Medical Matters: Psychedelic-assisted psychotherapy accreditation standards coming soon

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By Dr. Gordon Giddings, Assistant Registrar, Accreditation

The COVID-19 pandemic has shone a light on the prevalence of mental health disorders and created a renewed interest in novel treatments. One such innovation is psychedelic-assisted psychotherapy (PAPT), the professionally supervised use of psychedelic substances, such as ketamine and psilocybin, for the purpose of facilitating therapeutic insight and healing.

Psychedelics are a group of substances that can alter a person’s perception and mood, or change the way they process thoughts, emotions and behaviours.¹ Due to the changes in perception and awareness, psychedelics have the potential to make psychotherapy—such as cognitive behavioural therapy (CBT), or other types of talk and somatic therapies—more effective.

The concept of psychedelic therapy has been around for centuries and has deep roots with Indigenous cultures, practices and knowledge keepers. Indigenous approaches to sacred plants involve preparation, intention and integration, often structured in ritualistic settings that are as much about spiritual health as physical or mental health.² The psychotherapy portion of treatment can occur at the same time as the ingestion of the psychedelic medication or afterwards, in the days or weeks following.

According to the Canadian Agency for Drugs and Technologies in Health (CADTH), PAPT may be an option for some patients for whom conventional medications and psychotherapy alone have not been successful. Research conducted by CADTH in 2021 sought to answer the following questions:

• What is the clinical effectiveness of PAPT in the treatment of post-traumatic stress disorder (PTSD), anxiety disorders, mood disorders or substance use disorders?
• What are the evidence-based guidelines regarding PAPT for the treatment of PTSD, anxiety disorders, mood disorders or substance use disorders?

CADTH identified two systematic reviews, which included 31 individual relevant studies and three randomized controlled trials, on various combinations of PAPT for PTSD, anxiety, mood disorders or substance abuse disorders.³ The psychedelic most commonly tested was psilocybin; however, MDMA, LSD and ketamine were also included. Both systematic reviews concluded that PAPT generally led to an improvement in symptoms and outcomes, and the randomized controlled trials reported effectiveness in the treatment of substance use disorder and major depressive disorder (MDD). CADTH also identified two safety trials on the safety of MDMA-assisted psychotherapy for alcohol use disorder and PTSD. Both found the treatment to be safe and well tolerated. No serious adverse events were reported. No relevant evidence-based guidelines for PAPT were identified in the research.

The limitations of the aforementioned studies included, among others, small sample sizes, a lack of standardization in approach to psychotherapy and short follow-up timeframes.

Perhaps one of the most important considerations, however, is the vulnerability of patients undergoing PAPT. Not only are they struggling with psychiatric illness and under the influence of psychedelic medications, but they are also at risk of the inherent power imbalance that exists between a patient and their healthcare provider. Negative or unpleasant psychological experiences, destabilization of mood and development of suicidal ideation may also occur, as well as physical adverse effects depending on the psychedelic.

The heightened vulnerability of patients under the influence of agents with the capacity to acutely alter consciousness demonstrates the need for systems and processes that ensure patient safety. Health Canada issued a notice to stakeholders on Dec. 5, 2022 regarding risk-management of PAPT for therapists, clinical settings and informed consent.⁴ Alberta introduced an amendment to the Mental Health Services Protection Regulation, which came into effect on Jan. 16, 2023. As a result, PAPT has been added to CPSA’s bylaws as a prescribed health service, indicating a requirement for it to be performed in an accredited facility. All providers of PAPT in Alberta will be required to have approved licensure to ensure compliance with quality and safety standards.⁵

Accreditation standards to support the provision of PAPT will be made available in the next few months to further facilitate safer use of the therapy in community settings. This serves as additional recognition that whether these tools are beneficial, at least in part, depends on the how. That is, the setting and context in which they are used.

If you have any questions about PAPT, please feel free to reach out to papt@cpsa.ab.ca.

1. Nichols DE. Psychedelics. Pharmacol Rev. 2016 Apr;68(2):264-355. doi: 10.1124/pr.115.011478. Erratum in: Pharmacol Rev. 2016 Apr;68(2):356. PMID: 26841800; PMCID: PMC4813425.
2. https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061
3. https://www.cadth.ca/psychedelic-assisted-psychotherapy-post-traumatic-stress-disorder-anxiety-disorders-mood-disorders

4. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/expectations-risk-management-measures-clinical-trials-psychedelic-assisted-psychotherapy.html
5. https://www.alberta.ca/psychedelic-drug-treatment-service-provider-licensing.aspx#contact-compliance-and-monitoring

Dr. Gordon Giddings is a Physician-MBA, and a 2000 graduate of the University of Alabama School of Medicine (Birmingham). His clinical background spans 20 years in Palliative Medicine and Behavioural Sleep Medicine. Dr. Giddings was the 10th physician to be named Canadian Medical Association Journal (CMAJ) Physician Editorial Fellow (2013-2014), and subsequently, he became an Associate Editor of the journal. He arrived in Alberta in 2016 to join CPSA and assumed the role of Assistant Registrar, Department of Accreditation in 2020. He is also an appointed Councillor for the Medical Council of Canada.