A Framework for Patients to Safely Access Psychotherapeutic Medicine in Utah

This op-ed was originally published in the Salt Lake Tribune on November 18th, 2022.

It’s well understood that Utah is experiencing a mental health crisis. Recognizing this and the need for additional tools to help patients, the Legislature created the Utah Mental Illness and Psychotherapy Task Force earlier this year. The task force was charged with examining the evidence regarding psychotherapeutics and making recommendations on whether they can be safely used and, if so, how.

The task force concluded, following months of study, that MDMA and psilocybin (“magic mushrooms”) can offer significant benefits to those with mental illness. 

Regarding MDMA, the task force found that, “The overall body of evidence… supports a significant benefit from MDMA-assisted therapy for severe chronic PTSD.” Their review of psilocybin was equally positive: 

“Psilocybin-assisted therapy could offer an additional option for the armamentarium of depression treatments. An advantage of psilocybin-assisted therapy is that it does not require daily administration like an oral antidepressant. Additionally, psilocybin-assisted therapy may serve as an option for more difficult-to-treat cases.”

The task force also found that side effects of MDMA and psilocybin are generally mild and that when administered in a clinical setting, neither leads to substance abuse. 

These findings are consistent with what research shows and is welcome news to many who struggle with depression or PTSD and feel like current treatments just aren’t working. As a practicing psychiatrist, I am often frustrated by the limitations of current medications which too often come with serious side effects. Depression and anxiety medications have to be taken every day, in perpetuity. Having additional options available that promise long-term or even permanent relief from symptoms would be a game changer.

This isn’t wishful thinking on the part of some fringe advocates of drug legalization. The task force members are a “who’s who” of mental health leaders in Utah. Members include the CEO of the Huntsman Mental Health Institute, the executive medical director of the Department of Health and Human Services, the forensic director of the Utah State Hospital, and other notable doctors, pharmacists, social workers, and researchers in the field. They have dedicated their careers and lives to caring for those with mental illness and brought not only impeccable academic credentials, but decades of lived experience to the task. Their conclusions that “the preliminary safety data are encouraging” and that both MDMA and psilocybin are “more effective than placebo” carry significant weight. 

The methodology applied by the task force was conservative. Although there are thousands of extant papers on psychedelic medicines and their effects, the task force ultimately limited their review only to studies of MDMA and psilocybin since they have been most-extensively studied. Even within this narrowed universe, the task force employed rigorous eligibility criteria and only considered recent experimental trials that employed control groups. This methodology ensured that the task force’s conclusions erred on the side of caution. 

The task force report outlines a thoughtful framework to make these powerful medicines available while mitigating risk. It addresses safety and reporting requirements for producers, patient preparation and safety, licensure and training for providers, and ethical considerations. After careful screening and preparation, doctors would recommend MDMA or psilocybin to a patient. The patient would then ingest the medicine in-office under the supervision and guidance of trained professionals—not at home on their own. 

Doctors routinely prescribe addictive and mind-altering drugs which patients consume at home, with no supervision. What is being suggested here is a safer approach to treating mental illness. It doesn’t make sense to deny patients access to life-altering medicines that are safer and less-addictive than current options and which will only be used in a supervised setting by a licensed professional. 

The Utah legislature should build on the task force’s recommendations and create a legal framework for patients to safely access psychotherapeutics. Many of our family, friends, and neighbors are silently suffering from a lack of quality mental health care. Making these substances legal for clinical use can be a very important step to help providers like me help more of our fellow Utahns.

Dr. Reid Robison is a psychiatrist, neuroscience researcher, and Chief Clinical Officer at Numinus. He is an adjunct professor at both the University of Utah and Brigham Young University.