Disengaged: A systematic review of community engagement in psychedelic-assisted therapy research.

People of color have been significantly underincluded in psychedelic-assisted therapy (PAT) research, despite facing challenges commonly addressed in PAT and often more severe symptoms. It may be the case that people of color are underincluded because PAT researchers have not used approaches designed to promote sample diversity. Community-engaged research (CEnR) is a research paradigm that has demonstrated success in promoting participant diversity. We hypothesize that the absence of CEnR in psychedelic science may be a contributing factor to the lack of diversity in psychedelic studies. To examine the prevalence of CEnR practices in PAT research, we conducted a systematic review of the past 10 years of psilocybin, MDMA, and LSD clinical trials in the United States. We reviewed each study (N = 27) to assess whether researchers incorporated CEnR using the Continuum of Community Engagement and reached out to each individual study team to ensure comprehensiveness. Our analysis revealed that only 3/27 (11.11 %) studies incorporated CEnR. In the rare instances CEnR was integrated, PAT researchers used community consultation, which involves relatively little engagement with community members. To improve representation in PAT trials, we recommending incorporating the CEnR principles of 1) mapping and engaging local stakeholders, 2) leveraging existing university-hospital infrastructures, 3) co-designing research and outreach initiatives, 4) securing dedicated CEnR resources, and 5) establishing mechanisms for ongoing evaluation. This systematic review supports that there has been a paucity of community-engaged practices in PAT research, which can be addressed by incorporating our recommendations for implementing CEnR in PAT studies.