How to increase access to psychedelics?
There is some tension within the process of shaping post-drug law. Expanding the use of psychedelics by making them easier to access could increase risks to individuals and trigger new legal reactions. As different states continue to propose new bills, there is no clear plan of action. Each approach explores different ways to balance the benefits and risks.
One of the most popular approaches is the «adult use» model, first introduced in Oregon and set to take effect in early 2023. Any adults (except in certain categories) can enroll in a psychedelic service session that takes place only at a service center approved by the Oregon Health Authority and supervised by specially trained facilitators who have completed one of the Oregon Psilocybin Services OHA-validated training programs.
By eliminating the need for a medical diagnosis or referral, the adult use model of psychedelics does increase access to these substances. However, the requirement that the trip take place in a government-approved facility, under the supervision of an intermediary with whom the individual may have little relationship, and yet without the involvement of others, may conflict with a variety of social and natural settings. Immersive methods of utilizing psychedelics have been utilized by indigenous cultures for generations.
There is some tension within the process of shaping post-drug law. Expanding the use of psychedelics by making them easier to access could increase risks to individuals and trigger new legal reactions. As different states continue to propose new bills, there is no clear plan of action. Each approach explores different ways to balance the benefits and risks.
One of the most popular approaches is the «adult use» model, first introduced in Oregon and set to take effect in early 2023. Any adults (except in certain categories) can enroll in a psychedelic service session that takes place only at a service center approved by the Oregon Health Authority and supervised by specially trained facilitators who have completed one of the Oregon Psilocybin Services OHA-validated training programs.
By eliminating the need for a medical diagnosis or referral, the adult use model of psychedelics does increase access to these substances. However, the requirement that the trip take place in a government-approved facility, under the supervision of an intermediary with whom the individual may have little relationship, and yet without the involvement of others, may conflict with a variety of social and natural settings. Immersive methods of utilizing psychedelics have been utilized by indigenous cultures for generations.
The state of Colorado has recently gone a step further by including a decriminalization component to adult drug use legislation. This allows citizens to possess, grow, and exchange psychedelics for personal use in any form they see fit. However, psychedelics researchers and practitioners do not favor such unregulated access. They express concerns about the risks of using psychedelics in an uncontrolled environment, as well as fears that decriminalization could hinder rigorous clinical research or lead to an increased supply of drugs on the black market due to the lack of limits on the amount of psychedelics that can be grown for personal use.
In addition to the questions of «where» and «how», there is also the question of «when». As Rick Doblin, director of the Multidisciplinary Association for Psychedelic Studies (MAPS), explained to GQ magazine in 2021, «medicalization precedes legalization». However, the question arises as to how long that might take.
There are two opposing views on medicalization here. One camp (including Doblin) believes that medicalization is necessary to increase public acceptance of psychedelics as more evidence of their medical benefits emerges. Others, however, believe that medicalization will slow down the legalization process.
Clark expressed the view that it is important to develop strong regulatory policies, but she disagrees that medicalization is the best approach at this time. In her opinion, possession of psychedelics only within medical settings could exacerbate the diversity problem. She questioned, «How can you discuss Black or Indigenous history with the medical establishment? Who is having a dialog about medicine and therapy being the only right and safe way?».
In addition to the questions of «where» and «how», there is also the question of «when». As Rick Doblin, director of the Multidisciplinary Association for Psychedelic Studies (MAPS), explained to GQ magazine in 2021, «medicalization precedes legalization». However, the question arises as to how long that might take.
There are two opposing views on medicalization here. One camp (including Doblin) believes that medicalization is necessary to increase public acceptance of psychedelics as more evidence of their medical benefits emerges. Others, however, believe that medicalization will slow down the legalization process.
Clark expressed the view that it is important to develop strong regulatory policies, but she disagrees that medicalization is the best approach at this time. In her opinion, possession of psychedelics only within medical settings could exacerbate the diversity problem. She questioned, «How can you discuss Black or Indigenous history with the medical establishment? Who is having a dialog about medicine and therapy being the only right and safe way?».
