An Open Letter on Psychedelic-Assisted Psychotherapy, Public Protection, and Evidence-Informed Regulation
To the Leadership of the BC College of Social Workers and Other Canadian Health Regulatory Colleges,
We write as practitioners, educators, researchers, students, and clinicians working across mental health, public health, and social care. We support robust professional regulation and public protection. We also support an evidence-based, anti-oppressive harm-reduction-oriented approach to emerging therapies. This letter expresses our concern that the recently offered guidelines by the British Columbia College of Social Workers (BCCSW) on psychedelic-assisted psychotherapy prioritize legal defensiveness over patient safety, scientific evidence, and ethical clinical practice. We call for a more thorough, evidence-informed regulatory approach that reflects contemporary knowledge and lived and living experience.
The current guidelines clarify that psychedelic-assisted psychotherapy is outside the authorized scope of social work practice except within narrow federal legal pathways. It prohibits social workers from administering, possessing, facilitating access to, referring to, or advertising psychedelic-assisted therapy. It further restricts clinicians from "suggest[ing] or imply[ing] safer ways to use" psychedelics or engaging with unregulated providers. While it permits psychoeducation and preparation or integration counselling, the scope of these activities is unclear and these activities are required to be strictly separated from any facilitation or endorsement of psychedelic use, including harm-reduction discussions that could be interpreted as guidance.
We are also concerned that these guidelines appear to have been released without a transparent, structured consultation process that meaningfully engaged practising clinicians, researchers, educators, ethicists, and people with lived experience. In the absence of such engagement, key definitions and boundaries in the guidance remain ambiguous, which has predictably generated confusion and concern among regulated professionals and trainees who are trying to interpret their ethical and clinical obligations in real-world care. A proactive input process would have enabled the College to surface foreseeable implementation issues, clarify the intended scope of permissible clinical dialogue, and distinguish prohibited facilitation from clinically necessary risk assessment and harm reduction. In turn, this would have reduced uncertainty, supported consistent practice, and strengthened public confidence in the guidance’s purpose and application.
From a patient safety perspective, the guidance creates conditions that may discourage disclosure and meaningful clinical dialogue. Patients are increasingly aware of and interested in psychedelic therapies, and many will pursue these experiences regardless of regulatory positions. When clinicians are constrained from discussing risks, contraindications, medication interactions, trauma vulnerability, or warning signs, the quality of care becomes compromised. The guideline effectively pushes use into unsupported settings while preventing regulated professionals from applying basic clinical judgment and shared decision making to mitigate foreseeable harms.
Furthermore, the guidelines risk undermining trust between patients and regulated professionals. Patients who are informed about the scientific literature may perceive social workers and other clinicians as constrained, evasive, or ideologically opposed to care that is widely discussed in medical and academic contexts. This credibility gap threatens the therapeutic alliance and may drive patients away from licensed care toward underground facilitators who lack accountability, standards, or oversight.
Importantly, the guidance is misaligned with a growing body of peer-reviewed evidence demonstrating potential benefits of psychedelic-assisted therapy for treatment-resistant depression, post-traumatic stress disorder, end-of-life distress, and substance use disorders. By artificially separating preparation and integration from the therapeutic model in which evidence of benefit exists, the guideline fragments an intervention that is evaluated as a whole. This places practitioners in an ethical conflict between regulatory compliance and their obligation to practice in accordance with the best available evidence.
The conflict posed here props up and adopts a prohibitionist logic in which illegality is treated as a proxy for clinical harm. This approach reflects outdated drug policy paradigms that have repeatedly failed to protect public health. It sidelines harm reduction as a legitimate clinical framework and replaces it with a risk-avoidant posture focused on institutional liability. In doing so, it departs from contemporary public health approaches that recognize patient autonomy, reduce preventable harm, and prioritize safety over moral judgment.
Such actions, including the exclusion of social workers and other non-prescribing mental health professionals from meaningful participation in psychedelic care, diminish the value of expertise in trauma-informed practice, relational therapy, cultural safety, and integration. These competencies are central to patient outcomes in psychedelic-assisted therapy. The result is an erosion of interdisciplinary care models and an implicit reinforcement of medical dominance over fundamentally psychotherapeutic treatments.
Moreover, at the system level, the guideline restricts safe, supported access to only a small number of federally authorized pathways, leaving most patients without access. This exacerbates inequity by privileging those with financial means, geographic proximity, or eligibility for research trials. Patients outside these pathways are left without professional support, despite demonstrated need and growing evidence of benefit.
Our Call
Regulation should evolve alongside evidence and clinical reality. Current guidelines, while well-intentioned, risk increasing harm, undermining trust in regulated professionals, and entrenching outdated drug policy under the guise of public protection. A revised approach grounded in harm reduction, interdisciplinary care, and scientific evidence would better serve patients, practitioners, and the public interest. Greater clarity around key harm reduction practices is also needed so as to best support social workers and other regulated professionals as they strive to provide the best care to their clients.
We call on the College and peer regulators to revisit this guideline through a transparent, multidisciplinary, and evidence-informed process that meets existing gaps in the present guidelines. Such a review should meaningfully engage clinicians, researchers, ethicists, and people with lived experience. It should distinguish facilitation of illegal activity from clinically necessary risk assessment and harm reduction. It should align regulatory standards with contemporary science, public health principles, and the realities of substance use. Above all, it should prioritize patient safety and ethical care over legal minimalism.
