“How to Speak to Your Doctor About Intentional Psychedelic Use” with co-hosts Nicholas Levich and Jimmy Nguyen, explores nuances of navigating the developing intersection of traditional western healthcare and psychedelic healing.
They begin by discussing the breadth in which a licensed healthcare provider is legally allowed to help in the psychedelic healing process, and how to get answers to your questions without overstepping boundaries.
What kinds of healthcare providers offer the best support for psychedelic therapy, and what type of specialist can address your specific needs?
Our hosts share cues that indicate when your established support system is fulfilling your needs, verses when you need to make adjustments. This is how you, your facilitator, and healthcare provider can work in tandem to customize a care plan.
Finally, Nicholas and Jimmy offer resources for those looking to taper off of antidepressants, but aren’t receiving sufficient support and guidance from their doctor.
How can you speak to a healthcare provider about psychedelic therapy, while staying in integrity and within professional boundaries?
Episode 45: How to Speak to Your Doctor About Intentional Psychedelic Use
Nick: Welcome to the Psychedelic Passage podcast. My name is Nick Levich, I’m here with my cohost, Jimmy Nguyen. Thank you for joining us today. This week we are going to be addressing the topic of how to speak to your healthcare provider about psychedelics.
This is something that comes up a lot, especially for folks who are seeking treatment. As always, it’s a fairly nuanced topic that we want to get into today, so that you better understand how to actually approach this.
I want to be clear that we love the continuity of care that this provides when clients are willing to loop their healthcare provider into the chain of care-
But it also requires that they’re willing and able to do so and that you’re in-person supporter, if you’re working with a facilitator or guide, is also willing to include them in that chain of care.
So, there’s got to be consent all around. But that’s what happens when it goes smoothly and it doesn’t always happen that way. Perhaps we start by just diving into what this actually looks like.
Jimmy: Yeah, it’s actually a really short episode. Just talk to your healthcare provider, the end. [Nick laughs] You’re good to go. I mean, that’s like the first decision that people have to make.
Do I even need to talk to my healthcare provider about this? And I think that there’s a percentage of the population who may not. And then for folks who have–[crosstalk]
Nick: There’s definitely a large portion that doesn’t.
Jimmy: Yeah, I think Michael Pollan calls them the “healthy normals.” But then there are also other folks who may have an underlying medical condition, mental health issue, whether it’s you know–[crosstalk]
Jimmy: Medication issue, something that you have a predisposition of in your family, and so it’s always just helpful to be sure. I think that’s the first thing is, ask yourself the question, do I need to talk to a mental health or medical professional just about this anyways?
I think with psychedelics it has this potential to catalyze a lot of change, especially in the mental health world. And so, it’s always just worth just getting the opinion or disclosing some information to folks. But you’re right, sometimes that goes smoothly and sometimes that doesn’t.
You have to acknowledge that those psychedelics are this great potential revolutionizing tool for mental health and the medical field. It can also be really polarizing to existing practitioners.
How to Navigate a Conversation With Your Healthcare Provider
[00:02:38] Nick: Well, and then you couple the fact that most traditional health care providers carry some form of licensure which directly limits them in what they can and can’t say around psychedelics.
By way of example, if you walk into your primary care provider and say, “Hey, can you clear me for a psychedelic experience?” They’re not going to do it.
Jimmy: They’re like, “I can’t do that.” [laughs] And I can’t clear you with something that is a federally illegal substance and my licensure likely has both state and federal parameters to it.
Nick: So, they’re not going to be able to answer that. But you could say, “Hey, I’m interested in exploring something like this. Can we do a physical, so that you can help point out any potential red flags that you may see?”
Or, “I’m interested in doing more strenuous activity, something that would get heart rate and blood pressure up, am I safe to move forward with something like that?”
Those are kind of the less direct ways to get what is ultimately the end answer that most of us are seeking, which is like how big of a risk is this?
Jimmy: Yeah, it’s really important to be about as honest as you can. But also I just recognize that your privacy and sovereignty are really important here.
