Psychedelic Knowledge and Opinions in Psychiatrists at Two Professional Conferences: An Exploratory Survey

Following decades of limited progress because of stigma, regulatory barriers, and scarce funding, interest in medicinal psychedelic research has accelerated. The introduction summarises recent clinical advances: psilocybin showing promise for anxiety and depression, Phase 2 and Phase 3 trials underway for major depressive disorder and treatment-resistant depression, and a positive Phase 3 trial of MDMA-assisted therapy for PTSD that could lead to regulatory approval in the United States. The authors also note growing regulatory openness illustrated by esketamine approvals and legal exemptions or compassionate-use programmes for LSD, MDMA, and psilocybin in several countries. They describe the typical resource-intensive model for psychedelic-assisted therapy (preparatory sessions, long drug sessions co-led by two therapists, and integration sessions) and argue that psychiatry should prepare for likely wider adoption and the consequent changes to psychotherapy delivery. Barnett and colleagues set out to characterise psychiatrists' knowledge, attitudes, and educational interests regarding psychedelic-assisted therapies. Specifically, the study aimed to survey psychiatrists who attended psychedelic didactic presentations at two national U.S. professional meetings in late 2019 to assess (1) factual knowledge about psychedelics, (2) beliefs about treatment potential and funding, (3) concerns about implementation and safety, and (4) preferred topics for psychedelic-related education. The authors position the work as addressing a gap in the mainstream psychiatric literature, noting only one prior U.S. national survey of psychiatrists on these topics.

The investigators used an anonymous 26-item survey, available online or in hard copy, that solicited demographic and professional information (age, gender, training level and completion year, subspecialty fellowship type, and primary daily work activity). The instrument incorporated eight multiple-choice knowledge questions about psychedelics, six Likert-scale opinion items, and six additional questions covering concerns about medicinal and non-medicinal legalization, educational interests, and information sources. Because definitions of “psychedelic” vary, the survey explicitly asked participants to consider substances such as 5-MeO-DMT, ayahuasca, DMT, LSD, psilocybin, and MDMA. Surveys were distributed immediately prior to didactic presentations at two conferences: the Academy of Consultation-Liaison Psychiatry (ACLP) Annual Meeting on 14 November 2019 and the American Academy of Addiction Psychiatry (AAAP) Annual Meeting on 5 December 2019. Approximately 140 people attended the ACLP presentation and 124 attended the AAAP presentation. The extracted text notes that some questions (for example, items on hours of residency didactics) were added later and were available only to AAAP participants. Data management employed REDCap and statistical analyses were performed using Stata version 12.0 with statistical significance set at p < .05. Multivariate logistic regression models were specified to evaluate predictors of (a) moderate or strong belief that psychedelics show promise for treating psychiatric and substance use disorders and (b) moderate or strong support for legalization of medicinal and non-medicinal psychedelic use. Predictor variables were chosen based on prior psychiatrist surveys and studies of physician views on marijuana legalization; the authors also included the objective knowledge score on the multiple-choice items as a hypothesised predictor. The Cleveland Clinic Institutional Review Board declared the study exempt; written informed consent was not obtained in order to preserve anonymity, and the survey introduction explained that submission of responses constituted consent.

