Truffle Report Asked Psychedelics Practitioners and Experts to Weigh in
As more of us are learning about the healing potential of psychedelics through media, renewed investigations, and clinical trials, many undoubtedly find themselves wondering about taking that first step. Assuming you are looking for some kind of mental health benefit and want the aid of medical input, talking with your therapist or doctor about psychedelics can be difficult. Since most psychedelic drugs have been classified as “drugs of abuse” and are currently illegal in many countries (with the exception of ketamine, technically a dissociative anesthetic), doctors may be cautious or reluctant to discuss their use.
“It’s a tricky thing to try to talk to the health professional about psychedelic use because it’s not legal,” says Dr. Allison Feduccia, Co-Founder of Psychedelic Support and Project New Day. “There’s probably a majority of therapists and doctors out there that don’t have education on psychedelics. Their ability to answer these types of questions is quite limited, and oftentimes they may say that’s illegal and that’s a big risk on its own to go and do something that you could possibly get arrested for and go to jail.”
Dr. Joe Flanders, a clinical psychologist and director of Mindspace by Numinus, believes that therapists should get some education on psychedelics and psychedelic-assisted therapy.
“I would hope for an educational attitude from a therapist more so than a judgmental one or a closed posture to it. Adults are going to make their own decisions about consuming psychedelics and therapists are better off cultivating strong relationships with these clients with trust and open communication rather than judgment and closing off,” he tells Truffle Report.
According to Dr. Tatiana Zdyb, clinical psychologist and director of psychedelic-assisted therapy clinic MindSetting, most therapists are likely to avoid talking about psychedelics due to the risk of losing their licenses by discussing the use of psychedelic compounds, which could be construed as encouraging illegal behaviour.
Additionally, “many therapists are psychedelic-naive about the risks and benefits of using different psychedelic compounds and therefore do not feel competent to answer questions from clients about it,” she said.
Talking to Your Doctor About Psychedelics: Safety and Intention
The growing popularity of psychedelic research is leading many people to therapeutically consume psychedelics on their own, absent medical advice. Therapists and doctors, therefore, should consider adopting a harm reduction approach by providing support for clients using psychedelics, or who plan on trying them for the first time. While health practitioners cannot legally provide psychedelic substances to their patients, even to those few exempted to use them, they can at least raise issues for them to consider.
“People are interested in psychedelics. They’re online, they’re going to be watching documentaries, they’re going to want to know how to get access to the psychedelics. Maybe some health professionals’ reservations come from concerns about: Where the clients are going to get the medicine? What’s the quality? Are they going to have someone sitting with them so they are safe and secure?” says Dr. Flanders. “Patients need to know about the risks and benefits of psychedelic drugs before consuming them. However, health professionals should be in a position to educate, and so it is important for a client to feel comfortable asking their therapist or their family doctor.”
According to Dr. Zdyb, it is extremely important to understand the patient’s intentions and what they are trying to accomplish.
“Client intentions set the course for therapy. The work I do is client-centered, meaning I focus treatment on the wants and needs of the individual seeking therapy, not what I think they should get out of treatment,” says Dr. Zdyb. “Client intentions lead to co-creating goals for treatment and a targeted approach to psychotherapy.”
How to Ask for Help
So how should you speak to your doctor about psychedelics?
“Bring up some conversation and start by asking the therapist or the doctor if they had any training or education around psychedelic use for therapeutic approaches. It’s often recommended if people are going to be taking psychedelics that they get a medical evaluation, especially if they have some kind of underlying condition or they’re on medications. It’s important that people understand the risk of taking certain drugs depending on the substance they want to take,” says Dr. Feduccia.
“If the client did decide to taper off medications, it’s always a good idea to talk with doctors about that process because it can be not so easy for a lot of individuals. I think it depends on the experience of the clients and doctors, and how open-minded they are towards providing information, talking about risks and talking about safety,” she adds.
Nonetheless, having open communication with your therapist or doctor is an important step.
“Clients could ask therapists for book, podcast, documentary or peer-reviewed journal article recommendations to learn more about the use of psychedelics,” says Dr. Zdyb. “They could also inquire after whether their therapist is aware of any clinical trials that they may be eligible to participate in or about applying to Health Canada for an exemption to use a controlled substance as part of their treatment. The easiest psychedelic to ask a clinician about is likely ketamine because it is legally available in Canada with a prescription from a medical doctor.”
When talking to your doctor about psychedelics, remember that there’s nothing illegal about discussing psychedelic research and asking questions. Therapists do not have a duty to report criminal activity aside from their responsibility to warn authorities if they have reason to believe that a client is at imminent risk for harming or killing another person or themselves, or to report suspected child abuse.
“If the viewpoint of the therapist doesn’t align with what patients are reading or hearing, there are other people that they could work with that are more open-minded towards psychedelic use and can provide them with better information and supportive care,” says Dr. Feduccia.
An article in the Journal of Psychedelic Psychiatry authored by Dr. Feduccia reflects survey responses on practical and ethical considerations for psychedelic therapy and integration practices from seventy-six mental health professionals. According to the survey, over half of respondents planned on serving their current client with psychedelic-assisted therapies, while 26 responded “maybe.”
One survey respondent said that “One of the fundamentals in good therapy is not requiring clients to bear secrets – that can be deeply damaging to clients. So, when we are discussing these options, what does that look like ethically if a client is asking for underground referrals?”
Another one asked whether or not it is “ethical to withhold referrals when it is clear someone could greatly benefit from working with psychedelics/entheogens and don’t have the time/means to travel to a country where it’s legal?”
There are a number of harm reduction organizations that are open to discussions about all drugs, including psychedelics. These include:
Psychedelic Support offers a searchable directory of licensed health professionals and community groups that provide mental health services related to psychedelic medicine and integration.
Fireside Project offers confidential psychedelic peer support during or after the psychedelic experience.
The MAPS website has lots of resources, from mental health practitioners and coaches to research papers and books.
As psychedelics become more mainstream, it is very important that therapists and doctors continue their own medical education to at least inform their clients about what is known so far about the therapeutic potential of psychedelics and the risks and benefits associated with their use.
“It is incumbent on health professionals to be aware and educated about trends in mental healthcare. The psychedelic movement is accelerating big time; the potential to transform mental healthcare is exciting. Therapists need to be aware even if they don’t even try to agree or endorse it, and they have to be able to have an open conversation about it with their clients,” says Dr. Flanders.
