For something to be a first-line of treatment, it must have:
- high clinical effectiveness;
- strong safety profiles;
- broad accessibility; and
- cost-effectiveness.
-Psychoactive drugs are effective at changing minds. The exact effects vary from user to user, but can be largely controlled by the clinician/therapist/shamanic guide. Taken alone or in random circumstances they lead to more random (sometimes bad) results.
-Psychoactive drugs are safe. They will not kill you. They will not cause physical harm. In a controlled clinical situation, the chances of a "bad trip" (emotional harm) are very slim.
-Psychoactive drugs are not broadly accessible only because we choose to limit access to them.
-Psychoactive drugs are cheap. They can be produced in laboratories cheaply and cleanly and in controlled dosages.
The first point is the one that is being studied currently: How effective are they? What are the limits of the effects? How long do the effects last?
I cannot say that I would be comfortable with psychoactive drugs as a first line of treatment. I am not in favor of drugs of any sort as a first line of treatment. If not needed, don't prescribe them. But I would not hold them out as a last resort either. If it will help someone, it should be an option.