Whether we like it or not, this decade is already nothing like the last. The year 2020 introduced us to a whole new dimension of virtual experiences, from Zoom calls to online weddings (or worse, funerals) thanks to the pandemic. At the same time, as our personal lives were moved to screens in a matter of months, so were the services we rely on, including healthcare and therapy. Now, we live in a world where telehealth is the norm for seeking medical assistance.
The term telehealth is not new to us, having been in use since long before the current crisis. For those in need of a quick recap, telehealth is the practice of seeing your doctor or therapist over a phone or video call, without physically visiting the clinic. These days we mostly do it to abide by social distancing rules, but it also has intriguing legal and logistical implications, particularly for the budding psychedelics industry.
“The COVID-19 pandemic created the necessity for online ketamine therapy, says Veronika Gold, co-founder, therapist and lead trainer at Polaris Insight Center, “and we decided that there was an ethical imperative to continue to offer treatment virtually.” PIC is a ketamine-assisted therapy clinic based in San Francisco.
“Now with having provided hundreds of successful sessions, we have a better sense of how clients are responding,” she says, “It is apparent that a significant percentage of our clients prefer online therapy and will continue to seek to use this treatment modality. Online treatment increases accessibility due to greater ease of scheduling, the reduced financial burden for clients and clinics, and greater access geographically.”
Representative Michael Grieco (D) added language for telehealth when introducing a bill to legalize psilocybin-assisted therapy in the Florida legislature in late January, framing it as the most viable model for ensuring equitable access.
The bill says, “the department may develop and adopt rules to allow administration sessions to be conducted using telehealth” safely and effectively along with integration sessions.
Situationally, it seems ideal to add telehealth to the bill. Even in the long-term, it may emerge as a cost-effective tool for conducting expensive psychedelic-assisted therapies via online sessions. “If we’re able to do telehealth, you don’t have the overhead of the facility,” Dustin Robinson, co-founder of Mr. Psychedelic Law says. Robinson worked with Grieco in drafting the Florida legalization bill. He adds, “You have the shipping of the product to be done at home and there’s going to be rules around it. I am envisioning that you have to designate a sitter to be there with the person. It will hopefully drive some equity and help reduce the cost.”
As psychedelic-assisted therapy readily becomes legal in parts of the U.S., the conversation will eventually move towards the suitability of patients for either online or in-person services, Gold says.
Is Telehealth the Future?
While many companies have stepped up to seize the opportunity of creating apps and digital therapeutics platforms as an adjunct to psychedelic experiences and therapies over recent months, the Florida bill was the first attempt of its kind at legally codifying psychedelic telehealth language.
Virtual therapies for psychedelic-assisted treatments may prove to be more comfortable and convenient when conducted at home under professional supervision, keeping in mind the importance of set and setting during the administration of the substance. These therapies generally vary in duration between four to eight hours, depending on the individual. When conducted at home, the patient can rest or move around as they see fit.
“While the online format decreases intimacy due to not having physical proximity, it increases intimacy as clients are in their home, and often in their own bed, during the session,” says Eric Sienknecht, Co-Founder, therapist and lead trainer at Polaris. He adds, “Some clients feel more comfortable not having to leave home, and the time spent normally commuting to and from the clinic can be used for preparation for the session and rest during the recovery period.”
Until the onset of the COVID-19 pandemic, conducting online therapies with controlled substances was restricted under the Ryan Haight Online Pharmacy Consumer Protection Act of 2009. However, the Drug Enforcement Administration (DEA) recently revised the law considering the urgency of the pandemic and sudden surge in demand for mental health care solutions. Building upon the changed laws, similar bills such as Florida’s may bring a greater change in the online world of medical care, especially mental healthcare.
There has been a fair skepticism about telehealth for psychedelic-assisted therapy, considering its lack of intimacy and somatic work during the online sessions. “There are some unique challenges presented by this modality. The effectiveness of psychedelic-assisted teletherapy relies on the use of various technologies (i.e. laptop with a stable internet connection, Bluetooth headphones/external speakers), and there is more pressure on the client to prepare and organize for the session,” Gold writes in an email response to Truffle Report.
However, a study conducted by the Hazelden Betty Ford Foundation during the peak of the pandemic concluded that the virtual sessions for the Intensive Outpatient Program (IOP) were equally effective online. IOP consists of treatment programs to help people overcome addiction, depression, or other dependencies.
Gold and Sienknecht say, “We have observed higher therapeutic effects with some clients using this modality, as they are able to surrender to and stay with the process more effectively due to the added sense of safety of being at home. Finally, we are able to treat a much wider population of clients using online format, as for our California licensed providers any California residents are potentially eligible.”
Many psychedelic companies are already making full use of telehealth for psychedelic-assisted therapies. Mydecine Innovations launched a mental health-focused telehealth facility in September 2020 to help people assist with their mood tracking and psychedelic therapy aftercare. Field Trip Health has also announced its virtual psychedelic therapy services. Besides that, ATAI Life Sciences and MindMed are working separately towards developing digital therapeutics to track a patient’s individual development and provide optimized psychedelic dosages.
As scientists continue to develop psychedelics as breakthrough therapies to treat mental health issues, innovative technology and an increased acceptance of telehealth would provide an optimal solution to the growing pandemic-related mental health crisis. In all, industry developments alongside legislative changes may be a solution to build a framework for equitable and affordable access to psychedelic-assisted therapies in North America.
Would Patients Receive Sufficient Care During Psychedelic-Assisted Therapies?
It is too early to predict if these measures are effective as long-term solutions for other psychedelic substances, however, for ketamine treatment with low and moderate doses, Gold shared, “To provide proper safety and care, online sessions require additional preparation and discussion about the client’s circumstances at home and discussion around how to address relevant challenges, e.g. someone ringing the doorbell, or a phone ringing, or internet/computer problems. Additional support strategies should be prepared in advance, such as having an emergency person close by, having an emergency contact number, and having numbers to a local hospital and mobile crisis.”
She adds, “For online sessions, it is imperative that the therapist is with the client for the entire duration of the session (for us 3 hours) and may require remaining with the client longer, until the client is back to their ordinary state of consciousness and feeling safe and comfortable.”
The team developed a new protocol in 2020 to conduct virtual services, ensuring their patients the safety and support online. In terms of cost, it remains mostly similar, with online therapy being slightly cheaper as therapists do not need to commute or have a physical office.
“Currently, many clinicians have been seeing clients online while still paying the lease for their offices, but, once they do not have to pay for the lease, the cost of treatments will decrease as well. For the clients, as well, the cost is cheaper due to reduced expenses around commuting to the office,” Sienknecht says.
A Centers for Disease Control and Prevention (CDC) report compared the popularity of telehealth before and during the pandemic, concluding that there was a 154 percent increase in online health services in March 2020 against the same time in 2019. While the increase in online healthcare services is strongly related to the pandemic, it is still a question to observe if this method would continue to be a trend when social distancing ends.
“The majority of our clients have been as satisfied with our online services. A small percentage of clients, in undergoing online sessions, discover that they prefer in-office sessions and accommodations are then made to provide in-office care if possible,” Gold shares.