Psychedelics - reasons for caution: Stacy Fischer, Brian Anderson, Theora Cimino

Psychedelics are having a moment.  Enthusiasm is brimming.  Legalization is moving forward in several states, following the lead of Oregon and Colorado.  FDA is considering approval, shifting away from Schedule I restrictions, paving the way for use in clinical practice.  Potential use in palliative care, chronic pain, and for mood disorders is tantalizing. Early data on efficacy in patients with anxiety and demoralization are promising.  Research is exploding.  Two of our guests today, Stacy Fischer and Brian Anderson, are involved in large multicenter trials of psychedelics for patients with advanced cancer (Fischer) or life-limiting illness (Anderson).  Theora Cimino conducted an observational study (publication in the works) of marginally housed/homeless persons many of whom had experience with psychedelics.

And yet there are reasons for caution.  In our prior podcast with Ira Byock on psychedelics in 2019 we talked primarily about the potential of psychedelics.  Today we largely focus on reasons for caution, including:

• We know almost nothing about psychedelics in older adults - only about 1% of patients in published trials were older adults, much less older adults with multiple chronic conditions, multiple medications, and frailty.  Bree Johnston and Brian Anderson wrote a terrific summary of the evidence (or lack thereof) in older adults.

• There is a marked lack of diversity in published trials.  Most participants are White and well-resourced. 

• Psilocybin, the most commonly used psychedelic, increases heart rate and blood pressure, which may potentially lead to cardiovascular events.

• The efficacy of psychedelics without therapy, and the impact of variations in therapy type, training, duration, is unknown.

• Ethical issues, including colonization of psychedelics by big pharma. Psychedelics have been used by communities around the globe for hundreds of years (or more). 

We cover these issues and more in today’s podcast.

Note, I butchered the chorus on the YouTube version - please listen to the podcast for my souped up version with drums and bass!

-@AlexSmithMD