Critical to the research is a stable and responsible workforce. Nurses scope of practice has this covered but needs to be sanctioned by professional organizations to protect us legally. The research had some issues that can be overcome with good practice and REMS. Thanks for keep this ball moving!!!
I agree with altered states of America that many of those “leaders” in the field are, not just financially greedy but emotionally corrupt, flip, and careless in their arrogance.
That is why I so agree with Andrew that the people most immersed in patient care, with the right training and calling, are the ones best qualified to attend to patients in altered states. Nurses have so much going for them, including an energy of care, close monitoring, and the ability to “eyeball” a patient and know when something is wrong. It is both an uncanny, intuitive, and experience honed skill that I’ve seen as both patient and physician. It may interest people to know that Charles Dahlberg, an analyst/MD in the ‘60’s used nursing care to shepherd and monitor a patient in between sessions while conducting a microdosing psychoanalytic treatment using LSD. The article is dated and only available in limited settings but really captures the collaboration Andrew is imagining, albeit a slightly different model.
This is all very nice and good. Thoughtful, but not thorough. The United States of America was founded on important, no, essential principals, that bear on this matter directly: The first amendment, the separation of church a state. "There is a genius to our constitution." Psychedelic drugs are one of the oldest, ubiquitous, safest, continuously used means of attaining direct experience of the divine. There should be no institutional, governmental, interferences put between a responsible person and their use of them. So, fine, if you and other members of the scientific community want to research them, and apply them to your kinds of psychotherapy or healing. But if those rules you make for your profession interfere or take precedent over mine or anyone else whose motives for using them are spiritual or religious, they are unconstitutional. The first thing those of us who appreciate these drugs should do is petition our legislators to rescind the Controlled Substance Act. All the psychedelics are wrongly classified, and most importantly, the CSA grants the authority to determine a drug's value to the DEA, not to scientists, or philosophers, but to the police, who, as we well known, run a disgustingly corrupt institution. By redefining psychedelics properly as sacraments, it takes the business out of them, as it should be. Sacraments belong to the universe of god seeking human beings, not to greedy people, like MAPS founder Rick Doblin, or any of the other profiteers of this corrupt renaissance.
Also, I just want to be perfectly clear that I don't think all nurses would be good at PAT (I also don't think that most therapists or psychiatrists would be good at it either... it takes a certain kind of clinician to do this work). Just as I COULD work in an ICU, I really shouldn't as it's not my forte or skill set. And fortunately, no one is MAKING me work in an ICU - I self selected. The same will be the case for nurses working in PAT.
To some nurses, the idea of sitting with someone in a semi-catatonic state on psychedelics for 8 hours sounds like the most boring thing ever, and they probably would not select it as a place to work. But for those who are called, I still think the native intelligences of nursing and core skills of care, presence, and safety are well matched to PAT.
Hi Anna, thanks for taking the time to read and respond. As someone who has worked in mental health for 30 years with some of the most challenging populations (highly traumatized children, combat vets, and severely mentally ill), I have some appreciation for the needs of this population.
I think you'll find most of these concerns addressed in the piece:
• Yes, all personnel (including the nurses) would need to be trained in working with people on psychedelics.
• All personnel will need to be certified in PAT (probably by their respective professional organizations as it is increasingly looking challenging to complete an omnibus certification exam for all professions).
• The reality is that in a medicalized setting, psychedelic treatments have become a procedure (for better or worse, we can discuss if that's a good idea or not) and in medical settings, procedures are handled by different types of professionals along the process.
• Ethical transgressions can come from any profession (the abuse you reference that happened in phase 2 MDMA in Canada came from a licensed physician and her psychologist husband who had let his license lapse), both of whom had considerable experience in working with people in non ordinary states and still did substantial harm. However, this said, the number of reports of these kinds of transgressions coming from nurses (especially when compared to the sheer number of patients treated by nurses each year) is remarkably low.