And so if you feel like your honesty would cause your medical provider or mental health provider to treat you differently where your care is different, then I would say that’s a situation where you want to use a little discretion.
Let’s say you have a very traditional medical provider who for some reason politically is against psychedelics and drug use. No matter how well they try to create barriers around their personal opinion versus their professional service, those things blend sometimes.
We see all the time marginalized populations, folks who are on the fringes of society just get different care from service providers depending on a condition or substance use or whatnot. And so, you have to be really thoughtful of that too.
So, I just want to highlight that to folks that though we do think that being honest and providing as much context and information as you can is important so that the provider has the full picture, we just know that that’s not possible all the time. And this is where Nick’s advice comes in there.
Nick: And it’s also worth acknowledging that there’s going to be a really big difference in how your primary care physician approaches questions around psychedelics versus how a mental health professional, like a psychotherapist, would answer those questions.
Who to Talk to: Physicians, Psychiatrists, Counselors & More
[00:05:22] Jimmy: Even within mental health, like psychiatrists would be different than a psychotherapist would be different than a therapist would be different from maybe a counselor. So, even within that it’s going to range.
Nick: Right. But you have to think like for the most part doctors are specializing in the physical body and therapists are specializing in the mental emotional bodies.
In my own experience, I see therapists that are way more open to this than I see doctors who will endorse because they risk once again licensure. By formally endorsing something like psychedelic use.
Jimmy: You mean talking about psychedelics more directly.
Nick: Directly, correct. If you go and ask your doctor, “Hey, do you think psychedelics could help me with whatever?” You are not going to get a straight answer.
You ask the same thing to a therapist, you may actually get a better answer. And so, part of this is like who are you choosing to talk to about what it is that you’re exploring.
Jimmy: Yeah, some situations require both. Let’s say you’re in a situation where you have had a cardiac-related surgery, or let’s say you have a respiratory issue, or let’s say you have some poor knees or something like that.
There’s a way to just get physically assessed to just rule out any potential medical things. And then there are some folks who have some of those medical issues and they also have mental health issues. And so, that’s important to chat with a number of different folks as you can.
Nick: And so, that’s where if you’re exploring a potential physical risk factor with a doctor, there’s other ways to get the essence of the answer that you’re looking for. Are there any activities that I shouldn’t participate in?
Nick: And get a sense of what is on and off the table unrelated to psychedelics and that will help inform it. If they tell you can go lap swimming, a psychedelic experience probably isn’t a big risk factor there-
Compared to someone who’s like, maybe had two cardiac events and they’re like, “You probably shouldn’t have your heart rate above 100 beats per minute.” Okay.
Now you know that anything that induces stress is actually a pretty big risk factor. And so separating some of those things out can be very helpful.
Jimmy: Yeah, post-stroke patients, this isn’t an issue. Even seizures, depending on the severity and the level. I think a lot about the veteran community, especially with PTSD where you may have layers and combinations of things.
So, by the way, shout out to all the wonderful people in the VA because I’ve been hearing so many more stories of exactly what you’re talking about, where VA mental health professionals are like-
“I can’t advise you what to do, But I have heard of this research or this clinical study or this clinical trial.” And you happen to live in the state of Colorado where it’s decriminalized.
Nick: That’s another thing- is their views are often limited to studies.
Nick: They have concepts and awareness that this stuff exists, but they’re not going to be able most of the time to speak to your specific use case.
Jimmy: The other things I want to highlight is get specialists for your specific needs, even a medical thing. Like maybe you do need to talk to an ear, nose, and throat specialist if you’re having a respiratory something or whatnot.
It’s always okay to get a second opinion or find another provider if you feel like your mental health or medical provider isn’t supportive.
Just also know that there’s folks out there who may have no information or no opinion about it. And that’s where a lot of the suggestions that Nick is making may be useful to you. So, there’s limitations here.
How to Seek The Support You Need
[00:09:25] Nick: Yeah. I want to echo something that you touched on quickly there, which is: find someone else that supports you if your existing care system doesn’t.
