Since the beginning of the US-led War on Drugs nearly 50 years ago, when certain plants and molecules were criminalized—substances selected, in part, for their association with communities that threatened the status quo—people from every walk of life have fought against the structural injustice and grotesque, racist hypocrisy that is the foundation of the ongoing war on drug users and on the other marginalized and under-resourced people who are impacted by prohibition more than anyone else. However, contrary to the dominant narrative, there are, in fact, evidence-based and often time-tested models to integrate presently-criminalized substances into society in safe and intentional ways, while simultaneously reducing the harms that come from problematic use. After years of misinformation and propaganda, the application of these models to the decriminalization and legalization of psychedelics is beginning to reach mainstream audiences in the United States for the first time. As a result, we have reached a point where we must deeply and collectively reflect upon how to mindfully and intentionally create cultural and regulatory frameworks for these plants and molecules as they come back out of the shadows, and many questions remain.
A New Era
I have been working in the policy & advocacy department at the Multidisciplinary Association for Psychedelic Studies (MAPS) since early 2016, during which I have observed and participated in the gradually easing path toward legal access to psychedelics as it has passed numerous notable milestones. Today, we at MAPS, along with our colleagues at Drug Policy Alliance, Students for Sensible Drug Policy, DanceSafe, ICEERS and the Ayahuasca Defense Fund, the Beckley Foundation, and Chacruna are collaborating to explore and map the psychedelic legal and policy topography in the United States and around the world.
Following the momentum of Psychedelic Science 2017, which drew 3000 people earlier this year, MAPS Policy & Advocacy Director Natalie Ginsberg and I hosted a psychedelic law and policy community session at the Drug Policy Alliance’s International Drug Policy Reform Conference, where we facilitated a conversation between over 40 advocates, researchers, and enthusiasts. We discussed psychedelic public health, criminal justice, medical use, commercialization, and the sacramental use of psychedelic plants and molecules, including psilocybin, ayahuasca, MDMA, and ibogaine. Some of the room’s collective thoughts and reflections are captured here.
People use psychedelic substances at celebrations and gatherings of all kinds, so the most immediate way that prohibition affects many substance users is its suppression of on-site common sense, public health oriented practices that would prevent not only medical emergencies, but also unsafe and undesirably-challenging experiences. For instance, implementing harm reduction practices like drug checking and psychedelic peer-to-peer counseling at music venues and other places where people use psychedelic substances would significantly improve the safety and experience of every person participating. However, policies like the RAVE Act (which was passed in 2003, and expanded “crack house” laws to include commercial venues, allowing business owners to be prosecuted if they “maintain a drug-involved premises”) have scared American event producers away from openly implementing these practices, which has put the burden of providing these services on concerned, self-organized teams of activists and caretakers. While DanceSafe, Energy Control, and MAPS’ Zendo Project provide some models for harm reduction practices, it should not be entirely up to resource-strapped nonprofits to provide services that fall within broader public health and wellness policy. While that remains the case, and no major changes are yet on the horizon, ongoing reports of numerous fentanyl-adulterated substances lend an undeniable urgency to the need for access to these potentially life-saving harm reduction services.
The urgency for change is apparent in other sectors as well, including criminal justice policy. Earlier in 2017, the US Sentencing Commission asked MAPS Founder and Executive Director Rick Doblin to testify about MDMA’s sentencing guideline, which currently sits at a 500:1 sentencing disparity between MDMA and marijuana. In conjunction with Rick’s oral testimony to the Sentencing Commission in April, we also submitted a written testimony that argued that the present MDMA guideline is based on inaccurate science that exaggerates MDMA’s actual risks. The USSC’s evaluation of MDMA’s guidelines may mark the beginning of new opportunities for sentencing guideline and other criminal justice policy reforms to be informed more by science and evidence than by sensationalism and ideology.
In the last few months, news has rapidly spread about attempts to introduce initiatives that decriminalize or legalize psilocybin mushrooms in states like California and Oregon. Although we at MAPS—and I, personally—support ballot initiatives decriminalizing psychedelics and other drugs on principle, the introduction of the initiatives in this political climate merits a critical examination of their viability. That said, I am eager to see how these initiatives change the public conversation about options for legal access.
Whatever one’s perspective, these approaches suggest that, at the very least, there is increasing interest among members of the public to decouple the possession and use of the psychoactive mushroom from its current criminal penalties. However, this concerns some advocates who, while recognizing that decriminalization and legalization of psilocybin mushrooms would be promising steps toward a more rational drug policy, are also hesitant to participate in an exceptionalism that provides protections for some users of some substances, but leaves others behind. Selectively-enforced prohibition has been the unifying force at the heart of U.S. drug control strategy since its inception, and a true paradigm shift demands a more inclusive approach. With this in mind, and given the success of efforts to reduce criminal consequences for drug possession in some states (including California and Oregon), some advocates are turning their heads toward decriminalization of all drugs.