• I agree that we will have to build time and resources (i.e. people will need to be compensated for their time) for this warm handoff. Technology can also be leveraged (as a means of increasing safety, sessions should be videotaped) to highlight key sections of the session for the receiving therapist.
• I think the biggest question that this piece does not answer (and you appropriately critique) is if this model maintains the relational container needed to treat PTSD, let alone C-PTSD. I don't think we know the answer to this, because only one model of using MDMA in PTSD (i.e. MDMA + the MAPS therapy protocol) has been empirically tested. Irrespective of what model is used, the combination of MDMA + therapy in a new drug application will continue to stymie the FDA, since the regulation of psychotherapy is outside of the FDA's scope.
Thanks for participating in the discussion, Anna. There are a lot of bombs thrown in this space without opportunity the discourse that we're engaging in here. I appreciate the conversation.
There are certainly a lot of unknowns in PAT, and even more now following the FDA decision, and I could see how that uncertainty must be really unsettling for people with PTSD who were optimistic for treatment. That is the group that has really been hurt the most by this setback.
I don't think it's realistic to ask for the FDA to figure out how to regulate psychotherapy. If the FDA starts trying to wander into regulating medical practice, that will likely trigger lawsuits from medical stakeholders (e.g. AMA) to make them stick to their charter.
In my opinion, one of the conceits of the "psychedelic movement" (such that there is one) is that they are going to get to both use the system (i.e. push MDMA through a regulatory framework/FDA) and get to change the system (i.e. make the FDA opine on psychotherapy) at the same time. I don't think you get both. If you want to use "the system" to change things, one has to a certain extent, play by its rules. If the referee kicks you out of the game for not following the rules, you can't really cry foul. What concerns me the most is that in the aftermath of this denial, I see a lot of people in the "psychedelic space" talking about going back underground, or using the poorly regulated religious exception as a way of having personal access to psychedelics. I don't see a lot of advocacy for the patients who still need treatment. I want to be wrong on this one, but time will tell.
Critical to the research is a stable and responsible workforce. Nurses scope of practice has this covered but needs to be sanctioned by professional organizations to protect us legally. The research had some issues that can be overcome with good practice and REMS. Thanks for keep this ball moving!!!
This is so awesome! I love the proposal, everything about it. Makes me so proud and excited to be a nurse.
I agree with altered states of America that many of those “leaders” in the field are, not just financially greedy but emotionally corrupt, flip, and careless in their arrogance.
That is why I so agree with Andrew that the people most immersed in patient care, with the right training and calling, are the ones best qualified to attend to patients in altered states. Nurses have so much going for them, including an energy of care, close monitoring, and the ability to “eyeball” a patient and know when something is wrong. It is both an uncanny, intuitive, and experience honed skill that I’ve seen as both patient and physician. It may interest people to know that Charles Dahlberg, an analyst/MD in the ‘60’s used nursing care to shepherd and monitor a patient in between sessions while conducting a microdosing psychoanalytic treatment using LSD. The article is dated and only available in limited settings but really captures the collaboration Andrew is imagining, albeit a slightly different model.
This is all very nice and good. Thoughtful, but not thorough. The United States of America was founded on important, no, essential principals, that bear on this matter directly: The first amendment, the separation of church a state. "There is a genius to our constitution." Psychedelic drugs are one of the oldest, ubiquitous, safest, continuously used means of attaining direct experience of the divine. There should be no institutional, governmental, interferences put between a responsible person and their use of them. So, fine, if you and other members of the scientific community want to research them, and apply them to your kinds of psychotherapy or healing. But if those rules you make for your profession interfere or take precedent over mine or anyone else whose motives for using them are spiritual or religious, they are unconstitutional. The first thing those of us who appreciate these drugs should do is petition our legislators to rescind the Controlled Substance Act. All the psychedelics are wrongly classified, and most importantly, the CSA grants the authority to determine a drug's value to the DEA, not to scientists, or philosophers, but to the police, who, as we well known, run a disgustingly corrupt institution. By redefining psychedelics properly as sacraments, it takes the business out of them, as it should be. Sacraments belong to the universe of god seeking human beings, not to greedy people, like MAPS founder Rick Doblin, or any of the other profiteers of this corrupt renaissance.
