Interest in receiving psychedelic-assisted therapy among marginalized women: Implications and findings from a community-based study in Canada

Argento and colleagues situate their study within the recent revival of clinical and population research on psychedelics — including LSD, psilocybin, ayahuasca/DMT and MDMA — which has shown promise for treatment-resistant depression, end-of-life anxiety, PTSD and several substance use disorders. The authors note persistent gaps in equity and representation in psychedelic research: most trials to date have enrolled predominantly white participants, and it remains unclear whether structurally marginalised groups who bear a high burden of trauma, violence, mental health and substance use harms would be interested in, or benefit from, psychedelic-assisted therapy. The introduction also summarises hypothesised mechanisms of action (e.g. 5-HT2A receptor agonism, increased neural plasticity, and psychologically meaningful or mystical-type experiences) and highlights the potential risks of administering psychedelics without culturally safe, trauma-informed supports. This study therefore aimed to measure interest in receiving psychedelic-assisted therapy among marginalised women in Vancouver, Canada, and to identify socio-structural and clinical factors associated with that interest. A secondary aim was to describe, among women with prior psychedelic use, self-reported impacts on personal meaningfulness, wellbeing and spiritual significance. The authors framed the work as the first global examination of interest in psychedelic-assisted therapy specifically within a marginalised-women population, with implications for equitable design and delivery of future services.

The analysis used harmonised data pooled from two community-based prospective cohorts in Metro Vancouver: AESHA (sex work cohort, initiated 2010) and SHAWNA (women living with HIV, initiated 2014). Both cohorts recruit cis and trans women aged 14 years or older who can provide informed consent; AESHA required active engagement in sex work at baseline and SHAWNA included women living with HIV. Recruitment strategies included community mapping, time-location sampling for AESHA, and self-referral and provider referrals for SHAWNA. Trained community interviewers administered interviewer-led questionnaires at enrolment and every six months, and participants were offered voluntary clinical testing and an honorarium for visits. Cohort procedures were overseen by Community Advisory Boards and held ethical approval through Providence Health Care/University of British Columbia. A Psychedelic Supplement was appended to the harmonised questionnaire between September 2016 and October 2017 to capture lifetime history and types of psychedelic use, interest in receiving psychedelic-assisted therapy, and — for those with prior use — three items adapted from the Persisting Effects Questionnaire assessing personal meaningfulness, spiritual significance and change in wellbeing. The dependent variable was defined as answering "yes" to whether one would be interested in being treated with psychedelics for conditions such as anxiety/depression, PTSD, addiction or other mental health issues. Demographic, socio-structural, trauma and substance-use covariates were drawn from the core questionnaire; lifetime psychedelic use included a broad set of substances (LSD, psilocybin, DMT/ayahuasca, MDMA, ibogaine, mescaline, salvia, ketamine, etc.). Statistical analysis excluded participants who answered "Don't know" (n=33) about interest and therefore compared those who said "yes" versus "no" (analytic N=486). Descriptive comparisons used Wilcoxon rank-sum for continuous variables and chi-square or Fisher's exact tests for categorical variables. Bivariate logistic regression identified candidate predictors (p<0.05), and multivariable logistic regression used manual backward stepwise selection to yield the most parsimonious model as judged by lowest Akaike information criterion. Unadjusted and adjusted odds ratios with 95% confidence intervals were reported. Analyses were conducted in SAS version 9.4.

