Psychedelic Pharmacists Association Is Working to Promote, Establish the Role of the Pharmacist in Psychedelic-Assisted Therapy

Pharmacy Times interviewed the co-founders of the Psychedelic Pharmacists Association (PPA) on the work of the association and current efforts PPA is working on to establish pharmacist’s role in the growing psychedelic medicine industry. PPA co-founders who joined the conversation included Sa’ed Al-Olimat, PharmD, a board director of the Allegheny County Pharmacists Association and founder of PsiloHealth; Michael Haichin, PharmD, BCMAS, a senior medical information associate at Eli Lilly Canada and medical advisor at Psychedelic Alpha; Emily Kulpa, PharmD, a psychopharmacology and entheogen consultant; and Kevin Lanzo, PharmD, a lead clinical scientist – psychiatry at Genentech.

The panel outlined PPA's foundational principles, the potential role of pharmacists in the emerging field of psychedelic medicine, PPA’s ongoing initiatives, and the platform available for pharmacists to contribute, learn, and collaborate within the association.

Alana Hippensteele: Hi, I’m Alana Hippensteele with Pharmacy Times. Joining me for a conversation about the work of the Psychedelic Pharmacists Association, or PPA, and its current initiatives in the field of psychedelic medicine are PPA co-founders Sa’ed Al-Olimat, PharmD; Michael Haichin, PharmD, BCMAS; Emily Kulpa, PharmD; and Kevin Lanzo, PharmD. In addition to their work with PPA, Al-Olimat is also a board director of the Allegheny County Pharmacists Association and founder of PsiloHealth; Haichin is a senior medical information associate at Eli Lilly Canada and medical advisor at Psychedelic Alpha; Kulpa is a psychopharmacology and entheogen consultant; and Lanzo is a lead clinical scientist – psychiatry at Genentech.

What is the Psychedelic Pharmacists Association, or PPA, and why was it founded?

Sa’ed Al-Olimat, PharmD: The Psychedelic Pharmacists Association is a professional nonprofit focused on connecting pharmacists that are passionate and curious about psychedelics. We are also advocating for the need to include pharmacists into the standard of care as psychedelics become legalized. Additionally, the aim of our association is to also educate all stakeholders—patients, providers, and pharmacists—about what psychedelics are, what they can offer, and risks and benefits—everything there is to know about psychedelics.

Emily Kulpa, PharmD: Thanks, Sa’ed. And why was it founded? I think it's kind of a cool story, how we all came together. Right? I mean, it's it was kind of in the works for a while.

I think we came together as a group, what at the end of 2020, but we'd been conducting—I think what this was during COVID, like via LinkedIn virtually, I remember I was working at that time at Synthesis, [which is a] retreat center in the Netherlands where truffles were legal. And I have that on my profile. And I remember being super scared as a pharmacist to just put that I was working in this space. And then I had people kind of contact me, very curious, like “Oh my gosh, what are you doing? What is this?” I don't even know how I found myself kind of kind of doing this work, it’s really fascinating. But then we all kind of connected and had such a big passion and interest.

For me, I think I've been working in this space for maybe around a year. I also got connected with the group up at the University of Toronto, [where] they established the Canadian Center for Psychedelic Studies. I think right now they're running a clinical trial on microdosing psilocybin vs placebo, and I got connected with them and did some consulting work with them, trying to spearhead this project. And I just saw that there weren’t many pharmacists in the space. It was a lot of therapists, psychiatrists, other health care providers, and I'm like, “Oh, well, this is drug-assisted therapy, and pharmacists are the medication expert.” At the time, I was the screening director, so people from all over the world were coming to apply to these retreats. And we would do reviews looking at their health history, medications that we were on, and I think we were denying half of applicants due to that, because in the clinical trials, they weren't including anybody on antidepressants and anti-anxiety medication. So that was interesting.