There is some concern about psychedelic capitalism. Giving early access to psychedelics to pharmaceutical companies, medical researchers and opportunistic investors will transform the psychedelics industry, including the substances themselves, long before they become available to the general public. The main danger here is that capitalism's desire for profit will not necessarily encourage sensible research, implementation, and harm reduction measures to help guarantee smooth and fair reintroduction.
Schwartz-Plaschg argues that adding non-biomedical aspects (e.g., decriminalization) can help maximize benefits. «The wider the range of psychedelic services and legal use in society, the more people will be able to benefit from their own well-being, which ultimately contributes to societal prosperity in the long run».
However, the transition from biomedical to recreational cannabis legalization can be stressful and requires caution. Businesses dealing with this substance, which is legalized at the state level but prohibited at the federal level, face additional costs (e.g., they cannot write off business expenses on their federal taxes and face the challenge of finding insurers). Success in this industry is more often achieved by large corporations that have the financial resources to invest. «To move fast, you have to go slow» — Clark noted. «This lesson can be learned from the cannabis experience, and with psychedelics it's especially important to take your time in the beginning. It's the initial stages that are key because of the various large and important challenges that have to be faced».
Schwartz-Plaschg argues that adding non-biomedical aspects (e.g., decriminalization) can help maximize benefits. «The wider the range of psychedelic services and legal use in society, the more people will be able to benefit from their own well-being, which ultimately contributes to societal prosperity in the long run».
However, the transition from biomedical to recreational cannabis legalization can be stressful and requires caution. Businesses dealing with this substance, which is legalized at the state level but prohibited at the federal level, face additional costs (e.g., they cannot write off business expenses on their federal taxes and face the challenge of finding insurers). Success in this industry is more often achieved by large corporations that have the financial resources to invest. «To move fast, you have to go slow» — Clark noted. «This lesson can be learned from the cannabis experience, and with psychedelics it's especially important to take your time in the beginning. It's the initial stages that are key because of the various large and important challenges that have to be faced».
Today's moment presents an opportunity for broad representation and participation from all stakeholders, both in the field of psychedelic drugs and in the development of medicines based on sacred plants. The psychedelic renaissance is closely tied to colonial legacies, but movements towards decolonizing the industry can help strengthen principles of equity and increase dialogue about different models of access to these remedies.
These indigenous approaches vary by culture and place, but generally share several common themes. First, as Clark explained, psychedelics are not seen as substances you «take», like aspirin or an antidepressant, but as entities with which you enter into a relationship. «It's a deep and sacred relationship based on reverence and kinship». Second, many indigenous models could not be realized in a solitary journey in a cozy doctor's office, isolated from larger communities of practice.
Finally, many indigenous models do not recognize the distinction between the therapeutic and the spiritual. Illness and a person's existential relationship with self and the world go hand in hand. The idea that the therapeutic mechanism can be derived from a spiritual context is seen as a kind of Western conceit.
These indigenous approaches vary by culture and place, but generally share several common themes. First, as Clark explained, psychedelics are not seen as substances you «take», like aspirin or an antidepressant, but as entities with which you enter into a relationship. «It's a deep and sacred relationship based on reverence and kinship». Second, many indigenous models could not be realized in a solitary journey in a cozy doctor's office, isolated from larger communities of practice.
Finally, many indigenous models do not recognize the distinction between the therapeutic and the spiritual. Illness and a person's existential relationship with self and the world go hand in hand. The idea that the therapeutic mechanism can be derived from a spiritual context is seen as a kind of Western conceit.
Next stop on the trip
President Biden's administration expects the FDA to approve MDMA and psilocybin for the treatment of PTSD and depression in the next one or two years. This could create pressure on the DEA to revise its list of Schedule I drugs, which are considered to have no recognized medical use and a high potential for abuse. This status, many believe, limits access to these substances and makes further research and use difficult.
