Downloaded 15 times
![• Colors represent the search date
(and made it more fun)
• Boxes include:
• [total number of search results],
• [number of results reviewed],
• [number of articles yielded]
© Peacock 2023](https://image.slidesharecdn.com/2023-07-13psychedelicsinintegratedcarefinal-240222212333-8ebfabf7/75/Psychedelic-Treatment-Planning-Opportunities-in-Integrated-Care-7-2048.jpg)
![Ketamine for Alcohol Use Disorder
2021 Pilot Trial at Denver Health – Ketamine for high-utilization inpatients with AUD
• Principal Investigator: Dale Terasaki, M.D.
• Ketamine vs. Naltrexone vs. “Linkage Alone” (IV Ketamine 0.5 mg/kg)
• 30-day Readmission Rate:
• Ketamine 15.4% [n=13]
• Naltrexone 21.4% [n=14]
• Linkage Alone 41.2% [n=17]
• 14-day Addiction Clinic Encounter
• Ketamine 61.5%
• Naltrexone 50.0%
• Linkage Alone 41.2%
• Ketamine may help with depression and withdrawal in addition to cravings.
The Peacock Perspective™: This is AWESOME!
(Terasaki, 2023)
Current
© Peacock 2023](https://image.slidesharecdn.com/2023-07-13psychedelicsinintegratedcarefinal-240222212333-8ebfabf7/75/Psychedelic-Treatment-Planning-Opportunities-in-Integrated-Care-38-2048.jpg)
![Ayahuasca
(Peacock, 2022)
• Most research and current use is in ritual contexts.
The Peacock Perspective™:
• Hesitant about ayahuasca in a clinical setting due to established cultural lineage.
• More inclined to refer out to ritual ayahuasca treatment centers.
• Evidence of neurocognitive benefits from ritual ayahuasca use across all cognitive domains
except verbal memory, which according to one study may be reduced.
• Small study in South America suggested that rates of ADD may be lower among ritual ayahuasca-
using adolescents (2.5%) compared to controls (17.5%) [N=80; p<.057] (Da Silveira et al., 2005).
• Superior working memory and executive functions in ritual ayahuasca users compared to controls.
• Further research warranted as a possible treatment for ADHD.
Possible June 2026
© Peacock 2023](https://image.slidesharecdn.com/2023-07-13psychedelicsinintegratedcarefinal-240222212333-8ebfabf7/75/Psychedelic-Treatment-Planning-Opportunities-in-Integrated-Care-44-2048.jpg)
![References
Avanceña, A. L. V., Kahn, J. G., & Marseille, E. (2022). The Costs and Health Benefits of Expanded Access to MDMA-assisted
Therapy for Chronic and Severe PTSD in the USA: A Modeling Study. Clinical Drug Investigation, 42, 243–252.
https://doi.org/10.1007/s40261-022-01122-0.
Benzinga (May 2, 2023). EXCLUSIVE: AMA Moves Toward Psychedelic Therapy Reimbursement, Filing A Gap In Regulations
[online, accessed July 13, 2023]. Business Insider. https://markets.businessinsider.com/news/stocks/exclusive-ama-
moves-toward-psychedelic-therapy-reimbursement-filing-a-gap-in-regulations-1032283416.
Carron, B. (2022). Administration of intranasal ketamine for psychiatric inpatients. Denver Health and Hospital Authority
[Internal Clinical Care Guideline]. PolicyStat ID: 12275022.
Colorado Department of Regulatory Agencies. Natural Medicine Health Act - Implementation Timeframe. [online, accessed July
7, 2023]. https://dpo.colorado.gov/dpo-home/natural-medicine-health-act-home/natural-medicine-health-act-
implementation-timeframe.
Danforth, A. L., Grob, C. S., Struble, C., Feduccia, A. A., Walker, N., Jerome, L., Yazar- Klosinski, B. B., & Emerson, A. (2018).
