Equity Implications of Telehealth Policy on Medication Abortion Care Service Delivery

by Dana Northcraft and Natalie Birnbaum

Since Roe v. Wade was overturned in June 2022, fourteen states and two territories have banned the provision of abortion care altogether.[i] Still, abortion rates in the United States are on the rise. This is in part due to the expansion of care delivery through telehealth for medication abortion (TMAB), which now accounts for 19% of abortion care delivery.

Although TMAB improves accessibility to patient populations nationwide, access is not spread evenly. TMAB is prohibited in ten states and one territory in addition to the  states/territories with abortion bans.[ii] While some bans are explicit, others result from aggregate regulatory roadblocks that make care impracticable. These barriers to care most commonly impact Medicaid populations, populations living in rural or low-income urban areas, non-English speaking, and BlPOC communities. Research suggests that telehealth utilization more broadly has been lower amongst people in racial and ethnic minority groups than in groups of non-Hispanic White people.

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Stuck in the Middle with You: Licensing Reforms for Cross-State Telehealth

This post launches a Digital Symposium on The Future of Telehealth Regulation, edited by Carmel Shachar, Assistant Clinical Professor of Law and Faculty Director of the Health Law and Policy Clinic at the Center for Health Law and Policy Innovation. The symposium continues the conversation from a working group held in June 2023 titled “Achieving Telehealth’s Potential”, out of which a Consensus Statement for two feasible policy paths forward emerged. The working group was funded by a grant from the Commonwealth Fund. The symposium will run in Bill of Health until September 9, 2024.

by Carmel Shachar

Part of what makes telehealth an exciting new modality for delivering care is that it is geographically unconstrained. This proved to be an important feature during the pandemic, when connecting patients to physicians across the country during a time of health care shortages was challenging. Telehealth’s divorce from geography remains important, especially for patients who struggle to find appropriate providers within their local communities. Cancer patients may need to find an oncologist who specializes in their particular cancer.  College students going back and forth from home to campus may struggle to keep a consistent therapist as they shuttle between two states. Patients with rare diseases may find that they need to access specialists at academic medical centers.

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Bioethics, Psychedelic Therapy Abuse, and the Risk of Ethics Washing

By Tehseen Noorani and Neşe Devenot

Introduction

The academic discipline of bioethics is becoming a prominent arena for the discussion of ethics abuses in psychedelic therapy. With this being a relatively new topic of research for bioethics, it may be opportune to consider blind spots in the discipline’s own gaze and operations, which can otherwise hinder effective engagement with the issues at hand. We write in the wake of an extensive search by Gather Well Psychedelics, a psychedelic therapy training organization, to contract professional bioethicists to conduct an ethics audit of their organization. We ask, what challenges arise for bioethicists offering professional services when taking on commissions to work for organizations such as Gather Well that are emerging out of the psychedelic underground?

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View on Namche Bazar, Khumbu district, Himalayas, Nepal.

Intersectionality, Indigeneity, and Disability Climate Justice in Nepal

By Pratima Gurung, Penelope J.S. Stein, and Michael Ashley Stein

The climate crisis disproportionately impacts marginalized populations experiencing multilayered   and intersecting oppression, such as Indigenous Peoples with disabilities. To achieve climate justice, it is imperative to understand how multiple layers of oppression — arising from forces that include ableism, colonialism, patriarchy, and capitalism — interact and cause distinctive forms of multiple and intersectional discrimination. Only by understanding these forces can we develop effective, inclusive climate solutions.

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Person examining psilocybin mushrooms in lab.

Psychedelic Inequities and Unexplored Risk: Colonization, Commercialization, and Regulation

By Tegan M. Carr

As a researcher studying the psychedelic experiences of people of color in hopes of driving equitable psychedelic health care, I’m concerned about the ways in which Black, Brown, and Indigenous contributions have been excluded in the development of the psychedelic field and investigation of novel psychedelic therapies. By excluding diverse contributions to the psychedelic field, we risk establishing psychedelic practices that exacerbate racial health inequities (disparities) in which people of color experience worse health outcomes as compared to whites on a population level. These patterns are already emerging in therapeutic psychedelic outcomes.

This piece identifies three interrelated topics that warrant scrutiny as drivers of psychedelic racial health inequities: the colonization of psychedelics, psychedelic commercialization & rent-seeking, and regulatory processes.

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Two hands exchanging a pill.

Let Go and Surrender: Considerations on MDMA Couples Therapy and Coercive Control

Note from Susannah Baruch, Petrie-Flom Center: Following this recent post in the Critical Psychedelic Studies symposium on the Bill of Health blog, two sets of researchers whose studies were described in the post expressed concerns that the post contained inaccuracies. As the Executive Director of the Petrie-Flom Center, which publishes Bill of Health, I made the decision to temporarily remove the original post to look at the issues carefully and to give the author and researchers more time and space for discussion. The original post is now back up [below] with an addendum from the author. My thanks to everyone involved for being helpful and patient while we gathered more information.

By Kayla Greenstien

From 2016 – 2022, I worked in client-facing community support work, focusing on domestic abuse and sexual assault. Throughout this time, I regularly witnessed how the mental health system struggled to respond to non-physical violence in the form of coercive control — an insidious form of abuse that involves intimidation, threats, and manipulation to restrict the autonomy of another person. On countless occasions, I saw coercive and controlling behavior entirely attributed to mental illness, resulting in missed opportunities and devastating injustices. Outside of work, I also started to notice how little of the content in my psychology coursework discussed domestic abuse. Little (if any) content focused on the psychology of people who engage in abuse and coercive control. Despite more open discourse on domestic abuse, it seemed like the mental health system was still deeply reticent to talk about power and control.  

