Attitudes of psychedelic users regarding cost of treatment and non-hallucinogenic alternatives

Psychedelic drugs such as psilocybin, LSD and related compounds (for example, MDMA) have shown preliminary safety and efficacy when combined with psychotherapy for treating psychiatric disorders. A practical barrier to wider implementation is the high cost of the current psychedelic-assisted psychotherapy (PAP) model, which typically requires substantial therapist time: clinical-trial protocols often include two therapists present for multiple long preparatory and dosing sessions (commonly 6–8 hours each) plus several integration sessions. Researchers are therefore exploring cost-reduction strategies such as group therapy or non-hallucinogenic psychedelic analogs that might deliver therapeutic benefit without inducing an altered state of consciousness and thus with less psychotherapeutic support required. However, because subjective experiences (for example, mystical experiences or insights) have been linked to therapeutic outcomes, there is debate about whether non-hallucinogenic alternatives could be effective. This brief report, by Aday and colleagues, sought to address two consumer-centred questions that have received little attention: what do people who use psychedelics naturalistically consider a reasonable cost for various components of PAP, and would they be willing to try a non-hallucinogenic psychedelic-derived compound for treating a mental health condition? The investigators hypothesised that perceived reasonable costs would be below current projected market prices and that most respondents would be open to trying a non-hallucinogenic analog.

The survey formed part of a larger project on naturalistic psychedelic use and was reviewed as exempt by the University of Michigan institutional review board (IRB #HUM00205639). Recruitment occurred from 18 September to 5 November 2022 through social media (for example Reddit and Facebook) and psychedelic-related email listservs, which accounted for 83% of respondents, and via an in-person psychedelic advocacy event in Ann Arbor, MI (17%). Participants self-reported lifetime or recent use of psychedelics, could discontinue the survey at any time, and were not remunerated. The extracted text reports a sample size of N = 1,221 participants. The survey collected basic sociodemographic information and asked several attitudinal items relevant to the study aims. Key questions included: how important participants thought altered states of consciousness were to the therapeutic effects of psychedelics, and how likely they would be to try a non-hallucinogenic substance based on psychedelics to treat mental health conditions as an alternative to classical psychedelic-assisted therapy. Response options for those items were ordinal: Not at all, Somewhat, Moderately, Very, and Extremely. Participants were also asked to state what they considered a reasonable cost for different service types, specifically: a full day (6–12 h) psychedelic therapy session, a 2-h ketamine session, and a 1-h psychedelic therapy preparation or integration session (excluding drug costs). The Methods section does not describe detailed statistical analysis plans; the Results present descriptive statistics and at least one correlation between attitude items.

Participants largely endorsed the importance of the subjective experience: 76% indicated that altered states of consciousness were "very" or "extremely" important to the therapeutic effects of psychedelics. Despite that endorsement, a majority—61%—reported being moderately, very, or extremely likely to try a non-hallucinogenic substance derived from psychedelics to treat a mental health condition. The two attitude items were inversely related: the more important participants rated altered states of consciousness, the less likely they were to express willingness to try a non-hallucinogenic analog. This association was reported as r = −0.24 (p < 0.001). Regarding costs, respondents on average judged approximately $70–80 per hour to be a reasonable rate for various psychedelic-related services, including full-day psychedelic therapy sessions, 2-h ketamine sessions and 1-h preparation or integration sessions.

The researchers interpret the findings as indicating a nuanced stance among people who use psychedelics: most value the altered-state experience as important to therapeutic benefit, yet many remain open to a non-hallucinogenic analogue. They note this apparent tension may reflect broader personality and attitudinal patterns in psychedelic-using populations—such as elevated openness to experience—and a pragmatic desire for novel therapeutic options in psychiatry. A notable minority—reported later in the Discussion as 18%—expressed zero interest in a non-hallucinogenic option, which the authors suggest may reflect strong convictions within parts of the psychedelic community about the necessity of psychoactive effects. The monetary amounts respondents considered reasonable (around $70–80 per hour) are substantially lower than current market or service-model prices cited by the authors: intermediary organisations charging $1,500–$4,000 to connect clients with underground facilitators, and authorised supervised psilocybin courses in Oregon costing approximately $2,000–$3,000. The discussion highlights that therapist time and related structural costs (for example liability insurance, licensure, security requirements) appear to drive a large share of projected intervention costs; the authors cite an economic model of MDMA-assisted therapy in which provider time accounted for over 80% of direct intervention costs (approximately $7,543 in that model). Several limitations are acknowledged. The sample was a convenience sample recruited online and at one advocacy event, so generalisability to national or clinical populations of psychedelic users is uncertain. The views of people who do not use psychedelics were not assessed and may differ. Perceptions of reasonable cost likely vary with socioeconomic status, local cost of living and potential insurance coverage, and certain survey terms (for example "based on psychedelics" and "integration") were not explicitly defined for respondents. The authors recommend future studies use clearer definitions and more representative sampling to better inform scalability and implementation planning for PAP. They conclude that the study provides novel, community-informed data suggesting most psychedelic users value subjective experience, are often open to non-hallucinogenic analogs, and perceive a much lower acceptable hourly cost for treatment than current market projections.