Psychedelic Therapy: What Nurses Need To Know

Rebekah Berndt, BSN, RN

With lots of buzz in the media, new research breakthroughs, and hundreds of new healthcare startups flush with Silicon Valley money, it seems like you can't avoid hearing all about psychedelics. Many nurses are wondering what the hype is all about and what it might mean for their careers. Here's a primer on the history, science, and legal status of psychedelic medicine and the opportunities it holds for nurses.

History

Psychedelic therapy is one of the most intriguing and promising avenues of research in the fields of mental health and neurology. They're not exactly new— the oldest known depiction of "magic" mushroom use is found in a 10,000-year-old cave painting in Algeria, and many indigenous people around the world have long traditions of using these plant medicines. But after a long hiatus in western medicine, psychedelics are back, and they're poised to become big business for healthcare.

Recent history began in the 1950s when the first reports of a new synthetic drug called LSD appeared, and Life Magazine published a first-hand account of psilocybin mushroom use in Mexico. Government and university researchers became interested, and the 1960s was a time of pioneering psychedelic research.

It was also a time of great experimentation, as LSD and psilocybin spread from university campuses to the wider hippie counterculture. Concerned about the unpredictable effects of psychedelics, the U.S. Government labeled psychedelics as Schedule 1 drugs in 1970, forcing researchers to shut down their labs.

By the 1990s, new advances in neuroimaging, brain science, and a changing political climate allowed researchers to gain special permission from the FDA to work with psychedelics. In 2006, a groundbreaking study from Johns Hopkins showed that Psilocybin consistently produced mystical experiences that led to positive changes in behavior and attitude, inaugurating a new era of psychedelic research.

How They Work

Psychedelics act on neurotransmitter pathways to affect changes in cognition, mood, and perception. It is believed that one of the primary ways they work is by inhibiting a group of interconnected brain regions called the Default Mode Network (DMN).

The DMN is involved in the creation of memories of the past and anticipation of the future, a sense of self and others as distinct entities, and the capacity to analyze and judge other people's behavior. It is also activated in states of obsession and rumination.

Psychedelics decrease the activity of the DMN, creating an experience of oneness and boundlessness known as "ego dissolution" that facilitates reflection and objectivity. They increase neuroplasticity, allowing the brain to form new neural connections and improve mental flexibility, which allows people to form new habits and thought patterns.

These effects suggest tremendous potential when it comes to mental health problems like depression, anxiety, and substance use disorders. But there are also potential pitfalls. The experience can be difficult to control and is affected by both a person's attitude and expectations going into a psychedelic experience and the physical environment in which it occurs. These factors are also known as "set and setting.”

People can experience difficult emotions, relive past traumas, and experience frightening hallucinations. While these negative experiences can lead to personal breakthroughs and positive change, there are no guarantees.

Psychedelics can also leave people in a highly vulnerable and suggestible state, creating opportunities for abuse and manipulation. Development of protocols to provide emotional support, promote psychological integration, and ensure ethical behavior on the part of clinicians are crucial to providing effective treatment.

Types

Broadly speaking, there are three categories of psychedelics:

Classic

These include LSD; Psilocybin, found in mushrooms; Mescaline, found in peyote or San Pedro; and DMT, the active component in Ayahuasca.

Classic Psychedelics act as serotonin receptor agonists and create auditory and visual distortions, closed-eye visions, and, at high doses, ego dissolution. These drugs show promise for treating depression, end-of-life anxiety, OCD, cluster headaches, and substance use disorders.

Entactogens/Empathogens

This refers to MDMA, a synthetic compound that inhibits the reuptake of both serotonin and dopamine in the brain.

Entactogens increase empathy and emotional openness and show the potential to treat PTSD, eating disorders, and anxiety.

Dissociatives

Includes dextromethorphan (DMX), found in cough syrup, Nitrous Oxide, PCP, and Ketamine, a synthetic drug used in anesthesia. These drugs inhibit glutamine in the brain, which plays a role in memory, learning, and the perception of pain.

Dissociatives create a sense of "floating,” detachment from the self or the body, and a sense of being in an alternate reality. Ketamine is FDA-approved for treatment-resistant depression and is being used off-label to treat other mood disorders and chronic pain.

Current State of Legalization and Use

At the Federal level, MDMA and all the classic psychedelics are schedule 1 narcotics, with exceptions granted for research. Ayahuasca and peyote also have narrow exceptions for religious use. Ketamine is a schedule III anesthetic. At the state level, Oregon and Colorado have passed laws to legalize and regulate psilocybin, and legislation is under consideration in at least 14 other states.

Roles for Nurses

Currently, the primary opportunities for nurses in the field of psychedelic medicine lie in research and ketamine clinics, but MDMA and Psilocybin may be approved as early as the Spring of 2024. Once these therapies become widely available, it is believed there will be a shortage of clinicians trained to administer and facilitate them. Nurses are well-positioned to fill the gap. According to a 2021 article in the American Journal of Nursing:

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The knowledge, skills, and values nurses bring to patient care are central to the therapeutic use of psychedelic-assisted psychotherapy...Nurses are skilled in holding space as patients endure challenging events in real time and for prolonged periods, whether that be during childbirth, a sudden illness, an anxiety attack, or the time surrounding death. This skill translates well to being able to sit with a patient undergoing a therapeutic psychedelic experience, allowing space for whatever arises at physical, emotional, mental, or spiritual levels. Nurses can witness patient stories and help patients find meaning in these narratives, a crucial task in integrating the therapeutic psychedelic experience.

The scope of practice for nurses within the field of psychedelic therapy is yet to be defined. The Organization for Psychedelic and Entheogenic Nurses advocates for "full inclusion of nurses in psychedelic therapy" and the contribution of nursing knowledge to emerging codes of ethics and standards of practice.

There are a number of psychedelic training programs available, from short online courses open to the general public to University-based certificate programs. UCLA Berkeley, CIIS in San Francisco, and Naropa University in Colorado all offer 9-month certificates for licensed professionals, including RNs.

For nurses interested in the frontiers of medicine, consciousness, and healing, the field is wide open to contribute to the development of this exciting new specialty.

References/Resources

Organization of Psychedelic and Entheogenic Nurses (OPEN)

Multidisciplinary Association for Psychedelic Studies (MAPS)

Giorgio Samorini: The oldest Representations of Hallucinogenic Mushrooms in the world (Sahara Desert, 9000 -7000 B.P.)

Clinical Applications of Hallucinogens: A Review: National Library of Medicine

Human Psychedelic Research: A Historical And Sociological Analysis: Multidisciplinary Association for Psychedelic Studies (MAPS)

Default Mode Network Modulation by Psychedelics: A Systematic Review: National Library of Medicine

Psychedelics, Meditation, and Self-Consciousness: Frontiers Media S.A.

Psychedelics May Be Part of U.S. Medicine Sooner Than You Think: TIME USA, LLC

Nurses In Psychedelics, Naturals Caring For Patients In Non-Ordinary States Of Consciousness: Forbes

Nurses and the Brave New World of Psychedelic-Assisted Therapies: Aspen University

Psychedelic-Assisted Therapy: ResearchGate