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Does A Medical Setting Affect Psychedelic Treatment?

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As psychedelics gain acceptance quickly, laws in different states are changing to accommodate their possession and use. So far though, the only states to legalize have done so with an allowance for use in a medical/supervised setting. How useful is this medical setting to psychedelic treatment, and can it get in the way?

What is a medical setting?

When it comes to using psychedelics, there are no specific rules for what will lead to a good trip, and what will bring on a bad one. Though this can do with individual reaction to the drug, it also has to do with outside factors that can impact our individual reaction. We’re often told ‘set and setting’ play a big role in a trip going smoothly, and this can encompass different factors.

‘Set and setting’ refers to the place you’re having the experience, and the environment around. You could be in the woods, or on the beach, or at a dance club, or alone with your partner. The environment around might include the other people you’re interacting with, how crowded it is, if other people are also having the same experience, if you’re doing something organized or on your own, lighting and sound, and even the weather around you.

A medical setting is another type of setting, but until recently, it wasn’t associated with taking a psychedelic drug, or hallucinogen of any kind. However, as research amps up, and legalizations roll in, that idea of a medical, or supervised setting, becomes that much more important, as it’s the only setting legally available to use the compounds in question.


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A medical setting is not one specific thing. Also referred to as a ‘healthcare setting,’ and expanding into ‘supervised setting’, this term encompasses: “acute care hospitals, urgent care centers, rehabilitation centers, nursing homes and other long-term care facilities, specialized outpatient services (e.g., hemodialysis, dentistry, podiatry, chemotherapy, endoscopy, and pain management clinics), and outpatient surgery centers. In addition, some healthcare services are provided in private offices or homes.”

The last one is important, because it reminds us that our own home can be a medical setting under the right conditions; which is the medical setting most people should automatically be the most comfortable with. And when it comes to ketamine, it is offered by many clinics as an at-home treatment which both cuts costs, as well as gets away from the medical setting that not everyone is comfortable with.

In reality, both current psychedelics legalizations aren’t for medical use, and the legislation uses the term ‘service center’ instead. Considering it’s a formal setting, with a person watching over, it represents essentially the same thing. Perhaps its not so much about a ‘medical setting’ as a ‘controlled setting’, but the same idea of how it can affect a trip, applies. It seems Colorado might understand this a bit better, allowing for treatment outside of authorized service centers, but what this actually entails is not entirely clear.

Does being in a medical setting affect a psychedelic trip?

There isn’t one specific answer to this, and not everyone has the same requirements. For some people, the experience won’t differ greatly depending on set and setting, and for some people it will make all the difference. For everyone in between, well its hard to say. Plenty of trials for psychedelic medications have gone on at this point, and for those, we only get the results of the medical setting. Is it possible that results might have differed if the trials were run in a more familiar, or chosen, surrounding?

I came across an interesting statement when researching the Salvia divinorum plant, and the different ways that users describe the experience. Found in a Wired magazine article, and written by Daniel Oberhaus in 2020, the article details the writer’s own experience as a part of a research study into how the compound salvinorin A affects the brain during use. The trial took place at Johns Hopkins University in Baltimore, a research hospital, and involved being hooked up to an fMRI machine.

Per Oberhaus, “I had just inhaled an unspecified dose of the pure crystalline substance from a hose attached to what one of the researchers characterized as an ‘FDA-approved crack pipe.’” He continued, “My psychedelic experience in the fMRI machine was markedly less otherworldly. On the second round, I saw some colorful pinwheels and felt as though my body had merged with the machine. But I didn’t enter another dimension or dissolve into pure being”.

How much does set and setting affect psychedelic experience
How much does set and setting affect psychedelic experience

What are his thoughts as to why his experience in the trial differed from his experience using salvia illicitly, outside of a hospital setting? “This may have been because I received a lower dose. Or it may have been because it’s harder to give in to the experience when you’re inside a giant machine making a racket while it soaks your head in a powerful magnetic field.”

