Guidance for Clinicians on Patient Questions About Psychedelics, With Gus Alva, MD

General clinicians should take patient questions about psychedelic therapies seriously and respond with balanced, nonjudgmental information, even if they lack detailed expertise, according to Gus Alva, MD, psychiatrist and medical director of ATP Clinical Research. He emphasized that inquiries often reflect unmet treatment needs rather than curiosity alone.

“It's really important that if a clinician just dismisses the question, they might then push the patient towards [a] less safe, unsupervised route, and that would be catastrophic in and of itself,” Alva told HCPLive. “It's important for generalists also to know what is approved versus what is experimental.”

He cited ketamine, which is used off-label for treatment-resistant depression, and intranasal esketamine (Spravato), which has received approval from the Food and Drug Administration (FDA) under a Risk Evaluation and Mitigation Strategy. In contrast, agents such as psilocybin, MDMA, LSD, DMT, and ibogaine remain investigational and are generally accessible only through clinical trials or limited research settings.

He encouraged clinicians to screen for features that may increase risk, including histories of bipolar disorder, psychosis, or cardiovascular disease, when patients express interest in psychedelic therapies. These considerations are particularly relevant given reports of patients seeking treatment through retreat centers or other unregulated providers, he said.

“That would actually expose individuals to additional risks,” Alva noted.

Alva also recommended that generalists familiarize themselves with local research programs and referral pathways. Although most clinicians will not deliver psychedelic-assisted therapy, awareness of legitimate clinical trial options can help guide patients appropriately. He emphasized that many individuals pursuing these therapies have experienced partial response or failure with standard treatments, including antidepressants or psychotherapy, and may have higher symptom burden.

Providing clear, evidence-based information while acknowledging uncertainty may help clinicians support patient decision-making. According to Alva, clinicians should focus on understanding why patients are interested, assessing safety considerations, and maintaining open communication. He added that this approach can help strengthen trust while ensuring that patients receive guidance grounded in current evidence and regulatory status.

HCPLive spoke with Alva in light of the White Executive order issued on April 18, 2026, that directs federal agencies to accelerate psychedelic research for serious mental illness.1,2 The order, signed by President Donald Trump, outlines steps for prioritizing review of psychedelic compounds, facilitating access under the Right to Try framework, and supporting collaborative research efforts involving federal agencies, academic centers, and the private sector. With federal efforts accelerating psychedelic research, the field may be moving closer to establishing these agents as therapeutic options for patients with mental illness.

“It doesn't mean that every generalist is going to have to become now a psychedelic expert or therapist or clinician, but we should be able to figure out why [our] patients [are] asking about it who have high-risk features and provide non-judgmental information, as well as referring appropriately,” Alva said. “[This] subsequently will help strengthen the therapeutic relationship of the individual with their provider.”

Watch parts 1 and 2 of our interview with Alva here: White House Order Accelerates Psychedelic Research for Mental Illness, With Gus Alva, MD and Psychiatry Infrastructure Lags Psychedelic Momentum, With Gus Alva, MD, respectively.

Relevant disclosures for Alva include Teva Pharmaceuticals, Otsuka America Pharmaceuticals, AbbVie Inc., Axsome Therapeutics, Janssen Pharmaceuticals, and more.

References

1. O’Neil G. Accelerating Medical Treatments for Serious Mental Illness. The White House. Published on April 18, 2026. Accessed April 20, 2026. https://www.whitehouse.gov/presidential-actions/2026/04/accelerating-medical-treatments-for-serious-mental-illness/

2. Kotkiewicz J. Fact Sheet: President Donald J. Trump is Accelerating Medical Treatments for Serious Mental Illness. The White House. Published April 18, 2026. https://www.whitehouse.gov/fact-sheets/2026/04/fact-sheet-president-donald-j-trump-is-accelerating-medical-treatments-for-serious-mental-illness/