Five Principles for Reform

Thinking through the ethics of psychedelic liberalization

In last week’s newsletter, I talked about the exponential growth of public activity surrounding psychedelic drugs academically, therapeutically, legally, on the stock market and in the boardroom. Given this context, it is important to remember that despite disappearing from reputable public discourse about 50 years ago, they never really left, and that illicit use of psychedelic drugs has continued, virtually unabated, since then.

OOO, controversy. Get some popcorn! Or Hay.

This is an extremely complex situation. Let’s lay out some relevant facts:

1. Psychedelics, in general, present very little in the way of direct physiological risk.

2. Psychedelics do present the risk of serious adverse psychological experience, and can cause the user to behave erratically and at times dangerously. This is not the normal experience, but it happens.

3. Psychedelics, in particular the classical psychedelics, have been shown to be virtually non-addictive.

4. Long term effects, often called “flashbacks” can occur, though the effects are complex and unclear.

5. Prohibition has not proven to be an effective deterrent to drug use.

6. Prohibition ensures that drugs must be procured from black market sources, in which users will be exposed to drugs of unknown quality and information and practices that are likely to be very poor.

7. It is very difficult to demonstrate large scale public harm resulting from a person choosing to use psychedelic drugs.

8. In a free society, the rights of individual to behave in ways that alter their own consciousness should be given consideration.

9. Research into the use of psychedelic drugs for the enhancement of psychological function is growing at a rapid rate.

10. Research from the 1950’s and ‘60s was halted by the politically motivated prohibitionist campaign.

11. While not definitive, the volume of and quality of the early research cannot be dismissed out of hand.

12. Current research can not be said to be definitive either, but continued science is easily justified by results from previous and current research.

13. The use of psychedelic drugs in certain contexts with certain intentions may be useful for the treatment of mental illness, or for the psychological improvement of any interested adult.

14. In our current cultural environment, there is a great deal of clinical interest in new treatments for mental illness.

15. In our cultural current environment, there is a great deal of financial interest in new “innovative” and proprietary treatments for mental illness.

16. Psychedelic users are vulnerable when under the influence of the drug, and many seeking treatment for psychological distress are even more so. There is a risk of serious harm, not by the direct effects of the drug, but by the behaviour of unscrupulous practitioners. This remains true in all contexts, but is especially true in contexts shaped by secrecy, such as the current environment of prohibition.

17. Psychedelics can be hella fun.

18. Psychedelics may bring benefits to a person’s life that cannot simply be described as “psychological”.

19. Psychedelics may present risks to a person’s life that we are not well aware of.

20. The strongest scientific evidence for the benefit of psychedelics is for the alleviation of existential distress at the end of life.

21. It is hard to argue that psychedelics have not been responsible for some really incredible artwork and music.

22. Psychedelic-type drugs have been used for centuries, likely millenia, in cultures across the globe, for a vast array of purposes.

23. The western, US-led prohibitionist agenda has actively oppressed and disrupted indigenous use and practice of psychedelics around the globe

24. The current US medical system is rife with injustice and issues of affordability and accessibility.

25. The US mental healthcare system shares many of the same issues, only accessibility is arguably worse.

26. Many drugs such as marijuana and psilocybin mushrooms can be grown easily and for virtually no cost and are therefore no more inherently expensive than broccoli or refried beans. Certainly no more than high-quality grass-fed steak.

27. The broad field of mental health is currently ideologically somewhat fractured, with competing visions of human suffering and change. There is not wide agreement on whether the medicalized view, with checklists determining discrete psychiatric “disorders” is useful in provisioning effective treatment.

28. Many, many people find psychedelic drugs to be deeply fascinating, from a kaleidoscopic array of perspectives.

29. Just like in motocross, football, gym class, psychiatric clinics, therapy offices, motor vehicles, relationships, cattle farming, school attendance, horseback riding or any other endeavor in life, people have been harmed by psychedelic drugs. It is important to understand the risks without exaggerating them.

That is, I’m sure, a very partial list. If I have missed any that you find relevant, please add your “complicating factor” in the comment section here:

Given the complexity involved, many people who may be temperamentally cautious by nature may look at the situation and admonish everyone involved to slow down. This is understandable but deeply misguided. As we discussed last week, the repressive, prohibitionist status quo undermines freedom and promotes suffering with no defensible public benefit. Any change is an improvement.

This is why last week I advised that principle #1 for psychedelic reform must be:

Principle #1: Stop putting people in cages for drugs. Now.

No need to to add much here that I didn’t already say last week.

