7 Questions about Psychedelics and the Pharmacist

Friends, pharmacists, and media often ask me questions about psychedelics and pharmacy or psychedelic and the role of the pharmacist. So I thought to compile a list of 7 commonly ask questions and answer them! Take a look below or watch the video above to get my thoughts on these important questions relating to psychedelics and pharmacist.

1. What is the role of pharmacists in the area of psychedelic medicine?

From a big picture angle, the role of the pharmacist in medicine or on the healthcare team is the drug expert that focuses on two primary things – safety and efficacy.

While psychedelic drugs have special qualities and effects that set them apart from other drugs or medications, they’re not different from other drugs in that there are safety considerations, contraindications, drug-drug interactions, and particular methods of administering them that increase safety and potential benefits. So, I think pharmacists can really play an important role by focusing on championing these things.

Beyond things like screening individuals, their illnesses, and other medications they may be taking for appropriateness of psychedelic use, drug-drug, or drug-illness types of interactions, clinical pharmacists play important and leading roles in the development of systems of medication distribution and protocols for safe and effective use as well as educational efforts about drugs to other healthcare providers and the general public.

2. Why and how pharmacists should be involved in the psychedelic landscape?

The most succinct answer is that just about every time it’s studied, data supports that pharmacists ultimately increase safety and benefits of drug use while reducing resource expenditures to the healthcare system. Harms and failed therapies are costly to patients as well as the healthcare system at large and involving pharmacists to optimize things at the outset is ideal.

Pharmacists are trained at the doctorate level and equipped with skillsets that can be integrated into the psychedelic landscape at many different places. I already mentioned the role of a clinical pharmacist in supporting individual care, developing protocols for safe and effective use, and educating patients and other healthcare team members about drug use, but there’s much more to the psychedelic landscape and other opportunities for pharmacists to be involved.

For example, pharmacists are often employed within the pharmaceutical industry to help with the design and execution of clinical trials or act as data experts that liaison with clinicians. Once drugs are approved, pharmacists are also employed in the insurance industry to help manage drug formularies and benefits. So beyond clinical care, pharmacists play important roles in research and access to drugs or medications also.

3. Why do most pharmacists not want to discuss the use of psychedelics?

I’m not sure this issue is unique to pharmacists and believe that at this time, most licensed healthcare professionals do not feel comfortable discussing use of psychedelic drugs. Probably the biggest reasons this occurs is because there’s still a lack of high-quality clinical research for many psychedelics, institutions and professional organizations do not offer much in the way of programs to help them discuss psychedelics with confidence in their knowledge, and that the legal restrictions around psychedelics make persons hesitant to discuss therapeutic uses of drugs that are not approved for therapeutic purposes.

4. How can you have an open conversation with your pharmacist about psychedelics?

 I think at this time, the best way to have an open conversation about psychedelics with a pharmacist would be to have some judiciousness in who you approach and some strategy to get an idea of their willingness of have a conversation.

If wanting to test the waters, opening with a question like ‘did you hear about the results from recent studies about psilocybin for depression or MDMA for PTSD?’ may be effective ways of opening a conversation and gauging the level of knowledge or willingness to speak on the subject from their response. If it feels they are knowledgeable and it’s safe, you can then broach a more intimate conversation about whether they feel you could benefit.

Obviously, this is kind of a disappointing answer as pharmacists really should be and are often thought of as the most available or public-facing healthcare professionals. However, the points about having little awareness of positive research or carrying stigmatic attitudes as well as simply not having the time for the kind of conversation that does the topic justice in their workflow are all valid. In some ways, this isn’t an issue that’s even unique to psychedelics. For example, depending on who you’re talking there could also be similar risks in opening a conversation about emergency contraceptives like Plan B or use of drugs like suboxone for Opioid Use Disorder.

Choosing pharmacists that work in clinical settings with longer times for discussion, ones you already have good personal relationships with, as well as those that specialize in mental health, neurology, or pain and palliative care may be higher yield opportunities for deeper conversations about psychedelics.

