Psychedelics as a Catalyst for a New Mental Healthcare Model: Part III – The Potential Value of Digital Health

In our previous installment, we explored the fact that therapy with a psychedelic substance typically goes far beyond the medicine itself.  Most often, it’s integrated with preparatory counseling, therapist support during the drug treatment itself, and talk therapy after a drug treatment.  This, of course, can have significant implications for the overall cost of therapy, as well as access and reimbursement (particularly in the US).

However, digital health solutions may be able to help address potential cost issues while also supporting more integrated and effective therapeutic solutions for patients.  The promise and value of digital health in psychedelic-assisted therapy (AT) is the topic of this article, the final one in our 3-part series.

Digital Health:  Augmenting Psychedelics for Better Treatment

In today’s world, people spend about a third of their waking hours on their mobile phones.[1]  There’s no doubt that technology has become ingrained into the fabric of our lives, affecting nearly everything that we do.  So, it’s no surprise that our dependency on our smartphones has impacted how we learn about and access healthcare.

In the US, 87 million people used a health or fitness app monthly during 2020, and 62% of all smartphone users reported using their devices to gather health-related information.  That’s a higher percentage than online banking (57%), job searches (42%), or accessing school, work or educational content (30%).[2]  It stands to reason that digital health and therapeutics are well-positioned to play a crucial role in the future of medicine.  To learn more about digital health broadly and digital therapeutics specifically, see our whitepapers Digital Therapeutics 101 and Under Pressure: Prescription Digital Therapeutics, a Look at the 2022 US Market Landscape.

In general, digital health solutions have the potential to reduce inefficiencies, improve access, boost quality, reduce costs, and make healthcare more personalized for patients.  These value propositions are especially salient for the psychedelics industry, which involves potent compounds, large commitments of time and effort from therapists, and inexperienced patients.  All of the factors call for a more holistic and comprehensive approach to therapy.

Aligning the Psychedelics & Digital Value Propositions

When considering the potential benefits of integrating digital therapeutics with psychedelic therapy, they can be reasonably grouped into three main areas:

1. Efficacy
2. Access and Efficiency
3. Data and Personalization

Efficacy

Studies are finding increasing evidence that psychedelics such as LSD and psilocybin, as well as mind-altering drugs such as ketamine or MDMA, when combined with psychotherapy, can gain traction against hard-to-beat mental health conditions like post-traumatic stress disorder (PTSD),[3] depression, anxiety, substance use disorder, and obsessive compulsive disorder.[4]  In addition, several clinical studies indicate that digital psychotherapy can be just as effective for patients as traditional face-to-face sessions.  Furthermore, digitally-delivered psychotherapy has been found effective in treating many of the same psychiatric diseases that are targeted by psychedelic therapy research.[5]

The impact of psychedelics on aspects of mental health have been attributed to specific features of the psychedelic experience. The experience is modulated by the type of psychedelic drug, dosage, the environment in which it is administered, and the participant’s individual mindset (i.e., the patient’s predispositions and openness to the experience). These features are all thought to contribute to the therapeutic outcome and emergence of any persisting positive changes in behavior or attitude.[6]

Commonly digitized mental health treatments that have synergies with the psychedelic experience could be scalable, accessible, conduits for modulating the overall therapy session and enhancing outcomes.  Some examples might include:

• Virtual Reality (VR) – VR can prepare hallucinogen-naive participants for the sensory distortions they will experience in psychedelic states. It can also be used during psychedelic sessions to optimize the therapeutic setting.  Scientists may even delineate which settings are most effective for therapeutic benefit and simulate them in VR.[7] [8]
• Mindfulness and Meditation Training – Mindfulness-based approaches and psychedelics share various phenomenological and neuropsychological effects (e.g., altered states of consciousness, “peak” experiences, antidepressant and anxiolytic effects) that suggest a combined approach could yield synergistic effects.[9]
• Music Therapy – Clinical research demonstrates that music is integral for meaningful emotional and imagery experiences and self-exploration during psychedelic therapy.[10]

Access and Efficiency

As discussed earlier in this paper, behavioral therapy will be critical to administering psychedelic products, but access has historically been a challenge in the US.  Digital interventions can offer easier access to therapists or digitized psychotherapeutic elements, as well as access to information about psychedelics, the treatment experience, and ways to destigmatize it.

These solutions may be able to improve efficiency and even drive down costs by providing a mechanism for remote patient monitoring, appointment scheduling, tracking, and enabling communication between appointments.

Data and Personalization

Psychedelic research is still in its early stages.  Given the heterogeneous nature of patients’ experiences and responses to psychedelic drugs, the collection of real-world patient data will be important for further advancing the field.[11]

Patient-reported outcomes data collected via mobile apps or through wearable technology could provide insight into how patients respond to therapy.  That data could also be leveraged to optimize and personalize treatment and ensure continuity of care after sessions.  Eventually such data could form the basis to predict response (i.e., digital biomarkers).

Digital Health and Psychedelics: The Current Landscape

Psychedelic companies and their forays into digital health provide insight into how the market is seeking to align the value propositions of digital and psychedelic agents.  The list in Table 1 below is representative, though not necessarily exhaustive.

Table 1:  Selected Examples of How Psychedelics Companies are Integrating Digital Therapeutics (DTx)

As more psychedelics companies look to commercialize, digital health can provide a mechanism to improve treatment efficacy, broaden access, share information, and enhance the efficiency of delivering and coordinating care.  Furthermore, it has the potential to help deliver extremely personalized therapeutic experiences. Ultimately, digital health can help deliver disease-modifying therapy to patients.  Given the critical nature of each of these factors, we believe digital health to be an important component to psychedelics’ path to commercialization and anticipate these two industries will become further intertwined in the future.