Also, I just want to be perfectly clear that I don't think all nurses would be good at PAT (I also don't think that most therapists or psychiatrists would be good at it either... it takes a certain kind of clinician to do this work). Just as I COULD work in an ICU, I really shouldn't as it's not my forte or skill set. And fortunately, no one is MAKING me work in an ICU - I self selected. The same will be the case for nurses working in PAT.
To some nurses, the idea of sitting with someone in a semi-catatonic state on psychedelics for 8 hours sounds like the most boring thing ever, and they probably would not select it as a place to work. But for those who are called, I still think the native intelligences of nursing and core skills of care, presence, and safety are well matched to PAT.
Hi Anna, thanks for taking the time to read and respond. As someone who has worked in mental health for 30 years with some of the most challenging populations (highly traumatized children, combat vets, and severely mentally ill), I have some appreciation for the needs of this population.
I think you'll find most of these concerns addressed in the piece:
• Yes, all personnel (including the nurses) would need to be trained in working with people on psychedelics.
• All personnel will need to be certified in PAT (probably by their respective professional organizations as it is increasingly looking challenging to complete an omnibus certification exam for all professions).
• The reality is that in a medicalized setting, psychedelic treatments have become a procedure (for better or worse, we can discuss if that's a good idea or not) and in medical settings, procedures are handled by different types of professionals along the process.
• Ethical transgressions can come from any profession (the abuse you reference that happened in phase 2 MDMA in Canada came from a licensed physician and her psychologist husband who had let his license lapse), both of whom had considerable experience in working with people in non ordinary states and still did substantial harm. However, this said, the number of reports of these kinds of transgressions coming from nurses (especially when compared to the sheer number of patients treated by nurses each year) is remarkably low.
• I agree that we will have to build time and resources (i.e. people will need to be compensated for their time) for this warm handoff. Technology can also be leveraged (as a means of increasing safety, sessions should be videotaped) to highlight key sections of the session for the receiving therapist.
• I think the biggest question that this piece does not answer (and you appropriately critique) is if this model maintains the relational container needed to treat PTSD, let alone C-PTSD. I don't think we know the answer to this, because only one model of using MDMA in PTSD (i.e. MDMA + the MAPS therapy protocol) has been empirically tested. Irrespective of what model is used, the combination of MDMA + therapy in a new drug application will continue to stymie the FDA, since the regulation of psychotherapy is outside of the FDA's scope.
Thanks for participating in the discussion, Anna. There are a lot of bombs thrown in this space without opportunity the discourse that we're engaging in here. I appreciate the conversation.
There are certainly a lot of unknowns in PAT, and even more now following the FDA decision, and I could see how that uncertainty must be really unsettling for people with PTSD who were optimistic for treatment. That is the group that has really been hurt the most by this setback.
I don't think it's realistic to ask for the FDA to figure out how to regulate psychotherapy. If the FDA starts trying to wander into regulating medical practice, that will likely trigger lawsuits from medical stakeholders (e.g. AMA) to make them stick to their charter.
In my opinion, one of the conceits of the "psychedelic movement" (such that there is one) is that they are going to get to both use the system (i.e. push MDMA through a regulatory framework/FDA) and get to change the system (i.e. make the FDA opine on psychotherapy) at the same time. I don't think you get both. If you want to use "the system" to change things, one has to a certain extent, play by its rules. If the referee kicks you out of the game for not following the rules, you can't really cry foul. What concerns me the most is that in the aftermath of this denial, I see a lot of people in the "psychedelic space" talking about going back underground, or using the poorly regulated religious exception as a way of having personal access to psychedelics. I don't see a lot of advocacy for the patients who still need treatment. I want to be wrong on this one, but time will tell.