#007 Psychedelics & Relationship-Based Healthcare
Can Pharmaceutical-Based Care Transition to Relationship Based Care?
There are two trains racing down two tracks.
One train is marching down the Medicalization Track, the other is full steam ahead down the Decriminalization Track.
Just yesterday, the Oakland City Counsel approved a bill that if passed by voters would follow in the steps of Denver.
Just a few months ago the FDA fast-tracked Psilocybin assisted therapy for the treatment of PTSD with “Breakthrough Therapy” Status which means legal therapy assisted trips could be available by the end of the year through the FDA’s Expanded Access Program.
What we don’t know is if these two trains are in fact steaming towards each other on the same track.
Either way, it appears that medicalization will occur and this track will require the involvement of medical professionals that are able to prescribe pharmaceuticals.
That means psychiatrists.
There is a ton of hope for the future of psychology, psychiatry and all the other professions that treat diseases, dis-ease, illness and suffering of the mind, spirit, or soul.
It is a tough area of healthcare to compartmentalize because it is a tough area of life to compartmentalize, hence the broad spectrum of approaches, methodologies and schools of thought.
However, everyone in these fields are watching with various states of excitement, hope, worry and euphoria the emerging science, interest, investment and policy around the use of psychedelics.
Many believe these molecules represent a paradigm shift in the way we approach human suffering.
And for good reason, the evidence continues to come in from NYU, Johns Hopkins, Imperial College London and others. These molecules are helping us address the most stubborn problems in healthcare and perhaps human nature.
Last night in Brooklyn I listened to Michael Pollan discuss this very topic.
However, he also made the assertion that if we compare the mental health field to nearly any other specialty such as immunology, oncology, or cardiology it is an abysmal failure by any measurement. These other specialties have saved lives, made constant scientific progress and make life better.
Psychiatry and mental/behavioral health is in shambles.
The enthusiasm and excitement of the potential that psychedelics hold for addressing depression, trauma, PTSD, Anxiety as well as the “betterment of well people” is absolutely exciting and will be fascinating to see it happen over the next few years but it appears that it will have to involve psychiatry.
Relationship Based Mental Healthcare
I was motivated to think about this and think of “Relationship Based Mental Healthcare” today after seeing this tweet from Dr. Ben Sessa
In addition to involving psychiatry, the psychedelic community and future treatment models need to address the issue that these molecules have been showing incredible promise in scientific studies with:
Extensive pre-trip education and counselling
The presence of two extensively trained therapists for the duration of the trip
A set and setting that is more akin to a cozy living room than an exam room.
If psychiatry is going to take the baton, the field will need to adjust.
The medical profession, by and large is not the warmest group of professionals, especially psychiatrists I am afraid to say and the demand that these compounds make is human connection.
This is a tall task for many clinicians.
Psychedelic molecules are not merely another compound that can be prescribed, taken daily and checked upon a few weeks later.
The mechanism of action is a mystical experience, not merely the interaction with a specific receptor, a truth that the medical profession will have a VERY tough time coming to terms with.
Long Tail Costs
Unlike conventional pharmaceuticals with upfront costs of Research, Development, Marketing and all the rest, psychedelics will have a higher post-approval cost profile and I am not sure who plans to pick up the tab for these additional costs.
Integrative health centers that have sprung up in places like NYC, LA and other wellness hubs that prize themselves on the explicitly-non-medical setting and an emphasis on patient centered care are able to do so because they serve an affluent patient base.
Functional Medicine, Integrative Medicine, Complimentary Medicine, these have all been done outside of the usual insurance and hospital based systems.
And they are limiting in a number of ways; who they can accommodate, how many providers can undergo the necessary training, how many patients they can take, among others that I can’t think of at the moment.
If psychedelics are going to fulfill their promise for improving society and the human condition it is going to demand of medical professionals more human connection than I am afraid many are prepared to offer.
I hope I am wrong.