It’s not going to be like explicit support necessarily, but it’s pretty obvious when someone is not taking your request seriously or is talking down to you or-
Basically shames you for wanting to explore something nontraditional. Those to me are all red flags that it’s like maybe not the best fit anyway.
Jimmy: They likely shouldn’t be your provider regardless of whether you’re talking about psychedelics [laughs] or not it sounds like.
Nick: Yeah. And so, to be clear, there are lots of providers out there that are psychedelic friendly and this is becoming more and more common in the mental emotional health space is you have resources-
Full websites that are dedicated to listing all of the therapists that are open to working with folks who have had psychedelic experiences. We’ll drop those resources in the show description for anyone that’s interested.
But just know that there is a whole emerging cohort of healthcare providers of all different types that are openly acknowledging that they’re open and willing to explore working with clients who are exploring psychedelic use.
Jimmy: Yeah, it’s really promising. Also, at the same time acknowledge that it’s very early in the space of this crossover of provider services where there are limitations no matter what.
We are starting to see more professional association boards, medical provider boards and associations, pharmacy associations and boards though remember to Nick’s point-
Each one of those has state licensure and usually some type of a federal something, maybe they have a DA license who administer scheduled narcotics or something like that. And so, just know that the boundaries are really dependent on the service provider.
You may have a service provider who’s like, “I think psychedelics are helpful, but I really can’t directly help and support you in this.”
Or you may have somebody who’s like, “I don’t know a lot about this but I’m happy to be a part of your support team if you also have your own psychedelic-oriented professional or facilitator.”
And this is what Nick is talking about, continuity of care. I say other terms like realms of care or letting specialists do their specialty.
If you have a psychedelic facilitator or professional that you’re working with, that can actually take a lot of pressure off of the medical professional or mental health professional because they’re like-
“Oh, somebody’s handling this harm reduction on service side, now I can focus on my mental health side, the medical professional can focus on that.”
There’s also probably a world in certain states where therapists and mental health professionals may provide underground services, but just know that’s up to your own risk tolerance-
Especially if these people are also providing and administering substances. You just got to be thoughtful around what’s right for you and within your risk and your needs as well.
Nick: Yeah, and so I think that the providers that are the most open to engage in a discussion like this and to form this chain of care so that you feel like there’s always someone that’s got your back is often going to be a mental health professional.
If you’ve already got a therapist that you’re working with and you want to keep working with them, what I always advise, is to let them know that you’re moving towards or exploring a potential psychedelic experience, engage their willingness and ability to support you-
Because one of the challenges that I do see from time to time is someone has a therapist they’ve been working with for a while, they like them, they’ve got a good relationship, but they have no experience with altered states of consciousness or psychedelics.
It’s not that they don’t support you doing it, but they’re not going to be able to help in the integration because they have no frame of reference for what you just went through.
Jimmy: Yeah, I’ll give you a really great example. And to your point, this isn’t because they don’t mean well, it’s really just a limitation of knowledge and context.
If you are, let’s say, working with the more traditional talk therapist, even if they are willing to support you through their experience, you may then only be relegated to talk therapy in your integration process.
I have a client who’s going through exactly this. They’re on their 4th or 5th ceremony. We’ve been doing work for years. They found a mental health professional who basically plays, as their– call it, offensive coordinator in all thing’s mental health.
And then were trying all of these adjacent modalities, EFT, craniosacral, men’s workshops, advocacy groups, art therapy, music therapy in conjunction with psychedelic-oriented services.
Just to give folks an idea that there’s a lot of different ways and a lot of different modalities that can be implemented into this. And so, all of this starts with having honest and real conversations with your provider about your needs and your care, really.
Nick: I’ll share the flip side of this, which is if you can’t be fully honest with your mental health professional or therapist about what you just went through-
Which for most people is one of the top most significant experiences of their life, that can limit your progress because you’re basically–[crosstalk]
Jimmy: Yeah, you can’t talk about it.
Nick: Exactly. You’re dancing around this thing that’s up there with marriage and childbirth, but you can’t share it in the container that’s supposed to be your safe space to share whatever is important to you, on your mind, on your heart, etc.
