Interest in receiving psychedelic-assisted therapy among marginalized women: Implications and findings from a community-based study in Canada

This survey study (n=486) assessed the interest a cohort of marginalized women have in receiving psychedelic-assisted therapy (PAT). Of them, 43% (n=211) were interested in receiving PAT while factors associated with an interest in PAT included daily crystal methamphetamine use, lifetime mental health condition, childhood abuse and lifetime psychedelic use.

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 an 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 the 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.”

Authors: Elena Argento, Shira Goldenberg, Kathleen Deering, Jennifer Lavalley, Melissa Braschel, Brittany Bingham & Kate Shannon

Summary

Psychedelic-assisted therapies are receiving mounting attention for their therapeutic potential, but little is known about interest among marginalized women.

Data were collected from two community-based prospective open cohorts of >1000 marginalized women in Metro Vancouver, Canada.

Of 486 eligible participants, 43% were interested in receiving psychedelic-assisted therapy. Factors independently associated with interest included daily crystal methamphetamine use in the last six months, lifetime mental health conditions, childhood abuse, and younger age.

Conclusions: Several mental health and substance use-related variables were associated with interest in receiving psychedelic-assisted therapy among women in this setting.

Research into the therapeutic uses of psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, ayahuasca/dimethyltryptamine (DMT) and methylenedioxymethamphetamine (MDMA), has re-emerged worldwide, yielding promising findings for addressing several mental health and substance use issues. Psychedelic research faces ongoing challenges to foster a more equitable, diverse and inclusive research ecosystem, and there remains uncertainty as to whether marginalized populations most at risk of mental health and substance use-related harms will be interested in receiving psychedelic-assisted therapy.

Structurally marginalized women experience a disproportionate burden of overlapping social and health inequities, which is exacerbated by experiences of violence, trauma, social stigma, racialization, criminalization, and limited access to gender- and culturally-appropriate health services and supports. Psychedelic research among women and structurally marginalized groups has signaled potential therapeutic benefits, but interest in and the potential therapeutic benefits of psychedelic-assisted therapy among marginalized and underserved communities remains under-investigated.

The evidence for the therapeutic use of psychedelics is robust, including 40,000 individuals who received LSD therapy and over 500,000 doses of MDMA administered in the context psychotherapy by approximately 4000 psychiatrists and psychologists. While past research deemed psychedelics generally safe and promising medications, the US War on Drugs, regulations, and fears around recreational use led to a nearly half century-long hiatus in psychedelic research. Currently, psychedelic research has been revivified around the globe.

The Food and Drug Administration has designated psilocybin- and MDMA-assisted psychotherapy as breakthrough therapies for treatment-resistant depression and PTSD, respectively. However, little is known about the interest in receiving psychedelic-assisted therapy or potential impacts among structurally marginalized women.

This study drew on two community-based, open prospective cohorts of over 1000 cis and trans marginalized women in Metro Vancouver, Canada who completed harmonized interview questionnaires since 2010: AESHA and SHAWNA. Participants in both cohorts were cis and trans women aged 14 years or older and able to provide informed consent. They were recruited using community mapping strategies, day and late-night outreach to street, indoor and online sex work venues, and time-location sampling. Participants completed questionnaires related to socio-demographics, sex work variables, intimate partners, trauma and violence, and comprehensive injection and non-injection drug use patterns. They were also offered voluntary HIV/STI testing and treatment experiences.

Participants completed a harmonized interview questionnaire, a psychedelic supplement, and a clinical component at a study office or a safe location identified by them. They received an honorarium of $40-50 CAD at each bi-annual visit for their time, expertise and travel.

The dependent variable was interest in receiving psychedelic-assisted therapy, which was defined as responding “yes” to the following question. Demographic characteristics included age, gender minority/trans, and sexual minority.

