Psy-Q: How can clinicians advise patients who ask about psychedelic use?

Andrew Penn

Andrew Penn, NP

Answer: When patients ask about psychedelic use, clinicians should think about two main concerns: the patient’s safety and their intentions for using psychedelics, according to Andrew Penn, MS, NP, PMHNP-BC, a psychiatric nurse practitioner at the San Francisco Veterans Administration Hospital and an associate clinical professor at the Department of Community Health Systems, School of Nursing, University of California, San Francisco. Penn is trained in psychedelic-assisted therapy and is involved with two FDA clinical trials that focus on psychedelics: one on MDMA and PTSD, and the other on psilocybin and major depressive disorder (MDD).

Patients sometimes want to talk to their therapist before using psychedelics, and while a clinician cannot legally provide these substances to their patients, Penn says that they can discuss some issues for their patient to consider such as:

  • What do you know about the drug that you’re going to be taking?
  • What is the context in which you’re going to be taking it?
  • Are you going to be by yourself, in a group, with a therapist? Will you be medically or psychiatrically supervised?
  • Can you tell me about the physical safety of the place where you’ll take it?
  • Do you feel comfortable with your physical safety while taking the psychedelic?

In addition to the safety of the experience, Penn suggests asking about the patient’s intentions. Asking a patient about what they are trying to accomplish, and what their plan is for after the experience, would be appropriate to discuss.

“One thing that we know about psychedelics is that they tend to be very driven by your intentions,” he says. If a person wants to take psychedelics out of curiosity, he explains, “that is probably going to be novel but not necessarily therapeutic.” Other intentions, such as someone wanting to go on a spiritual journey, or wanting to work their history of childhood trauma, for example, could produce different feelings and conversations after the experience.

Another thing to discuss with patients is who they plan to talk to afterward. Will this same person who facilitates the experience work with the patient afterward? Penn says that particularly when it comes to “psychedelic tourism,” there isn’t always a focus on processing the experience afterward.

“These can be pretty big experiences and you might want to have someplace to talk about it — and that could be with your therapist,” Penn says. “We think about psychedelics in the therapeutic space as being bookended by a period of preparatory psychotherapy and a period of integrative psychotherapy that happens afterward.”

Integration and Harm Reduction with Psychedelic Use

Post-experience integration is the process of understanding and integrating the experiences gained while using psychedelics and is considered an important part of the psychedelic experience. For clinicians not familiar with integration, Penn recommends a recent article by Gorman et al which describes an approach that incorporates elements of harm reduction psychotherapy when it comes to treating patients who are interested in psychedelics.

“One of the key values of harm reduction is valuing and honoring patient choice and autonomy,” Penn explains. “In harm reduction, we take the approach that we can’t control whether people use substances, but we can help them use it in a way that is less dangerous to them.”

Clinicians who are interested in training in this area can visit the website for Fluence, which was co-founded by Gorman and provides education in psychedelic-assisted psychotherapy and integration. Other resources for training include the California Institute of Integral Studies’ Center for Psychedelic Therapies and Research and Compass Pathways’ pilot training program for the administration of psychedelic-assisted therapy.

Psychedelic Support offers a searchable network of psychedelic therapists and provides guidance for people seeking to enroll in a psychedelic clinical trial.

There is also a new text and phone hotline for those “having a bad trip” launched in April 2021 by the San Francisco-based nonprofit Fireside Project Line. The psychedelic peer support line promises to provide confidential emotional support during or after a psychedelic experience.

A Psychedelic App?

Lumenate is an app that launched in March 2021 that aims to provide users with a way to “effortlessly explore your subconscious” using soothing music and stroboscopic light sequences with a smartphone’s flashlight. Penn, who is not a spokesperson for the app, tried Lumenate and appreciated its meditative qualities, but he hesitates to call it a psychedelic experience.

“It’s curious,” says Penn. “It’s an interesting way to meditate. I found it relaxing. Did I find it psychedelic? Not particularly.”

Penn says that when looking at psychedelics as therapeutics, the kaleidoscopic images and visual changes that people experience are secondary to the main goal, which is the relaxation of rigidly held beliefs. These could be beliefs about oneself, the world, one’s history, for example (and are also known as schemas in cognitive behavioral therapy). He adds that a psychedelic experience is more than just a sensorium experience.

Where mental health apps such as Lumenate could be helpful, he notes, is for people who have trouble meditating. “I don’t think there’s any harm in it,” he says. “I’m not sure how useful it is, but I remain open-minded.”

[The author of this Q&A experienced relaxation during the app’s free trial sessions, followed by a slight headache.]

Last Updated: Jun 3, 2021