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”.
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…
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.
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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