There will likely remain many restrictions and laws governing access to psychedelic substances even after they are approved. One study, based on cannabis legalization trends, suggests that most states will be able to legalize psychedelics in the next 14 years. However, it remains to be seen what opportunities (and risks), researchers will be able to explore with these changes or whether they will only study a narrow range of potential uses for these substances.
How can legalization efforts be advanced to increase access to psychedelics outside of medical practice? This requires creating a variety of programs and settings beyond standard clinical trials or government-approved psychotherapeutic practices. This requires the participation of diverse populations, not just the privileged few who can afford expensive therapeutic services. It also requires even implementation of harm reduction programs, combined with maximization of benefits.
One idea that has been proposed is licensing legalization. This is similar to obtaining a driver's license, but for the purchase of psychedelics. Once a person reaches a certain age, they would be given the opportunity to undergo a supervised psychedelic experience in a specialized facility, which could be compared to an initiation ritual in which the basic principles are learned. There may also be theoretical training to gain basic knowledge. After successful completion of the procedure, the person is given a license that allows them to buy and use psychedelics as they see fit. However, if the rules are violated, the license can be revoked, as is done with traffic offenders.
Proponents of regulated legalization do not yet have answers to the question of how to reduce procurement costs, which is one of the reasons for supporting decriminalization. With decriminalization, personal cultivation becomes more accessible and cheaper. Experience with cannabis legalization shows that trading in Category I substances requires regulatory compliance and tax burdens, resulting in higher prices.
The path to licensed legalization is also not without challenges. Lowering barriers may increase the risk of harm, as safety measures are more developed in clinical settings than for communities unaccustomed to drugs. Business models for psychedelics involving collaboration with indigenous communities have not been established.
Proponents of regulated legalization do not yet have answers to the question of how to reduce procurement costs, which is one of the reasons for supporting decriminalization. With decriminalization, personal cultivation becomes more accessible and cheaper. Experience with cannabis legalization shows that trading in Category I substances requires regulatory compliance and tax burdens, resulting in higher prices.
The path to licensed legalization is also not without challenges. Lowering barriers may increase the risk of harm, as safety measures are more developed in clinical settings than for communities unaccustomed to drugs. Business models for psychedelics involving collaboration with indigenous communities have not been established.
However, there are experiments, such as Journey Colab's Reciprocity Trust, which allocate a portion of their capital to give back to indigenous communities and other stakeholders. Increasing demand due to widespread access could put pressure on the ecosystems where psychedelics grow. The development of synthetic alternatives based on open science may help, but the question remains as to their efficacy compared to their natural counterparts.
Anyone, regardless of their inclinations or anxieties, can find something deeper and potentially useful in psychedelics. While disturbances in everyday life can be easily detected by measuring the electrical activity of the brain, the question of how rich ordinary experience can be remains open and is rarely discussed.
Psychedelics allow attention to be paid to the construction of ordinary consciousness, regardless of where a person is on the scale of mental disorders. However, the norms and rules of access are part of a larger system of conditions that define the psychedelic experience. Hopefully, in the growing post-prohibition world of psychedelics, we will not limit ourselves to laboratory research and medical aspects, and will be able to enjoy the strange, fascinating, sometimes risky, and meaningful visions offered by a broader approach to psychedelics.
Anyone, regardless of their inclinations or anxieties, can find something deeper and potentially useful in psychedelics. While disturbances in everyday life can be easily detected by measuring the electrical activity of the brain, the question of how rich ordinary experience can be remains open and is rarely discussed.
Psychedelics allow attention to be paid to the construction of ordinary consciousness, regardless of where a person is on the scale of mental disorders. However, the norms and rules of access are part of a larger system of conditions that define the psychedelic experience. Hopefully, in the growing post-prohibition world of psychedelics, we will not limit ourselves to laboratory research and medical aspects, and will be able to enjoy the strange, fascinating, sometimes risky, and meaningful visions offered by a broader approach to psychedelics.