Reduction in social anxiety after MDMA- assisted psychotherapy with autistic adults: A randomized, double-blind,
placebo- controlled pilot study. Psychopharmacology, 235(11), 3137–3148. https://doi.org/10.1007/s00213-018-5010-9.
Da Silveira, D. X., Grob, C. S., de Rios, M. D., Lopez, E., Alonso, L. K., Tacla, C., & Doering-Silveira, E. (2005). Ayahuasca in
adolescence: A preliminary psychiatric assessment. Journal of Psychoactive Drugs, 37(2), 129–134.
Kary, T. (October 17, 2022). Will Medical Insurers Agree to Cover Psychedelic Trips? [online, accessed July 13, 2023]. Bloomberg
Newsletter. https://www.bloomberg.com/news/newsletters/2022-10-17/could-psychedelic-trips-end-up-being-covered-
by-health-insurance.
© Peacock 2023](https://image.slidesharecdn.com/2023-07-13psychedelicsinintegratedcarefinal-240222212333-8ebfabf7/75/Psychedelic-Treatment-Planning-Opportunities-in-Integrated-Care-51-2048.jpg)
![References
Marseille, E., Mitchell, J. M., & Kahn, J. G. (2022). Updated cost-effectiveness of MDMA-assisted therapy for
the treatment of posttraumatic stress disorder in the United States: Findings from a phase 3 trial. PLOS
ONE, 17(2). https://doi.org/10.1371/journal.pone.0263252.
Peacock, B. C. (2022). Applications of psychedelic-assisted psychotherapy across personalities and
psychopathologies: An integrative literature review with meta-analysis [Doctoral Dissertation, The
Wright Institute]. ProQuest Dissertations and Theses Global (In Press).
Sprunt, B. (October 15, 2019). Psilocybin Paves Path For Addiction Research At Johns Hopkins [online,
accessed July 13, 2023]. WAMU American University Radio.
https://wamu.org/story/19/10/15/psilocybin-therapy-at-john-hopkins-finds-success-in-addiction-
research/
Steinberg, B. (April 21, 2023). MDMA expected to be approved to treat PTSD by October: study [online,
accessed July 7, 2023]. New York Post. https://nypost.com/2023/04/21/mdma-expected-to-be-
approved-to-treat-ptsd-by-october-study/
Terasaki, D. (2023). MAF presentation: Ketamine on acute care floors [oral presentation]. Denver Health.
© Peacock 2023](https://image.slidesharecdn.com/2023-07-13psychedelicsinintegratedcarefinal-240222212333-8ebfabf7/75/Psychedelic-Treatment-Planning-Opportunities-in-Integrated-Care-52-2048.jpg)
Uploaded byBrian Peacock
Psychedelic Treatment Planning: Opportunities in Integrated Care
The document discusses Brian Peacock's research on psychedelic therapy, focusing on its potential applications, constraints, and clinical practices, particularly in treating various psychiatric conditions. The dissertation evaluates different psychedelics' efficacy and their long-term effects, while also addressing the infrastructure needed for safe and effective group and individual therapy sessions. Future plans include a proposed book and developing assessment measures for optimizing psychedelic-assisted treatments.
![Psychedelic Interventions for Neurological Conditions [NAN 2022 Poster]](https://cdn.slidesharecdn.com/ss_thumbnails/peacock-psychedelicinterventionsforneurologicalconditions-240222210939-5e922478-thumbnail.jpg?width=640&height=640&fit=bounds)
Psychedelic Treatment Planning: Opportunities in Integrated Care
- 1. Brian C. Peacock,Psy.D. Candidate Psychology Resident, Denver Health Psychedelic Treatment Planning: Opportunities in Integrated Care © Brian Peacock, 2023
- 2. Overview MY RESEARCH CONSTRAINTSOF MANAGED CARE INDICATIONS & USE CASES © Peacock 2023
- 3. What’s different about psychedelics? (comparedto other therapies) • Psychedelics produce striking changes across all levels of the human system—molecular, neurological, phenomenological, affective, and cognitive. • Effects propagate through time, resulting in changes to mind, brain, body, and behavior lasting anywhere from minutes up to a lifetime. • Clinical decision making is complicated by the varied properties of psychedelics and the environmental variables that affect psychedelic experience. • We most choose among psychedelics, therapeutic techniques, and therapeutic sequences to maximize treatment efficacy while minimizing risk. © Peacock 2023
- 4.