Being in an fMRI machine is much more extreme than simply sitting in a doctor’s office. But consider that most people who do ketamine illicitly, do it by snorting the drug; and one of the more common medical techniques is hooking someone up to an IV. The idea still resonates. Neither being stuck in a tube, or hooked up to an IV in a doctor’s office will likely be the chosen set and setting for many people. And no matter how comfortable you try to make a doctor’s office, it might still have the ability to change the experience.

Tack onto that the cost of the treatments, and this could make patients apprehensive about the outcome of their treatment, which could also affect experience. When getting a service is so expensive, you can’t mess around with it, and for people scraping to make this happen, there’s increased pressure to ‘get it right’. A less controlled environment could pose cost reduction ability, and make users more comfortable about what they’re spending.

My own experience in a medical setting for psychedelic treatment

On this particular topic, I can throw in my own opinion, as I did receive ketamine treatments in a doctor’s office, as well as having previously used the drug on my own illicitly. I’ll take a second to remind that ketamine is a dissociative hallucinogen, not a psychedelic. It is used for therapy in a similar way to psychedelics, and is currently the only legal way to get such treatment, as neither state thus far that legalized any form of a hallucinogen, started services yet.

I ended up in the office of a psychiatrist in Guadalajara, Mexico, which is one of the only places in Mexico that provides ketamine treatments. Most of the doctor’s business is for pain. I went because of sleep issues, which falls under psychiatric. There are very few people who do this there. As such, the procedure isn’t established like it is in American facilities; and from the beginning I was left to feel like not everything was being covered. I made the most of the experience, but looking back I can see how badly it went.

I was hooked up to an IV, and I sat in a comfortable enough place, but was it really? It was a kind of cold office, with no blanket offered, dim lighting, and no window. I was on a couch facing a desk, with very little around me. Sure, it was okay, but I wasn’t super comfortable. Nor did I like having an IV hooked up to me, or seeing the blood squirt out when they had a hard time getting my vein (both times!) I left with blood stains on my pants the second time. I didn’t enjoy the actual drug experience at all; it left me feeling queasy, shaky, and incredibly anxious. And while this could represent my own personal reaction to ketamine, there’s a problem here…

IV ketamine treatment in medical setting
IV ketamine treatment in medical setting

I did ketamine plenty illicitly. I used to do lines with an ex-boyfriend frequently enough to have a great idea how the drug affects me. I liked it back then. Not my favorite of all drug experiences, but very interesting. I used to feel like I was floating, disconnected, like my brain was pulling in different directions. But not bad. And at no point with the anxiety and discomfort I suffered in the doctor’s office. An anxiety so bad the doctor did not push me for another appointment (or even contact me again for follow-up…I would never got back to that provider).

The experiences were so wildly different, that it makes me wonder how much of my negative experience in the medical setting with the psychedelic-like drug, was related to being in that setting, rather than a place I am more comfortable with. My experience gives a huge amount of credence to the idea of at-home ketamine therapy, and the ability to do the treatment in the comfort and privacy of your chosen location. Perhaps under other circumstances, I would not have been a non-responder.

Conclusion

It’s not for me to say what works for other people. But when it comes to expensive treatments, or ‘services’, how many people want to pay out for something that isn’t what they’re looking for? And how much do we damage our own understanding of the usefulness of something, when the controls for use are so extreme? It’s not like these drugs are used illicitly in a medical setting; and people turn out just fine when using a psychedelic on their own, or in a less restrictive way. Maybe that’s something that should be remembered.

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The Future Of Cannabis After Rescheduling

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The federal government has decided to move toward marijuana rescheduling.  So what’s next and how long until it done?

The Drug Enforcement Agency (DEA) has agreed with Health and Human Service’s (HHS) recommendation for cannabis to be rescheduled to Schedule III, with Schedule III drugs defined as having a moderate to low potential for physical and psychological dependence (Schedule III drugs include ketamine, anabolic steroids, and testosterone). This rescheduling will have a significant impact on state-legal cannabis businesses, but some uncertainty remains. Once the DEA publishes its proposed rule, it will be reviewed by the White House Office of Management and Budget (“White House”) and if approved, it would then proceed to a public comment period. Notably, the DEA could reschedule cannabis by issuing a final order and bypass the notice and comment period which would allow the change to become effective 30 days after publication in the Federal Register.