That one is the gimme. After that, we have to think about what values we put at the center of discussion. To do that we have to look at a central tension that seems to be at play.

An anti-coercion agenda

Opposition to major reform often hinges on concerns for safety, particularly the safety of children. This is certainly well-meaning, but at odds with the manner in which we actually live our lives. Risk is inherently a part of life, and many activities that people of all ages routinely engage in are quite dangerous.

On the other hand, what are the risks involved in legally curtailing the freedom of people to behave as they choose? A popular argument is that drug use effects no one but the user, but that is not exactly true. Many other people are in fact affected by the choices of others, and drug use is very often a social phenomena. This is often used as an argument to restrict freedom of choice around drugs, but I think it strongly implies the opposite.

More restrictive drug laws ensure that supply will be met illicitly. Services provided will be provided illicitly. None of these activities will be subject to review and regulation, and providers of these illicit goods and services will be invested in keeping their own behavior secret.

Instead of paternalistically focusing on “safety”, which paradoxically may decrease actual safety, we should instead focus on the autonomy of free adults to behave in a manner of their own choosing. Instead of controlling the behavior of the individual, we should instead focus our efforts on ensuring that he or she has safe access to the experiences that they would like to choose, and access to high quality information about the products and services they choose.

In order to maximize autonomy while also giving citizens the widest array of safe options for using psychedelics, we should support full legalization of psychedelics and open sales of regulated, high quality substances.

Principle #2: Full Legalization is better than Decriminalization

I expect that some who care about the issue and value autonomy may disagree with me. On one hand, reasonable people can agree that prohibition is the worst of all worlds. (Yes, I did imply that proponents of prohibition are unreasonable, and I’m very willing to stand by that implication. Obviously 😊). On the other, are we really thrilled about fully legalizing into a capitalist context in which there is a very powerful profit motive at work to push these substances, using whatever unscrupulous tactics marketing folks often use?

That is, in actual fact, the current situation. The black market is an EXTREMELY effective marketing and distribution network. This network is diffuse, robust, resilient and is not bound by any prosocial code of ethics- including marketing to children. The only required consideration for black market operators are “don’t get caught”. Quality control and quality of point of sale information are not necessarily concerns. If we were interested in making drug use maximally dangerous, this is the way we would do it.

Decriminalization doesn’t disrupt this network in any way. Legalizing sales, if done without undue burdensome regulation (big if), while creating its own problems, can bring sales and distribution into a framework that controls quality and information at the point of sale. It also respects individual autonomy to make their own choices, which, without compelling reason to do otherwise, must be the default. Bottom line- it’s not like we are talking about an addictive, extremely dangerous, regularly behaviorally dysregulating drug such as alcohol.

A regime of full legalization and direct sales must also allow interested people to grow their own and share (not sell) limited quantities with whomever they wish (of age).

Principle #3: Therapeutic use must be AN option, but not THE option

The fields of psychiatry, psychology, counseling and social work have an autonomy problem. They always have. The history of these fields contains a history of forced hospitalization, deranged and coercive treatment, and social control.

Members of these fields have been involved in forced lobotomy, torture programs (recently), widespread forced medication, all kinds of institutional manipulation, mass incarceration, racism, eugenics, and, many would say, pathologizing normalcy.

Please don’t get me wrong, that does not define these fields as they are currently practiced. But it is an important piece of (in some cases not very far removed) history and is still, in certain contexts, relevant today. It’s easy to find professionals working in coercive environments in which it isn’t really clear from the outside if their primary client is the person they are working with or the institution who is paying them.

Many of my readers are therapists or folks involved in research or other capacities within the broad field of mental health, and may bristle a bit at this very unflattering description. Not everyone sees us as we see ourselves, and we have to remember this very ugly history as agents of social control. The profession’s current willingness to collaborate with our monstrous prison system is a case in point that things perhaps haven’t changed as much as we’d like to think.

In this context, is it wise that we insist that this “new”, very experiential and experimental treatment, seen for years as very risky; one that makes participants vulnerable and suggestible, be under the exclusive domain of a field with an extremely checkered history of psychological manipulation?

It’s not.

This isn’t to say that psychological science and the theory and practice of psychotherapy don’t have something to offer to psychedelic practice. I emphatically think they do. That’s actually my prefered topic, for the podcast I co-produce and for this newsletter. I think that conceptually, there are very consilient accounts for understanding the processes of change from both a psychological and a psychedelic perspective. How psychedelics and therapy can work synergistically to cultivate desirable change is extremely exciting.

