Cost Considerations in Psychedelic Therapy

As a psychotherapist practicing for over 23 years, I’ve found this work comes with the responsibility of educating and advocating for cost-transparency and fair pay.

Psychedelic-assisted psychotherapy with mental health specialists might be with one therapist, or a second therapist during the medicine session. One or both of those people, or a third therapist, in some cases your own ongoing therapist, will help you integrate the medicine experience beyond the chemical activity in your body to apply it to your ongoing mental health practice. How much each of the people may charge per hour depends on their training, experience and overhead in the area in which they live. Their hourly jobs, which are often as small business owners, are to help support you in your transformation from suffering and trauma to not needing a constant medication and a chance of an improved quality of life.

How much should that person make? Should they have to do it for free? Should they get a subsidized education (scholarships, student loan repayment, grants) for doing this work? What about healthcare? How much does that person need to make to have a chance at financial health, savings, a retirement? If they took student loans out to do this work, should those be forgiven? These are the people TREATING the vets, first responders, the abused, the hopeless, the traumatized. These are the people trying to create a container for an experience that may lead to a transformation that it’s been described with phrases like “mystical” or “near-death experience”. Without this support, these experiences are also described as an adverse effect– terrifying, useless, a funny feeling, dissociation, or something like psychosis.

As it turns out, seeking out a psychedelic experience with no psychotherapeutic support for your click-bait article on WaPo might not be the best intentional way to approach medicines that elicit this experience

**How to write a hack article on ketamine** -- this is 9 of hundreds of examples. Ketamine may only be prescribed by licensed medical providers working within their scope of practice and competency in the highly regulated medical industry-- hardly the "wild west". Medical providers, however, are rarely competent in mental health counseling / psychotherapy, another highly-regulated profession governed by state licensing boards, who must then pursue ongoing minimal training to meet scope of competencies within their scopes of practices.

More billable visits

There are clinicians charging upwards of $250, often more, for a 15 minute appointment, sometimes scheduling 5 appointments per hour while their nurse or staff watch you take $800 sniffs of eskatamine while monitoring for a bad reaction. Another version of this is upwards of $500 for a 40 minute iv visit with racemic ketamine, a generic medicine, when other routes of administration are available and have been studied and prescribed outside of iv form for decades. On that 15 minute medical appointment– that is the reality of healthcare in the United States, not something unique to "at-home ketamine" practices like Mindbloom. Once every few months someone writes a new sensationalized article about the "Wild West of ketamine" and how quick and the "proliferation of ketamine clinics" advertising online. Last I checked, there was an ad for Spravato by Johnson & Johnson just above the ad for Mindbloom, as well as clinics offering in office sessions through less accessible routes of administration. Spravato, a patented form of the generic drug esketamine, is sold as a weekly treatment at $800+ per dose, and is prescribed in the same 15 minute medical visit time slot as Mindbloom's offering of compounded racemic ketamine, a generic medicine sold at around the same price for 6 doses. Ketamine itself costs just a few dollars per dose. That 15 minute medical visit, whether for Spravato or compounded racemic ketamine, or for a medical visit for strep throat, or your ER visit after a 9 hour wait- these appointments costs American patients sometimes hundreds of dollars per visit. Have kidney stones? (For which ketamine has been studied as a pain and trauma relief in acute kidney stone pain.) After waiting in excruciating pain in your local emergency room (looking at you Eisenhower Hospital in Rancho Mirage, California), the medical provider will prescribe you with an opioid painkiller after seeing you for 37 seconds. Seriously. A NINE HOUR WAIT, then after literally 37 seconds with the attending physician, a prescription for a month's worth of Oxtycontin with the advice "Whatever you've done in the past for kidney stones... keep doing that."

These are examples of direct to patient advertising, originated by Republicans led by Ronald Reagan in the 1980's, shown here as examples only. Interestingly, the current rulers of the US want to ban pharmaceutical advertisements on television, les they advertise any helpful medicines or vaccines. /s

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It turns out, in that 15 minute medical visit, it takes just as long for your medical provider to refer you to a psychotherapist as it does to write a prescription for Zoloft, Spravato, or generic ketamine with a huge markup. Many find benefit in the psycholytic dose where the psychotherapist is able to work with newfound cognitive flexibility in a therapy session, while others find that the psychedelic approach, where you talk before and after the acute medicine experience. The therapist/s may also sit with you in every medicine session, or just in the preparation and integration sessions. Some study has been done on types of psychotherapy practices that may work during a window period after taking the medicine, such as cognitive behavioral therapy. To be a psychotherapist in the US requires at least a Masters Degree in most cases. Psychotherapists at the Masters level are required to be licensed by most states as Counselors, Marriage and Family Therapists, Social Workers, Creative Arts Therapists or Nurse Practitioners.

These people are also the unmentioned stakeholders in the news coverage of psychedelic therapy costs and insurance coverage. Most insurance companies reimburse masters level therapists right around $100 an hour, but can range from 65-125 or so. A PhD for the same procedure code? A few dollars more than that. An MD for the same code? A few dollars more than that. So whatever an individual clinician’s training, debt, fancy school, housing situation, or business overhead (marketing, malpractice insurance) may be beyond that, insurance corporations declare how much they’re paying different licensed experts for their time for the same “procedure code” per hour (which is actually 45-50 minutes because it builds in ten minutes to do a note, cry, stretch, pee, etc between clients). The mean yearly income for a masters level LMFT - $ 30.44 per hour or $ 63,300 per year — https://www.bls.gov/oes/current/oes211013.htm .

Salaries recently listed on Indeed for MD level prescribing clinicians $300-400k per year.

