Psychedelic-assisted psychotherapies are generating excitement in psychiatry and the media, but they remain investigational and not yet approved for general clinical use. This review helps psychiatrists navigate the complexities of the field, covering research equipoise, informed consent, patient vulnerability, equity and access, differences between clinical and nonclinical uses, and psychedelic self-enhancement. The unique altered states of consciousness and patient vulnerability require careful ethical consideration to minimize pitfalls. The goal is to equip psychiatrists to use psychedelic psychotherapy ethically and effectively as it moves toward regulatory approval.
Public policy changes in the United States, including decriminalization in Oakland and Denver in 2019, alongside a resurgence in research, suggest psychedelic compounds may become viable treatments for psychiatric conditions. Psychiatrists should be central to prescribing and managing psychedelic therapy due to risks of adverse psychological and medical effects. The literature on psychedelic-assisted psychotherapy offers guidance for handling patient treatment sessions.
Psychedelics can fundamentally alter consciousness, creating unique legal risks for psychiatrists who incorporate them into practice. Key malpractice concerns include the absence of standards of care, risk of harm, inappropriate treatment, and the doctrine of respondeat superior. Psychiatrists also face potential civil claims such as battery and intentional or negligent infliction of emotional distress. To safely provide psychedelic treatments, psychiatrists must understand and mitigate their risk of malpractice and other civil claims.