Integrating psychedelic-assisted psychotherapy into addiction care in the Czech Republic: Clinical evidence, safety, and regulatory developments

Abstract The Czech Republic, like many European countries, continues to face significant challenges in treating substance use disorders (SUDs), with high relapse rates and complex comorbidities often linked to trauma and mental illness. Psychedelic-assisted psychotherapy (PAP) has re-emerged internationally as a promising therapeutic modality, although available evidence remains heterogeneous across substances, populations, and study designs. This narrative review critically examines clinical evidence relevant to psychedelic-assisted interventions in SUDs and selected dual-diagnosis populations, with particular attention to evidence quality, safety, and implementation constraints. It also contextualizes recent Czech developments, including ketamine-assisted psychotherapy initiatives, the inclusion of PAP in national addictology guidance, the publication of national psychiatry guidelines for psilocybin-assisted psychotherapy for medical use, and the 2025 legislative reform introducing psilocybin for medical use from January 2026. Across the reviewed literature, the strongest direct evidence for addiction treatment currently comes from a limited number of randomized and controlled studies, while much of the remaining literature remains observational, open-label, historical, or naturalistic. These findings suggest cautious clinical potential rather than established effectiveness across addiction care settings. Recent Czech legal and clinical developments may create a basis for carefully monitored pilot implementation and evaluation, but broader integration will depend on clearer indications, accredited training, longitudinal outcome monitoring, and transparent communication of both potential benefits and unresolved risks.