I’ll preface this by stating that I obviously believe psychedelics are an extremely important area. I’ll focus on challenges. One is that they are not FDA (or international equivalents) approved for treatment yet, so for therapeutics as a field we need to continue to follow the regulatory pathway with larger and more definitive studies. Another is that at least as currently conducted this is a pretty expensive treatment due to professional time. However I think that is more than off set by the large success rates—it pays for itself in the long run so long to the degree that the payer is incentivized to care about long term costs. And more scalable and safe treatment models need to be explored in studies. Another challenge is that given that people often grapple with the “big questions” during psychedelic sessions, there is a potential that therapists coopt the patient experience (intentionally or unintentionally) toward the therapists’ own metaphysical belief system. At the extremes this can lead to cults, but the risks are present even short of the extremes. Another legitimate question and challenge is determining how many people would want and benefit from these treatments. I think in terms of safety exclusions, it will be the large majority of adults, although more work needs to be done to understand the proportion in more detail. In terms of interest, I think it will never be everybody, but I think the number is already large enough to help a lot of people if approved by the medical agencies, but that the interest will also grow greatly if initial success is seen in the larger population once approved. For more info, I discuss some of these challenges here: https://pubs.acs.org/doi/10.1021/acsptsci.0c00198
What is the best case against psychedelics being an important area?
I’ll preface this by stating that I obviously believe psychedelics are an extremely important area. I’ll focus on challenges. One is that they are not FDA (or international equivalents) approved for treatment yet, so for therapeutics as a field we need to continue to follow the regulatory pathway with larger and more definitive studies. Another is that at least as currently conducted this is a pretty expensive treatment due to professional time. However I think that is more than off set by the large success rates—it pays for itself in the long run so long to the degree that the payer is incentivized to care about long term costs. And more scalable and safe treatment models need to be explored in studies. Another challenge is that given that people often grapple with the “big questions” during psychedelic sessions, there is a potential that therapists coopt the patient experience (intentionally or unintentionally) toward the therapists’ own metaphysical belief system. At the extremes this can lead to cults, but the risks are present even short of the extremes. Another legitimate question and challenge is determining how many people would want and benefit from these treatments. I think in terms of safety exclusions, it will be the large majority of adults, although more work needs to be done to understand the proportion in more detail. In terms of interest, I think it will never be everybody, but I think the number is already large enough to help a lot of people if approved by the medical agencies, but that the interest will also grow greatly if initial success is seen in the larger population once approved. For more info, I discuss some of these challenges here: https://pubs.acs.org/doi/10.1021/acsptsci.0c00198