UK Royal College of Psychiatrists Weighs In: Promise in Psychedelics, But Hype Mustn’t Outpace Evidence

This morning, the UK’s Royal College of Psychiatrists published a Position Statement on psychedelic and related substances (which it calls PARS) for medical use.

Here, we briefly unpack the statement, as well as related guidance it published for psychiatrists working on studies of psychedelics.

In its report, the Royal College of Psychiatrists (RCPsych) reviews the available evidence for the use of psilocybin, LSD, MDMA, and ketamine, as well as other PARS, both as standalone treatments and in combination with psychotherapy.

Following its review, the College concluded that there is “currently limited high-quality evidence for the efficacy of these compounds”, and highlights questions around blinding, side effects, and the durability of effects. It also raised questions regarding how well current findings will translate to real-world clinical populations.

As such, RCPsych does not recommend their routine use in clinical practice, other than where licensed (here, it is referring to (es)ketamine).

Further research is needed, it says, which should focus on the therapeutic mechanisms and processes that drive efficacy as well as risks and benefits of PARS in ‘pharmacologically assisted psychotherapy’, including in clinical populations that don’t map neatly onto the selection criteria used in current trials. That research should also investigate risks like persistent psychotic and perceptual disorders, “as well as other untoward consequences”, the College says.

It also states that the College believes the therapeutic effects of PARS “are likely to be due to the interplay between the pharmacological effects … and the therapeutic relationship.” As such, it says, good therapeutic practice for the “psychological aspects of the treatment” should be managed via training and supervision...