Psychedelic-Assisted Psychotherapy After COVID-19: The Therapeutic Uses of Psilocybin and MDMA for Pandemic-Related Mental Health Problems

Abstract

The COVID-19 pandemic stands to have impacts on mental health and well-being that will extend beyond its formal resolution. Before COVID-19, mental health disorders were already challenging global healthcare systems, directly accounting for 7.4% of the total burden of disease (1, 2). An estimated 1 billion people worldwide suffer from a mental health disorder, with the two most common disorders—depression and anxiety—costing the global economy US$1 trillion per year (3). Stigma and limited treatment options have amounted to substantial unmet need and violations in human rights for people with mental health disorders (1, 4, 5). Looking ahead, heightened post-pandemic demand for mental healthcare signifies an urgent need to bolster clinical capacity by integrating novel, cost-effective approaches into existing systems (6). Emergent literature globally describes the diverse impacts of COVID-19 on mental health (7, 8). For instance, available data among hospitalized COVID-19 patients in China revealed that approximately 96% suffered post-traumatic stress symptoms (9). Studies among intensive care unit (ICU) patients with previous coronaviruses infer high rates of posttraumatic stress disorder (PTSD), depression and anxiety (30-40%) persisting months after discharge (10), with similar rates observed in patients infected with COVID-19 (11). Highly exposed individuals such as frontline healthcare workers are susceptible to similarly negative outcomes due to prolonged occupational stress, elevating risk of PTSD and suicidality (12–14). Importantly, post-pandemic mental disorders are not limited to individuals directly exposed to COVID-19. Rather, research documents PTSD symptoms among individuals who have been indirectly exposed by witnessing (e.g., via the media) or being confronted with the threat of death or serious illness (e.g., worry/anticipation about the future) (7). COVID-19 has significantly altered lives in ways that exacerbate drivers of mental health problems, with widespread uncertainty, increased experiences of grief and loss, social isolation, economic and housing instability, and decreased access to critical services related to lockdowns (6, 15). Further, available data on the impacts of COVID-19 on substance use patterns indicate increased use of alcohol and other substances in response to stress and negative emotions (8, 16, 17). Social connections are crucial for people struggling with addiction and comorbidities such as depression, and increased social disconnection represents a key risk factor for adverse outcomes (e.g., relapse and overdose) (1, 6, 18). The societal and economic consequences are tremendous, with structurally vulnerable groups at greatest risk of harms. For example, North America has seen dramatic spikes in fatal overdoses attributable to socio-structural conditions worsened by COVID-19 (18, 19), disproportionately impacting racialized groups (20). The legacy of mental health problems that will be left behind by COVID-19 incites innovative solutions to address rising rates of PTSD, depression, anxiety, addictions, and social disconnection. As such, we would be remiss not to consider a novel approach with anti-depressive, anxiolytic, and antiaddictive potential that may also foster a sense of social and environmental connectedness, known as psychedelic-assisted psychotherapy (21–24). A considerable and growing body of evidence speaks to the potential of psychedelic-assisted psychotherapies to enhance treatments for PTSD, depression, end-of-life anxiety, and substance use disorders (23, 24). The ensuing government, industry and social support includes the US Food and Drug Administration (FDA) granting breakthrough therapy designation for psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) for treatment-resistant depression and PTSD, respectively (24). A range of jurisdictions worldwide are expanding access to psychedelic-assisted psychotherapies, including through compassionate use or “right-to-try” pathways. In 2019, the Israeli government approved its first Compassionate Use Program for MDMA-assisted psychotherapy, shortly followed by FDA approval for an Expanded Access program in the US (25). Switzerland has permitted compassionate use of MDMA and lysergic acid diethylamide (LSD) since 2014 (26). The state of Oregon has now legalized psilocybin-assisted psychotherapy and decriminalized all drugs, alongside dozens of similar legislative reforms to legalize or decriminalize psychedelic plants and fungi across the US, including bills to expand “right-to-try” laws for people with serious or life-threatening illnesses (27). In Canada, a growing number of permissions have been granted by the federal government to use psilocybin for existential distress, and for therapist training purposes (28). Health Canada recently announced a notice of intent to restore access to psilocybin and MDMA through the Special Access Programme, which followed a national petition signed by nearly 15,000 Canadians in support of decriminalizing psychedelic plants and fungi (29). Mounting public interest in psychedelic-assisted psychotherapy is reflected in the 2020 Global Drug Survey. Nearly 6% of 110,000 respondents used psychedelics in the past year for self-treatment of mental health conditions, and 90% who had a supervised psychedelic experience in an uncontrolled setting indicated interest in taking psychedelics under a legally regulated and approved treatment system (30). These findings underscore the need for increased public education, training of qualified care providers, and harm reduction approaches as regulatory frameworks evolve. While, the pandemic has illuminated deficiencies and inequalities in our healthcare systems, it also provides a rare opportunity for change. The collective experience of COVID-19 has rearranged priorities by bringing mortality, loss, and mental health to the forefront, and is generating...