- 5. Dissertation “Applications of psychedelic-assistedpsychotherapy across personalities and psychopathologies: An integrative literature review with meta-analysis.” • Compared different psychedelic therapies and their efficacy in treating psychiatric conditions. • Examined variation in response to psychedelics across different personality traits. • Drew insights from basic psychedelic research that can be applied clinically. • Completed July 2022 Psilocybin Mescaline LSD DMT Ayahuasca MDMA Ketamine Ibogaine DEFENDED © Peacock 2023
- 6. Method • Systematic LiteratureSearch • Matrix of 128 topic keywords combined with 8 psychedelics for a total of 1,024 Google Scholar searches. • Yielded 4,409 references • 1,164 references were included • Preliminary Meta-analysis – Normalize data across studies by calculating effect sizes when not reported. • Integration & Synthesis – A method for making all this data clinically useful! Psilocybin Mescaline LSD DMT Ayahuasca MDMA Ketamine Ibogaine © Peacock 2023
- 7. • Colors representthe search date (and made it more fun) • Boxes include: • [total number of search results], • [number of results reviewed], • [number of articles yielded] © Peacock 2023
- 8. Summary Tables • PharmacologicalProperties • Impacts on Neurotransmission • Life Stage and Psychedelic Safety • Medical Risk Factors and Contraindications • Long-Term Medical Risks • Psychedelic Phenomenology • Acute • Subacute • Psychological Change • Subacute • Long-term • Neuropsychological Effects • Acute • Subacute • Long-term • Psychological Risks • Acute and Subacute • Long-Term Psychopathogenesis • Psychological Risk Factors • Patient Factors Affecting Psychedelic Experience and Outcome • Psychedelic Treatment Targets (Peacock, 2022) © Peacock 2023
- 9.
- 10. Gertrude Smith 72-year-old, White, cis-genderwoman 72 72 Gertrude Smith Brian Peacock / / O / / / / O © Peacock 2023
- 11. Gertrude Smith 72-year-old, White, cis-genderwoman 72 72 Gertrude Smith Brian Peacock / / O / / / / O None Heart Disease Cystitis / / / / / X X © Peacock 2023
- 12. 72 72 Gertrude Smith BrianPeacock / / O / / / / O None Heart Disease Cystitis / / / / / X X Depression 2x Suicide Atmpt. Ket associated w/ dev./worsening cystitis SSRI / / / X X MDMA and MAOI risk serotonin syndrome Gertrude Smith 72-year-old, White, cis-gender woman / / / / / / X / X X / / / / / / © Peacock 2023
- 13. 72 72 Gertrude Smith BrianPeacock / / O / / / / O None Heart Disease Cystitis / / / / / X X Depression 2x Suicide Atmpt. Ket associated w/ dev./worsening cystitis SSRI / / / X X MDMA and MAOI risk serotonin syndrome Gertrude Smith 72-year-old, White, cis-gender woman / / / / / / X / X X / / / / / / / X / X X X / X © Peacock 2023
- 14. Jon George 21-year-old, biracial, transgenderman Jon George Age 21 PTSD AUD Dysthymia ADHD O O O O X / O O + + / + ++ ++ + ? ? ? ? ? ? ++ ++ ++ + + + ? ++ ++ ++ ++ ++ ++ ++ ++ ? ? ? ? © Peacock 2023
- 15. Jon George 21-year-old, biracial, transgenderman Jon George Age 21 PTSD AUD Dysthymia ADHD O O O O X / O O + + / + ++ ++ + ? ? ? ? ? ? ++ ++ ++ + + + ? ++ ++ ++ ++ ++ ++ ++ ++ ? ? ? ? © Peacock 2023
- 16. Influencing Factors • Sex • Age •Personality Traits • Psychopathology • Family History • Cognitive Ability • BMI • Genetics (Peacock, 2022) © Peacock 2023