RELATED: Pakistan Makes Positive Move On Cannabis

However, it seems certain that the DEA will elect to do so by proposed rule, which is followed by a comment period of between 30-90 days. This comment period will be followed by a formal administrative hearing if requested, which rescheduling opponents will most certainly want, along with a flood of comments ranging from why cannabis should remain in Schedule I to why it should not be rescheduled lower than Schedule II. While rescheduling to Schedule III is almost certain, it is critical that proponents submit comments as well in order to ensure a robust record supporting marijuana’s reclassification.

Once the comment period and administrative hearing have concluded, the DEA will review the entire record and issue its final rule based on its analysis, HHS’ analysis, the comments submitted, and the administrative hearing record. The timeframe for issuing a final rule is uncertain and not statutorily defined, but since the DEA is required to review and respond to every comment submitted during the notice period, it could take some time.

Photo by 2H Media via Unsplash

Whether the DEA goes straight to issuing a final order or allows notice and comment, after the final decision/order is issued, it will not become effective until 30 days after it is published in the Federal Register. During this time, an aggrieved party that participated in the notice and comment period has 30 days to file a lawsuit to seek judicial review of the agency’s decision. In the event of a lawsuit, it is possible the effective date of the reclassification is delayed by a court order.

RELATED: Senate Leadership Pushes End of Federal Prohibition Of Cannabis

Federal Regulations

Cannabis rescheduling is likely to inspire further federal regulations, but the nature of said regulations is uncertain. Since 2009, during the Obama administration, the federal government has declined to enforce federal law against the overwhelming majority of state compliant marijuana businesses. The federal government’s reluctance since the 2013 Cole Memorandum continued despite the DOJs enforcement guidance being rescinded during the Trump administration. It is possible we will see the DOJ reissue another enforcement memo. While it is still uncertain, enforcement action may follow cannabis rescheduling in an attempt to form a more cohesive national industry. For example, rescheduling cannabis to Schedule III may push the FDA to enforce against false and misleading drug claims as it has for hemp products. The DEA would continue to regulate cannabis as it had under Schedule I, however, they could now require dispensaries to conform to pharmacy regulations and the significant requirements associated with such. It is unclear but unlikely that the DEA will enforce pharmacy requirements upon state-legal dispensaries, since the difficulties and required resources associated with such enforcement will likely be too burdensome for the DEA immediately following rescheduling.

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The FDA may also become more involved in the regulation of cannabis, particularly concerning cannabis products’ dietary supplements and conventional food claims. While regulatory clarity would be welcome, we must be careful as to over-regulating the various cannabinoids (or compounds found in cannabis). It is likely that the FDA receives an influx of new drug applications following cannabis rescheduling, as FDA approval of any specific cannabinoids as drugs may be quite valuable. However, since FDA-approved medications cannot typically be legally added to conventional foods or dietary supplements, FDA approval of certain cannabinoids would create a complicated regulatory environment and spur subsequent consumer confusion (similar to the FDA’s approval of CBD in the form of Epidiolex).

Timeline

As for the timing of the rescheduling process, it will not happen overnight. Following approval by the White House, the DEA will likely initiate a public comment period. While this comment period itself will likely last from 30 to 90 days, the overall rescheduling process may take much longer. A previous drug rescheduling via rulemaking, for Hydrocodone Combination Products, took years to fully reschedule (though the timeline from HHS’ recommendation to the new rule taking effect was within one year). Following the quick turnaround by HHS to recommend cannabis rescheduling, it is possible that the DEA publishes its final rule as early as 2024.

Terran Cooper is a regular contributor to The Fresh Toast.  He is part of Falcon Rappaport & Berkman LLP. This article was developed in part with the help of Andrew Cooper and Matthew Foreman.



