Host: Dr. Ryan Cole | Guest: Dr. Molly Rutherford
Psychedelic-assisted therapies are drawing renewed attention in medicine, with early studies pointing to potential uses in addiction care, depression, and trauma. But are these treatments ready to open new doors in clinical practice, or are patients being asked to trust the promise before the proof is in?
This week, host Dr. Ryan Cole, IMA Head of Medical & Scientific Affairs, is joined by Dr. Molly Rutherford, IMA Senior Fellow in Family Medicine and Addiction Medicine, for a timely conversation on psychedelic-assisted therapies and what physicians and patients should understand as research and clinical interest accelerate.
Last week, the federal government opened the door to a category of medicine that has spent decades on the regulatory sidelines. The executive order signed by President Trump directs federal agencies to accelerate research review of psychedelic drugs including ibogaine, prioritizes FDA review, and sets aside ARPA-H funding to study compounds that Schedule I status has long kept outside the mainstream of clinical research.
The order arrives at a moment of genuine patient need. People who have failed multiple courses of FDA-approved therapy are looking elsewhere: for treatment-resistant depression, for opioid dependence they cannot break, for PTSD from combat and other trauma. The early evidence on psychedelic-assisted therapies is real, and for some patients it has already changed lives. The next phase of work, broader trials and careful clinical integration, will determine how widely those benefits can extend.
Dr. Cole sits down with Dr. Molly Rutherford to walk through what the evidence actually shows, where the gaps still are, and how physicians can hold compassion for suffering patients alongside the rigor that protects them.
Meet the Expert
Dr. Molly Rutherford, MD, MPH
IMA Senior Fellow in Family Medicine and Addiction Medicine. Dr. Rutherford is a board-certified family physician and addiction specialist, and the founder of Bluegrass Family Wellness, a Kentucky-based direct care practice combining primary care, addiction treatment, and functional medicine. She earned her Master of Public Health in epidemiology and health policy from Johns Hopkins University.
1. Why Now: The Executive Order and the Patient Demand Behind It
Last week’s executive order is the catalyst, but it is not the cause. The order directs federal agencies to accelerate psychedelic research review, prioritizes FDA pathways for compounds like ibogaine, supports right-to-try access for eligible patients, and includes around $50 million in ARPA-H funding plus commissioner’s national priority vouchers for qualifying psychedelic drugs. That is meaningful policy infrastructure.
But the policy is downstream of the demand. Patients are not getting better on FDA-approved therapies, and they are searching elsewhere: through alternative media, through word of mouth, through the kind of bottom-up information networks that have changed how people access medical knowledge over the past five years.
In Dr. Rutherford’s clinic, the pattern shows up daily. Dual-diagnosis patients live with addiction layered over trauma, depression, ADHD, and anxiety. Many opioid-dependent patients now feel “stuck” on buprenorphine and want an off-ramp, while alcohol-dependent patients cycle through 30-day rehab stays that aren’t long enough to build durable sobriety.
“I just think a lot of people are really struggling. And so they’re not getting better on the approved, the FDA approved therapies.” — Dr. Molly Rutherford
2. What Patients Are Seeking, and Why Desperation Is Part of the Picture
These patients are not chasing recreational experiences. They are chasing freedom from a cycle their current treatments cannot break. Stigma still flattens that distinction, and when a physician dismisses the question rather than engage it, the patient pays.
Three populations stand out:
- Opioid-dependent patients trying to taper off buprenorphine, who often feel physically dependent on the medication-assisted treatment that helped them stop using
- Alcohol-dependent patients with trauma overlay, who face the hardest treatment ceiling in addiction medicine and continue to relapse on the best current tools
- Veterans and trauma survivors with PTSD, who are watching peers die from suicide while waiting for therapies that work
The street-drug landscape has made desperation more dangerous. Fentanyl adulteration has turned street use into a deadly gamble, and that danger is part of why patients are willing to consider any legitimate alternative, including ones their physicians have never been trained to discuss.