So, I think, for me, it was like, I see kind of a gap that I think pharmacists could fill. And I was looking around to see are there any other pharmacists in this space? And I think there were a handful at the time, but that's when I started to connect with more people who were very interested about the psychedelic-assisted therapy space.

Kevin Lanzo, PharmD: Yeah, absolutely. And to build on Emily's point, we founded the PPA, all of us having got together just how Emily described because we wanted to do something to bring pharmacists together, right? We weren't sure at first exactly what that was, whether it would be some kind of a paper that we would publish together, or a working group of some kind. But we eventually settled and decided that a nonprofit association could have the greatest impact.

Once we all got together and decided that that's what we wanted to do, we really put our boots on the ground and tried to figure out how do we set this thing up right. None of us had ever created or ran a nonprofit before or been a founder, and it was just a really beautiful process along the way. We've learned so much and grown really close as a group, and I'm just really proud of all the work that we've done together.

Hippensteele: So, who make up the membership of PPA? Would they be pharmacists only or is it a bit more expansive?

Lanzo: I can say right off the bat that we have a lot of diverse members from all different kinds of professional backgrounds in the PPA. I know since the beginning we've had very vocal nurses, as well as pharmacy technicians now, as well as pharmacy students. And many pharmacists, of course, with different varieties of backgrounds. We have clinical pharmacist, community pharmacists, compounding pharmacist, pharmacist that have exited the pharmacy field and still want to be involved, those who are just getting involved in the first place, all throughout the continuum of what it means to be a drug expert and a pharmacist. And in many different states and countries as well. We have members in Lebanon, Canada, the UK, just to name a few. And even more from there.

Al-Olimat: We got some lawyers too, some psychiatrists, some MDs, DOs too. All are pharmacist allies.

Michael Haichin, PharmD, BCMAS: Yeah, we have a fairly open door policy. So, although our organization is more targeted towards pharmacists, pharmacy students, and those working in the related professions, we encourage all interested parties to join just because it is ultimately an educational offering. That all can benefit from.

Kulpa: Yeah, we have students as well who are interested. And like Kevin said, it's people who have maybe been involved in the space or had an interest for a while or also people who are just kind of curious and maybe very new to this. But yeah, they have a curiosity of like, “Okay, let's, let's look at the data, look at the research, and kind of see what potential benefits are there.”

Hippensteele: So, you mentioned as you were figuring out what a collaboration would look like for this group—what was the mission and scope of founding PPA as a nonprofit organization, and why was that the most advantageous?

Haichin: Harping back to what we discussed in terms of the founding story. For me, it was about finding the others. The fact that I had found a small group of pharmacists that shared a similar passion and interest, I wanted to know how could we do this on a larger scale? I thought back to when I was in pharmacy school, and how I would have killed to join a club related to this, so making it accessible online as a nonprofit association, with an educational mission in mind, it seemed like the most obvious avenue. I'll let others speak to our mission and vision more specifically.

Kulpa: Yeah, thanks for that, Michael. So, we have 3 pillars advocacy, education, and collaboration. And I think for me, when I was working at the retreat center, there was then—now I'm based in Oregon, that's why I'm based here is Measure 109 was in progress, and they were trying to get that passed—and it did. But then in that process, they had created a board to advise, and so one of our other co-founders, who also is an Oregon, Regina Moore, and I applied to that board and saw that no pharmacists got picked. But every other discipline got picked to be on this board. So, we talked, and I think that was a big pillar, because we recognized especially I think what happened in the cannabis industry that I think we kind of got left behind.

So, it's like, “Hey, if we want to be involved in this, we really need to pave the way; we need to get ahead of it. We need to get involved in these legislation efforts and these advocacy efforts. So that's a big pillar, if we're going to be a part this process, we have to talk to the lawmakers and the key stakeholders and make sure that they're aware of what we can do as pharmacists and how to incorporate and include us and our expertise and knowledge as these rules and regulations get created and implemented.