Jimmy: Yeah, there’s the elephant in the room. And any good mental health provider is going to know, they’re going to know that something shifted. They’re like “Huh. You’re showing up different to these things.”
Whether for better or for worse because, look, you may have a very positive outcome, and that can fuel a lot of content for your normal therapy-
Or you may actually need that therapist’s support if you’re going through a challenging, difficult landing or through really, really tough integration, which you and I have been through, both of them since– [crosstalk]
Nick: Well, I want to touch on this for a second because a lot of times a spiritual emergence or emergency, if not handled by someone who understands what that is in relation to a psychedelic event, catalyzing it, they’ll take you to the loony bin.
I mean it sounds crazy, it sounds extreme, but we don’t have a lot of frameworks to use in the western world when folks are going through these really destabilizing integration experiences.
And that’s another example where a psychedelic-friendly therapist who understands the gravity of putting the puzzle pieces back together will have likely a very different approach than someone who’s never been in an altered state before.
I think my call to action for anyone that’s listening to this and exploring this kind of continuous chain of care is to solve for this on the front end before your experience-
Because after the experience now you’re potentially destabilized, they’re not supporting you and you’re trying to find a new provider.
Jimmy: You don’t want to be reactionary to that or left hanging there. These are all scenarios and somewhat theoreticals that can take on a lot of shapes and forms.
Knowing you and I, we’ve had all the different iterations of this. We’ve had the ones where we came out very smooth and it was really joyful, blissful.
We’ve had the ones where it was acute for a couple of days or a week and then we’re back and we for sure had ones that have just taken us out of the daily flow of life for weeks or in my case months on that.
Nick: Oh, months for me, for sure.
Jimmy: Yeah. And so, what does your care look like around that? This is really important because we want you to get the support that you need. The only way to do that is to disclose to a couple of people that you’re going to have a psychedelic experience.
Nick: Yeah, and you touch on this a lot, which is also clear on the type of support that you need. Do you need your primary care physician involved in your integration? Probably not.
But do you need your mental emotional supporter, whether it’s a coach, therapist or otherwise? They should probably be aware it’s going to drastically impact the work that you two do together.
Just being very clear on what your needs are can be important and it also trickles down into what is the requirement of the healthcare provider.
For you, think, “Okay, well they don’t need to have direct experience with psychedelics so long as they can hold the space for me.”
Or you may think, “Well, I actually don’t want to work with someone if they don’t have direct experience.” Only you’re going to know what factors are important to you there.
Jimmy: Or, some examples that I’ve seen of this is that an individual really likes their ongoing provider and then they also get a specialist, let’s say an integration specialist or the facilitator serves.
There are so many times where I stay as the integration psychedelic-oriented person and then they’re also doing ongoing therapy and work with other providers.
So that’s an option that can be seasonal. You may just need that for a little period of time, then you may be back to therapy.
Or, what I see more commonly is the psychedelic experience can catalyze your process in a way that you then identify a new specialist or provider or something that you need.
And then that’s where it gets really cool to feel like, “Oh, I have a couple of people advising me on, okay, what things should I try or what things should I explore and experiment?”
Because if you’re open to trying an alternative, that’s the way that our modern society sees it, in psychedelics, that opens up a whole world of a lot of different types of care to you and you get to decide which is really, really cool.
How to Discuss Medication With Your Doctor
[00:20:32] Nick: Yeah, one of the other things that I think people most often go to their health care provider around as they’re preparing for a psychedelic experience is their medication.
This is another one of those interesting ones because most likely the psychedelic professional that you’re working with, whether it’s a facilitator guide or trip sitter etc-
They’re going to weigh in on what are risk factors as far as medications, but ultimately how you choose to taper and if you choose to taper, is going to be entirely up to you and the prescribing doctor.
And so, it’s important because I think this is one of the places where folks have some of the most questions and so it’s important to understand what your prescribing doctor can advise on and what they can’t.
And so, you also have to be your advocate here because there’s a lot of doctors who quite frankly are better at prescribing the medicine than they are at helping folks taper.