- 17. Jon George 21-year-old, biracial, transgenderman Jon George Age 21 PTSD AUD Dysthymia ADHD O O O O X / O O + + / + ++ ++ + ? ? ? ? ? ? ++ ++ ++ + + + ? ++ ++ ++ ++ ++ ++ ++ ++ ? ? ? ? Trans Man - Consider transference - Psilocybin: More ‘bad trips’ for female sex. - MDMA: Reduce dose and monitor closely for subacute depressive sx more common in female sex. Under 22 - LSD: Less insight gain High Neuroticism - Psilocybin: More challenging experience -> increased efficacy Low trait absorption - Classical psychedelics: Less mystical experience -> decreased efficacy Little positively valenced language - Psilocybin: Predictive of treatment response for depression SUDs hx - Ketamine Inf: Greater reduction in depressive sx @ 1 & 7 days - Ketamine Inf: Greater tx response for depression Slowed processing speed © Peacock 2023
- 18. Jon George 21-year-old, biracial, transgenderman Jon George Age 21 PTSD AUD Dysthymia ADHD O O O O X / O O + + / + ++ ++ + ? ? ? ? ? ? ++ ++ ++ + + + ? ++ ++ ++ ++ ++ ++ ++ ++ ? ? ? ? X X 1. - - 2. - 3. - Trans Man - Consider transference - Psilocybin: More ‘bad trips’ for female sex. - MDMA: Reduce dose and monitor closely for subacute depressive sx more common in female sex. Under 22 - LSD: Less insight gain High Neuroticism - Psilocybin: More challenging experience -> increased efficacy Low trait absorption - Classical psychedelics: Less mystical experience -> decreased efficacy Little positively valenced language - Psilocybin: Predictive of treatment response for depression SUDs hx - Ketamine Inf: Greater reduction in depressive sx @ 1 & 7 days - Ketamine Inf: Greater tx response for depression Slowed processing speed © Peacock 2023
- 19. Next Steps • ProposedBook: Psychedelic Treatment Planning: An Evidence-Based Clinical Guide • Simplified symbols and treatment planning workflow • Clinical case examples • Revisions and updates • Starting independent practice for: • Pre-evaluation and preparation for psychedelic therapy. • Psychedelic integration therapy for patients experiencing distress, spiritual emergency, or emerging psychopathology following psychedelic therapy with other providers. • Develop assessment measure designed for assessing traits relevant to psychedelic-assisted treatments. © Peacock 2023
- 20. Constraints of Managed Care ©Peacock 2023
- 21. Current Availability • Off-label ketamine •Other psychedelics used in: • Clinical research • Underground practice © Peacock 2023
- 22. Nov 2024 Natural MedicineHealth Act • Colorado Prop. 122 • Psilocybin and psilocin • Licensed treatment centers • Regulated by the Natural Medicine Advisory Board (Colorado Department of Regulatory Agencies) © Peacock 2023
- 23. • FDA ApprovalPending • Phase 3 Clinical Trial Complete • Currently in “Expanded Access” phase • Priority roll-out to academic medical centers (Steinberg, 2023) Mid 2024 MDMA-PT for PTSD © Peacock 2023
- 24. • DMT, ayahuasca, ibogaine,and mescaline (excluding peyote) may become available in CO. • Only if recommended by the Natural Medicine Advisory Board (Colorado Department of Regulatory Agencies) June 2026 Natural Medicine Health Act © Peacock 2023
- 25. Bias Against LSDRemains
- 26. Who pays? • RightNow, Most Psychedelic Therapy is Out of Pocket • Most psychedelics are generic medications • Predominant costs are: • Evaluation/screening • Therapist time – Including preparation, drug, and integration sessions • Facility costs • March 3, 2023 – AMA approved new CPT III code for “Continuous In-Person Monitoring and Intervention during Psychedelic Medication Therapy” to become effective January 1, 2024 (Benzinga, 2023). © Peacock 2023
- 27. Cost Savings • MDMA-ATcosts $11,537 per patient using protocol from FDA Phase 3 trials • Per 1,000 patients, compared to standard of care: • MDMA-AT saves $132.9 million over 30 years in discounted net health care savings • Averts 61.4 premature deaths • Generates 4,856 quality-adjusted life-years (QALYs) • Break-even at 3.8 years • Expanding access for MDMA-AT to 25-75% of eligible patients is projected to: • Averts 43,618–106,932 deaths • Gains 3.3–8.2 million QALYs • “Most of the expected cost-savings aren’t on the psychiatric side, they’re on the physical side.” – Elliot Marseille (Kary, 2022) (Marseille et al., 2022; Avanceña et al., 2022) © Peacock 2023
