Over the past few years, media hype has portrayed therapies using once-stigmatized hallucinogenic drugs as miracle cures for psychiatric problems, despite the lack of good research and the failure of clinical trials. Researchers have warned that these treatments pose a “significant risk to the public.”
In a new Viewpoint article published in JAMA Psychiatry, Sarah McNamee from McGill University, Neşe Devenot from the Institute for Research in Sensing at the University of Cincinnati, and independent researcher Meaghan Buisson argue that more attention needs to be paid to the potential harms of psychedelic-assisted therapy. The risks include increased suicidality, “paradoxical” reactions to the drugs, and even abuse by therapists.
The authors highlight the lack of regulatory infrastructure to monitor both the drug and psychotherapy components, which could lead to the imposition of unevaluated and potentially harmful practices on vulnerable patients seeking psychedelic-assisted therapy if these treatments are legalized in their current form.
“The absence of regulatory infrastructure to adequately monitor both the drug and psychotherapy components creates a situation in which—if legalized in their current form—unevaluated and potentially harmful practices will be imposed on vulnerable patients seeking [psychedelic assisted therapy],” the researchers write.
Devenot is a board member for Psymposia, a nonprofit research organization focused on psychedelics. McNamee and Buisson participated in trials of psychedelic-assisted therapy.
Psychedelic-assisted therapy aims to combine the mind-altering effect of hallucinogenic drugs with the power of psychotherapy. One of the key players in this space is MAPS (the Multidisciplinary Association for Psychedelic Studies).
Buisson was a participant in a 2015 MAPS clinical trial of MDMA who was allegedly touched inappropriately by her therapists, married couple Richard Yensen and Donna Dryer, throughout her session. The video of the alleged assault shows her being touched, laid on, kissed, and pressed against by both therapists and even having her hands and body repeatedly restrained, despite many vocalizations and gestures demonstrating a lack of consent.
Buisson was considered a “success” in the clinical trial and spent the intervening years attempting to obtain data from the trial. She reported the assault to MAPS, which, according to news outlets, did not bother to view the footage until 2021; they eventually admitted that the therapists’ behavior was not acceptable.
In a 2018 lawsuit, Buisson described sexual abuse from Yensen. Having sex with clients violates the ethical guidelines for various therapist licensing groups; however, it turned out that Yensen wasn’t actually a licensed therapist.
And Buisson is not the only one warning of the risk of sexual assault when the patient is under the influence of mind-altering drugs. Last year, Erica Rex wrote of her experience, and the year before, Will Hall wrote of a similar experience.
These stories follow a similar pattern: take a person at their most vulnerable moment and give them hallucinogenic drugs—inducing “loving and trusting feelings,” as the head of MAPS wrote, that “make patients more vulnerable to sexual pressure.” Then, the therapists inappropriately touch their patients and convince them that this is “therapy.”
According to the JAMA Psychiatry Viewpoint by McNamee, Devenot, and Buisson, “nurturing touch” is actually considered a key part of psychedelic-assisted therapy. But there are no clear guidelines for what kind of touch is “acceptable” in this setting.
“Researchers have noted that the absence of clear guidelines leaves acceptable forms of touch open to interpretation by therapists and clients, which can lead to boundary violations while clients are in altered states. The use of touch in psychotherapy is controversial and understudied, even without adding psychedelics,” they write.
They add that psychotherapy requires active consent. So how, they ask, can a patient consent to being touched when under the influence of drugs which—again, according to the head of MAPS—induce loving, trusting feelings that “make patients more vulnerable to sexual pressure”?
In addition to the normalization of touch, and the lack of boundaries around it, particularly for vulnerable people under the influence of mind-altering drugs, other harms have been found in the trials of these therapies.
According to McNamee, Devenot, and Buisson, psychedelic drugs can transform our understanding of ourselves and the universe. The darker side of this power, though, is that the drugs have the potential to destabilize and unmoor us, which can lead to increased distress—and suicidality.
For instance, they note that one recent trial of psychedelic-assisted therapy found that the risk of suicidal thoughts and behavior was increased eight times higher—from about 1% in the control group to 8% for those who took the largest dose. As another example, in an open-label trial of ketamine for depression that included 12 participants, one participant died by suicide, and another was hospitalized for suicidality.
The researchers add that in MAPS trials, people who have been counted as “responding” to treatment end up worsening afterward, including experiencing psychosis and suicidality. In another study, a participant “recovered” from depression but ended up with severe anxiety instead.
“These paradoxical responses suggest that emerging symptoms may elude short follow-up windows and disorder-specific outcome measures and that decompensation is occurring even in treatment responders,” they write.
Ultimately, McNamee, Devenot, and Buisson argue that the field must incorporate the voices of those who have been harmed—beginning with the oft-omitted admission that these drugs and the associated psychotherapy can even cause harm—and better assess the risks and benefits of these experiences. They suggest that independent researchers—not pharmaceutical company employees or psychedelic medicine promoters—must be involved in every step of the research.
As it stands now, they write, the research literature is missing vital aspects of these drugs’ risks, making it difficult to judge whether psychedelic-assisted therapy has utility and in what situations.
“To ethically and safely move forward,” they write, “the field must invite researchers without personal or financial ties to psychedelic medicine to retroactively assess work completed to date, conduct phenomenological research to better understand [significant adverse effects] and harm, and integrate into research teams that are running clinical trials. Researchers and proponents of [psychedelic-assisted therapy] must grapple with ethical and methodological issues regarding risk, distress, psychotherapy, informed consent, suggestibility, blinding, and expectancy effects, all of which limit the usefulness of safety and efficacy data.”
McNamee, S., Devenot, N., & Buisson, M. (2023). Studying Harms Is Key to Improving Psychedelic-Assisted Therapy—Participants Call for Changes to Research Landscape. JAMA Psychiatry. Published online March 29, 2023. doi:10.1001/jamapsychiatry.2023.0099 (Link)