Of 519 women who completed the Psychedelic Supplement, 33 responded "Don't know" about interest and were excluded from comparative analyses, leaving 486 participants (age range 20–67 years; median age 44 years). Overall, 43% (n=211) said they would be interested in receiving psychedelic-assisted therapy for a current or future mental health or substance use issue. The sample included 41% living with HIV (n=197) and 49% who had engaged in sex work in the last six months (n=237). Over half identified as Indigenous (52%; n=255), 37% identified as sexual minorities (n=182), and 8% as gender minorities/trans (n=41); these identity characteristics were significantly more prevalent among women who expressed interest in psychedelic-assisted therapy (all p<0.02). High prevalences of trauma and mental health issues were reported: 77% (n=376) experienced physical and/or sexual childhood abuse, 68% (n=330) had ever been diagnosed with or treated for depression, anxiety, or PTSD, and 63% (n=307) reported lifetime suicidality. Women interested in psychedelic-assisted therapy were significantly more likely to report these trauma and mental-health indicators (all p<0.001). Lifetime psychedelic use was common (72%; n=376), with LSD and psilocybin reported by 83% and 82% of users respectively. Among those with prior psychedelic experiences, 15% (n=55) rated an experience as among the five most personally meaningful or the single most meaningful in their life; 14% (n=53) reported increased current wellbeing somewhat or very much, and 10% (n=36) described their experience as among the top five or the single most spiritual experience. In multivariable logistic regression, factors independently associated with interest in psychedelic-assisted therapy were: daily crystal methamphetamine use in the past six months (AOR 3.02; 95% CI 1.37–6.65), lifetime mental health issues (diagnosed/treated depression, anxiety or PTSD) (AOR 2.13; 95% CI 1.27–3.59), history of physical and/or sexual childhood abuse (AOR 1.99; 95% CI 1.02–3.88), lifetime psychedelic use (AOR 1.97; 95% CI 1.14–3.38), and younger age (AOR 0.97 per additional year; 95% CI 0.95–0.99). In bivariate analyses, barriers to accessing counselling for trauma were also associated with interest, but this did not remain in the final adjusted model. Reasons for respondents saying "no" or "don't know" were collected and displayed in a figure in the paper, but detailed breakdowns are not provided in the extracted text.

Argento and colleagues interpret their findings as evidence that a substantial proportion — roughly half — of marginalised women in this Vancouver-based sample express interest in psychedelic-assisted therapy, particularly those with histories of trauma, mental health diagnoses and daily crystal methamphetamine use. The authors position this interest within a growing literature demonstrating safety and efficacy of psychedelic-assisted approaches for conditions such as PTSD, depression and substance use disorders, and they note preliminary observational and qualitative reports suggesting benefits among Indigenous and other marginalised groups. The study authors link the observed associations to lived experience and treatment need: women who have experienced violence and trauma, or who have tried psychedelics before, may be more open to novel therapies for conditions that are often difficult to treat. They further discuss how mystical or awe-type experiences, documented in prior psychedelic trials, have been correlated with sustained improvements in wellbeing and reductions in substance use; although the present data come from non-clinical, uncontrolled psychedelic use, 10–15% of users still reported highly meaningful or spiritual effects. Cultural and ethical considerations receive particular attention. The authors highlight the longstanding Indigenous traditions involving plant and fungal medicines and argue for active engagement with Indigenous women and communities to develop Indigenous-led, culturally safe approaches. They raise concerns about the historical lack of diversity in psychedelic research and stress the need for trauma-informed, culturally competent care to mitigate risks such as retraumatisation when psychedelics are administered without adequate supports. Strengths cited include use of two large, community-based cohorts developed with community partnerships and staff with lived experience, which the authors argue reduces social desirability and reporting biases. Limitations acknowledged are the cross-sectional design, non-random sampling limiting generalisability (especially to rural or other marginalised groups), reliance on self-report, and a broad operational definition of "psychedelics" that included substances with varying risk/benefit profiles (e.g. MDMA, ketamine, ibogaine). The investigators also note potential unmeasured confounding and that the data could not capture nuanced motivations for interest in psychedelic-assisted therapy. In terms of implications, the authors recommend that any expansion of psychedelic-assisted therapies to marginalised women be embedded within trauma-informed and culturally safe frameworks, and integrated with broader socio-structural interventions (for example, decriminalisation, violence prevention and harm reduction). They call for further research focused on marginalised populations, and for prioritising diversity, equity and inclusion in future psychedelic science to improve generalisability and ensure equitable access.

The study concludes that roughly half of marginalised women in this sample expressed interest in psychedelic-assisted therapy, and that interest was associated with trauma, mental health diagnoses, substance-use patterns and prior psychedelic experience. The authors recommend that future efforts to expand psychedelic medicine to marginalised women be accompanied by trauma-informed, culturally safe care and broader socio-structural supports to maximise benefit and minimise harm.