5. Do you think pharmacists are more likely to recommend traditional medication instead of illicit psychedelic substances?

Yes, I do. In Doctor of Pharmacy curriculums there is a heavy premium placed upon being an evidence-based healthcare professional and acting within the standards set by state and federal law. Given harms associated with certain treatments of the past that lacked efficacy, it’s not without good intention for public welfare these things are emphasized.

There could be real risks to an individual’s pharmacy license to begin “recommending” use of an illicit substance, which for most pharmacists, represents their livelihood and is not something they want to risk.

This is another problem or issue with the drug war that is not discussed as much: there are differences between what may be ethical (e.g., compassionate use of a psychedelic in persons that have tried and failed existing options) and what is legal. There are also historical restrictions on the ability to ask and answer valid scientific questions about the benefits of substances that are regulated as illicit drugs.

From this perspective, healthcare operates closer to evidence-biased medicine than evidence-based medicine.

It takes someone that’s quite determined to step outside the law with their pharmacy license on the line. Even for myself, who operates in a psychopharmacology consultant capacity that may not require a pharmacy license, I still do not “recommend” persons use psychedelics or tell persons where or how to procure them. I give persons information about the risks, benefits, and alternatives and let them choose the path of treatment that they think best suits them. By limiting myself to being an ‘information dealer’ I can be more open than many working in traditional settings.

6. What consequences can a person have when admitting the use of illegal drugs to a pharmacist?

 There are probably several possible consequences and could depend upon what kind of context it’s admitted. However, pharmacists are healthcare professionals and are not law enforcement officers, so the chances of facing any kind of legal consequence for admitting use is very low. Likely the biggest risks or consequences would involve being judged, shamed, or stigmatized for psychedelic use. Use could also be documented in your medical record depending on what setting and how significant the use is to the pharmacist you’re speaking with. This may create a ’telephone’ effect in which the mark of psychedelic use follows you wherever your medical record goes or runs the risk of being documented in a way that does not fairly represent what happened.

If you believe that psychedelics are responsible for benefits or harms that you’re experiencing, I do think that it’s a good idea to admit their use to healthcare professionals. This will allow them to correctly attribute benefits to psychedelics opposed to other drugs or therapies you may be or have engaged with as well as allow a better understanding of what issues you’re currently facing if you’ve had a psychedelic experience that was adverse and are now suffering post-use consequences.

7. What do you believe is the most important thing for people to understand about the future of psychedelics as medicine?

That truly there is space for it all.

I think everyone comes with a different viewpoint with psychedelics, they are mind manifesting with high degrees of personal meaning and significance after all. I’m first and foremost a cognitive libertarian and think there really needs to be a narrative that it can all be done.

Many medical professionals may think ritual or psychospiritual uses, uses for religious freedom, or plainly recreational use should remain prohibited or that the risks are too high for this to be done safely – I disagree and can find little evidence that would support this is true. It’s just not right in my opinion to restrict an individual that wants this experience because they’re not mentally ill or don’t have a refractory illness or don’t want or care to access a psychedelic within a healthcare setting.

Many non-medical persons have counter-cultural and anti-establishment opinions, they think the pharmaceutical industry and healthcare system will absolutely poison psychedelics and that psychedelics won’t have benefits if they’re placed in traditional healthcare settings with corporate entities researching and developing them – I disagree and would point to the trials done in the modern era demonstrating unprecedented benefits for persons with refractory mental illness to argue my point.

Psychedelics could be some of the most difficult substances to agree upon a regulatory structure for due to the various interests, parties, and use cases out there, yet ultimately there is a place for it all and it comes down to employing strategies, policies, and structures to minimize risk, maximize benefits, and heavy levels of education for everyone involved.

At the end of the day, psychedelics have always been around and people have always used them, so in this renaissance or as some call it ‘the third wave’ a premium needs to be placed on this fact and cognitive liberty should be prioritized.