Lanzo: Absolutely. I'll add that. As far as the choice of how to format the founding of the PPA, we decided that creating it as a trade association of sorts, it's a 501C6, so not your traditional 501C3, would be the most advantageous to allow us to advocate for our profession of pharmacy, which means that we can spend more time than most nonprofits on advocacy, and we're very proud of this because we really believe that it's not just—the community that plays a huge role, but also the governance and regulation over all of pharmacy, and psychedelics as a medicine is something that we want to play a role in. And we believe that it can be shaped.

Al-Olimat: Yeah, and it's really the lobbying aspect to, right? That's the perk of being that 501C6, and you have this field of medicine that has been around for a long period of time. It's only for us to lose, like no one's talking about pharmacists, everyone's talking about psychotherapists, psychiatrists, and different types of prescribers. They all have a role to play. And so do we. So, the reason why we need to be advocating for ourselves is no one else is going to, we have to.

Hippensteele: So, I'm curious, you're talking about trying to kind of lobby and establish a role for pharmacists and make sure that that's a part of the current process that's being developed. What I mean, this might be difficult to say there's one ideal model, but is there an example of what that involvement might look like as we're looking at upcoming approvals and availability of some of these drugs, and what that might look like down the road?

Kulpa: I think there’s multiple different approaches, I'll just touch briefly, but multiple different areas, I think one just being included in the conversation, right, like I said, there was this board that was created in Oregon, and there wasn't a single pharmacist on there. And in these meetings, they were like, “Oh, we really could have done with a pharmacist on X, Y, and Z.”

And I think sometimes in the conversations that we have with people, they don't even think of us, right, or they don't even know our expertise outside of the dispensing role. So that's one piece.

Al-Olimat: It's also getting ourselves out there to those key decision makers. So, for example, having calls with like MAPS PBC [recently renamed to Lykos Therapeutics], who are in the process of [submitting an NDA to the FDA for] MDMA-assisted psychotherapy. Making sure that they know that, “Hey, we're more than just specialty pharmacy, we're more than just again, dispensing. There are so many more avenues that we as a profession can take.” But we need to be seen and heard about that.

It also means for different states legalization efforts, as Emily mentioned, like getting involved in some of the decision making there, because there's going to be the federal legalization, which will happen. But then there's also the state by state approach that is really the “Wild West.” Being able to make sure that pharmacists can have a role, or at least the pharmacist perspective is included in the decision making, that's an utmost priority as well.

Haichin: Our organization, although heavily focused on the medical model, we are not solely focused on that. And so, we do take into account the bigger picture. And the fact of the matter is that with the increasing amount of research and attention on these substances, people are already using these substances. And the hope is that they'd be open to speaking to their pharmacist about their use and seeking information from them.

So, in terms of the ideal model that we're thinking of, I don't know that there is one. I personally see it as a sort of plug and play where we are meeting needs that are coming up as patients use these substances, and subsequently, through the medical model where we can provide our expertise.

Lanzo: One thing I want to continue highlighting that Michael has inspired is just the realization that pharmacists are the most accessible health care provider. Everybody knows a pharmacist in their neighborhood, right? Everyone has pharmacists nearby. And if psychedelics truly do expand to the point where they're more accessible, perhaps via the medical route, perhaps by other state routes, people will have more questions, people will need more sources of education, and if we have health care providers that can become more educated about psychedelics, and how they interact with the mind and the body around and accessible, then it will be very scalable. And I think this is a huge pillar of what we believe with how pharmacists can help the implementation of psychedelic medicine.

Kulpa: And going off of what Michael said about the plug and play, I just see the continuum of care in this therapy where we can be inserted right away at screening. I think pharmacists can be on a team to help screen looking at medication interactions, looking at which psychedelic is the best fit for the indication. Also, because a lot of people are going to be on antidepressants, anti-anxiety medications—to taper and not to taper—is that a goal of therapy? That’s something that pharmacists could help with. Even possibly maybe facilitation as an option—that is something that we were kind of thinking about with the MDMA therapy. And for example, I just finished an accredited psychedelic facilitation training program here in Oregon, which will make me eligible to get a license to be one of the first psilocybin facilitators in the nation. I think pharmacists who are appropriately trained could do well in that role, as well. And then even afterwards, we know that the therapy component is very important, and we're not therapists, but there's this integration, and I do think that pharmacists could provide some kind of support in the integration piece, as well.