The overall response rate was 40.20% (106/264); two respondents who were not psychiatrists were excluded, leaving 104 participants for analysis. Of those, 33.02% (35) completed hard-copy surveys and 66.98% (71) completed the online form. Half of respondents (52.88%) attended the AAAP session. Mean age was 41.73 ± 13.31 years (range: 24–80), and 64.42% were male. Most participants were attending psychiatrists (63.46%), with 25.96% residents and 10.58% fellows. Regarding primary work activity, 87.50% worked primarily in clinical care, 7.69% primarily in research, and 4.81% in administration. Subspecialty training included no subspecialty for 34.62%, addiction psychiatry for 32.69%, and consultation–liaison psychiatry for 25.00% (nine reported other subspecialties and one had two subspecialties). On the eight-item knowledge test, the mean score was 4.21 ± 1.84 (range: 0–8). Large majorities expressed moderate or strong belief that psychedelics show treatment potential for psychiatric disorders (80.39%) and for substance use disorders (59.80%). Most respondents (90.20%) moderately or strongly believed the U.S. federal government should fund medicinal psychedelic research. The most common concerns listed were the lack of trained psychedelic-assisted therapy providers, logistics and time demands of delivery, avoiding administration to patients with contraindications, and diversion. Nearly one-third of participants (31.73%) reported having read Michael Pollan’s How to Change Your Mind. Questions added for AAAP participants showed that respondents reported receiving a mean of 1.53 ± 1.76 hours (range: 0–8; n = 51) of psychedelic didactics during residency but believed residency should include a mean of 8.37 ± 13.29 hours (range: 0–80; n = 49). Regarding patient or family inquiries, among 102 respondents 21.57% reported never being asked about psychedelic-assisted therapies, 8.82% once, 59.80% a few times, and 9.80% often. Multivariate logistic regression identified several associations. Working primarily in research was associated with stronger belief that psychedelics show promise for psychiatric disorders (adjusted odds ratio [aOR] 2.59; p = .00). Belief that psychedelics show promise for treating substance use disorders was positively associated with working primarily in research (aOR 2.00; p = .01) and with higher scores on the knowledge questions (aOR 1.50; p = .01), and negatively associated with concerns about addictive potential (aOR 0.31; p = .03). Support for legalization of medicinal psychedelic use was positively associated with working primarily in research (aOR 2.47; p = .00) and with consultation–liaison psychiatry training (aOR 10.33; p = .02), and negatively associated with attending psychiatrist status (aOR 0.12; p = .02) and concerns about addictive potential (aOR 0.16; p = .003). Support for legalization of non-medicinal psychedelic use was positively associated with support for medicinal legalization (aOR 2.38; p = .01) and negatively associated with age (aOR 0.93; p = .02). The paper refers to additional details presented in tables, which are not included in the extracted text.

Barnett and colleagues interpret their findings as evidence that this self-selected group of psychiatrists attending psychedelic didactics held generally favourable attitudes toward medicinal psychedelic therapies and strongly supported federal funding for related research, while expressing more ambivalence about non-medicinal use. They emphasise that notable gaps in objective knowledge were apparent even among interested clinicians, citing specific misunderstandings such as overestimating the past-year prevalence of hallucinogen use disorder. Respondents’ principal concerns clustered around workforce and delivery issues: insufficient numbers of trained psychedelic-assisted therapy providers, logistical and time burdens of long drug sessions, risks of administering psychedelics to patients with contraindications, and diversion. The authors argue these concerns are legitimate given the current resource-intensive model and suggest research into scalable delivery (for example, group therapy) and development of training pathways. They also discuss the probable role of non-physician therapists in delivering drug therapy sessions to improve access and contain costs, while noting that regulators may still require physicians or midlevel providers to prescribe. The discussion addresses implementation safeguards: strict adherence to treatment guidelines to prevent inappropriate prescribing, and regulatory tools such as a Risk Evaluation and Mitigation Strategy (REMS) to reduce diversion by requiring on-site administration. Training needs identified by respondents included how to conduct psychedelic-assisted therapy, psychedelic pharmacology, side effects, and medication interactions. The authors note the relevance of ongoing policy developments, for example Oregon’s psilocybin implementation and its emerging therapist training requirements. Comparing results to a prior national survey, the study found different patterns of association; in particular, no association between support for medicinal legalization and age or gender in this sample. The authors highlight the consistent influence of concerns about addictive potential—despite the low addictive risk of classic psychedelics—as these concerns were associated with lower belief in treatment potential for substance use disorders and reduced support for medicinal legalization. Limitations are acknowledged: the self-selected sample limits generalisability, the moderate response rate may introduce non-response bias, the modest sample size reduces power, some respondents completed surveys during presentations which could have influenced answers, and some participants may have had variable definitions of “psychedelic” (for example, possibly including marijuana or ketamine). The authors recommend larger, randomly selected national and international studies to better characterise psychiatrists’ views and to guide development of educational programmes so clinicians can form evidence-based opinions about psychedelic-assisted therapy.