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Cannabis

Stormy Daniels Is Immortalized With A Marijuana Strain

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You have to say she is interesting – a dancer, porn star, director, trial witness and more. And, Stormy Daniels is immortalized with a marijuana strain. Yes, you and Stormy can chill together.  She entered the greater cannabis world in 2020 working with Forest Farms who develop a CBD lube with Forest Farms. Since then, a chill strain has been named after the blonde bombshell.

RELATED: Everything You Should Know About CBD Lube

Daniels rose to fame in 2004 when she won the Best New Starlet Award from Adult Video News. She went on to win more awards and eventually moved to behind the camera, directing over 150 films. She has appeared in mainstreams shows and also in a Maroon 5 music video. Currently she is appearing in New York for a courtroom battle Royale.

Photo via Pixabay

While the lube is no longer on the market, you can purchase a marijuana strain in Oregon named after her. This strain is known for its high potency and low THC content, making it perfect for those who want to enjoy the benefits of cannabidiol without getting too high. You can even buy the seeds to grow your own.

For her part, Daniels said that she believed CBD was a fad until she experienced the benefits of the compound herself. She fractured her spine and severely sprained her pelvis while jumping her horse.  She was told it would be a minimum of six weeks until she could walk with crutches. Hating pain pills, she decided to use some CBD products a friend sent.  From them on she has been a fan.

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In another turn of events Daniels attempted to run for senator in Louisiana. She was approached and conisidered when she discovered the Republican National Committee (RNC) paid expenses for fundraisers at a “lesbian bondage” themed nightclub. She felt the RNC’s use of party funds for sex convinced her Republicans represented her libertarian values. Daniels had been a registered Democrat but now identifies as a libertarian and bisexual.



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bromance

Tips To Building Better Relationships

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Having someone to turn to, laugh and having adventures is good for your soul and your mental health.  And you don’t have to be perfect to have great friends – here are some tips.

Finding someone to share your life with can be challenging, even finding someone to share a meal or activities is tough. But if you take a breath, here are tips to building better relationships.  Sometimes we don’t fully understand art of relationships, it seems complicated.  But one doesn’t need to love oneself perfectly to love others.  Women and men need others in their life. In fact, a recent study showed bromances were more satisfying in their emotional intimacy, compared to their heterosexual romances. But sometimes, we get in our own way of finding and enjoying relationships.

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Everyone has flaws, but it shouldn’t interfere with having true friends and meaningful love. Dr. Carla Manly has written a new book about how to build better relationships – both friends and lovers, including gay and straight. It explains you can be imperfect and still have great relationships.  And explains the need for multiple people are in to fulfill our needs. Here new book is The Joy of Imperfect Love and explains the need and process of building relationships.

Photo by Felix via rawpixel.com

Here are some tips and insight from Dr. Manly

  • Sometimes the wisest step is to invest primarily in the relationship you have with yourself.  Taking a time out from dating and relationships can give your soul a chance to reset and breathe.
  • You do not need to love ourselves perfectly to love others well. The journey of imperfect love never asks for perfection; it only asks you strive to evolve toward the best self.
  • Regardless of the pasts, you have the power to leave intergenerational wounds and patterns behind us so you can enjoy life more fully.
  • Relationships with others tend to mirror the relationship with yourself and the greater world. Making the choice to lovingly invest in relationships can be life-changing.
  • When we dive into relationships with honesty, courage, and respect, you cannot help but change and evolve.
  • Love—or its absence—is where our lives begin and end. It is never too late to foster love in one’s inner and external life. In today’s fragmented world where material success and excess are often prioritized, millions suffer from empty, false, or broken promises of love. Yet, no matter how much you have in the external world, the lack of love from a partner or friend is hurtful. Everyone has the power to reset—to shift priorities—and focus on fostering genuine love in all our relationships, from romantic partnerships and family connections to our vital friendships.

RELATED: How To Be Discreet When Using Weed

Finding the right relationships takes patience and investigation. The first step is to consider what you have to offer – what you have to give in a relationship. The second step is to determine what you want. The third step is to put yourself out there, keep your heart open, and dare to find the person who fits well into the puzzle of your life.

Having friends and others in your life is key to your mental health. But finding others to share your life is a process, and it is important to give yourself permission to be happy on in the journey.



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