r/shroomstocks

https://ca.finance.yahoo.com/news/compass-pathways-announces-employee-inducement-102500633.html

Includes exclusive comments from Kabir et al.

https://darkmatterpragmatism.substack.com/p/the-elegant-challenger?utm_source=notes-share-action&r=3zqme1

depsite having been deep in the rabit hole since jan 25. i learned a lot reading this piece which author was highlighted by u/therealseba !

CMPS unknowns 👀

The five variables Borecky says will decide everything

1. REMS staffing requirement — MA vs licensed therapist. Single most important regulatory decision.
2. Actual payer reimbursement for 0820T CPT codes. Category III ≠ guaranteed payment.
3. Drug pricing and buy-and-bill margin. Compass needs to price for clinic profitability.
4. DEA scheduling and state implementation. Friction that doesn't appear in models.
5. Antidepressant washout requirement. Real adoption barrier.

few extracts to peak your interest :

Compass’s Phase 3 retained the one-to-one Certified Psilocybin Session Monitor structure that the FDA’s guidance treats as an uncharacterized variable; the company is now attempting to translate that trial architecture into a lighter commercial model.

 

BPL-003 excluded prior non-response to ketamine, esketamine, ECT, VNS, or DBS, which excludes the patients for whom every prior interventional option has already failed [21]

The trial tells you what the drug does in a population the drug will struggle to reach.

 

Consider the modal patient who sits in an interventional psychiatry clinic after two or three failed SSRI trials. She is sixty-something. She is on 25 mg of sertraline, a dose her primary care physician started her on four years ago and never titrated; her daughter is on the same medication at the same dose. She has heard of ketamine, has strong opinions about it, and is not sure whether those opinions would survive her reading the label carefully. She has not heard of Spravato. She has not heard of COMP360 by name. She has heard of 5-MeO-DMT exactly once, on a podcast her adult son sent her, and what she heard was enough to make her decline the conversation before it began.

She is not the exception in the clinic. She is the modal TRD patient. The likelihood that such a patient consents to inhale a drug whose cultural footprint consists of Tyson, Pollan, Johnson, Town & Country, and a set of recent federal headlines drops sharply relative to her likelihood of consenting to a ketamine infusion, and drops further still relative to her likelihood of accepting a fifth oral antidepressant. Multiply her across a practice and the constraint becomes visible. The infrastructure constraint is real. The recruitment constraint is upstream of it.

 

Compass’s 3.8-point MADRS delta looks modest until the question becomes who it applies to. COMP360’s Phase 2b enrolled 6% of its patients with prior psychedelic experience, the lowest proportion of any modern psychedelic TRD trial; [11] its cohort is more naive, more representative of the average TRD patient’s cultural distance from the drug class. The six-hour session with a therapist in the room is operationally worse on every AtaiBeckley slide. It is also the model that can absorb a patient who would otherwise never consent.

A model that maximizes per-room throughput is not necessarily the model that maximizes treated patients.

The reader who sees only the short-acting elegance is missing the denominator. The reader who sees only the denominator is missing what the short-acting architecture genuinely solves.

The model that produces the cleanest trial result is not necessarily the model that treats the most patients.

The patient who will decide which bet was right exists in every interventional psychiatry practice. She is on a submaximal dose of an SSRI her daughter also takes. She has heard things about 5-MeO-DMT from her son’s podcast, none of them reassuring.

The spreadsheet does not see her. The clinician who might prescribe the drug does.