Translating Psychedelic Therapies From Clinical Trials to Community Clinics: Building Bridges and Addressing Potential Challenges Ahead

In this paper (2021) the challenges to implementing psychedelic therapies at the community level are discussed. Five broad categories of challenges were identified; 1) inherent risks; 2) poor clinical practice; 3) inadequate infrastructure; 4) problematic perceptions; and 5) divisive relationships and fractionation of the field. Proposed solutions include public sector support of research and training as well as the establishment of a multidisciplinary advisory body to represent all major stakeholders.

Abstract

“Research exploring the potential of psychedelic-assisted therapies to treat a range of mental illnesses is flourishing, after the problematic sociopolitical history of psychedelics led to the shutdown of clinical research for almost 40 years. Encouraged by positive results, clinicians and patients are now hopeful that further interruptions to research will be avoided, so that the early promise of these therapies might be fulfilled. At this early stage of renewed interest, researchers are understandably focusing more on clinical trials to investigate safety and efficacy, than on longer-term goals such as progression to community practice. Looking to identify and avoid potential pitfalls on the path to community clinics, the authors, a group of Australian clinicians and researchers, met to discuss possible obstacles. Five broad categories of challenge were identified: 1) inherent risks; 2) poor clinical practice; 3) inadequate infrastructure; 4) problematic perceptions; and 5) divisive relationships and fractionation of the field. Our analysis led us to propose some strategies, including public sector support of research and training to establish best practice and optimize translation, and funding to address issues of equitable access to treatment. Above all, we believe that strategic planning and professional cohesion will be crucial for success. Accordingly, our key recommendation is the establishment of a multidisciplinary advisory body, broadly endorsed and representing all major stakeholders, to guide policy and implementation of psychedelic-assisted therapies in Australia. Although these challenges and strategies are framed within the Australian context, we sense that they may generalize to other parts of the world. Wherever they apply, we believe that anticipation of potential difficulties, and creative responses to address them, will be important to avoid roadblocks in the future and keep the “psychedelic renaissance” on track.”

Authors: Martin L. Williams, Diana Korevaar, Renee Harvey, Paul B. Fitzgerald, Paul Liknaitzky, Sean O’Carroll, Prashanth Puspanathan, Margaret Ross, Nigel Strauss & James Bennett-Levy

Notes

Research into the therapeutic potential of psychedelics is continuously reaching new heights. Moreover, the socio-cultural attitude towards psychedelics appears to be changing thanks to the flurry of evidence-based research that is emerging. While treatment models utilizing psychedelics are likely to be accessible to some under certain circumstances in the not too distant future, a lot of work needs to be done for such treatment models to become widely accessible.

Thus, it is important we discuss issues surrounding the widescale implementation of psychedelic-assisted therapy (PAT) models sooner rather than later, as preparation is essential to ensure that people get the treatment they need in a manner that is safe.

In this paper, Australian clinicians and researchers in the field identify and discuss what they believe may be challenging to implementing psychedelic treatment models at the community level. Although this paper is written from an Australian perspective, it may be possible to generalize their findings to other parts of the world.

Main challenges

• Inherent risks with implementation include; medical risks such as interactions with other medications and psychological risks like a patient’s susceptibility to manic episodes.
• Potential for poor clinical practice; lack of adequate expertise, procedures and ethical standards could put patients safety at risk.
• Infrastructure issues; the labour intensive nature of PAT may render these treatments inaccessible to those most in need, lack of appropriate therapist training and the need for an appropriate setting for the experience, which many clinics lack at present.
• Problematic perceptions and expectations; the overwhelmingly positive connotations accompanying PAT may create misconceptions for some.
• Divisive relationships and fractionation of the field; differing opinions amongst mental health professionals and commercial interests may jeopardize adequate implementation.

The implementation of PATs at the community level is conceivable. However, adequate expertise, protocols and standards of care are needed and therefore, careful planning is warranted. Therefore, it is important that we discuss these issues now in preparation for the successful scaling of psychedelic-assisted therapies.

Several training programs, of which one is based in Australia, are addressing the need for better-trained therapists. And although not explicitly mentioned here, regulation will need to catch up with the (future) scientific findings and remove that roadblock before psychedelics can come to community clinics.

Summary of Translating Psychedelic Therapies From Clinical Trials to Community Clinics: Building Bridges and Addressing Potential Challenges Ahead