At the same time, a new wave of research on psychedelic and MDMA therapy was underway. In 2021, I signed up for a psychedelic therapist training program, and the next year I started a PhD in Australia, studying the theoretical underpinnings of psychedelic therapies. I saw psychedelic therapy as a “paradigm shift” in mental health care. I wanted to believe psychedelics could get rid of the patriarchy, just like Ben Sessa said it did at raves in the 1980s. (Sessa is now facing medical practitioners’ tribunal in the U.K. for an alleged relationship with a patient.) But as I learned more about the theories and practices accompanying clinical trials of psychedelics and MDMA, I found misogyny, queerphobia, and alt-right New Age spirituality woven throughout. When multiple reports of sexual abuse emerged from underground, ceremonial, and clinical trial settings, I heard the same tropes that are used to discredit women in court: “It was a consensual relationship…She has BPD and manipulated him…This is all about a scorned woman seeking and revenge…”. Slowly, I started to see how historic and contemporary discussions on psychedelic and MDMA research largely ignored theories on power, control, and abusive interpersonal relationships, particularly in couples therapy.   

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Healthcare concept of professional psychologist doctor consult in psychotherapy session or counsel diagnosis health.

Should a Psychedelic Therapist Be Able to Continue Therapy for Their Patients Beyond Formal Integration Sessions?

By Samuel Hatfield

Psilocybin and MDMA were recently rescheduled in Australia for clinical use, leading many mental health professionals to question how psychedelic therapy will work in practice. As part of a research team at the University of Sydney, I recently interviewed as number of experts in the field, with the aim of developing a comprehensive taxonomy of matters relating to psychedelic therapy that are or could be regulated. We also sought to identify where there was uncertainty or disagreement about the implementation of these matters. One point of contention was the provision of ongoing psychotherapy by the psychedelic therapist beyond the formal integration phase — which, given the vulnerability and suggestibility of patients undergoing psychedelic therapy, may give rise to important ethical considerations. With practitioners from a range of professions likely to act in the role of psychedelic therapist, this is an issue with cross-disciplinary relevance.

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A Brief Political Economy of Hype

By Maxim Tvorun-Dunn

Silicon Valley depends on boom-and-bust cycles, manufacturing a new wave of investments every few months by promising grand technological revolutions, whether through AI, cryptocurrency, metaverses, or any other buzzword of the tech industry. These bubbles are furnished by media narratives and tech journalism. Through uncritical reporting of press releases and overexaggerating claims, news outlets help tech industrialists inflate their stock portfolios, while regularly ignoring the politics of privatization and automation. Reporting on psychedelics has followed similar trends, regularly positioning research on psychedelic therapy or drug manufacturing as Silicon Valley’s latest panacea.

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medieval castle and moat at sunrise with mist over moat and sunlight behind castle

Beyond the Psychedelic Competitive Moat: Chasing the Patent Dragon

By Amanda Rose Pratt and Shahin Shams

In the last five years, the granting of overly broad psychedelic patents led to the creation of the nonprofit online psychedelic prior art library Porta Sophia. As Porta Sophia-affiliated researchers with expertise in psychedelic science, patent law, archival history, and rhetoric, we have come face to face with the way psychedelic hype manifests within the world of psychedelic patent documents.

Here, we examine hype in the context of a perennial tension at the heart of patenting communication: between advertising innovation and keeping it secret. Given the fact that innovators cannot disclose their technological innovations if they hope to gain patent rights over them, and that they simultaneously need to attract investors—often on the merits of their intellectual property portfolios—what public communication strategies emerge? We look closely at the patenting strategies of the psychedelic biotech company MindMed here because their case reveals important insights about the rhetorical dynamics related to tensions around public psychedelic patent communication.

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Person examining psilocybin mushrooms in lab.

When the Promises of a Policy Do Not Meet the Reality of Its Practice: Ethical Issues Within Oregon’s Measure 109

By Tahlia Harrison

As a practicing therapist in Oregon working with complex trauma survivors, I was optimistic at first about the passage in 2020 of Measure 109 and its promise of legalizing psilocybin-assisted therapy. Psilocybin has been shown in small samples to be an effective intervention for many challenges my clients face; I was excited about this option to further support their healing. As a bioethicist and researcher examining topics related to psychedelic-assisted therapy, and a former faculty member at one of the psilocybin facilitation programs, Measure 109 also brought feelings of trepidation and a flood of questions such as: Would my national associations be amenable to this intervention? Would my liability insurance provide coverage? What about the ethics of engaging clients in a treatment involving a federally illegal substance? What about informed consent and other ethical issues? While the current informed consent form used by facilitators does address some aspects of concern (like the use of touch, 333-333-5040 (9)), it does not address other aspects like suggestibility or power dynamics within the facilitator/client relationship. Additionally, the form states “I understand that psilocybin services do not require medical diagnosis or referral and that psilocybin services are not a medical or clinical treatment,” yet it is reported that many are still seeking this as part of treatment for a medical diagnosis. How do multiple licensures apply to understanding scope of practice? Three years later, many of these questions remain unanswered, and the option of offering psilocybin-assisted therapy remains illegal and off the table.

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