“The percentage of relapse is extremely high for all addictions… people are feeling desperate, too, because it’s so dangerous now to use drugs on the street.” — Dr. Molly Rutherford
3. Where the Evidence Is Strongest, and Where It’s Still Thin
The evidence picture is uneven across compounds, but one mechanism applies broadly: synaptogenesis (the regrowth of broken neuronal connections) is documented across several of these compounds, which is why patients sometimes describe the shift as a rewiring rather than a numbing.
Where the evidence is strongest:
- Ketamine: FDA-approved as Schedule II, used in supervised clinics for treatment-resistant depression, and backed by a meaningful body of NIH-supported research. The most-developed clinical footprint of any psychedelic-adjacent therapy.
Where the evidence is still thin:
- Ibogaine: Early evidence on opioid addiction is genuinely promising, but cardiac toxicity is real and medical supervision is non-negotiable. The 24-to-30-hour experience itself is, by patient report, deeply unpleasant; the transformation, they say, comes after.
- Psilocybin: Foundational work at Johns Hopkins and other institutions has accumulated evidence on hospice and end-of-life care, depression, and PTSD. The signal is there; the trials are still building.
Schedule I status is the central barrier. Researchers face significant hurdles to study these compounds, and pharma has limited incentive to fund work on substances that cannot be effectively patented.
Dr. Cole’s own experience is one example. After a traumatic brain injury years ago, he developed a severe depression that did not respond to standard care. A medically supervised series of ketamine infusions, modeled on NIH-backed research, was, in his words, life-changing. He is careful to note that this is patient experience, not evidence.
4. Holding Caution and Compassion Together
The trap is binary thinking: dismiss patients chasing alternatives, or open the floodgates without rigor. Neither serves the patient.
The COVID-era lessons apply. Observational evidence accumulates into signal. Anecdotes from clinicians treating real patients are not RCTs, but dismissing them as “just anecdote” is a failure mode the profession should have already learned from.
Individualized counsel beats categorical answers. A patient who has been to rehab eight times and is heading to a reputable ibogaine clinic in Mexico is a different conversation than a stable patient on buprenorphine looking for a faster off-ramp.
The risks are real and worth naming clearly:
- Cardiac toxicity with ibogaine, which makes medical supervision non-negotiable
- Individual brain variability: what is transformative for one patient can be destabilizing for another
- Impurity hazards when patients self-source outside supervised clinical settings
- Provider red flags including price gouging, lack of follow-up, inadequate examination, and unclear motivations
These are reasons for physician engagement, not avoidance.
“I learned so many lessons from that experience. It made me a better doctor. It made me doubt a lot more of my medical education. But I think it made me a better one on one doctor with people.” — Dr. Molly Rutherford
5. Research, Access, and Approval: Three Different Things
The executive order is primarily a research instrument. It makes studying these compounds easier; it does not directly make patient access easier. Treatment centers will not appear overnight, and the cannabis precedent illustrates the timeline: rescheduling and broad clinical access took years and remain uneven across states.
Insurance coverage is another bottleneck. Out-of-pocket is the current reality even for ketamine therapy backed by NIH-supported research, which means the patients who could benefit most are often the ones who cannot afford to try.
The Kentucky ibogaine effort shows the political headwinds. Progress was reversed by a state administration change, then rebuilt through advocacy from physicians and people with lived experience. That kind of political fragility will shape what the new federal posture actually delivers.
Building the evidence base without lowering standards is the work. The path runs through universities willing to study these compounds without ideological filtering and journals willing to publish the findings.
“The aim is to make it easier to study. Not necessarily to make it easier to get treatment in the United States as of yet. And that’s going to be a challenge.” — Dr. Molly Rutherford
Conclusion: What Comes Next
For physicians, the path forward is engagement, not avoidance. Patients who have failed the standard of care are already finding their way toward these therapies, sometimes well, sometimes badly. The choice is not whether to participate in that conversation. It is whether to be useful in it. First, do no harm includes the harm of inaction when current treatments are failing.
Related Reading
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