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September 2, 2021

In The Research Briefing:

  • Legalization of psychedelics going too fast?
  • Health care worker attitudes when treating cancer patients with psychedelics
  • The morality of psychedelics

Worries about routes to legalization

Recently, the west coast of the United States has taken significant steps towards expanding access to psychedelics not only within a clinical context but directly moving towards the legalization of possession, personal use, and non-commercial sharing. And although the scientific community is widely in agreement that the adverse and psychosis-inducing risks of psychedelics have been widely overstated in the past, others fear that as the pendulum swings in the opposite direction, there begets a one-sided emphasis of its positive effects. Indeed, the current golden standards of the controlled clinical trial dictate that these trials are conducted within clearly defined diagnoses, often ignoring the real-world convolution of comorbid disorders and widely divergent socioeconomic and cultural circumstances. In short, what works in the clinic, doesn’t always work in real life. Hence the authors of this paper express concern over the current models of legalization.

What are the initiatives?

  • The Oregon Psilocybin Services Act went through a November 2020 ballot initiative and legalized the broad clinical use of psilocybin. In doing so, it created the Oregon Psilocybin Advisory Board, with members from psychology, allopathic and naturopathic medicine, public health, and other professions, to oversee regulation and licensure.
  • The California Senate bill, in contrast, would make the state the first to legalize the possession, personal use, and non-commercial sharing of psychedelics by adults.

What has the legalization of marijuana and ketamine taught us about the legalization process?

The authors of the article base most of their concerns on the examples set by legalization and commercial expansion of cannabis and ketamine. They note that the proliferation of for-profit ketamine clinics has engendered practices that fail to screen patients properly, offer ketamine at invalid doses and diagnoses, lack mental health professionals on staff, and promote their services with claims far exceeding the base of evidence. They attribute this to the fact that ketamine is classified as an anaesthetic, and thus off-label use remains unregulated. Concurrently, cannabis legalization in Portugal has been correlated with a significant increase in the prevalence of psychosis, a rise in psychosis hospitalization, and a greater proportion of concomitant cannabis use disorder among these patients.

In a similar vein, psychedelics are often praised for their potential for facilitating peak experiences that are rated among the most meaningful within a lifetime (Griffiths et al., 2019), ‘bad trips’ are, in contrast, characterized as among the most challenging (Carbonaro et al., 2016). Suppose the legalization of psychedelics is thus followed by commercialization in the same manner as ketamine or cannabis. In that case, the authors fear that this would overlook the real-world risks of using psychedelics, which are understudied outside the clinically controlled context. Therefore, non–evidence-based marketing strategies founded on one-sided enthusiasm for the benefits of psychedelics mustn’t supplant evidence-based practices.

Positive attitudes of health care workers to psychedelics

As psychedelic treatment access is looming on the horizon, it is crucial to cultivate an understanding of the perspectives of healthcare workers who will ultimately translate the research into clinical practice and perform vital responsibilities as the gatekeepers of the mental health care system.

Cancer treatment in particular, which involves the alleviation of psychological symptoms related to a life-threatening illness and the management of multiple medications, requires the integration of various perspectives. Health workers who are highly sensitive towards the needs of their patients and their responsibility to alleviate suffering may also be extremely cautious when it comes to implementing novel therapies.

However, the benefits of psychedelics in this context were already investigated as early as 1985 in a study wherein trained personnel could facilitate peak experiences with relatively high safety and efficacy. More recent clinical trials (20162016) have also shown that psychedelic-assisted psychotherapy can yield substantial and sustained improvements in anxiety, depression, and overall quality of life in patients with life-threatening cancer. But how have these results been received by mental health workers who aren’t necessarily psychedelic enthusiasts? This study sought to find out.

What do health workers say?

This qualitative study conducted interviews with healthcare professionals (psychology practitioners, medical clinicians, academic researchers, doctors) working with advanced cancer patients in New Zealand. The researchers found that they viewed psychedelic-assisted therapy as an innovative approach and were generally open to the concept.

Many people even viewed it as a transformative approach but were uncertain over the cost-benefit ratio of this intervention and whether current research is necessary for this assessment.

While the authors acknowledge and support further research using randomized controlled trials, they also suggest the pragmatic trials that aim to elucidate the specific implications of psychedelic treatments and how they affect patients in their real life.

The moral psychopharmacology psychedelics

The widely promoted therapeutic benefits of using psychedelics often make people wonder whether these could benefit society as a whole or usher in a societal paradigm shift. Indeed, there is some initial evidence that shows that psilocybin can decrease authoritarian views and increase nature-relatedness. Thus the idea that psychedelics are intrinsically good may entice us to think that they might remedy societal ills, like saving the environment or spreading liberalism.

However, as David Dupuis points out in a recent article, these one-sided narratives often gloss over the convoluted history of psychedelics within the context of MK-Ultra experiments, the Manson murders, and right-wing occultists.

He argues for a more nuanced approach that treats psychedelics as a type of technology and shifts our focus towards the utilization of psychedelics within a variety of contexts.

So, what makes psychedelic technologies special?

In his most recent article, Nicholas Langlitz and colleagues examine the case of psychedelics within the context of Moral Psychopharmacology, the study of how pharmacological interventions shape ethical behaviour and values. It is immediately apparent that this question is not only exclusive to psychedelics but that similar claims have been raised over substances such as oxytocin, which was once hailed as the molecule of love, trust, and morality. Yet, the subsequent research showed that the empathogenic effects of this molecule increase trust within one’s social group but increase hostility towards members of the outgroup.

The subjective effects of drugs appear always to be context-dependent. Still, the defining feature of psychedelics seems to be that they are influenced by extra-pharmacological factors above and beyond other substances.

It is important to note that although psychedelics are often referred to as ‘non-specific amplifiers’, this has never actually been proven within the context of psychopharmacological paradigms. In this respect, the authors are hopeful that the rapid expansion of psychedelics will embolden researchers from multiple research disciplines to investigate the relationships between psychedelics and social transformations and their political and ethical implications, as this may prove crucial for their technological utilization.