MAPS has received a tremendous amount of positive media coverage about the news that FDA assigned breakthrough therapy designation to MDMA-assisted psychotherapy for PTSD and, although the fundraising is ongoing, is set to start Phase 3 clinical trials next year. At the opposite extreme, the President’s Opioid Commission ignored MAPS’ comment recommending that the federal government allocate funds to ibogaine research in the United States; this was not a surprise. But in the background, other movement toward medical options for access to psychedelics has also begun to appear. In 2015 and 2016, bipartisan state legislators in New York and Vermont introduced bills to fund and establish clinical trials to study ibogaine. Earlier in 2017, a representative in Maryland introduced a bill to develop and implement ibogaine treatment programs in the state for opioid use disorder. While all of the bills have stalled or are inactive at this time, their introduction demonstrates fresh attempts at problem solving in the face of a rising opioid epidemic, and may mark the beginning of ongoing legislative engagement for advocates of psychedelic medicine and therapy.
The conversation about medical use at the community forum foreshadowed a recent deepening of these themes. Two weeks after Reform, on October 27 at the University of Washington School of Law, the End of Life Liberty Project and DPA organized a one-day symposium called Psychedelic Medicine: New Frontiers in Palliative Care, where palliative care providers, physicians, legal professionals, and other community members gathered to discuss the medical, compassionate, and psycho-spiritual potential for psychedelics as a tool for end-of-life mental health care. Besides being the conference with the most suits I had seen since I was in law school, it is a sign that people from an increasing number and diversity of communities are recognizing the revolutionary impact that psychedelic medicine and consciousness can have on systems that affect the health and wellbeing of millions of people.
In the midst of discussions about legalization and medical use of psychedelics comes the complex and sometimes uncomfortable discussions about how to deal with their marketing, sale, and distribution; in particular, for substances that become accessible through pre-existing regulatory schemes like the FDA drug approval process. In particular, there is an ongoing discussion about the value of pursuing various models for drug development and sale. MAPS and the MAPS Public Benefit Corp (MPBC) operate within a hybrid for-profit/non-profit model; unlike traditional C-Corporations, the Public Benefit Corporation (PBC) structure allows for public benefit to be included in a company’s mission and purpose. That means that eventual profits from MPBC’s legal sale of MDMA for FDA-approved therapy need not only go to maximize profit for shareholders as with a traditional corporation, but also to more psychedelic research, education, and advocacy in the public interest.
Nonetheless, access to mental healthcare in the United States remains within the treatment-for-sale model. This means that, without efforts to build in mechanisms for equitable access, psychedelic psychotherapy will remain out of reach for many, including marginalized populations that are already less likely to be able to afford and access effective mental healthcare. This is particularly harmful because PTSD in marginalized populations is often under-reported and under-diagnosed; failing to acknowledge and respond to this problem will end up contributing to the present treatment gap rather than solving it. This problem is bigger than psychedelic therapy, but we cannot confront this tension without linking it to a larger conversation about the structural, racial, and economic factors that impact access to healthcare generally.
Ultimately, different substances with different effects or contexts will require different structures for legal access. This openness provides us an opportunity to critique traditional economic models and be creative in the ones we propose. Many in the movement hope to elevate and support the creation of structures that are liberating, equitable, intentional, and in line with our values as a movement.
It has now been over 10 years since the U.S. Supreme Court’s decision in Gonzales v. O Centro Espirita Beneficente União do Vegetal (UDV) that granted members of the UDV, a syncretic Brazilian ayahuasca religion that has spread around the world, an exemption to the Controlled Substances Act (CSA) to import and utilize ayahuasca in their services, and also set the precedent for the Ninth Circuit’s ruling in 2009 that granted a similar exemption for specific branches of the Santo Daime church to import and utilize ayahuasca as well. Since then, both underground and open—but rarely legal—ayahuasca-drinking communities have proliferated in the United States, with some even taking to Facebook to advertise their services. Some communities and their interactions with DEA have made the news; for instance, both Soul Quest and Ayahuasca Healings have received media attention regarding their attempts to navigate the DEA’s Controlled Substance Act exemption process after receiving cease-and-desist letters from the DEA.
Many communities have remained underground, but are increasingly interested in finding ways to either fit their own practices within the expectations of the U.S. Supreme Court and the DEA or—perhaps, more interesting—to push the courts and DEA to acknowledge the authenticity of a wider breadth of spiritual practices. Limitations of the current paradigm provide opportunities for us to challenge our understanding of the legal categories we have available, an essential step to acknowledging the psychospiritual elements of healing.
Listening to people excitedly speaking, sharing, and debating throughout the room at the Reform conference, I realized that the conversations we were having were continuations of discussions that have been going on for decades. We had all watched the movement pass all of these recent milestones, and we knew that many of the conversations that we tapped into in that room at the Omni Hotel in Atlanta were already blooming into realities that may eventually impact us all.
Safe, equitable, and decriminalized access to psychedelic plants and molecules for respectful and intentional spiritual, medical, or personal use is a human right. That access does not fit neatly into the structures that we already have available to us, and perhaps it shouldn’t. Indeed, part of the value of these substances is their ability to dissolve the ways we have internalized the boundaries of those structures. Resilient movement toward a shared goal through mechanisms of strategic progress—as I believe we are beginning to see on many fronts—can help us create systems of access with integrity that are informed by principles of compassion, reciprocity, and love. Onward!