Psychedelic-assisted therapy: a survey on the clinical methods of Swiss physicians.

In Switzerland, physicians provide psychedelic-assisted therapy (PAT) with psilocybin, LSD, or MDMA under case-by-case exemptions from the Federal Office of Public Health. An anonymous survey of 41 physicians found that PAT is used mainly for depression, anxiety, PTSD, and chronic pain. Most physicians work in private practices (82%) and use body-oriented (61%), psychodynamic (59%), and eclectic (54%) approaches. Psilocybin is the most used substance (85%), followed by MDMA (71%) and LSD (65.9%). Substance choice is linked to diagnosis: psilocybin for depression (54%) and substance use disorder (46%), MDMA for PTSD (86%) and anxiety (54%). Music is played in 90% of sessions. Group therapy is common; 42% provide both individual and group settings. Challenges include legal constraints, high patient expectations, and financial barriers.

Study at a glance

Abstract

The Swiss Federal Office of Public Health provides case-by-case exemptions allowing physicians to provide psychedelic-assisted therapy (PAT) using psilocybin, lysergic acid diethylamide (LSD), or 3,4-methylenedioxy-N-methamphetamine (MDMA). The study provided an overview of PAT as currently provided in Switzerland under the regulatory framework of the Federal Office of Public Health (FOPH). Swiss PAT practices were examined using an anonymous survey of physicians providing PAT. Questions included physicians' backgrounds, training, therapeutic orientation, treatment protocols, patient characteristics, and perceived benefits. Participants were recruited from PAT professional associations and the research team network. Forty-one physicians providing PAT under FOPH exemptions contributed to the survey. Respondents used PAT primarily for depression, anxiety, post-traumatic stress disorder (PTSD), and chronic pain. Most physicians practiced in private practices, private outpatient clinics or shared practices (82%), with a minority in hospitals (18%). The most reported labels when providing PAT were body-oriented (61%), psychodynamic (59%), and eclectic (54%) approaches. Respondents provided PAT using psilocybin (85%), MDMA (71%), and LSD (65.9%). Choice of first substance was linked to diagnosis, with physicians preferring psilocybin for depression (54%) and substance use disorder (46%) and MDMA for PTSD (86%) and anxiety disorders (54%). A total of 90% reported always playing music during psychedelic sessions. Loss of orientation in time and space, feeling too cold, anxiety, and nausea where the most frequent adverse effects of PAT. 95% had emergency medication available, on average used during 2.4% of sessions. Challenges included legal constraints, high patient expectations, and financial barriers. Group therapy was common, with 9% reporting providing only group sessions, 42% providing both individual and group settings, and 47% providing only individual sessions. Only 9% reported never using co-sitters. This study offers valuable insights into the methods and experiences of physicians providing PAT in a legal clinical context, giving insight into the considerable variety of clinical methods. Cultural and regulatory differences may limit generalizability.