No FDA-approved psychedelic therapy landed today. The agency held a four-hour public hearing on future use in supervised settings. Patients will still come in tomorrow and ask. The note has to separate curiosity, last weekend’s retreat, and a recommendation I did not make.

I watched pieces of the hearing. Training, safety, access, data. Veterans, therapists, a few skeptics. Useful as policy. Useless as a plan I can sign. I am not going to write “pending federal pathway” in someone’s assessment like it is a pharmacy.

What they said, not what the internet said

Quote the question. “My neighbor did a week in Mexico for PTSD” is a different visit from “are you going to prescribe COMP360 when it exists.” I answer both. I chart both.

If they used something, get the name they used, the setting (clinic, church, Airbnb, forest), whether anyone was actually watching them, and the last date. Lithium plus psilocybin is a seizure conversation. SSRI plus MDMA is a different one. “Patient interested in psychedelics” erases the interaction.

Do not upgrade a retreat into “psychedelic-assisted psychotherapy” because that is the phrase on a slide. If there was no licensed therapist and no protocol, write “unsupervised use” or “facilitated retreat, not medical.”

What I did not do

I did not start a medicine that does not exist on a label. The note can say that in one line: “No FDA-approved psilocybin or MDMA product available; I did not recommend underground use; continue sertraline and prolonged exposure with Maria.”

I did not promise a timeline. People heard “priority vouchers” and “executive order” and thought next month. I say I do not know, and I write that I said I do not know. False hope in a chart is still false hope.

If they want a trial, I name how one would enroll, or I say I do not have one. I do not become their dealer of waitlists I invented.

Safety without a sermon

Unsupervised use, cardiac history, psychosis history, family mania, current lithium, pregnancy. I ask the ones that change advice. I write the answers.

If they are going to do it anyway, I would rather they tell me the date. I cannot consent to it. I can tell them not to mix it with their MAOI, and I can put that warning in the plan so the next person sees it. That is ugly and it is honest. Pretending they will wait for a REMS program I cannot offer is how they disappear for six weeks and come back worse.

Questions I get

Can I be “supportive of psychedelic medicine” in the assessment? You can be accurate. Evidence exists in trials. You do not have a product. Support without a protocol is a vibe. Vibes do not belong in the plan.

What if they ask me to write a letter for a retreat? I don’t. If you do, that is a separate document with its own counsel, not a sentence buried in a progress note that looks like you ordered the trip.

Should I wait to document until comments close October 5? No. The docket is for the FDA. Your patient is Tuesday. Write Tuesday.