Written by Dr Sara Tookey
A True North Psychology Publication
Key Points
Indigenous wisdom and practices must be respected and acknowledged in modern psychedelic therapy
Clear professional boundaries and safety protocols are essential, particularly regarding consent and touch
Equity in access and representation is crucial to avoid perpetuating healthcare disparities
Balanced communication about benefits and risks is necessary to avoid sensationalisation
Comprehensive ethical frameworks must guide research, training and clinical practice
If you like this article you might enjoy reading our other psychedelic-assisted therapy related articles:
Psychedelic Harm Reduction and Integration for Mental Health Professionals, by Dr Sara Tookey
Psychedelic Integration: What is it and who can benefit from it? by Dr Sara Tookey
Psychedelic Integration Tools and Techniques by Dr Sara Tookey
Psychedelic Preparation: What is it and who can benefit from it? by Dr Sara Tookey
Beyond the Hype: A Balanced Look at Psychedelic Therapy Risks by Dr Sara Tookey
Exploring the Psychedelic Renaissance: Psychedelic Therapy, a Crucial Conversation for Mental Health by Dr Sara Tookey
Introduction
As psychedelic-assisted therapy gains momentum in mental health research and moves closer to mainstream practice in several regions worldwide, it brings important ethical considerations to the forefront. This article builds upon our previous discussion of risks and harm reduction in psychedelic therapy to explore key ethical challenges facing the field today.
The increasing commercialisation of psychedelic-assisted therapy raises complex ethical concerns that extend beyond the clinical realm. A recent consensus statement from the Hopkins-Oxford Psychedelics Ethics (HOPE) Working Group highlights several key ethical considerations (Jacobs et al., 2024).
Historical Roots and Indigenous Recognition
Ancient Wisdom in Modern Practice
Archaeological evidence reveals a 10,000-year history of structured psychedelic use in human societies. As noted by UC Berkeley researcher Yuria Celidwen, what we call 'psychedelics' were known as 'spirit medicines' in indigenous traditions, serving not only healing purposes but also strengthening community bonds and maintaining ecological balance. This long history of safe and effective use offers important lessons for modern practice (Celidwen et al., 2023).
The psychedelic research community must acknowledge the contributions of Indigenous communities with long histories of psychedelic use. Efforts should be made to engage with these communities in respect, reciprocity and appropriate benefit-sharing. This includes ensuring Western medical practices and health policies respect rather than interfere with traditional and spiritual uses (Celidwen et al., 2023).
Cultural Preservation and Indigenous Rights
The surge in interest in psychedelic therapy has raised serious concerns about impacts on indigenous communities. Current challenges include:
The rise of 'psychedelic tourism' disrupting traditional practices
Concerns regarding cultural appropriation and exploitation of indigenous knowledge
Questions surrounding intellectual property rights as Western companies patent psychedelic compounds
The pressing need for protection of traditional practices and knowledge systems
Safety and Professional Standards in Psychedelic-Therapy
Clinical Guidelines and Risk Assessment
Whilst classic psychedelics are generally safer than previously thought, their risks require careful consideration. Researchers and regulatory bodies must ensure rigorous collection of both benefit and adverse effect data, particularly regarding long-term and 'nonstandard' effects (Breeksema et al., 2022).
The informed consent process presents unique challenges given the nature of psychedelic experiences. Clinicians must carefully balance discussing potential transformative benefits with the risks of adverse effects or disappointment. The framing of information during consent may significantly impact patient experiences by influencing their mindset and the therapeutic environment (McGuire et al.,2024).
Professional Boundaries and Touch
The altered state induced by psychedelics creates distinct challenges for maintaining professional boundaries, particularly regarding physical touch. Whilst indigenous healing traditions may have different cultural protocols, Western clinical settings require specific guidelines, especially given recent cases of abuse in North American psychedelic research (McGuire et al.,2024).
Clinical practice distinguishes between three types of touch:
Safety-related touch (necessary and permitted)
Supportive/'therapeutic' touch (requires careful consideration)
Sexual touch (strictly prohibited)
Current best practices require explicit discussion of touch during informed consent, shared decision-making, ongoing consent protocols and thorough practitioner training in boundary maintenance. These guidelines must balance potential therapeutic benefits with patient safety whilst remaining culturally appropriate.
Equity and Access of Psychedelic Therapy
Addressing Systemic Barriers
The path towards mainstream acceptance raises critical questions about who can access these treatments and under what conditions. As Hughes and Garcia-Romeu (2024) emphasise, an equity-oriented approach must be central to both research and clinical practice to avoid perpetuating existing healthcare disparities.
Ensuring equity requires meaningful representation of marginalised groups across research, training and policy development (Fogg et al., 2021). Building trust demands culturally competent protocols, reduced financial and geographic barriers to access, and targeted outreach to underserved communities. and targeted outreach and education efforts.
