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Psychedelic-assisted therapies show such promise for intractable mental health conditions like depression, PTSD and addiction that they’ve won bipartisan political support.
Prominent researchers and mental health professionals “are starting to wake up to what shamans have been saying for years,” Vittoria D’Alessio writes at Horizon. “Psychoactive substances have immense therapeutic potential.”
Investors are betting hundreds of millions of dollars that these new therapies will be a gold mine—but legally and logistically, we’re in uncharted waters. How do you define psychedelic therapy? Is it safe? Does it require regulation? Will insurance cover it? Who gets to call themselves a psychedelic therapist? We know psychedelic therapy could potentially benefit millions, but how people will access it (especially as most psychedelics are still Schedule I controlled substances) is contentious indeed.
The Access-First Argument
The mental health problems that psychedelics seem to address — PTSD, depression, addiction, eating disorders — are serious and life-threatening. Because we have so few effective treatments for these illnesses, psychedelic therapy advocates want these substances made available to the public as soon as possible. They argue that restricting psychedelic therapy access is far riskier than opening the gates — especially when you consider that these substances have been in use by humans for thousands of years.
The grassroots psychedelic community is understandably invested in decriminalization and in countering decades of anti-psychedelic propaganda around the risks of these substances. Many see guardrails, restrictions and insurance approvals as code for profit-based restriction or bureaucratic barriers to entry that will leave suffering people out in the cold.
The Access-With-Caution-And-Qualified-Support Argument
Some pro-psychedelic medical professionals say that implementing some type of screening around both psychedelic treatments and psychedelic therapists will provide better outcomes for patients. Clinical psychologist Dr. Rosalind Watts champions psychedelics’ therapeutic potential—and yet she argues that psychedelics alone are not a magic bullet for mental health. In multiple clinical trials, she’s seen that psilocybin can open a door to recovery — but that the therapeutic process, not the drug itself, is needed to help people heal.
Dr. Watts and other mental health specialists say that administering psychedelics without trained support, monitoring and integration will worsen outcomes for patients in need. For those with particular mental health issues, taking psychedelics without supervision could be dangerous.
Anyone who’s ever had a bad trip knows it’s risky to consume psychedelics alone. For most of us, the risks are minimal — but these experiences can unearth trauma. Even Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies (MAPS) told the Washington Post that “minimizing risks” around psychedelic consumption was key. “I don’t want people to think that this is like going on a carnival ride,” Doblin said. “There’s always a risk.”
Those risks are exacerbated for people with histories of schizophrenia, mania, bipolar 1 disorder or psychosis, which is why psychedelic studies typically screen subjects for these neurological issues.
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That said, the grassroots psychedelic community is quick to point out that we already have models for trained guidance and community support that don’t require advanced degrees or licenses. They argue that educating the public about the risks of psychedelics for people with specific mental illnesses, while making mental health screening and care more accessible, will help more than restricting access.
The Exclusive Medical Model
The psychedelic investor space is filled with claims that psychedelics are simply too powerful to consume outside of a clinical setting, so much so that Russell Hausfeld at Psymposia dubbed this cohort “the psychedelic medicalization industry.”
Billionaire ATAI Life Sciences founder Christian Angermayer insists that although humankind has consumed psychedelics for all of recorded history, “they were always regulated. You had to go to a shaman or priest….You should only take these substances with them in a controlled environment and in the right setting.” (Critics note that Angermeyer himself first consumed psychedelics on a yacht with friends.)
ATAI Life Sciences CEO Florian Brand claimed in an interview that “insurance…will play an essential role in actually making those therapies accessible to patients” because most people won’t be able to afford them at “$5000 or $2000 or $3000 per session out of pocket.” At the Green Market Summit on the Economics of Psychedelic Investing in 2020, Field Trip co-founder and CEO Ronan Levy admitted that “marginalized people…might be excluded from accessing this care, because it is going to be expensive.”
There’s a lot to unpack here. First, prohibiting psychedelic therapy outside of medical contexts will fail, just like prohibition always fails. One need only look at the sorry state of cannabis legalization to see how a strictly medical model will pan out.
Second, these investors seem ignorant of the psychedelic gray market. Their actual competition is not one another: It’s the underground psychedelic economy, which is going to grow and thrive no matter what they patent. Consumers will be the ones to decide what costs are reasonable, not CEOs. If nine out of 10 people prefer a $40 infused chocolate bar and a tripsitter from a nonprofit to a $4,000 clinical session with a $500 co-pay? FDA approval won’t change that.
Finally, choosing one “right” path to providing safe, accessible psychedelic therapy is impossible. Everyone can be better served by having options and choices. Insurance-covered psychedelic therapy is a great goal, but doctors’ offices can’t or shouldn’t be the only legitimate route to access it. Some patients may require a clinical approach or a trained therapist, while others would be fine working with a friend, family member or tripsitter.
Any framework we create must co-exist with what Oakland Hyphae founder Reggie Harris calls everyone’s “right to cognitive freedom—the ability to explore the depths of their consciousness without fear of legal repercussions.” Criminalization has already failed. Laws that prohibit personal cultivation will be ignored. Psychedelics grow wild on every continent except Antarctica—and millions of Americans are already consuming psychedelics with the goal of improving their mental health.