Conclusion:  A New Care Model

As the psychedelics market continues to grow and generate more mature clinical evidence, the traditional (and oftentimes fragmented) care model will need to adapt to support effective clinical use and commercialization of these products. There are high hopes that the introduction of regulated psychedelics-AT products will provide a stronger motive force for development of a new and better care model that integrates drugs, clinicians, and digital health in novel ways.  This would provide modern holistic care to patients in a way that has not been available in the U.S.  With all the right ingredients, this may also help to reorient the way that behavioral and mental health services are paid for, provided, and measured to reach more patients and make mental health treatment more equitable and effective.

Endnotes:

[1] Wakefield, Jane, People devote third of waking time to mobile apps, BBC News, Jan. 12, 2022. https://www.bbc.com/news/technology-59952557

[2] Franklin, Remy, 11 surprising mobile health statistics, Mobius MD, Oct. 25, 2021, https://mobius.md/2021/10/25/11-mobile-health-statistics/#:~:text=3.,in%20the%20next%20three%20years

[3] Mithoefer, M.C., Feduccia, A.A., Jerome, L. et al. MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology 236, 2735–2745 (2019). https://doi.org/10.1007/s00213-019-05249-5

[4] Castro Santos H, Gama Marques J. What is the clinical evidence on psilocybin for the treatment of psychiatric disorders? A systematic review. Porto Biomed J. 2021 Feb 11, https://pubmed.ncbi.nlm.nih.gov/33884324/

[5] Luo, Candice, et al, A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis, The Lancet, VOLUME 24, 100442, July 1, 2020, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30186-3/fulltext

[6] Sekula, Agnieszka D. et al, Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy, Frontiers in Psychology, March 4, 2022, https://www.frontiersin.org/articles/10.3389/fpsyg.2022.813746/full

[7] Aday JS, Davoli CC, Bloesch EK. Psychedelics and virtual reality: parallels and applications. Ther Adv Psychopharmacol. 2020 Aug 14;10:2045125320948356. doi: 10.1177/2045125320948356. PMID: 32922734; PMCID: PMC7446267.

[8] Kiros, Hana, VR is as good as psychedelics at helping people reach transcendence, MIT Technology Review, Aug. 6, 2022, https://www.technologyreview.com/2022/08/06/1056727/vr-virtual-reality-psychedelics-transcendence/?truid=&utm_source=the_download&utm_medium=email&utm_campaign=the_download.unpaid.engagement&utm_term=&utm_content=09-22-2022&mc_cid=b9a417312e

[9] Eleftheriou and Thomas, Examining the Potential Synergistic Effects Between Mindfulness Training and Psychedelic-Assisted Therapy, Frontiers in Psychiatry, Aug. 11, 2021, https://www.frontiersin.org/articles/10.3389/fpsyt.2021.707057/full

[10] O’Callaghan, et al, Experience of Music Used With Psychedelic Therapy: A Rapid Review and Implications, Journal of Music Therapy, April, 10, 2020, https://mindmedicineaustralia.org.au/wp-content/uploads/2_Experience-of-Music-Used-With-Psychedelic-Therapy.pdf

[11] Carhart-Harris RL, Wagner AC, Agrawal M, et al. Can pragmatic research, real-world data and digital technologies aid the development of psychedelic medicine? Journal of Psychopharmacology. 2022;36(1):6-11. doi:10.1177/02698811211008567

[12] Field Trip Health press release, Sept. 2, 2020, https://www.prnewswire.com/news-releases/field-trip-psychedelics-inc-introduces-trip-a-mobile-app-designed-to-expand-your-mind-301122785.html

[13] Wavepaths website, https://wavepaths.com/music-for-psychedelic-therapy, accessed Oct 13, 2022

[14] Entheo website, https://entheo.digital/product, accessed Oct. 13, 2022

[15] MindMed press release, MindMed to Launch Albert, A Digital Medicine Division for Psychedelic Medicines, Nov. 24, 2020, https://mindmed.co/news/press-release/mindmed-to-launch-albert-a-digital-medicine-division-for-psychedelic-medicines/

[16] MindMed press release, MindMed Developing IP For Personalized Psychedelic Assisted Therapies, Jun. 24, 2020, https://www.prnewswire.com/news-releases/mindmed-developing-ip-for-personalized-psychedelic-assisted-therapies-301082578.html

[17] MindMed press release, MindMed Closes Acquisition of HealthMode, a Leading Machine Learning Digital Medicine Company, Feb. 26, 2021, https://mindmed.co/news/press-release/mindmed-closes-acquisition-of-healthmode-a-leading-machine-learning-digital-medicine-company/

[18] MindMed press release, MindMed and BioXcel Therapeutics Publish an International Patent Application Describing a System for Identifying Agitation Episodes, Sept. 2, 2021, https://www.prnewswire.com/news-releases/mindmed-and-bioxcel-therapeutics-publish-an-international-patent-application-describing-a-system-for-identifying-agitation-episodes-301368033.html

[19] atai website, https://atai.life/programs/introspect/, accessed Oct. 13, 2022

[20] Butcher, Mike, Nue Life Health raises $23M Series A Led by Obvious Ventures for psychedelics platform, April 19, 2022, TechCrunch, https://techcrunch.com/2022/04/19/nue-life-health-raises-23m-series-a-led-by-obvious-ventures-for-psychedelics-platform/