- 28. Infrastructure – CurrentResearch (Sprunt/WAMU, 2019) Johns Hopkins University – Center for Psychedelic and Consciousness Research • Individual Psilocybin Therapy Room • Two Therapists Present • One Licensed Psychologist or Psychiatrist • One Other Provider • EXPENSIVE • Similar protocols for MDMA-AT © Peacock 2023
- 29. Infrastructure – IndividualPsychedelic Therapy • Ketamine Infusions can be done in: • Inpatient units (as is being done at Denver Health) • Outpatient infusion clinic in group setting • MDMA-AT and Ketamine-AT can be done in outpatient therapy offices modified to have: • Calm lighting and décor • Windows to monitor sessions and prevent boundary violations while patient is in a vulnerable, suggestable, and disinhibited state. © Peacock 2023
- 30. Infrastructure – GroupPsychedelic Therapy • Group psychedelic therapy will reduce costs in managed care setting. • Indigenously, ritual administration in groups has been the norm. • Group psychedelic therapy is safe and feasible per recent studies. • Therapies not requiring intensive individual intervention during the psychedelic experience can be done in groups: • High-dose psilocybin therapy (depression, cancer-related distress, AUD, etc.) • Ibogaine for SUDs • Ayahuasca, DMT, and Mescaline • Ketamine Infusion • Active group process may be feasible with low-dose psychedelic therapy. • This is similar to ritual practices and more research is needed. © Peacock 2023
- 31. What might apsychedelic treatment center look like? © Peacock 2023
- 32. Group Psychedelic TherapyRoom • Inpatient and outpatient groups for various indications. • Two group sessions per day. Psychedelic Treatment Unit • Infrastructure to treat patients needing medical support. Main Hospital • Quick access to emergency medical care if needed. Individual Therapy Rooms • Space for individual care when respite from group needed. • Individual MDMA-AT and Ketamine-AT sessions. Two Bathrooms • On unit so no tripping patients interact with others. • Showers for emergent hygiene needs *Lack of patient diversity pictured due to software limitation. © Peacock 2023
- 33. Windows Make it Brightand Airy Natural Elements to Create Therapeutic Setting Sound System for Music Guides Standing By Windows to Monitor Patient-Therapist Dyads Empty Room Available in Case Individual Attention is Needed by Group Member Unit Separated From Hospital for Tranquility Psychedelic Treatment Unit Main Hospital © Peacock 2023
- 34. Indications & Use Cases ©Peacock 2023
- 35. Ketamine in InpatientPsychiatry & Eating Disorder Treatment August 2022 – Denver Health policy approved for using intranasal racemic ketamine to treat patients with treatment-resistant MDD or bipolar depression. • Adult inpatients on Psychiatry Unit and ACUTE Center for Eating Disorders. • Low-stimulation environment for 120 minutes on the unit. • Re-dose every 2-4 days. • No guidelines for psychotherapy during session or preparation/integration therapy. • Has been put to use! (Carron, 2022) Current © Peacock 2023