And when a patient comes in and says, “Hey, I want to taper.” Their first question is going to be, “Why?” This is one of those ones where I think maybe we can give some practical guidance on how to approach.
Jimmy: Yeah, I’ll follow up with what you just said about tapering protocols, and then let me backup also to something important that you said.
But around tapering protocols, usually, there are parameters and guidelines, but unless you are working with the specialist, you likely won’t get the hands-on, week-to-week adjustment in a tapering protocol that’s specialized for you.
We’re talking about tapering protocols that can range for weeks and months. Like there are some medications that say, two to three weeks on the general advisement if you’re looking at a tapering protocol.
And there are folks who need to wean off for six months. And so it’s very, very dependent on the individual. Luckily, there are some specialists and consultants, providers that I’m starting to see more in this space.
But to backup to something that you said earlier, and I think you’re really talking about the delineation of the responsibility of the facilitator versus the responsibility of healthcare providers versus your own responsibility for yourself.
Nick: Right. It’s a trifecta.
Separating and Assigning Responsibilities to Your Facilitator, Healthcare Provider & Yourself
[00:23:00] Jimmy: For sure. So, the facilitator, even if they have a medical background, likely in the context of providing you psychedelic services as it stands in the legal landscape today, can’t give you medical advice.
Until licensure happens at a state level or federal level around psychedelics–
Nick: Even, then it’s unclear–
Jimmy: Yeah, then it’s unclear. Then, you might have an MD or a medical director or something. But just know that as it stands today, probably for the next couple of years, a facilitator likely shouldn’t be giving you medical advice.
Now, they can have their own boundaries. They might say, “Hey, based on my experience, I only work with clients who taper.” Or you might find facilitators out there who work with the whole range of status around that–[crosstalk]
Nick: And to be clear, like in our network, we’ve got both. We’ve got some facilitators who will work with folks who are on SSRIs, others who won’t.
There’s also other medications where they may ask you– they may have a boundary around ceasing use in the 24 hours leading up to the journey or seven days before.
And so, the facilitator has a right and should, if they’re properly trained, have boundaries around how they approach medication.
Jimmy: Yeah, this is what’s within my scope and what’s not, essentially. Then it’s left up to you to then figure out what works for you.
If you have a facilitator or a service provider who’s like, “I only work with folks who taper.” That’s still your sovereign decision on whether you taper on and off with meds.
That either means you find a psychedelic service provider that can meet that specific need, or you’re talking to a professional, mental health professional, medical professional about tapering.
There’s so much that goes into this. Your own standard of living or living condition, quality of life, your own current stability, your own relationship with medications. You can start to see really quickly that nobody can answer these questions but you.
But you should get the advisement to know, “Okay, if I do taper, what would that look like? How long would that take? What are the potential side effects? Is this something that I can try for a little bit?
And then what if I decide to stay on this medication? How does that affect my mental health,” and all of this stuff. And so, it’s worth exploring. And you can see how these honest conversations are helpful, but at the end of the day, you’re the one that decides.
I’ve had plenty of people who are like, “You know what? I can see the value of tapering. I’m investing all of this time, energy, money, into an experience. I want to go into the experience of having the best chance of an altered state of consciousness.
But I also feel right now, like my medication is working really well and I just want to stay here.” And that’s amazing.
And then maybe they try microdosing, maybe they revisit psychedelics in a year or something like that. But all of this is under advisement from your care team to talk through that stuff.
Nick: I want to be clear that what we’re saying here is: ask your provider and also, they may not be that helpful.
This is another thing that we see is sometimes the advice that patients receive from their prescribing doctor is blatantly wrong. I don’t know how else to put it. I mean the way that SSRIs and certain antidepressants work is that they stay in your system for quite a long time.
And so, if you start drastically reducing dosages or skipping dosages and things like that, it can start to wreak havoc on your system.
And so, for those who are interested, we’ll drop a link to a resource below called Surviving Antidepressants. But they talk a lot about how to approach that and it’s from patients’ perspectives and literature.
I just want to be clear that even if your mental health professional won’t help you with tapering, which is crazy because they’re legally required to do so, there are other resources and there are other professionals that likely will help.
