By David Heitz / NewsBreak Denver
(Denver, Colo.) Now that Colorado voters have legalized psilocybin mushrooms and other hallucinogenic substances, the state must decide how to regulate the industry.
The way the regulations will be implemented will depend on suggestions from the state Natural Medicine Advisory Board. The board will make recommendations to the state Department of Regulatory Agencies, or DORA.
But according to an article published by the Colorado Sun, DORA does not know where to begin when it comes to regulating the use of mushrooms. “This is an area completely outside the scope of any existing expertise or regulatory history within the department,” the Sun quoted DORA from a budget document submitted to the legislature’s Joint Budget Committee. “This is unlike anything else the department regulates. The department has no resources or expertise to begin implementation of this expansive new program involving substances with agricultural, controlled substance, chemical/scientific and facility issues.”
Therapy puts patients in ‘vulnerable’ state
Meanwhile, medical journals have begun to address psychedelic therapy as it becomes legalized. “Treatment effects of these drugs notoriously depend on context, and they put patients in an unusually vulnerable state,” according to a viewpoint published May 31 in JAMA Psychiatry. “Furthermore, the recent hyperbole surrounding psychedelic therapies has led to great expectations in both patients and therapists. These circumstances can make patients more vulnerable to therapist ineptitude or misconduct, as well as to disappointment due to unrealistic expectations.”
The authors of the viewpoint, Swiss psychotherapists Abigail Calder and Dr. Gregor Halser, say such concerns can be lessened. “Switzerland has a uniquely long history of legal psychedelic-assisted psychotherapy with lysergic acid diethylamide (LSD), psilocybin, and 3,4-methylenedioxy-methamphetamine (MDMA) through a restricted medical use program dating to 1988. Licensed psychiatrists can apply for permission to practice psychedelic-assisted psychotherapy, then request allowances to use psychedelic agents for patients who do not respond to standard treatments on a case-by-case basis given at least preliminary evidence that the agent is effective in treating the patient’s diagnosis.”
Setting realistic expectations
The viewpoint advises therapists to set realistic expectations. “Highly optimistic media reports and overly confident therapists can give the impression that these agents are a miracle cure promising rapid recovery. The psychedelic-assisted psychotherapy practitioners in Switzerland recognize that this is the exception rather than the rule. Some patients require multiple psychedelic sessions with intensive psychotherapy over months or years, and some do not clinically respond at all. Patients who hope for a miracle cure may experience disappointment, hopelessness, or even guilt when this does not happen, potentially worsening their original symptoms.”
The risks of using touch
The viewpoint calls for letting psychedelic-assisted psychotherapy sessions unfold naturally as opposed to forcing particular issues to emerge. The viewpoint also cautions against overusing touch in therapy. “We have observed that appropriate physical touch (e.g., hand-holding) can be extremely comforting to people who are in distress during psychedelic-assisted psychotherapy. Many therapists also see value in combining body-oriented techniques with psychedelic-assisted psychotherapy.
“However, touch can be a risk: when applied unskillfully or inappropriately, it can make people who are already in a vulnerable state feel uncomfortable or violated. In our view, relatively conservative guidelines on touch are safest …. If touch is an option, we recommend discussing it in detail with the patient before each psychedelic-assisted psychotherapy session and thoroughly documenting consent to different forms of touch to prevent accidentally violating boundaries.”
The role of spiritual, existential components
In a special communication to JAMA Psychiatry published May 31, scholars from Emory University discuss the role of spiritual, existential, religious, and theological components in psychedelic-assisted psychotherapy. “Spiritual, existential, religious, and theological topics’ integration in psychedelic-assisted therapy is needed to ensure culturally competent, evidence-based treatment aligned with the highest standards of clinical care. Neglecting to address these topics can detract from cultural competence, contribute to risks for patients, and potentially undermine treatment success.”
Duties of Natural Medicine Advisory Board
Members of the Natural Medicine Advisory Board have their work cut out for them. Duties of the board include:
- Developing accurate public health approaches and the content and scope of educational campaigns
- Studying research related to the efficacy and regulation of natural medicine
- Developing training programs, educational and experiential requirements, and qualifications for facilitators
- Ensuring access to natural medicine is affordable, equitable, ethical, and culturally responsible
- Developing appropriate regulatory considerations for each natural medicine.
- Collecting accurate and complete data
Videotaping sessions may prevent misunderstandings
According to the Swiss viewpoint, videotaping therapy sessions could prevent misunderstandings between patients and therapists. Sometimes patients undergoing psychedelic-assisted psychotherapy lose touch with reality, according to the authors.
“Psychedelic medications have inspired earnest hope for mental health benefits and better outcomes for under-served patients,” the viewpoint states. “They are also capable of inspiring blind devotion, savior complexes, and abuses of power. As research and practice of psychedelic-assisted psychotherapy moves forward, it is imperative to advance the former and undermine the latter.”
Ultimately, the governor-appointed Natural Medicine Advisory Board comprised of doctors, natural medicine experts, mental health providers, first responders, and health insurance providers will regulate Colorado’s up and coming psychedelic industry Members of the board include those with knowledge of indigenous use of natural medicines and issues confronting veterans.