Random news here- CA just voted to pay fast food workers $20 an hour. Wild that university plus 2 years, then another 2-3 years of clinical supervision for licensure, then specialized training at MAPS, Fluence, PRATI, Sage, and CIIS at $10k or so per program, then clinical supervision for THAT. It took at least that for that person to help you through what may be your most vulnerable and transformative experience in healing. And they have a take-home pay ten dollars above a fast-food worker. Mad props to workers. Therapists are also workers. Therapists aren’t “above” fast-food workers. But it seems like a question of pay for skilled vs unskilled labor, especially considering what it takes to do the work and the number of people willing to do the work. Fast-food workers need to be able to access psychedelic mental health therapy as much as any one else. Psychotherapists have specialized training at the graduate level with ongoing continuing education requirements to achieve and maintain licensure, with specialty training in psychedelics beyond that base training. There is a minimum of what they have to charge per hour to be able to do this important work with you.

I wonder about the value the humans that are called to do this work are given in all of those minor policy details that are actually very important to the quality of life of the person providing mental health support, and how their work is supported. Should they make $800 an hour?! But also, should they do it for free?! Their personal branding, online clout as defined by likes and subscribes, or the branding of their educational or professional background, their office location or decor– is not what makes them more or less valuable (or effective) in this process. Whether this happens at a retreat, in a fancy designer office, or in community mental health or via telehealth - these folks have very specialized training in order to do their work. How much do THOSE workers need to make? And many of us learn from indigenous world heritages spanning thousand of years which are on the verge of collapse. How much do our teachers need to make and how are these elder practitioners and world cultures supported?

Ketamine as a generic medicine from an accredited compounding pharmacy is as affordable as those pharmacies decide to sell it based on their overhead and the supply and demand of the medicine, and has not been shown to be inferior to the brandname variant of esketamine released by J & J. It seems to work even better with a supportive wisdom approach, with psychedelic-assisted psychotherapy being one approach studied by various fields employing various medicines since the late 1800’s.

Do we minimize the value of the humans doing this work by outsourcing their gifts to AI and underpaying them or removing their value by distilling it down to brain chemistry and cutting out the human aspects covered in counseling and therapy? Not the Muskovian reality many of us want to live in. AI therapist apps have reportedly led to one person's suicide when used without an actual human therapist connection.

This feels like a necessary conversation to have, especially considering the various strikes and lawsuits happening around the country and around the world as society is deciding the value of our roles and gifts. This discussion requires self-advocacy and collective bargaining, or we risk being assigned a value by the Billionaire class.

Some psychedelic medicine developers want to ditch the therapy aspect. What could go wrong?Are drugs like psilocybin and MDMA still safe and effective in the absence of psychotherapy?

Updated cost-effectiveness of MDMA-assisted therapy for the treatment of posttraumatic stress disorder in the United States: Findings from a phase 3 trial (Marseille, et al, 2022)

$11357 was the cost in the study over 42 treatment hours hours (two therapist model) and at about $270 an hour or about $135 per therapist hour.

The medical visit involves a different provider, who will have to be paid for their time and craft, same as the therapists, pharmacist and manufacturer of the medicine. (Reminder- they charge in 15 minute increments at most physician practices in the US, as well as emergency rooms and urgent care clinics.)

This study found that this IS cost-effective, and comes with great societal benefit.

Is psychedelic-assisted psychotherapy for depression more cost-effective than conventional treatments? (2023)

Raise your hand if your medical provider ever prescribed you medication plus cognitive behavioral therapy, or cognitive behavioral therapy alone? It's exceedingly less likely than prescribing you a daily pharmaceutical drug, which are deemed safe enough to be prescribed by general practitioners with no referral for cognitive behavioral therapy, although this is less effective, this study suggests.

The Wild West to the Rescue: Utah suggests MDMA or mushrooms should be done in medical facilities.. Set? Setting?

Utah MDMA-Assisted Therapy & Psilocybin Therapy for hospital setting only, requiring facility fees and higher cost of staffing, however using existing medical infrastructure may facilitate insurance reimbursements. (https://www.americanpatient.org/chargemaster/)

What Psilocybin Costs

2025: Psychedelic treatments in Oregon are expensive, and are likely to be so in Colorado, too, said Tasia Poinsatte, Colorado director of the nonprofit Healing Advocacy Fund, which supports state-regulated programs for psychedelic therapy. In Oregon, psychedelic mushroom sessions are typically $1,000 to $3,000, are not covered by insurance, and must be paid for up front.

The mushrooms themselves are not expensive, Poinsatte said, but a facilitator's time and support services are costly, and there are state fees. In Colorado, for doses over 2 milligrams, facilitators will screen participants at least 24 hours in advance, then supervise the session in which the participant consumes and experiences mushrooms, lasting several hours, plus a later meeting to integrate the experience.

Facilitators, who may not have experience with mental health emergencies, need training in screening, informed consent, and postsession monitoring, Smith said. "Because these models are new, we need to gather data from Colorado and Oregon to ensure safety."

Facilitators generally pay a $420 training fee, which allows them to pursue the necessary consultation hours, and roughly $900 a year for a license, and healing centers pay $3,000 to $6,000 for initial licenses in Colorado. But the up-front cost for facilitators is significant: The required 150 hours in a state-accredited program and 80 hours of hands-on training can cost $10,000 or more, and Clark said she wouldn't pursue a facilitator license due to the prohibitive time and cost.

MSN

August 2024: "What Psilocybin Costs-- It is estimated that the average journey costs about US$1,500. That includes $500-$2,000 for the facilitator, $300-$600 for the room, and $150-$200 for the psilocybin itself. For more intensive facilitation at pricier facilities, costs can be upward of $5,000 per journey."