Hippensteele: So, one topic that comes up for me is around some of the things we've learned from cannabis and cannabis dispensaries and models that may be improved upon. It's going to be very—a lot of the psychedelic medicines that are up for approval are going to be very different than cannabis in terms of the process for that. But I have heard that a pharmacy model for cannabis dispensing would be more valuable where those on site are not viewed as kind of retail, but instead, like pharmacists, where they will be able to provide treatments specific to a course recommended by a provider, something like that. And that's kind of maybe a fault in the current cannabis dispensing system.

Are there any things like that that might be ideas to keep an eye on as we're progressing? Certain areas that could be bettered in this process?

Kulpa: Absolutely. I mean, already, I think there's a lot of critiques with the Oregon model. It's not a medical model, it's a legalization model, so you don't need diagnosis, you just have to be 21 years and older and go through a screening process. I was looking at because they have rules and regulations for where you get the products and all of that, and I think just looking at the cost of a certain amount of psilocybin dried mushroom product, because of all the rules and regulations, is significantly more expensive than if you were getting it elsewhere. I think just the barrier to entry too—it’s $3,000 to apply for license for one year. I mean, if you compare that to pharmacists license every few years, a couple $100. That's significant. To open a service center, it's $10,000. So that's just going to make the price significantly more expensive, which is going to leave a lot of people—this isn't going to be accessible for a lot of people, unfortunately, in the Oregon model, with how that’ set up. So, I do think there's room for improvement.

Lanzo: Yeah, sort of in a slightly different direction. I don't have an answer to the challenges of the cannabis model, but I would like to call attention to historical pharmacy, even in the realm of apothecaries of the past, where pharmacists and their equivalents served as sort of holistic providers of health care. They were at the front line able to help hear, listen, diagnose a patient, and then provide medication there. And, it seems the model that you're discussing of a pharmacist in a cannabis dispensary, for example, would be more along that line of listening to the patient, understanding what their condition is, and then providing a relevant medication. So, just highlighting that there’s historical precedent to things like this, whether it's, cannabis or other medicinal products. There's a lot of value that pharmacists can provide in that way.

Al-Olimat: I think it's also hard to answer that question because there's only so many parallels we can draw between the cannabis industry and what the psychedelic space is shaping up to look like. These compounds—I could argue that cannabis at a high enough dose, depending on how you consume it can be a psychedelic, but if we're just dispensing 5 grams of psilocybin to anyone that walks in with a diagnosis and then letting them go home, I don't know if that's necessarily the way we want to move forward personally speaking, just in terms of risk reduction and safety considerations. I really like the tri-phasic approach where you have the preparation which includes a screening, you have your dose administration, where you have 2 people present supporting the dosage for that patient, potentially a pharmacist could be a person in that room, or may be a facilitator even. And then you have the integration afterward. And we don't see that with cannabis or haven't seen that with cannabis.

So, I think there's a lot we can learn from with the cannabis industry, but there's also only a finite number of parallels we can draw to really understand how the psychedelic space will be practiced.

Kulpa: That's a really good point because I think everything we’ve seen [has shown that] set and setting is so important. So far in the clinical trials with the safe container, there hasn't been any severe adverse events happening. However, I could envision in my mind, what I would love for us to move forward to for pharmacists as a profession is really increasing our scope. So, I think in Oregon, if you get trained, you can prescribe oral contraceptives, and we have these collaborative practice agreements. And I don't see why, if we get trained appropriately on some of these medicines, could we prescribe under collaborative practice agreement and have some kind of clinic model being led by pharmacists in partner with prescribers, especially in rural areas and things like that. That I could see maybe closer to that model, but not exactly, but being the place where the person could come, go get educated, and then have an experience there.

