Ethnoracial health disparities and the ethnopsychopharmacology of psychedelic-assisted psychotherapies.

Abstract

Emerging evidence from randomized, double-blind, placebo-controlled clinical trials suggests psychedelic compounds such as 3,4-methylenedioxymethamphetamine (MDMA), psilocybin, and lysergic acid diethylamide (LSD), when administered as an adjunct to psychotherapy, that is, psychedelic-assisted psychotherapy (PAP), may be beneficial for treating substance use disorders, posttraumatic stress disorder (PTSD), depression, anxiety, and other psychiatric conditions. Previous ethnopsychopharmacological research has identified ethnoracial differences in the metabolism, safety, and efficacy of psychotropic drugs, yet no studies have directly investigated the impact of ethnoracially based differences in psychedelic drug pharmacology. Although there is an extensive global history of psychedelic use among peoples of various cultures, ethnicities, and intersectional identities, psychedelic research has been conducted almost exclusively on White populations in North America and Western Europe. The failure to include Black, Indigenous, and People of Color (BIPOC) in psychedelic research trials neglects the ethnic, racial, and cultural factors that may impact individual responses to PAP and thereby prevents generalizability of findings. This article investigates the impact of biological and social factors related to culture, ethnicity, and race on pharmacological responses to PAP, as well as clinical outcomes. The limitations of ethnopsychopharmacology are discussed, and the authors present expected cultural, clinical, and public health benefits of expanding funding for this area. This work will draw attention to the unique and individualized needs of ethnoracially diverse clients in therapeutic settings and is intended to inform future PAP trials. Public Health SignificanceThis literature review addresses the influence of ethnoracial factors on psychedelic-assisted psychotherapy, and elucidates the individualized needs of ethnoracially diverse clients in therapeutic settings. This work may inform future psychedelic-assisted trials.

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

“…However, therapist training in PAP clinical trials has yet to devote adequate attention to ethical concerns despite their central importance in the provision of safe, efficacious care to participants. The field has struggled to rise to the full breadth of the ethical responsibility that PAP treatment warrants, which includes not only the prevention of boundary transgressions, but attentiveness to other areas where ethical competence is needed, such as attending to cultural considerations ( Fogg et al, 2021 ), ensuring that structural injustices are not replicated in treatment settings ( Michaels et al, 2018 ; George et al, 2020 ), and providing care that is mindful of the understudied risks to participant wellbeing posed by psychedelic medicines, particularly in the presence of trauma ( Haridy, 2021 ; Love, 2022 ). Taken together, these concerns represent areas for ethical growth to which future PAP models should attend.…”

“…However, training therapists to consider these factors when treating those who are culturally different has often lagged behind this realization. This has been particularly true in clinical PAP trials, which have received much scrutiny for not recognizing the importance of cultural considerations ( Herzberg and Butler, 2019 ; George et al, 2020 ; Williams et al, 2020 ; Fogg et al, 2021 ). While an appropriate response to these concerns would entail structural and cultural changes in the field of PAP research that go beyond therapist training, EMBARK training was designed to minimize iatrogenic harm by helping therapists to engage in culturally humble and attuned ways that avoid replicating oppressive dynamics in the therapist-participant relationship.…”

Acute and enduring effects of naturalistic psychedelic use among Indigenous peoples in Canada and the United States.

“…LSD has primarily been found to be effective in the treatment of alcoholism and end-of-life anxiety, although additional trials for other psychiatric conditions are ongoing (Fuentes et al, 2020). Both biological and sociocultural determinants may contribute to responses to psychedelic-assisted psychotherapy, though current research is lacking (Fogg et al, 2021). One possible explanation for psilocybin's purported beneficial effects in this subsample may be due to the differences in perception between psilocybin (naturally produced, medicinal/ceremonial use) and the more modern and synthetic substances (LSD, MDMA), which may in turn have influenced the "Set" of the participant (beliefs, expectations, intentions) during their experience.…”

Exploring psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder

“…Other risk factors for methamphetamine use and methamphetamine use disorder include lower educational attainment, lower annual household income, lack of insurance, housing instability, criminal justice involvement, and medical and psychiatric comorbidities ( 9 ). To explore the utility of this treatment approach for individuals most in need, psychedelic study samples should represent diverse populations and actively address health disparities known to exist within psychedelic therapy research ( 76 ). Funding for transportation and, potentially, phones would help support community-based outpatient protocols.…”