Psychedelic policy: speed up or slow down?

A debate with Philippe Lucas, MAPS' director of safe acess

This week, I had an enjoyable public discussion / debate with Philippe Lucas, director of research and safe access at MAPS, in response to my NYT op-ed in which I warned about the risks of ‘psychedelic accelerationism’ in US public policy.

In that op-ed, I expressed concern about the wealthy pro-psychedelic lobby (ie millionaire and billionaire psychedelic investors and philanthropists) using their access to the Trump government and to RFK and his MAHA crew at the Department of Health and Human Services to shoe-horn psychedelics into the market without going through the usual FDA approval process or putting proper safeguards in place.

There are signs this could occur, with Antonio Gracias – Elon Musk’s friend, investor and collaborator at DOGE – poised to purchase MAPS’ MDMA corporate spin-off, Lykos, apparently with the hope it can brings its MDMA therapy to market despite being turned down by the FDA last year.

Remember the old Bertolt Brecht saying about totalitarian government - ‘it is necessary to dissolve the people and elect another’? Well, if the FDA turns down your favourite drug, it’s necessary to dissolve the FDA and elect another.

In my op-ed, I suggested any oligarchic special favours for psychedelics would be a bad idea for two reasons. First, it risks politicizing psychedelic science and tying it to the MAGA-MAHA regime (not a regime that is noticeably pro-science). In the words of Michael Pollan:

I know there are people in the psychedelic community who are fervently hoping that between Elon Musk and RFK, they will force the hand of the FDA. But politically, I don’t think that’s a good way to go, long-term. You don’t want to tangle psychedelics up with the kind of science that RFK Jr. has been promoting. My worry is that his embrace will make psychedelics seem kooky, and they’re anything but kooky. This is a very promising treatment for PTSD in particular. If the science is as good as the promoters think it is, then it will be approved under its own steam, without forcing it down the throat of the FDA.

Second, it risks causing harm if the White House gives its federal seal of approval to psychedelic drugs without giving the public accurate information about the risks. This is the heart of a liberal attitude towards drugs, going back to John Stuart Mill’s On Liberty: adults should be free to buy dangerous drugs if potential harms are largely limited to themselves, but the market should be required to give them accurate information on the risks. I suggest we don’t yet have a clear picture of the risks of psychedelics, although I’ve gathered some of the emerging data here. That document doesn’t mention anything about spiritual risks, by the way, although one of the core beliefs of plant-medicine shamanism is that such risks exist and are significant.

In addition, we don’t yet have a proper safety net for those who are destabilized following the use of psychedelics (this is not just my opinion but the opinion of 31 leading researchers into psychedelic safety). Why not? Because we don’t have a clear picture of the possible harms (there isn’t a single paper on, say, post-psychedelic sleep disturbances for example) and we don’t have a clear idea of what helps people recover from those harms (CPEP is the only organisation that has published peer-reviewed studies on recovering from severe post-psychedelic difficulties, and we’re still very much learning). So if people roll the dice and are in the 3-5% (that’s a guestimate) who experience severe post-psychedelic difficulties, they’re left flailing around desperately trying to find out how to return to normal functioning.

Could a REMS slow-roll out of psychedelic medicine give us a clearer picture of these harms? Yes. But we still need to learn what helps people recover from these harms. This is not hard to do and I don’t know why psychedelic science and industry doesn’t make it a top priority.

In terms of public communication, the public needs to know that psychedelics are not a magic pill and can lead to extended periods of destabilization. It’s true that sometimes people emerge from this destabilization feeling better than before, but remember that psychedelic users at the moment skew wealthy and educated. Joe Public might not be able to afford months off work and hours in therapy.

Philippe wrote a response for MAPS’ magazine. His main point, and the main point he made in our friendly discussion (video below), was that prohibition makes everything worse – it allows bad actors to operate outside of accountability, it makes harm reduction methods like drug-testing harder, it makes people less likely to seek help if they’re in crisis, and so on. In his vivid phrase, prohibition is like being trapped in a burning car, and me quibbling about safety issues is like insisting they put on their seatbelts. We need to get them out of the burning car now!

Very few people support the total prohibition of mind-altering drugs these days, and I certainly don’t support it. The real question is what form of regulation, liberalization and commercialization do you support. One can see from the ketamine market or the cannabis market there are a wide variety of options. Each option involves trade-offs between safety and access, freedom (personal and commercial) and public health.

Over on Linkedin, someone accused me of being a ‘slowhibitionist’ (which sounds like an extended form of strip-tease) and suggested I was standing in the way of people desperate for treatment. Anyone can get psychedelics delivered to their door in 24 hours, without any legal consequences. Possession of small amounts of psychedelics is already decriminalized, practically speaking. If you really care about the most vulnerable getting access to insurance-covered psychedelic medicine, follow the FDA route and don’t cut any corners, or insurance companies will decide your much-vaunted treatment is a lot of hot air.

I’m reminded of a conversation between Steve Rolles, director of Transform (a leading drug reform organisation), and Ethan Nadelmann, executive director of Drug Policy Alliance. Rolles said this about drug legalization:

As a starting point you should err on the side of a more restrictive more heavily-regulated model, and then over time as things are shown to be working ok, you can then relax things. What is problematic is if you start with a very underregulated market, it’s much harder then to impose restrictions or regulations if thing aren’t working. We’ve seen that with alcohol and tobacco – it’s been a decade-long battle to impose better regulations against tobacco. When you’ve got a multi-billion-dollar entrenched industry lobbying against regulation it’s much harder to pursue public health goals in that context.

Look at ketamine – even its staunchest advocates now think home-delivery ketamine should be more tightly controlled or even illegalized but it’s too late, because it’s now a multi-million industry with ties to the government through Elon Musk’s DOGE. (Side note: DOGE must be the most drugged-up quango of all time…)

Anyway, I usually steer clear of drug policy discussions, if for no other reason than CPEP has a range of researchers involved and they have a range of opinions on such matters. We’re not a policy organisation. CPEP’s core mission is to educate the public about psychedelic risks and support those in difficulties, not try to influence policy in one way or another. Once adults know the risks of psychedelics, they should be free to roll the dice, in my personal opinion, though I also think it behoves the industry to learn what helps people recover from the harms, just like the diving industry learned how to help people recover from the bends.

After the paywall, watch Philippe and my hour-long debate, with some great questions and comments from the expert audience. Thanks Philippe for the convivial and constructive discussion.