Hippensteele: Fantastic. What are some current initiatives that PPA is working on or focused on right now?

Kulpa: So, we have a variety of committees, one being our education committee within the association. In the education committee, we have a handful of initiatives. We have ongoing educational events where we bring the community together for specific educational topics and discussions. We bring in key experts in the field to talk about specific topics that they're familiar with. We're in the process of providing a comprehensive educational training program as well. That's going to be an 8-hour long course that will be public quarter 1 of next year that will be available for members of our association. It'll walk through a lot of the basics and the skill sets to understand the work of the pharmacist in the psychedelic care systems relating to ketamine, MDMA, and psilocybin. So, we're going to be focusing on those 3 compounds.

Additionally, we have a lot of awesome document shares and a lot of ongoing discussions within the association. It's really like a LinkedIn channel, or LinkedIn platform, but for the association. We can ask questions, get answers, facilitate educational discussion. So, there's a variety of educational initiatives that we're spearheading right now.

Lanzo: I will add that we really are dedicated to collaborating with other organizations, both in psychedelics and we want to work with other pharmacy associations too. So, for example, we have gone to a number of conferences in the last few years, we have community partnerships with such events, where we have spread information in the form of booklets and handouts on drug information for psychedelics, for example. And that's been very popular with a lot of people. And even, outside the pharmacy professionals, it's a good service, we believe. We're also working on the advocacy side, as we mentioned earlier. And so, we're forming committees dedicated to really addressing both local state initiatives and also federal initiatives, developing our perspectives, and we hope to share those in a publicly approved format with perhaps government agencies, and those such opportunities.

Hippensteele: So, kind of expanding on the platform that was mentioned for PPA, what resources are available to members, and how do members collaborate on these projects through the PPA platform?

Al-Olimat: We have a video library of all of our recorded educational events that people can stream whenever they want, wherever they want, as long as they have internet access. So that's one ongoing resource.

We also have a growing repository of drug infographic sheets that are downloadable and printable. They just walk through the mechanism of action, some of the PK/PD, drug interactions, all the clinical pearls related to some of these psychedelic compounds.

Then I really think the biggest resource is the membership—our list keeps growing. I think we're nearing probably 200 members internationally right now. And to be able to, again, just utilize the platform to ask questions to the entire membership community, and then being able to get perspectives and insights from everyone across the globe, I would say the community is really the biggest resource there.

Kulpa: Yeah, absolutely. As soon as you join, we have resources available that get people up to speed, if they're new in this space, like some of the top journal articles and research studies that have been done and website links to have those accessible for members. We've also done book clubs and journal clubs, and all of that has been really cool to be a part of.

Haichin: Just to throw in, because I'm not sure it was mentioned, we also host monthly membership forums. So, it's an opportunity for members to come ask questions about the association or things they are interested in suggesting and projects that the association should pursue.

It can act as like a level setting for new members who want to get to know the association better. So that's also one of our community events that I think members find quite valuable.

Lanzo: Absolutely. We have a number of committees that were mentioned earlier in this conversation that members are able to join. We have new volunteer positions that open up all the time, and just really excited to work with anyone of a diverse background. We believe that all pharmacists have skill sets that they can use to benefit our profession. And yeah, just looking forward to working more with people on creating opportunities like that.

Hippensteele: So, for pharmacists who are interested, how can they become a part of PPA or get involved? Is there a website? How would they go about that?

Lanzo: www.psychedelicpharmacists.org and you'll have the information for how to join there. You can see our board members and our advisors and learn more on the website.

Kulpa: Yeah, we have a Twitter page, we have an Instagram. We have a LinkedIn page as well. So, you can check that out. Yeah, I mean love for you to get involved and help us shape the future of pharmacists in the psychedelic space.