Equity and Ethical Considerations With The Use of Psychedelics

Psychedelic medicine has already arrived at our doorstep. Figuratively, like the gush of Forbes articles clogging up our news feeds with speculation about the (still unverified) benefits of microdosing. Literally, through start-ups like Mindbloom that promise “a personalized therapeutic journey” via a bolus of ketamine delivered direct to your home. It seems like a law of physics at this point that you can’t attend a happy hour without someone asking whether you’ve read Michel Pollan’s “How to Change Your Mind.” This psychedelic renaissance feels as much a part of our cultural zeitgeist as COVID rapid tests and TikTok.

Some excitement is certainly justified as advocates for psychedelic science point to impressive improvements for chronic, intractable conditions like PTSD and treatment-resistant depression. In a recent paper published in “The Journal of Psychedelic Studies,” the authors present retrospective survey data supporting the promise of psychedelic treatments for Special Operations Forces Veterans of the military, a population “often exposed to a greater number of deployments and intense combat episodes” than average wartime servicemembers.

Studies like this beg some questions. What might be the unforeseen impacts if we had widespread access to truly effective, brief interventions for people with severe trauma? When we think of MDMA helping wounded veterans heal and return to their communities, we might see the risks as minimal compared to the opportunities. How do we feel about ibogaine and 5 meo-DMT eventually helping active duty Special Forces assets to return six months sooner to their next classified deployment abroad? How about DARPA-funded novel psychedelic compounds helping private security contractors like Triple Canopy (formerly Blackwater Security Company) reach more corporate clients around the embattled world, by being able to maintain a reliable, untraumatized mercenary workforce?

True believers in the field continue to express a certain urgency in bringing these medicines to people. It borders on impatience. But our path forward must be accountable to community. Others wiser than I have already put forth areas where significant growth is needed before we can call psychedelic medicine fully developed:

1. Address many ethical concerns.

Ethical concerns are sadly nothing new to the field of psychiatry, but psychedelics add layers of both complexity and subtlety to patient-clinician relationships that demands high level oversight.

2. Build systems of supervision, accountability, and restorative justice.

Many of the psychedelic therapy providers in the media who’ve been accused of misconduct have been unlicensed. Providers should be held accountable by their peers and professional institutions.

3. Prioritize replication trials and critical peer review.

One critique of psychedelic research over the past 20 years is that the researchers leading the field lack scientific objectivity in both the design and interpretation of that research. If we really believe in the power of these medicines, we should be humble enough to back it up scientifically through independent verification, vigorous scrutiny, and novel study designs. We can start by ensuring that our research data include populations that might respond differently to interventions, compared to the affluent, white, and heterosexual men that have traditionally dominated the research.

4. Ensure access for historically marginalized groups.

The roots of Western psychedelic medicine are inexorably tied to Indigenous and queer healing traditions. It’s incumbent on those of us who enjoy greater privilege to recenter and to amplify these voices as the field develops.

5. Provide stewardship for the plants, animals, environments, and cultures where natural psychedelic medicines originate, and protect spiritual practices that involve psychedelics.

Many peoples around the world have some tradition of sacred psychedelic use with aboriginal roots. Several of the organisms that produce these psychedelic compounds are already threatened by psychedelic tourism. And voices like Johns Hopkins’ researcher Dr. Robert Jesse have pointed out the potential risks of a psychedelic revolution that lacks a moral center or cultural humility.

The coming of age of psychedelics in our medical system has the potential to do a lot of harm as well as a lot of good. Let’s make sure we act as good stewards.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.