Summary: The Trip Report highlights the rapidly expanding field of psychedelic research while exploring the future potential of psychedelic clinics run by MAPS. The article expands upon the opportunities and challenges of organizing and managing, the “business side” of psychedelic clinics.

Originally appearing here.

Legal Psychedelic Medicine is almost here. Many are anxiously awaiting the announcement of the Expanded Access Program which would make MDMA assisted Psychotherapy available to anyone with a PTSD diagnosis and ability to pay for it, assuming that the personnel and clinical infrastructure are in place to meet the demand, which is far from guaranteed.

The bottleneck in rolling out Psychedelic Medicine will be the ability to meet the expected demand, a three-part problem:

1. Number of trained therapists

2. The number of clinics that satisfy the criteria for offering Psychedelic Assisted Therapy.

3. Patient’s ability to pay for it

MAPS has taken the reign on #1 in addition to steering the research, regulatory and public education for the past 30+ years.

In so doing they have created a market where one didn’t exist, at least legally.

They generated excitement and opportunity for other players to step in to develop new compounds and initiate research (ATAI) and a market for investing (Field Trip Ventures, Orthogonal Thinker) in a novel and ‘disruptive’ therapy for addressing emotional and behavioral health.

However, the turn towards psychedelic medicine is unlike any other new form of therapy in that it combines punctuated treatment with psychotherapy. While proving wildly successful in clinical trials will flummox established clinics, facilities, and payers who want to embrace it.

As far as I know, there hasn’t been any public indication that MAPS would itself get involved in the creation, funding, organization, and management of the Psychedelic Clinics themselves.

Until this week.

Every challenge is an opportunity.

In an email titled Business of Psychedelic Medicine Survey to the MDMA training participants, Scott Shannon, a principal investigator of the MAPS Phase 3 MDMA for PTSD trial expressed concern for the fate of psychedelic medicine if those expected to carry the torch, MAPS trained Psychedelic Therapists, are ill-equipped to manage the organization and management, the ‘business side’ of psychedelic clinics.

The body of the email:

Business of Psychedelic Medicine Survey

Dear Colleague:

The rescheduling of MDMA and psilocybin has the potential to change the face of mental health care around the world. We are witnessing a massive surge in the interest and support for psychedelic medicine. This includes interest in training for mental health practitioners to provide this care. A number of psychedelic medicine supporters have concerns that the strong interest in psychedelic medicine training by psychotherapists and psychiatrists will not translate well into the business of setting up and running clinics for this type of care. We are concerned that the lack of business expertise will create a roadblock for this paradigm shift in mental health that may become a significant business opportunity as well. (emphasis mine)

As a result, we are considering whether to provide concise and practical trainings about how to set up and run a psychedelic medicine clinic. This training would help individuals without business or start up experience feel more comfortable about starting a new clinic with this specific focus. In collaboration with MAPS, we have attached a link to a brief (less than 5 minutes) survey to explore your views and interest in this topic. This training would be supported by philanthropy and run by our non-profit organization PRATI. This project is not being run by MAPS, so please do not reach out to them. If we decide to move forward I will be the point person. 

If you complete the survey we will send you a copy of our summary of the data we collected.

In the above-mentioned survey, the eighth question discloses that MAPS is entertaining the possibility of getting into psychedelic clinics, an idea that makes complete sense:

8. MAPS is considering whether to get involved in creating a network of psychedelic psychotherapy clinics, initially with MDMA and adding ketamine and cannabis and one day psilocybin, etc. Would you prefer MAPS to create a model clinic template that you would manage or would you prefer to create your own?

I think about this exact issue all the time.

The announcement of Expanded Access approval is imminent.

Throngs of patients are anxiously awaiting this watershed moment.

Equally, the announcement will be broadcast across major media outlets and spark exponential growth of interest in psychedelic based therapy.

This could be a problem.

Let’s face it, those who go down the path of extensive training and rigorous study born out of a sincere desire to help in the healing process of others are generally not interested or well equipped in the organization and management of a business.

I have seen this play out first hand.

In 2012 I decided to pursue training in Acupuncture and Chinese Medicine. I enrolled in school, signed up for student loans and off I went.

It very quickly became apparent that I joined a cohort of caring, compassionate and enthusiastic individuals coming together in order to serve others in their healing but I struggled to envision many of them in a professional capacity managing a business, even a one-person practice.

After three years of training, apprenticeship and study we had the skills, the credentials, and the ambition. So we set out to heal the world.

“Clear Eyes, Full Hearts, Can’t Lose”

The dirty secret of Alternative Medicine and schools that teach Acupuncture, Naturopathic, Chiropractic, Herbal, etc. is that most of the students who graduate from these programs never actually practice, in large part because they can’t run a business.

Thinking back on this time two things strike me about my class, and the broader grouping of “alternative medicine” as a whole— and I assume this is somewhat true about trainees in many of the current psychedelic therapist programs;

1. Many of us are here to heal ourselves—the old trope is the psychologist becomes a psychologist to work on their own shit— can be broadly applied to the Alternative Medicine field

2. While compassionate, caring and good-natured most are ill-equipped for the rigors of organizing and managing a business. Myself included.

We cannot allow the caring, compassionate and committed people who took the leap early to train in Psychedelic Assisted Therapy to add to the body count of wounded, debt-riddled, underpaid healers.

So to hear that MAPS is at least thinking about this problem is a very good thing.

At least one venture entering the Psychedelic Medicine space has declared therapist training and a franchisee of clinics as their first objectives.

And more will follow.

This is, after all, an inflection point in the mental health sector, a$17.9 billion industry.

Billion.

There is an understandable mistrust of for-profit entities entering the space. Compass Pathways bears the brunt of this criticism. But in the regulatory and development arenas, like drug development and deployment, the for-profit schema is necessary to make this form of medicine widely available.

Taking a drug to market can cost billions and much of the work that needs to be done for psychedelic medicine is getting payers on board. This is a task for pros.

However, I am not sure that venture capital, accustomed to unicorn hunting is the most appropriate model for rolling out the clinical infrastructure required of Psychedelic Medicine.

MAPS has a proven track record of respecting the history and cultures that have leveraged psychedelics for emotional, spiritual and health purposes, taking the plodding and painstaking but necessary course through the rigors of the scientific method and through the MAPS PBC ensured that the availability and access to care come before corporate profits.

But there is more work to be done.

MDMA is just the beginning. Companies such as Compass, ATAI, Field Trip Ventures, Orthogonal Thinker and others are ready to expand the number of molecules and indications that can be drawn from psychedelic plants and compounds through the required regulatory and research pathways.

MAPS is in the perfect position to break the rapidly approaching bottleneck by creating, organizing and managing Psychedelic Clinics.

I hope they go through with it.