayacodi S, Luan LX, Carhart-Harris R, Spriggs MJ. Co-design of Guidance for Patient and Public Involvement in Psychedelic Research. Front Psychiatry 2021; 12:727496. [PMID: 34658961 PMCID: PMC8514741 DOI: 10.3389/fpsyt.2021.727496] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/06/2021] [Indexed: 01/17/2023] Open
Abstract
Within the context of scientific research, patient and public involvement (PPI) is defined as research performed "with" or "by" patients and members of the public, rather than "to," "about", or "for" them. When carried out systematically and thoughtfully, PPI has the potential to strengthen the quality and impact of research by fostering accountability, transparency, and relevance. There exist numerous guidelines, frameworks and tools for supporting PPI, however, these do not account for the unique challenges faced in psychedelic research. This paper describes the co-design of guidance intended to help build, evaluate and improve PPI in psychedelic research. A steering group was formed to design and run a co-design workshop alongside public collaborators. Insights from this workshop were analyzed and refined into a comprehensive and readily usable guide for planning PPI specific to the field of psychedelic research. Core values emerging from the process focused on the essential importance of trust, learning, purpose and inclusivity. It is hoped that this guidance will be a starting point for incorporating PPI in future psychedelic research, so that it can grow and adapt as this burgeoning field of research progresses.
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Affiliation(s)
- James B Close
- Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Julia Bornemann
- Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Maria Piggin
- Patient Experience Research Centre, Imperial College London, London, United Kingdom
| | - Sandra Jayacodi
- Imperial Biomedical Research Centre Public Panel, London, United Kingdom
| | - Lisa Xiaolu Luan
- Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Meg Jo Spriggs
- Centre for Psychedelic Research, Division of Brain Sciences, Imperial College London, London, United Kingdom
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Fotiou E. Shamanic Tourism in the Peruvian Lowlands: Critical and Ethical Considerations. JOURNAL OF LATIN AMERICAN AND CARIBBEAN ANTHROPOLOGY 2020. [DOI: 10.1111/jlca.12508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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