Psychedelics are gaining the attention of the federal government as a potential treatment for complex mental health conditions, but healthcare leaders remain divided on their readiness for broader clinical use. While some see promise for patients with treatment-resistant conditions, others emphasize the lack of long-term evidence, the need for rigorous safeguards and concerns about ethical risks and patient safety.
Five behavioral health executives shared their reactions to President Donald Trump’s April 18 executive order directing federal agencies to accelerate research, regulatory review and access to psychedelic drugs, including ibogaine compounds, for serious mental illnesses.
Editor’s note: Responses have been lightly edited for clarity and length.
Karl Benzio, MD. Co-founder and Chief Psychiatric Officer of Honey Lake Clinic (Greenville, Fla.): As a board-certified psychiatrist clinically innovating for more than 35 years in addiction medicine, trauma recovery and decision-making sciences, I must register clear and substantive opposition to the fast-tracking of psychedelics as therapeutic agents in behavioral healthcare.
I hold this position both as a scientist and as a follower of Jesus. I don’t see these commitments as competing — in fact, clinical experience and recent research clearly show their convergence. Science, rightly understood, points toward truth. Accordingly, genuine healing, neurologically and psychospiritually, requires that patients engage with reality more deeply, not less. Psychedelics, by pharmacological definition, distort reality.
This is not a minor clinical footnote — it is a foundational therapeutic contradiction. Physically, serious medical complications have killed patients. Neurobiologically, psychedelics lower the threshold for future psychotic breaks while creating states of heightened suggestibility that dangerously compromise the therapeutic frame. The transference and countertransference safeguards essential to ethical clinical practice are virtually eliminated when a patient’s reality-testing is pharmacologically impaired, and this vulnerability to manipulation — financial, sexual or otherwise — isn’t theoretical. It’s documented.
Clinically, I am also concerned that substance-induced altered states train patients to pursue neurochemical shortcuts rather than develop the durable psychospiritual skills necessary not just for sustained healing but also future adversities. Quick openings without sustained integration don’t equip — they produce dependence on the next dose. The history of methadone, suboxone, OxyContin, benzodiazepines and cannabis legalization should give every responsible clinician pause before we accelerate down this slippery slope of quickly disappearing safeguards and giving our impressionable and quick-fix-oriented society the idea that these toxins are safe and can be used recreationally.
We achieve profound increased neuroplasticity using various psychospiritual interventions — without these psychedelic risks — through depth-oriented, Christ-centered, evidence-based psychiatric residential treatment. Lasting healing emerges not from a substance-induced state, but from the courageous, supported work of replacing distortions with truth. That framework — integrating biological, psychological and spiritual dimensions of the whole person — produces skills patients carry into every area of life.
We owe our patients that, and nothing less.
Brittany Evans. Assistant Vice President of Patient Services and Psychiatry at Cincinnati Children’s College Hill (Cincinnati): I am cautiously optimistic about the growing federal momentum around psychedelic-assisted therapy. The therapeutic potential is compelling. For people carrying complex trauma, dissociative presentations, treatment-resistant depression, and grief — populations our current toolbox consistently underserves — these compounds represent a frontier worthy of serious pursuit.
That said, there are two sides to this coin. The populations who stand to benefit most from psychedelic therapies are also at heightened risk for harm in the process. Psychedelics can induce altered states that make patients particularly vulnerable to undue influence, suggestibility, and exploitation — and even within controlled research settings, ethical violations have already occurred. In recent years, we’ve also seen cannabis enthusiasm outpace evidence and telehealth demand outpace regulatory oversight — patterns we cannot afford to repeat with psychedelics. With reported estimates that millions of adults are already using psilocybin annually through largely unregulated channels, the black and street market reality is already there. Enhanced patient-centered safeguards, robust ethical infrastructure, and widespread public education are imperative.
Garima Singh, MD. Chief Medical Officer of Centerstone (St. Louis): It’s a little complicated: Short‑term studies suggest that certain psychedelic‑assisted treatments may lead to improvements in symptoms of depression and PTSD, particularly in individuals with severe and treatment‑refractory illness. However, more robust, long‑term studies are needed to better understand durability of benefit, optimal dosing, long‑term risks, side effects, and strategies to mitigate adverse psychological or medical outcomes.
While these treatments hold promise, they should not be considered first‑line therapies at this time. The potential for adverse effects, the need for specialized clinical oversight, and the lack of comprehensive long‑term safety data warrant a cautious and highly regulated approach. Standardization of adverse event reporting and clear clinical protocols will be essential to ensure patient safety as the field evolves.
Additional caution is warranted in individuals under 25 years of age, as the brain is still developing during this period. At present, there is insufficient evidence to understand the potential impact of psychedelic medications on neurodevelopment, and prescribing in this population should therefore be approached with significant restraint. Overall, psychedelic treatments may have an appropriate role in carefully selected, severe, and refractory cases, but further research and regulatory guidance are necessary before broader clinical implementation.
Robert Trestman, MD, PhD. Professor and Chair of Psychiatry and Behavioral Medicine at Virginia Tech/Carilion School of Medicine and SVP and Institutional Research Officer of Carilion Clinic (Roanoke, Va.): Our current treatments for serious mental illness are frequently inadequate to assist our patients to full recovery and to have the ability to thrive. I support the effort to prioritize and destigmatize the search for such treatments. Right now, though, there isn’t meaningful evidence to guide whether psychedelics in general may be beneficial, let alone which psychedelics at what doses are appropriate for which specific disorders and for which specific individuals. Further, it may likely require careful research into what concomitant therapies (such as guided psychotherapies) may be needed to yield consistent benefit to patients. This is the work of appropriately designed and approved research studies conducted and monitored safely by those with appropriate clinical expertise. If we invest in high-quality research on psychedelics, the work must be done responsibly. Psychedelic research should follow the same ethical and regulatory standards as any other potential medical treatment, utilizing unbiased study designs, protecting patients who participate, and interpreting results carefully.
Tobias Wasser, MD. Chair of Psychiatry and Behavioral Health, Hartford HealthCare — Fairfield Region and Chair of Psychiatry at Frank H. Netter MD School of Medicine at Quinnipiac University (Bridgeport, Conn.): This could be a meaningful step forward toward accelerating research for new potential treatment options for a variety of conditions. I just hope that we maintain the proper and rigorous regulatory practices in place to ensure we maintain patient safety in investigating and potentially bringing new treatments to market. The APA released a statement on this that captures my sentiments.
The APA said it “recognizes the urgent need for new and effective treatments for serious mental illness, particularly for patients whose conditions have not responded adequately to existing therapies. We commend the federal government for elevating this issue as a national priority. At the same time, additional research is essential. There is currently inadequate scientific evidence for endorsing the use of psychedelics to treat any psychiatric disorder except within the context of approved investigational studies. Research trials should be conducted only by fully trained clinicians in controlled and strictly monitored clinical settings.”
Read the APA’s full statement here.
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