- 36. The Peacock Perspective™: •Ketamine should be a first-line treatment for depression and acute suicidality. • Ketamine robustly and rapidly reduces symptoms of depression and suicidality. • Ketamine effects only last a week (though emerging research may suggest that repeat dosing may be more durable) • This provides a functional window for other intervention (e.g., psychotherapy or other psychedelic treatments). • Frequent and ongoing ketamine treatments are concerning • Chronic recreational ketamine use is linked to bladder cystitis, abdominal pain, sexual dysfunction, and fertility decline. • Both clinically and recreationally, long-term ketamine use is linked to neurocognitive damage. • There is substantial evidence for ketamine’s addictive potential, which is particularly relevant to self-administered ketamine nasal sprays. (Peacock, 2022) Ketamine in Inpatient Psychiatry & Eating Disorder Treatment Current © Peacock 2023
- 37. The Peacock Perspective™: •Like depression PTSD symptoms are rapidly reduced by ketamine, again providing a window for other interventions. • Ketamine-assisted psychotherapies show promise in durably treating: • OCD • PTSD • SUDs • Avoidant Personality Disorder • Given low-risk of ketamine therapy, attempting off-label treatment when other therapies are not working may be worthwhile. (Peacock, 2022) Ketamine in Inpatient Psychiatry & Eating Disorder Treatment Current © Peacock 2023
- 38. Ketamine for AlcoholUse Disorder 2021 Pilot Trial at Denver Health – Ketamine for high-utilization inpatients with AUD • Principal Investigator: Dale Terasaki, M.D. • Ketamine vs. Naltrexone vs. “Linkage Alone” (IV Ketamine 0.5 mg/kg) • 30-day Readmission Rate: • Ketamine 15.4% [n=13] • Naltrexone 21.4% [n=14] • Linkage Alone 41.2% [n=17] • 14-day Addiction Clinic Encounter • Ketamine 61.5% • Naltrexone 50.0% • Linkage Alone 41.2% • Ketamine may help with depression and withdrawal in addition to cravings. The Peacock Perspective™: This is AWESOME! (Terasaki, 2023) Current © Peacock 2023
- 39. Psilocybin-AT for Cancer-Related Distress •FDA trials taking place at CU Anschutz led by Stacy Fischer, M.D. • Highly effective treatment The Peacock Perspective™: • There is NOTHING available for these patients who are suffering profound existential distress while suffering from extreme pain. • Psilocybin therapy is exceptionally low risk. • Evidence is emerging about the potential for psilocybin to treat chronic pain, making psilocybin treatment a double whammy. • We need this treatment available as soon as possible. (Peacock, 2022) September 2024 © Peacock 2023
- 40. Psilocybin-AT for OtherIndications The Peacock Perspective™: • Psilocybin-AT has shown robust efficacy to durably treat: • Unipolar Depression • Suicidality • Anxiety • OCD • Alcohol Use Disorder • Tobacco Use Disorder • Outcomes tend to improve with higher doses! • High-dose psilocybin therapy tends to be an introspective experience where patients typically wear eye-shades. This lends itself to group administration. (Peacock, 2022) September 2024 © Peacock 2023
- 41. MDMA-AT for PTSD •Phase 3 FDA trials of MDMA-AT for PTSD have been successfully completed. • MDMA-AT has received Breakthrough Therapy Status • The expanded access program for MDMA-AT is prioritizing academic medical centers. • MDMA-AT requires individual rooms for conversation with therapist during the session. The Peacock Perspective™: • MDMA experience tends to be gentler than other psychedelics, making it ideal for emotionally vulnerable patients. • MDMA’s neurocognitive impact is minimized by avoiding body temperature elevation: • Administer MDMA in a cool environment and monitor for increased body temperature. • Use the R(–)-MDMA instead of racemic or S(+)-MDMA. • Need more research on neurocognitive impacts of clinical MDMA. (Peacock, 2022) Mid 2024 © Peacock 2023
