Discover more from The Trip Report by Beckley Waves
Access to Psychedelic Medicine: The Toms Model
A Paradigm Shift in Care Requires a Paradigm Shift in Access
It is weird to think about psychedelics as a technology and an industry, but that’s what’s shaping up, so it might be time to think about some of the changes we need to make in the delivery of care to make sure we don’t screw this thing up.
Whenever we talk about psychedelics, the compounds, the experience, the meaning, the message, the aftermath all tumble along to the question about how these molecules could reshape society.
It often feels like an unnecessary leap to go from personal experience to societal overhaul, but that is what tends to happen.
And I think it’s OK, it’s fun and it is interesting to play these kind of thought experiments.
These assertions are usually made in the vein of utopic vision of a restructured society.
Even the most sober minds seem to traverse this path.
But I think there are predictable scenarios an emerging technology/field/industry has to wrestle with and psychedelics are no exception.
The First Hope: Access
The announcement of Breakthrough Therapy Status of both MDMA and Psilocybin have been met with excitement. This is a signal from the FDA that they are committed to playing ball. They have set the parameters for what success looks like and if Phase 3 trials of MDMA go as expected Expanded Access will be an actual thing.
Last I heard the trial had 19 enrolled (or screened?) of he first 100 cohort.
Expanded Access, as I understand it will allow people with a diagnosis of Treatment Resistant PTSD to receive off-study treatment. This will presumably take place at current research sites, but there is also information on the requirements a clinic must fulfill in order to participate in Expanded Access so presumably this opens up the field.
I presume there will also be a price structure that clinics must adhere to if they are to participate.
But once it gets approved there will be a boom in demand and insurances, medical systems like the VA and Medicare, providers, and other stakeholders are going to be scrambling to offer care, receive payment and figure out how to make this transition.
The Toms Model
Perhaps you’ve heard of Toms shoe company. They donate a pair of shoes for every pair purchased.
So Steve in Cinncinatti buys a pair of Toms and Steve in the Liberia receives a pair of Toms for free.
Can this model work for MDMA/psychedelic assisted therapy?
Are there enough people of means to pay more in order to create the opportunity for someone of lesser means to participate at a reduced cost?
Rick Doblin put the cost at $40,000 per participant in the research trial and suggested that the market rate would be at $15,000 when it makes its way into the wild.
I bet that the normalizing Psychedelic therapy, through people like Tim Ferris, Michael Pollan, has created a caste of well to do people who are not at the point of going to Peru or Holland, but are eager to undergo treatment in a “safe” place. To these people safety means an MD, local office and trappings of professionalsim.
They want the reassurance that involvement with medicine will provide.
I would not be surprised if there are many people who are willing to pay in excess of $50,000.
If an organization can link these big spenders with those who would benefit the most but don’t have the means, it could be a way to create access to care.
I am excited to ask about this on Thursday at a MAPS sanctioned event here in NYC.
I plan to get as informed as I can about what the making of a psychedelic clinic looks like.
How much it will cost?
Who Needs to be involved?
Who needs to sign off on a clinic?
How does a clinic get sanctioned MDMA?
How much therapists can expect to earn
How many patients can a therapist work with at a time?
How structured will the treatment schedule be? How much play do clinics/therapists have?
What am I missing here?