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Writer's pictureSara Tookey, PhD

Navigating the Ethical Landscape of Psychedelic Therapy

Updated: 1 day ago

Written by Dr Sara Tookey


A True North Psychology Publication



Helping Hand: Harm reduction strategies for mental health professionals


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


 



 

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).



Light shining through magnificent tree with large exposed roots


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




hand gently holding red leaf in the palm of hands


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 - clear path through trees (True North Psychology)

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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Our TNP DISCLAIMER:

  • Our site provides information for educational purposes only, and is a platform to connect people with qualified therapists. It does not provide professional mental health or medical advice.

  • We do not offer psychedelic-assisted therapies or access to illegal substances. Requesting such services is prohibited.

  • We cannot help locate psychedelic-assisted therapy, guided sessions, or retreats.

  • We may provide publicly available information about eligible clinical research trials for research participation purposes only.

  • Our therapists provide support which adopts a harm reduction perspective and does not encourage illicit substance use.

  • We do not work with individuals experiencing active psychosis, although we can assist in making sense of past psychotic episodes for those under professional care.

  • We do not act as experts on psychedelics or altered states, nor provide advice on their use.

  • We are not liable for risks associated with using information from our site.



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Psychedelic Science Resources and References- created by True North Psychology, protected image

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/


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