- 42. MDMA-AT for OtherIndications • FDA appears to be restricting off-label use of MDMA more so than other drugs through regulating a drug/therapy combination for the first time. The Peacock Perspective™: • Strong findings for treating social anxiety in autism spectrum disorder (Danforth et al., 2018) • Some evidence for MDMA-AT to treat: • Generalized anxiety • Phobias • Avoidant personality disorder • Could help build therapeutic alliance with paranoid and schizoid patients who tend to be resistant to therapy due to difficulty trusting clinicians. • Historically used in couples therapy, which will likely return. (Peacock, 2022) Timeline Unknown © Peacock 2023
- 43. Ibogaine (Peacock, 2022) • Substantialpromise as an addiction treatment • Can completely attenuate withdrawal symptoms for opioids and other drugs. • Low relapse rates compared to conventional treatment. • Fatal cardiovascular risk is exceptionally high; therapeutic doses commonly exceed pharmaceutical safety standards. The Peacock Perspective™: • Risk of death may be deemed acceptable for those with terminal SUDs. • Alternatives with less toxicity but similar antiaddictive properties: • Noribogaine, the primary metabolite of ibogaine. • 18-methoxycoronaridine (18-MC), an ibogaine analog. Possible June 2026 © Peacock 2023
- 44. Ayahuasca (Peacock, 2022) • Mostresearch and current use is in ritual contexts. The Peacock Perspective™: • Hesitant about ayahuasca in a clinical setting due to established cultural lineage. • More inclined to refer out to ritual ayahuasca treatment centers. • Evidence of neurocognitive benefits from ritual ayahuasca use across all cognitive domains except verbal memory, which according to one study may be reduced. • Small study in South America suggested that rates of ADD may be lower among ritual ayahuasca- using adolescents (2.5%) compared to controls (17.5%) [N=80; p<.057] (Da Silveira et al., 2005). • Superior working memory and executive functions in ritual ayahuasca users compared to controls. • Further research warranted as a possible treatment for ADHD. Possible June 2026 © Peacock 2023
- 45. Ayahuasca (Peacock, 2022) The PeacockPerspective™: • Ritual ayahuasca use associated with fewer symptoms of: • Anxiety • OCD • PTSD • Substance Abuse • Grief • Borderline Personality Disorder (observational study) • Ayahuasca SUDs treatment centers exist in South America. • Efficacy has only been demonstrated through uncontrolled trials. • Findings are mixed. Possible June 2026 © Peacock 2023
- 46. DMT (Peacock, 2022) The PeacockPerspective™: • Few known clinical applications • Could be useful for preparing patients for successful treatment with other psychedelics (E. Sola, personal communication): • Psychedelic-induced mystical experience strongly predicts symptom improvement across treatment targets • A, “tendency to reject information that is not easily explained through rational, logical, and scientific processes” was negatively correlated to mystical experiences from psilocybin (Russ et al., 2019, p. 4). • The all-encompassing intensity and ineffability of DMT experience may help gain a broader epistemological perspective, leading to better treatment outcomes with other psychedelics. Possible June 2026 © Peacock 2023
- 47. Mescaline • Most researchis pre-1950 and most current use is in ritual contexts. The Peacock Perspective™: • Very long duration (12–18 hours) makes it impractical for clinical use. • No indications where mescaline would be more effective than psilocybin or LSD, though appears to have similar effectiveness in ritual contexts. • Should be considered when culturally congruent for a patient. (Peacock, 2022) Possible June 2026 © Peacock 2023