Participants were categorized as gay, bisexual, queer, or asexual, had Indigenous ancestry, high school or greater education, HIV serostatus, and experienced physical and/or sexual childhood abuse. Lifetime socio-structural and substance use related factors included ever experienced an overdose, self-reported mental health issues, suicidality and psychedelic use. Data was collected from the Psychedelic Supplement questionnaire between September 2016 and October 2017. Participants who responded ‘No’ to being interested in receiving psychedelic-assisted therapy were excluded from remaining analyses.

Statistical analyses were performed using SAS software version 9.4 (SAS Institute, Cary, NC, USA). Bivariate and multivariable logistic regression were used to estimate associations with interest in receiving psychedelic-assisted therapy.

519 women completed the psychedelic supplement questionnaire, and 486 responded ‘yes’ to being interested in receiving psychedelic-assisted therapy. 43% were living with HIV, and 49% had engaged in sex work in the last six months.

Women who were interested in receiving psychedelic-assisted therapy were significantly more likely to report experiencing physical and/or sexual childhood abuse, depression, anxiety, or PTSD, and lifetime suicidality than those who were not. Women who used psychedelics reported that their experience was personally meaningful, increased their sense of wellbeing somewhat or very much, and was associated with a younger age, daily use of crystal methamphetamine in the last six months, lifetime mental health issues, physical and/or sexual childhood abuse, and lifetime psychedelic use.

A study of marginalized women found that half of the women surveyed reported interest in receiving psychedelic-assisted therapy for a current or future mental health or substance use issue. The study found that recent daily crystal methamphetamine use, lifetime mental health disorders, physical and/or sexual childhood abuse, and younger age were independently associated with interest.

Several studies have found that ayahuasca-based therapy can reduce problematic substance use and cravings in marginalized and racialized populations, and that enhanced connectedness to others, nature, and spirit is a key factor. Prior research has demonstrated that psychedelic-assisted therapy is effective for treating PTSD among women who have experienced sexual trauma, including childhood sexual abuse. The current study investigated the impact of psychedelic experiences on personal meaningfulness, wellbeing, and spiritual significance among marginalized women.

A literature review found that mystical experiences were significantly correlated with quitting smoking and reduced depression and anxiety among patients receiving psilocybin-assisted therapy. In a recent randomized, double-blind crossover study, 71% of participants rated their LSD experience as one of the top 10 most meaningful experiences of their lives. This effect was even greater in women who had used LSD outside of clinical settings.

The present analysis found that women with a history of physical and sexual abuse, living with HIV, and younger age were more likely to seek psychedelic-assisted therapy. While there may be unmeasured confounding variables at play, women who have tried other therapies or experienced barriers to accessing therapy are more open to exploring new therapeutic modalities. Women who have prior experiences with psychedelics are also more open to receiving psychedelic-assisted therapy.

Indigenous groups have contributed substantially to the progress of psychedelics as medicines, yet their knowledge and experience is being missed in mainstream psychedelic research and medicine. While there is much work to be done to reduce health disparities and ensure equitable access for marginalized and racialized groups in psychedelic science, prior research has demonstrated that psychedelics are associated with significant reductions in symptoms related to race-based trauma.

This study looked at the interest of marginalized women in psychedelic-assisted therapy, and found that the interest was influenced by several variables, including social desirability and reporting biases. Further research is needed to address barriers to psychedelic-assisted therapy and acknowledge the unique, intersecting and heterogeneous identities and experiences of marginalized women.

Approximately half of marginalized women in this setting reported interest in receiving psychedelic-assisted therapy. Several mental health and substance use-related variables were associated with interest in receiving psychedelic-assisted therapy.

This research was partially supported by grants from the US National Institutes of Health and the Canadian Institutes of Health Research.

Contributors: EA, SG, MB, BB, KS conceived and designed the experiments, performed the experiments, analyzed the data, and wrote the first draft.

The authors would like to thank all those who contributed their time and expertise to this project, including participants, the SHAWNA and AESHA community advisory board members and partner agencies, and the CGSHE team.

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