• Otávio Santiago

As psychedelic drugs are poised to join the mainstream, what is the role of the prescriber?

The tpharmaceutical industry is constantly cutting research into psychiatric medicines, and the drug development pipeline for psychiatric drugs is almost empty,” French psychiatrist Florence Thibaut lamented in 2019, pointing to just 40 new drugs for psychiatric conditions launched since 1980.

Meanwhile, the FDA approved 50 new drugs for a variety of medical conditions in 2021 alone and averages 40 new approvals per year. With the coming “precision medicine” revolution, the future looks even more promising because those drugs are being designed with genetic insight to be more effective, less toxic, and better for the individual. Mental health has largely been left out of this revolution, though there are signs that may be changing.

If there is one bright spot on the horizon for psychopharmacology, then it is this: Psychedelic drugs are breaking through into mainstream psychiatry. A phase 2 clinical trial of LSD for adult attention-deficit/hyperactivity disorder (ADHD) was launched four months ago in Europe. The Multidisciplinary Association for Psychedelic Studies (MAPS) has completed phase 3 clinical trials showing that MDMA is effective for post-traumatic stress disorder (PTSD) in veterans when combined with psychotherapy.

The state of Oregon has promised to begin licensing guides—who don’t need to be medical providers—to offer in-office psychedelic sessions starting January 2023, and municipalities in California and Colorado have also decriminalized certain Schedule I substances (the U.S. Drug Enforcement Agency designation for drugs with a high potential for abuse that have no currently accepted medical use). Denver, for instance, has decriminalized psilocybin.

In a 2021 webinar on psychedelics, Oregon Health & Science University psychiatrist Chris Stauffer described an inbox crammed with requests from potential patients to join his next research trial. Letters written to psychiatric journals alternately disparage consumers’ desire for a quick fix and excitedly discuss the therapeutic possibility of that very thing.

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