- 48. LSD • Long timelinefor clinical availability but research is happening. • Abundance of historical LSD research up until mid 70s. The Peacock Perspective™: • Historically, psycholytic LSD therapy was used to treat many conditions including depression, anxiety, phobias, OCD, conversion disorders, personality disorders, and schizophrenia. • Findings are yet to be validated according to modern medical standards. • LSD is uniquely suited for psycholytic therapy compared to psilocybin: • Increases outward focus and extraversion vs. psilocybin being more sedating and inward-focused. • LSD has dopaminergic effects and weaker agonism of the sedating 5-HT2C receptors. • These properties make low-dose LSD uniquely suited for active intervention during the experience, allowing for therapeutic work using psychodynamic techniques (Peacock, 2022) Timeline Unknown © Peacock 2023
- 49. Call to Action •All Providers: • Seek training in psychedelic-assisted modalities. • Lobby for availability of psychedelic medicines and insurance reimbursement. • Psychiatrists: • Offer ketamine therapy when indicated. • Arrange preparation and integration therapy. • Psychologists and Therapists: • Provide preparation and integration therapy for ketamine therapy patients. • Suggest psychedelic therapies when indicated. • Provide input on how patient personality may impact psychedelic therapy. • Administrators and Clinical Leaders: • Work to develop policies for providing other psychedelic-assisted therapies, particularly with psilocybin and MDMA. • Apply to become a licensed facility with the Natural Medicine Advisory Board. • Obtain funding for a dedicated psychedelic-assisted treatment center. © Peacock 2023
- 50.
- 51. References Avanceña, A. L.V., Kahn, J. G., & Marseille, E. (2022). The Costs and Health Benefits of Expanded Access to MDMA-assisted Therapy for Chronic and Severe PTSD in the USA: A Modeling Study. Clinical Drug Investigation, 42, 243–252. https://doi.org/10.1007/s40261-022-01122-0. Benzinga (May 2, 2023). EXCLUSIVE: AMA Moves Toward Psychedelic Therapy Reimbursement, Filing A Gap In Regulations [online, accessed July 13, 2023]. Business Insider. https://markets.businessinsider.com/news/stocks/exclusive-ama- moves-toward-psychedelic-therapy-reimbursement-filing-a-gap-in-regulations-1032283416. Carron, B. (2022). Administration of intranasal ketamine for psychiatric inpatients. Denver Health and Hospital Authority [Internal Clinical Care Guideline]. PolicyStat ID: 12275022. Colorado Department of Regulatory Agencies. Natural Medicine Health Act - Implementation Timeframe. [online, accessed July 7, 2023]. https://dpo.colorado.gov/dpo-home/natural-medicine-health-act-home/natural-medicine-health-act- implementation-timeframe. Danforth, A. L., Grob, C. S., Struble, C., Feduccia, A. A., Walker, N., Jerome, L., Yazar- Klosinski, B. B., & Emerson, A. (2018). Reduction in social anxiety after MDMA- assisted psychotherapy with autistic adults: A randomized, double-blind, placebo- controlled pilot study. Psychopharmacology, 235(11), 3137–3148. https://doi.org/10.1007/s00213-018-5010-9. Da Silveira, D. X., Grob, C. S., de Rios, M. D., Lopez, E., Alonso, L. K., Tacla, C., & Doering-Silveira, E. (2005). Ayahuasca in adolescence: A preliminary psychiatric assessment. Journal of Psychoactive Drugs, 37(2), 129–134. Kary, T. (October 17, 2022). Will Medical Insurers Agree to Cover Psychedelic Trips? [online, accessed July 13, 2023]. Bloomberg Newsletter. https://www.bloomberg.com/news/newsletters/2022-10-17/could-psychedelic-trips-end-up-being-covered- by-health-insurance. © Peacock 2023
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