And so, if you feel like you don’t have the direction that you need there, just know that there are these resources available.
Jimmy: Yeah. The whole thing about speaking to your health care provider about psychedelics, in general, is about reclaiming your own sovereignty and power around your health care.
Nick: You’re your own biggest advocate. And if you’re not, it’s time to get in the seat of being your own advocate because there’s a difference between knowing what you need and then the how. So, only you know what you need. The how is often what we go to the specialist or the provider for.
Jimmy: This reminds me of somebody that I was talking to who had just a lot of things going on with them, mental health-wise and medically and neurologically and whatnot.
They were really adamant about moving forward in a medium or large-dose experience because I actually feel like their existing medical and mental health professionals ran out of options.
They had tried all the stuff, they ran out of options like, “Okay, now actually you should maybe move towards a psychedelic experience.”
And with that bias, the well-intentioned person was really gung-ho about moving forward in experience. And I had to slow them down, I had to really challenge them around what their intentions are and where it’s coming from.
Is this really a last resort? Is it coming from scarcity? What other type of work are you doing? And actually just got an email from them the other week, this was months ago.
They’re like, “Hey, actually thank you for slowing me down,” and actually started microdosing instead and I helped with some of this underlying stuff. And I’m like, that’s when you see it working.
And I think that’s the example of what you’re talking about, Nick, almost in opposite is that all of the folk’s input and opinions, regardless of if they’re specialists or professionals or not, they’re still opinions.
The more varying perspectives that you get, the more input that you get, the better that can inform your own process with this.
Nick: Yeah, I mean, ultimately, it’s your body, your mind, your emotional state, your health. That’s a large part of the sovereignty that we talk about, is like there’s no possible way that any other human can know you better than you know yourself.
I know that can sound a little challenging when we’re in states of despair, distress, discomfort, but it is true. We all have this little intuitive nudge or little intuitive knowing of what we need.
Part of the preparation process is cultivating that so that we can start to listen and get clarity before we even get to the dosing session or the ceremony.
Jimmy: It’s got to be a full “f*ck yes” on a lot of different regards. I want to normalize for people that if you run into one of these situations that we’re talking about that causes you to pause or to wait, and you’re like, “Ah, I’m not ready for this.”
Or, “Oh, I then just have this physical that then actually highlighted an underlying medical condition that I wasn’t aware of and now I got to go and address this before I move into a psychedelic experience.”
Or, “I’m not ready,” or there’s something that isn’t quite aligned. That’s a great outcome. That’s an amazing place to be for you to realize, “Oh, there’s something that’s giving me pause or giving me a reason to hold off.” I think that’s also totally okay.
Nick: Yeah. I’m curious, as we kind of approach our time here today, is there anything else that you feel like we haven’t touched on that’s important around this topic of how to speak to your healthcare provider?
Jimmy: No, I think I’ve ranted everything I wanted to rant. I’ll say that we’re in an environment where more of these services are coming online and-
There are more things available even year over year in the past two or three years, we’re seeing a lot of change and definitely so decade over decade. And I think that’s really promising.
I know that for folks, there’s a lot of folks who are suffering and a lot of folks who feel they don’t have a lot of time, and that can add to some desperation around, like skipping some of these steps that we’re talking about or glazing over some things.
But let me tell you this, what if that exact service of psychedelic care was like just around the corner? What if that exact thing that you needed was six months away?
And then you then pulled the trigger early and had an experience that didn’t meet your needs or was subpar, didn’t have the care. Just think about these things and think about what’s right for you.
I just want to provide just some hope for folks that more services are coming online, more ways to engage with psychedelics are becoming available, and I just think that’s really promising for folks in need.
Nick: And especially for just the more complex cases that require a stronger, more informed container around it. That’s a dynamic that does exist.
Thank you all for joining us on our episode today. We really hope that you enjoyed this one. You can download episodes of the Psychedelic Passage podcast on all major streaming platforms Apple Podcast, Amazon, Spotify, IHeartRadio, or wherever else you listen.
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