Dr Salvatore Cognetti attended the "Terapia Assistita con Psichedelici a Bologna: Il futuro alle porte" conference. A reflection...

A special thank you to Federico Seragnoli for making our attendance possible. If you would like something more technical to read about the topic, may we suggest his recent papers Psychedelic-assisted therapy for palliative care within a home treatment setting: A case report and Psychedelic assisted psychotherapy (PAP): The Geneva model)

The following is a report (and some reflections) by Dr Salvatore Cognetti:

 I'm delighted to have attended the "Terapia Assistita con Psichedelici a Bologna: Il futuro alle porte" conference, organised with the collaboration of SIMEPSI, ALPS, and Psychedeliques en therapie. It delighted me that psychedelic assisted therapy, a topic that I have been following for at least the last 15 years, is something that is being actively discussed in Italy too.

"Hypnotiq No. 71" by Shane Gorski, licensed under CC BY-ND 2.0

<<How many people are, or have been affected by mental health issues? I remember a big campaign in London in the 2010s, where the subways were plastered with colourful posters explaining that 1 in 4 people are affected by mental health issues at some point during their lifetime. It of course varies when one takes into consideration different studies, different populations and modifiers such as nation, wealth, physical health, and so on -- and that's just with regards to psychiatric diagnoses. Right now, psychedelic assisted therapy has focused mostly on patients with Post-traumatic stress disorders, and severe depression, and there is a body of mounting evidence that psychedelic assisted therapy helps people deal with the end of their life, a time that will come -- unless our death is sudden and unforeseen -- for all of us.  And then, there is the wider world: just as psychotherapy, some psychologists say, is not just for those who are ill, but can help just about everyone make sense of their lives, one day psychedelic assisted therapy may also do just that. But let's not run before we can walk: even for its current indications, what is clear is that, if psychedelic assisted therapy is proven to deliver even a fraction of what we hope it might, it could change millions, if not billions, of lives for the better. >>

While psychedelic assisted therapy seems to hold great promise, a theme that I could not help but notice, is that of interprofessional collaboration. When one thinks about why psychedelic assisted therapy may work as an effective treatment for many psychiatric conditions, one may be tempted to think that the success is solely due to the pharmacological effects and aftermath of the psychedelic substance itself. This could not be more wrong, for if this were the case, people who suffer from such psychiatric illnesses and who happened to consume the substances in question recreationally, would be seen to experience remission almost as if by magic, and this is not the case: psychedelics are no magic pill. Is it, then, the psychedelic experience itself, the insights one might gain, and the reflection that might occur after? Partially, though in today's conference (and many other similar meetings) it has been mentioned how there have been cases where self administration of psychedelics without supervision has led to psychological harm. Is it then the therapist's guidance and psychotherapy? Of course it plays a part, but there are many for whom psychotherapy alone does not achieve the results of psychedelic assisted psychotherapy, and even when it does, psychedelics might significantly shorten the timeframes.

My personal opinion is that all three are required in combination to maximise the risk/benefit ratio. The psychedelic compounds lead to an altered state and altered insight. The insights one receives during the experience are as irreplaceable as they are ineffable. The guidance from a trained therapist during the experience, as well as afterwards, when it falls to the patient to make sense of it all and integrate it in their life going forward, perhaps making important changes, is both the glue that holds it together and the guardrail that minimises harms.

In this view of interprofessional collaboration -- a topic that I have been fond of and have written about previously regarding risk reduction in the treatment of tuberculosis -- every healthcare professional could have a role to play.

What then, is the role of a General Practitioner? Once psychedelic therapy gains more mainstream acceptance, and hopefully regulatory and legal frameworks for the therapeutic use of psychedelics replace the current blanket prohibition that we currently have in Italy and many other countries, a GP who is aware of it may identify suitable patients and refer them to the service, if nothing else. For a GP who wanted to get more involved, well, there are many things to do: Just as clinical trials for every other drug we prescribe typically study the drug's effect on healthy controls, or people with hardly any comorbidity, and then we are faced with the task of choosing what blood pressure medication to prescribe to someone who takes twelve other drugs for eight other diagnoses, administration of psychedelics will inevitably face the same challenges. And here is where the GP can shine: specialists have very deep and specialised knowledge about the drugs that are used in their speciality, but GPs know all drugs: we either prescribe them all, or at the very least, even in the case of the most obscure drugs for the rarest diseases, we look after patients who take them and prescribe much of the rest of their medication anyway. A GP who is well trained in psychedelic assisted psychotherapy can be invaluable in the context of a multidisciplinary team who is looking after a complex patient for whom psychedelic assisted therapy is considered.

The other role that does come to mind is in the aftermath of a psychedelic assisted therapy course. While post-experience follow up would be, I expect, carried out by the same team of pscyhiatrists and psychotherapists who were there to guide the patient during the experience, the patient is still going to go to their GP for other issues, or (as it happens more often than specialists would imagine), to discuss what happened during the session with a specialist. Again, this is a strong argument for a GP to want to train in psychedelic assisted therapy.

In Italy, however, the country I moved to in 2020, at the moment there are no trials, and all we can do is talk and raise awareness. Much like the psychonaut's journey brilliantly explained in Dr. Georgia Wilson Jones' masterful lecture, can be seen as a hero's journey, the professional who would like to be involved with participating in trials, and (assuming further trials are as successful as the previous ones would forecast) eventually deliver such therapy... We such professionals face a hero's journey of our own, mired with legal and ethical hurdles, and the first step of this journey is making our voices be heard.