The undersigned,
We write as practitioners, educators, researchers, students, and clinicians working across mental health, public health, and social care. We support robust professional regulation and public protection. We also support an evidence-based, anti-oppressive harm-reduction-oriented approach to emerging therapies. This letter expresses our concern that the recently offered guidelines by the British Columbia College of Social Workers (BCCSW) on psychedelic-assisted psychotherapy prioritize legal defensiveness over patient safety, scientific evidence, and ethical clinical practice. We call for a more thorough, evidence-informed regulatory approach that reflects contemporary knowledge and lived and living experience.
The current guidelines clarify that psychedelic-assisted psychotherapy is outside the authorized scope of social work practice except within narrow federal legal pathways. It prohibits social workers from administering, possessing, facilitating access to, referring to, or advertising psychedelic-assisted therapy. It further restricts clinicians from "suggest[ing] or imply[ing] safer ways to use" psychedelics or engaging with unregulated providers. While it permits psychoeducation and preparation or integration counselling, the scope of these activities is unclear and these activities are required to be strictly separated from any facilitation or endorsement of psychedelic use, including harm-reduction discussions that could be interpreted as guidance.
We are also concerned that these guidelines appear to have been released without a transparent, structured consultation process that meaningfully engaged practising clinicians, researchers, educators, ethicists, and people with lived experience. In the absence of such engagement, key definitions and boundaries in the guidance remain ambiguous, which has predictably generated confusion and concern among regulated professionals and trainees who are trying to interpret their ethical and clinical obligations in real-world care. A proactive input process would have enabled the College to surface foreseeable implementation issues, clarify the intended scope of permissible clinical dialogue, and distinguish prohibited facilitation from clinically necessary risk assessment and harm reduction. In turn, this would have reduced uncertainty, supported consistent practice, and strengthened public confidence in the guidance’s purpose and application.
From a patient safety perspective, the guidance creates conditions that may discourage disclosure and meaningful clinical dialogue. Patients are increasingly aware of and interested in psychedelic therapies, and many will pursue these experiences regardless of regulatory positions. When clinicians are constrained from discussing risks, contraindications, medication interactions, trauma vulnerability, or warning signs, the quality of care becomes compromised. The guideline effectively pushes use into unsupported settings while preventing regulated professionals from applying basic clinical judgment and shared decision making to mitigate foreseeable harms.
Furthermore, the guidelines risk undermining trust between patients and regulated professionals. Patients who are informed about the scientific literature may perceive social workers and other clinicians as constrained, evasive, or ideologically opposed to care that is widely discussed in medical and academic contexts. This credibility gap threatens the therapeutic alliance and may drive patients away from licensed care toward underground facilitators who lack accountability, standards, or oversight.
Importantly, the guidance is misaligned with a growing body of peer-reviewed evidence demonstrating potential benefits of psychedelic-assisted therapy for treatment-resistant depression, post-traumatic stress disorder, end-of-life distress, and substance use disorders. By artificially separating preparation and integration from the therapeutic model in which evidence of benefit exists, the guideline fragments an intervention that is evaluated as a whole. This places practitioners in an ethical conflict between regulatory compliance and their obligation to practice in accordance with the best available evidence.
The conflict posed here props up and adopts a prohibitionist logic in which illegality is treated as a proxy for clinical harm. This approach reflects outdated drug policy paradigms that have repeatedly failed to protect public health. It sidelines harm reduction as a legitimate clinical framework and replaces it with a risk-avoidant posture focused on institutional liability. In doing so, it departs from contemporary public health approaches that recognize patient autonomy, reduce preventable harm, and prioritize safety over moral judgment.
Such actions, including the exclusion of social workers and other non-prescribing mental health professionals from meaningful participation in psychedelic care, diminish the value of expertise in trauma-informed practice, relational therapy, cultural safety, and integration. These competencies are central to patient outcomes in psychedelic-assisted therapy. The result is an erosion of interdisciplinary care models and an implicit reinforcement of medical dominance over fundamentally psychotherapeutic treatments.
Moreover, at the system level, the guideline restricts safe, supported access to only a small number of federally authorized pathways, leaving most patients without access. This exacerbates inequity by privileging those with financial means, geographic proximity, or eligibility for research trials. Patients outside these pathways are left without professional support, despite demonstrated need and growing evidence of benefit.
Our Call
Regulation should evolve alongside evidence and clinical reality. Current guidelines, while well-intentioned, risk increasing harm, undermining trust in regulated professionals, and entrenching outdated drug policy under the guise of public protection. A revised approach grounded in harm reduction, interdisciplinary care, and scientific evidence would better serve patients, practitioners, and the public interest. Greater clarity around key harm reduction practices is also needed so as to best support social workers and other regulated professionals as they strive to provide the best care to their clients.
We call on the College and peer regulators to revisit this guideline through a transparent, multidisciplinary, and evidence-informed process that meets existing gaps in the present guidelines. Such a review should meaningfully engage clinicians, researchers, ethicists, and people with lived experience. It should distinguish facilitation of illegal activity from clinically necessary risk assessment and harm reduction. It should align regulatory standards with contemporary science, public health principles, and the realities of substance use. Above all, it should prioritize patient safety and ethical care over legal minimalism.
The undersigned,