Ensuring Access to Psychedelic-Assisted Therapy in Rural Communities

With several classical psychedelics being designated as breakthrough therapies and the recent review of a New Drug Application for 3,4-Methylenedioxymethamphetamine in the treatment of posttraumatic stress disorder, the likelihood of psychedelic medication becoming approved for clinical use in the United States is high. Psychedelic-assisted therapy (PAT) may have a high demand in rural America, where residents experience higher burdens of morbidity and premature mortality, due to unique social disparities not shared by urban residents. In these rural settings, barriers to accessing PAT include geographic, economic, and cultural factors as well as the preexisting shortage of health care providers. Disparate access to PAT for rural residents in the United States could exacerbate existing rural-urban inequities. Thus far, the potential challenges of implementing PAT in rural communities have not been extensively discussed in the medical literature. In this perspective, we explore notable implementation barriers in the rural setting and propose potential solutions, including the incorporation of PAT into rural health care training programs, leveraging tools for remote care such as teletherapy for PAT preparation and integration sessions, and implementing new models of care and economic incentives to enable rural PAT providers and rural generalists to deliver PAT. Providing PAT in rural areas will require creative approaches to surmount significant obstacles: the potential solutions discussed here may help ensure rural populations are not left behind if psychedelic medicine is reincorporated into clinical practice in the United States.