Additionally, while it is important to acknowledge that while the fields of psychology, psychiatry and psychotherapy do have skeletons in the closet, they’ve come a long way. It’s now commonly (not universally) understood that is is vital to center the needs of individual, acknowledge the social and contextual source of many problems rather than pawning blame off on the individual sufferer, and to highly value the autonomy, privacy and dignity of people receiving care.

Zooming out, there is no way for the study and practice surrounding human behavior to NOT be controversial. The relevant questions are ripe for disagreement: how humans act, why we act certain ways, who is responsible for what type of problem, how folks SHOULD act, what is actually helpful to suffering people, what may be harmful, how someone's suffering may create problems for others, what do we owe each other, what is the role of “society”, and what does it owe individuals, what to DO when someone's suffering creates problems for others... there aren't simple or easy answers. When considering human behavior and suffering, we have to wade right into the thick of political, existential, ontological, and economic questions. We can acknowledge many areas of misstep and even outright abuse and dehumanization without throwing out the entire enterprise and uncharitably ascribing bad motives to all involved. It’s also clearly possible to see there are fault lines and heated debate within the field about these very issues, and it’s completely defensible to suggest that the field is continuing to learn from its mistakes.

Still, while psychological science may have important contributions to make, it is wrong for the fields of medicine and psychology to assert any ownership over currently available, public-domain psychedelic drugs. It’s clear, no matter how much good work is being done clinically and scientifically, that there is still a long way to go, and a medical mindset will only minister very partially to the needs of the psychedelic novice. Pure medicalization would be a brazen overreach beyond the scope of medicine into the realm of individual liberty, mental and even spiritual autonomy.

Psychedelics DO appear to have therapeutic qualities, but those wishing to use them as therapeutics must demonstrate that their formulations, practices and conceptualizations add value over stuff that simply grows in the ground or is already a public good.

Principle #4: Service providers must be credentialed and stay within their scope of practice

In an environment in which psychedelic drugs are legal, any interested adult must be able to try them, because it’s a free country, dammit. This also implies that they can use them in an environment of their choosing. Many will choose, as users currently do, to use with friends, at concerts, at an art museum, alone in a tent in the woods. Many may choose to have professional support for their journey, and they should be able to choose among registered professionals who are suitably trained to create and maintain an environment conducive to the safety and autonomy of the participant.

All “supervisors” “facilitators” “sitters”- whichever moniker you prefer- must be credentialed, registered and subject to disciplinary action through a licensing board. They must meet certain minimal standards of ethics and competence- to value autonomy, to screen and refer to a higher level of care when appropriate, to practice non-harming, to demonstrate competence in the case of emergency, to create and execute a safety plan, to provide an adequate space.

If one wishes to provide supervised sessions for the facilitation of mental health or for the purposes of psychotherapy, they must be credentialed as above AND ALSO licensed to provide mental health services.

There is a lot more to say here, regarding what may be the RESPONSIBILITY of a person who would sit for a tripping person, but that is for another newsletter.

Principle #5: The purpose of science is to increase human knowledge

No one should be allowed to assert private ownership over a public good through the regulatory capture of the patent process. If private companies want to pursue truly novel therapeutics, that’s fine, but they must do so in an environment in which compounds already in the public domain such as MDMA, LSD, psilocybin and others are widely available, and their novel formulations must prove themselves to be desirable improvements.

The willingness if the National Institutes of Health to become involved in psychedelic science is a major victory (if it proceeds), as it allows a scientific agenda more focused on basic science and public benefit rather than corporate-funded science, mainly motivated by ROI. Many points made above about not allowing medicine and psychology to be the sole providers for psychedelics and psychedelic services are relevant here. Psychedelic science must not be under exclusively corporate control. It’s good to see major public institutions and public funders come on board, as the information we are likely to learn from psychedelic research is very much in the public interest and should be for the advancement of the human race generally.

Our current societal relationships with what are currently illegal drugs is untenable. Drug warriors use incredible resources to violate human rights in a manner that doesn’t even achieve their own repressive goals. Fortunately, the public at large is starting to see this, and is starting to decouple drug related “crimes” from ACTUALLY problematic crime that impacts public safety. Drug use is itself not inherently problematic, and the problem of addiction, which is real and exists prevalently with alcohol and tobacco, is best treated compassionately outside a criminal or coercive context.

Prohibition is a problem across all drug categories, this particular newsletter has only focused on issues specific to psychedelics. Please don’t take this omission as an implicit rebuke of work being done to liberalize drug policy in other domains.

So these are my 5 principles for psychedelic drug policy reform. What do you think? I’m very curious to hear, please let me know in the comment section below. See you next week!