Ethical and Legal Considerations

There are several factors to consider when offering preparation and integration services for altered states of consciousness. It is important that these services align with the guidelines and policies of your governing professional body and address other medical legal issues, if pertinent.

This work is a gray area for many professionals, and recognizing your degree of comfort, scope of practice, competence, and relevant boundaries is crucial prior to engaging in this work.

Health Professional Considerations

These are some of the legal and ethical variables to consider:

  • Know your scope of practice defined by your governing body (if you have one) and by relevant training in providing PHRI.
  • Examine and reflect on personal biases towards the use of psychedelics, noting any preferences, judgments, or aversions to this work.
  • Ensure that the treatment you provide, and your charting, meet the standard of practice as defined by your profession.
  • Ensure informed consent and the understanding that you, as a licensed professional, are not condoning, providing, or advising the use of illicit substances.
  • Know that preparation for altered states may come with increased ethical or legal risks for professionals, as it may be viewed as condoning the use of illegal compounds.
  • If you are working under a license or registration, you cannot recommend or refer clients to unregulated health professionals.
  • Educate yourself on the topics regarding ethics, harm reduction and legal issues as these relate to working with clients who may be using psycho-active substances.
  • Research some of the clinical trials, basic information on psychedelics, and contraindications for your own knowledge, competency, and to understand the experience and potential risks.
  • Ensure that your client signs a document that clearly states they understand all these points.

Resource

For an example of a consent form that you can use, please download this example consent form.

Client Considerations

Increasing numbers of people are seeking altered states of consciousness in a variety of settings inside and outside of clinical contexts. Currently, limited legal access has resulted in clients seeking recommendations from health professionals about engaging in the use of psychedelics and other methods that lead to altered states of consciousness. The PHRI approach entails supporting clients who have decided to, or are already working with, altered states of consciousness to make informed choices, create safety plans, and understand the inherent risks, rather than encouraging or advising them to engage in illegal substance use. Here are some specific considerations for preparing clients for this work:

Define “harm reduction” in the psychedelic context for the client, as an approach aimed at reducing the recognized harm to the user of illegal substances, to enhance safety, and optimize therapeutic outcomes relevant to wellbeing.

Encourage clients to do their own research on topics related to the specific substance or experience in which they are already engaged, or are planning to engage, and provide the opportunity for them to share their findings and explore potential concerns with you in a subsequent Preparation Session.

Educate clients and ensure that they are aware of the potential risks and benefits, manage their expectations for the session(s) and beyond, and support the exploration of elements that can increase or reduce the therapeutic impact for the client.

Direct clients to the research literature and other resources

Support informed choices

Ask:

  • Have you thought about what you will do for personal support, before, during, and after?
  • Have you investigated what introductory dosage is often used for this substance? How does this land for you?
  • I can’t advise you on this, but if you’re going ahead with this, have you considered…?)

Support clients to formulate their intentions and goals and develop a clear plan once they have decided to use the psychedelic medicines.

Ensure that your preparation and integration process follow the procedures in the research you cite (e.g., FDA/DEA approved trials), and if different, explain your rationale.

Explain that you will not know what your client ingested, and that drug testing is essential.

In addition, inform the client about how clinical trials and phases work and the current status of the drug they are considering taking. Explain how clinical trial outcomes are relevant to your assisting clients in “integrating” illegal acts with illegal substances in non-clinical settings.

Ethics In Psychedelic-Assisted Therapy

You'll also want to review the following key ethical considerations from the MAPS Bulletin (2019):

  • Safety - suitability, assessment, emergencies, informed consent
  • Confidentiality and privacy - limits to confidentiality, privacy laws, communication agreements
  • Transparency - client centered, informed consent
  • Therapeutic Alliance and Trust - clear agreements, collaboration, no dual relationships, professional boundaries
  • Use of touch - consent, therapeutic touch - within scope/competence
  • Sexual boundaries - zero tolerance for sexual touch
  • Diversity - inclusion, examine implicit bias
  • Enhanced attention to transference, countertransference, potentially changing informed consent
  • Finances - attention to accessibility, transparency re: fees
  • Competence - scope of practice, continuing education, maintenance of licensure
  • Relationship to colleagues and the profession - maintenance of collegial relationships; peer supervision and consultation
  • Relationship to self - safe and effective use of self; seeking collegial support as required

Learn More

To learn more about ethical and legal issues in PHRI, please read Pilecki et al., 2021.

References

Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic harm reduction and integration: a transtheoretical model for clinical practice. Frontiers in psychology, 12, 710.

Jade, R. (2018). Integrating Underground Psychedelic Use: A Cautionary Note for Licensed Health Care Providers. Available at SSRN 3181334.

MAPS (2019). MDMA-Assisted Psychotherapy Code of Ethics Updated & Published in the MAPS Bulletin

Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18(1), 1-14.