Psychedelic research leaves people of color out


Research in ethnopsychopharmacology studies differences in how racial and ethnic groups respond to psychiatric drugs or pharmacology, often evaluating differences in metabolism, safety, and efficacy. As the evidence continues to grow from clinical trials quantifying the effectiveness of psychedelic-assisted psychotherapy (PAP) for treating a variety of mental distress, researchers are concerned about the exclusion of blacks, Indigenous people and people. color (BIPOC) in these samples.

While there is a long, global history of psychedelic use among diverse cultures, ethnicities, and intersectional identities, current research has almost exclusively been conducted on white populations. Thus, the results are not generalizable and there is a lack of knowledge about biological and social factors related to culture, ethnicity and race on pharmacological responses to PAP.

The present study conducted a qualitative review of the biological, social and cultural factors of pharmacological research on MDMA, psilocybin and LSD. With these data, the authors propose an analysis of ethnopsychopharmacological factors for future clinical trials.

“Psychedelic medicine is well positioned to advance the study of ethnopsychopharmacology through pragmatic and achievable study designs, and should be viewed as an important opportunity to develop innovative and integrative pharmacological and psychological treatment,” write the authors.
“I hope this review will help help researchers and clinicians recognize the potential value of PAP in addressing unmet mental health treatment needs. Additionally, this work should help mental health professionals understand the importance of making PAP available to all who can benefit from it, regardless of their ethnoracial background, and providing PAP in a way. culturally sensitive and ethical.

Psychedelic plants and fungi have long been used by tribes native to their respective botanical regions to healing and sacred rituals. However, it was not until the mid-1920se century that Western societies began to encounter them for recreation and for scientific research.

Before psychedelics were labeled as a Schedule 1 drug through the United States Controlled Substance Act of 1970, drugs such as MDMA, ketamine, mescaline, and psilocybin were all studied and used by psychotherapists, researchers and laypersons for their healing potential. However, this criminalization ultimately ended research until the 1990s, when the United States Food and Drug Administration approved the study of Intravenous DMT in humans. Since then, many ongoing clinical trials are expected to be approved by the FDA for therapeutic use soon.

With the ever increasing expansion of randomized controlled trials (RCTs) for various psychedelics, there remains a significant lack of inclusion of BIPOC in these trials. The reasons are varied and influenced by systemic racism and a history of research abuse. However, the homogeneity of the populations studied is not unique to the psychedelic field, and individuals of various racial and ethnic backgrounds are systematically under-represented in RCTs of new pharmacological treatments for chronic diseases and psychological disorders.

Ethnoracial identity is defined as a construct that encompasses both biological and socio-cultural components. Race refers to a socially constructed group of individuals based on skin color, physical attributes, and geographic region. In contrast, ethnicity reflects the development of an individual’s identity on the basis of a shared culture, language, nationality and beliefs.

Although there is evidence of biological differences in response to psychotropic drugs based on ethnicity, there is a lot of non-biological mechanisms by which ethnoracial identity shapes the effectiveness of treatment. Environmental factors such as stress, trauma, cultural beliefs, and the role of racism in healthcare settings all interact with ethnoracial identity and contribute to pharmacological response and clinical outcomes. The authors write,

“Any attempt to understand ethnoracial differences in pharmacology must not only take into account the biological aspects of race, but also the socio-cultural factors that both independently and interactively shape the BIPOC experience and results. “

“Effectiveness” within an intervention study is generally defined as the performance of a given treatment under ideal and controlled conditions, while “effectiveness” reflects performance under “real world” conditions. . RCTs are designed to prioritize efficiency; however, if treatments are evaluated in predominantly white individuals and approved by the FDA on the basis of such evidence, the efficacy and safety data cannot be extrapolated to various populations.

All drugs have variable pharmacokinetic (i.e., rate and modes of absorption, distribution, metabolism, and excretion of a drug) and pharmacodynamic (i.e., effects) properties. . Additionally, other factors that influence pharmacokinetic and pharmacodynamic properties include age, gender, medical conditions, disease states, diet, and behavior. Therefore, these processes are imperative for examining ethnoracial differences in responses to PAP.

The authors provide an overview of the biological determinants known to be affected by the use of MDMA, psilocybin and LSD. These factors will undoubtedly influence the patient’s response to PAP and include gender, other drug interactions, age, co-morbidities, genetic polymorphisms, and inflammation. These factors can be altered in BIPOC populations and are often influenced by variation in diet and expression of enzymes. Given the health disparities within the BIPOC, the biological determinants of these responses within the PAP are crucial to guarantee the efficacy and effectiveness of these treatments to the entire population.

In addition, multiculturalism in the PAP requires attention not only to the immediate contextual factors, but also to the encompassing socio-cultural contexts which undoubtedly influence what is called “the whole” and “place”.

“Together” generally encompasses a person’s state of mind, including their own preparation, expectations and intentions. Taking into account the ways in which “set” could be uniquely influenced for BIPOC, the authors write:

“Although the lived experiences of BIPOC are diverse, shared socio-cultural factors, such as racism, discrimination and microaggressions, can influence ‘the set’ of PAP experiences. Social status and ethnoracial identity may be confronted during PAP, and BIPOC should be sufficiently prepared for this meeting.

Especially, Previous search suggests that a participant’s willingness to surrender to the experiment was the best predictor of optimal experiences, with preoccupation and rumination being associated with difficult experiences and poorer long-term outcomes. However, the historical and continuing misinformation about the abuse and harms of psychedelics is a particularly important factor for BIPOC, as well as the long-standing inequalities and prosecutions of drug-related offenses in the United States. Therefore, participation in psychedelic studies requires BIPOC not only to overcome mistrust. health issues due to persistent racism and historical exploitation, but also to fears and expectations associated with illicit substance use.

“Setting” is an amalgamation of environmental, social, cultural and physical factors in which a PAP session takes place. Given this backdrop of centuries of overt and hidden racism within science that has led to a contempt for BIPOC’s contributions, it is imperative to establish reliable links and a welcoming PAP environment.

In addition, media coverage of the “third wave” of psychedelics is continually distorted as a pioneer by white male scientists, ignoring the appropriation of these drugs by indigenous cultures. It is well known that the quality of the therapeutic relationship has an important impact on the results of any psychotherapy. It is therefore important to train BIPOC as guides for PAPs. The authors write:

“PAP makes a participant emotionally vulnerable, and culturally insensitive guides who cannot recognize racial trauma or moderate their own biases may not offer the empathy, respect and care necessary for positive outcomes in the process. PAP, contributing to other psychological injuries; ethnoracial matching of participants and guides can avoid this problem.

Representing one’s identity in the context of the PAP is an important way of signaling to the individual that they belong and that the issues that affect them most intimately will be understood and addressed.

In conclusion, the authors suggest that psychedelic medicine is well placed to advance ethnopsychopharmacology through pragmatic and achievable study designs. Finally, they offer designs and analyzes for future clinical trials in PAP.

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Fogg, C., Michaels, TI, de la Salle, S., Jahn, ZW and Williams, MT (2021). Ethnoracial health disparities and ethnopsychopharmacology of psychotherapies assisted by psychedelics. Experimental and clinical psychopharmacology. https://doi.org/10.1037/pha0000490 (Connect)

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