Professional Gatekeeping and Regulation
As psychedelic therapies move towards approval, the field must carefully balance safety through appropriate regulation with the need for broad access (McGuire et al.,2024). Key considerations include determining who will have authority to prescribe and administer treatments, what qualifications and training will be required, how to ensure diverse representation among practitioners, and whether practitioners should have personal psychedelic experience (Viligger, 2024).
Clear professional codes of conduct and accountability structures are essential, particularly given patients' heightened vulnerability during psychedelic experiences (McGuire et al.,2024). These frameworks must address both clinical safety and cultural competency.
Communication and Public Education
Researchers, practitioners and media have a responsibility to provide accurate, transparent and non-sensationalised information about psychedelics, acknowledging both potential benefits and risks. Jules Evans (Director of the Challenging Psychedelic Experiences Project) and colleagues have noted that adverse experiences sometimes occur because psychedelic states are foreign to secular Western culture. This highlights the importance of developing better integration frameworks and public education about the nature of these experiences.
The Way Forward
The psychedelic renaissance holds immense promise, but it must be undertaken with great care, responsibility and humility. We must resist the lure of the 'psychedelic miracle' and adopt a nuanced, empirically grounded approach that prioritises ethical practices, participant well-being and harm reduction.
Through ongoing research, ethical frameworks, public education and open dialogue, we can develop a more robust understanding of psychedelics and how they could be used safely and effectively in mental healthcare. This requires:
Continuing rigorous research into benefits and risks
Developing comprehensive ethical guidelines
Ensuring adequate practitioner training and supervision
Maintaining open dialogue about challenges and best practices
Providing balanced public education
Respecting indigenous wisdom and practices
Addressing equity and access issues
Carefully considering regulatory frameworks
Conclusion
The psychedelic renaissance presents both immense promise and significant ethical challenges. As we navigate this complex landscape, it is crucial to prioritise patient safety, respect for indigenous wisdom, equitable access and scientific integrity. By maintaining a balanced, ethically-grounded approach, we can work towards realising the therapeutic potential of psychedelics whilst mitigating risks and respecting the complex cultural and historical contexts surrounding these substances.
Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance.
We welcome your thoughts and reflections on this article.
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References
References from research cited:
References:
Breeksema, J. J., Kuin, B. W., Liechti, M. E., Kaelen, M., van Amsterdam, J., Roseman, L., & Schenberg, E. E. (2022). Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review. Journal of Psychopharmacology, 36(10), 1100-1117. https://pubmed.ncbi.nlm.nih.gov/36017784/
Celidwen, Y., Redvers, N., Githaiga, C., Habek, N., Wyndham, J. M., & Nicholas, G. (2023). Ethical principles of traditional indigenous medicine to guide western psychedelic research and practice. The Lancet Regional Health–Americas, 18. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00227-7/fulltext
Fogg, C., Michaels, T. I., de la Salle, S., Jahn, Z. W., & Williams, M. T. (2021). Ethnoracial health disparities and the ethnopsychopharmacology of psychedelic-assisted psychotherapies. Experimental and Clinical Psychopharmacology, 29(5), 539-554. https://pubmed.ncbi.nlm.nih.gov/34096755/
Hughes, M. E., & Garcia-Romeu, A. (2024). Ethnoracial inclusion in clinical trials of psychedelics: a systematic review. EClinicalMedicine, 74, 102711. https://www.thelancet.com/action/showPdf?pii=S2589-5370%2824%2900290-6
Jacobs, E., et al. (2024). The Hopkins-Oxford Psychedelics Ethics (HOPE) Working Group Consensus Statement. Bioethics Today. https://doi.org/10.1080/15265161.2024.2342764
McGuire AL, Cohen IG, Sisti D, et al. Developing an Ethics and Policy Framework for Psychedelic Clinical Care: A Consensus Statement. JAMA Netw Open. 2024;7(6):e2414650. doi:10.1001/jamanetworkopen.2024.14650
McNamee S, Devenot N, Buisson M. Studying harms is key to improving psychedelic-assisted therapy—participants call for changes to research landscape. JAMA Psychiatry. 2023;80(5):411-412. doi:10.1001/jamapsychiatry.2023.0099
Villiger, D. (2024). Personal psychedelic experience of psychedelic therapists during training: should it be required, optional, or prohibited? International Review of Psychiatry, 1–10. https://doi.org/10.1080/09540261.2024.2357669
Links/articles referenced in text:
Cox, D. (2024). What Western medicine can learn from the ancient history of psychedelics. BBC online publication. https://www.bbc.com/future/article/20240910-the-ancient-history-behind-healing-trauma-with-psychedelics
Labate, B. & Antunes, H.F. (2024). Where Is the Psychedelic Movement Headed Next? https://doubleblindmag.com/where-is-the-psychedelic-movement-headed-to-next/
Evans, Jules: Challenging Experiences Project. https://challengingpsychedelicexperiences.com/about-us-and-our-research
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