Healthcare Providers' Perspectives on Psychedelic-Assisted Therapies Across Clinical Contexts: "I Can Offer Medical Assistance in Dying, but I Can't Prescribe Psychedelics".

Abstract

Background: Healthcare providers' (HCPs) perspectives on psychedelic-assisted therapy (PAT) are critical to clinical integration but remain underexplored in Canadian palliative and oncology contexts. This study examines HCP attitudes toward ketamine, psilocybin, and MDMA, and the systemic and ethical factors influencing implementation.

Methods: An exploratory qualitative study using semi-structured interviews was conducted with 12 HCPs across Canada. Interviews explored attitudes, perceived barriers, and implementation considerations. Data were analyzed using thematic analysis and interpreted through the Theory of Planned Behaviour (TPB) to examine how attitudes, subjective norms, and perceived behavioural control shape clinical integration.

Results: Attitudes toward PAT ranged from caution to advocacy, with neutral-to-cautious positions predominating. Ketamine was pragmatically accepted for rapid efficacy but raised concerns regarding commercialization and misuse. Psilocybin elicited mixed views, particularly in relation to end-of-life existential distress. MDMA was considered promising for trauma-related indications but was constrained by neurotoxicity concerns and regulatory barriers. Subjective norms were shaped by stigma, media narratives, and institutional culture, while perceived behavioural control was limited by restrictive policies, infrastructure gaps, and funding inequities. An ethical tension emerged between access to medical assistance in dying (MAiD) and restrictions on PAT in end-of-life care, highlighting perceived policy inconsistencies.

Conclusion: Participants expressed a range of attitudes toward PAT, from caution to advocacy, alongside substantial ethical, regulatory, and systemic constraints to clinical integration. A notable ethical tension emerged between MAiD accessibility and PAT restrictions in end-of-life contexts, reflecting broader questions about Canadian health policy. Participants emphasized the need for substance-specific guidelines, interdisciplinary education, and evidence-informed regulatory reform to guide future clinical consideration of PAT.