As California Goes: The Revolution Will Be Medicalized

Governor Newsom vetoes Decrim bill and the TREAT California Initiative begins signature gathering

As California Goes is an ongoing series on psychedelic policy developments in California. Part I is here.

Today, I want to dive into three developments from last week out of the state of California  that are worth unpacking in some detail; here’s a brief overview:

• Governor Gavin Newsom signed legislation into state law that you would be forgiven for thinking was significant since it allows doctors to prescribe MDMA and psilocybin (when they are federally rescheduled). But this is a mostly inconsequential piece of legislation and should instead be understood as a redirection from his vetoing Senate Bill 58.

• Most significantly, on Saturday, the Governor vetoed Senate Bill 58, which sought to decriminalize the possession, cultivation, consumption, and non-monetary exchange of several psychedelics. The bill was introduced by fellow Democratic State Senator Scott Weiner of San Francisco. This decision reflects an important philosophical distinction between local and national politics among Democrats when it comes to psychedelics.

• And finally, the TREAT California Initiative, the most ambitious state policy effort we’ve seen to date, began signature gathering from state residents in the hopes of making it to the November 2024 ballot. The measure would appropriate $5 billion in state funding for psychedelic clinical research.

Let’s dive into each of these.

AB 1021: The (Mostly) Inconsequential Legislation

From Marijuana Moment:

“California Gov. Gavin Newsom (D) has signed a bill that would allow doctors to immediately start prescribing certain currently illicit drugs like psilocybin and MDMA if they’re federally rescheduled…

AB 1021, sponsored by Assemblymembers Buffy Wicks (D), Isaac Bryan (D) and Corey Jackson (D), says that, if the federal government reschedules any Schedule I drug under the Controlled Substances Act (CSA), California health professionals will automatically be able to legally prescribe and dispense it.”

Here’s the deal with this one.

Scheduled substances are classified at the federal level and the state level.

The Controlled Substances Act stipulates that when the FDA approves a scheduled substance for medical use—as is expected with MDMA-Assisted Therapy for the treatment of PTSD sometime next year—the DEA is required to reschedule the substance.

Upon FDA approval, the DEA has 90 days to move the substance to Schedule II, III, or IV.

But before it can be prescribed, the scheduling in individual states must be amended.

Many states are harmonized with the DEA, meaning state laws change as federal scheduling changes. But for others, additional action needs to be taken to align state and federal scheduling classifications.

This bill ensures that when (if) MDMA and psilocybin are approved by the FDA and subsequently federally rescheduled, California state law will reflect the federal scheduling and not create further delay in allowing physicians to prescribe these medications to patients.

This should be understood as a sign that Newsom supports psychedelic medicine so long as it comes through the approved pathway, namely the medical system.

Vetoed: California Senate Bill 58

The week’s big news is that Governor Newsom vetoed a psychedelic decriminalization bill that would have been the most significant and most consequential psychedelic policy reform measure since the passing of the Controlled Substances Act.

Senate Bill 58, introduced by state senator Scott Wiener (D-San Francisco), would have decriminalized several psychedelic substances on January 1st, 2025.

Here is the pertinent language from the bill itself:

The bill made it all the way through the arduous state legislative process—with bipartisan support—and landed on his desk for his signature.

The bill does not create a legal market, regulate manufacturing, quality control, or tax sales. 

It is very similar to other decriminalization statutes implemented in 21 cities and municipalities around the United States in that it allows adults over the age of 21 to possess, prepare/cultivate, obtain through non-monetary exchange, and transport several classes of psychedelic compounds up to a certain amount.

However, the Governor vetoed the bill while noting optimism for psychedelics’ therapeutic potential but citing the lack of administrative guidelines as the reason he couldn’t provide his signature.

From a public letter the Governor sent to the state senate, returning the unsigned bill (emphasis added):

“Both peer-reviewed science and powerful personal anecdotes lead me to support new opportunities to address mental health through psychedelic medicines like those addressed in this bill. Psychedelics have proven to relieve people suffering from certain conditions such as depression, PTSD, traumatic brain injury, and other addictive personality traits. This is an exciting frontier and California will be on the front-end of leading it.

California should immediately begin work to set up regulated treatment guidelines - replete with dosing information, therapeutic guidelines, rules to prevent against exploitation during guided treatments, and medical clearance of no underlying psychoses. Unfortunately, this bill would decriminalize possession prior to these guidelines going into place, and I cannot sign it. I urge the legislature to send me legislation next year that includes therapeutic guidelines.”

One could be forgiven for assuming the Democratic Governor of the progressive state of California, a former Mayor of San Francisco who proudly championed cannabis reform and acknowledges the therapeutic potential of psychedelics, would have signed such a decriminalization of psychedelics bill into law.

There are just two problems with this.

1. The prevailing rationale is that it would be too politically risky if he were to assume the Democratic presidential nomination. Growing concerns with Biden as a candidate are making it increasingly likely that the Democrats will need to find a replacement candidate for the 2024 election—and it sure won’t be Robert F. Kennedy Jr.—so Newsom is thought to be the man and signing such a radical measure would not look good to moderates and never-Trump Republicans, who might be persuaded to give Newsom their vote if he were to face Trump.

2. The assumption that psychedelic policy reform is championed mainly by Democrats is probably still valid, but only at the city and municipal level. Instead, psychedelic decriminalization and legalization should be viewed as a party-neutral populist position rather than framing it as a conventional left vs right issue.

How to Interpret?

The dominant frame in American politics is the left-right, progressive-conservative, Democrats-Republicans.

However, there has been an ongoing political realignment over the last several years that makes this conventional framing incorrect when it comes to psychedelics.

Given the cultural and political history, you would think that liberalizing the laws around psychedelics would be a liberal/progressive/Democratic position; after all, the counterculture movement of the 60s and 70s with which most people associate psychedelics was a liberal/progressive movement that had strong civil rights, anti-authoritarian, anti-war, communal and environmental orientation.

Furthermore, Bill-58 was introduced and sponsored by a Democratic state senator from San Francisco, the spiritual home of the counterculture movement of the ‘60s and a bastion of progressive politics.

Drug policy reform is usually associated with the liberal/Democratic agenda as it has been closely related to punishment that disproportionately affects minorities.

The current Governor of California, Gavin Newsom, is a Democrat who gives himself much credit for moving the needle on cannabis, so one could be forgiven for thinking signing Bill 58 would be a slam dunk.

However, this left-right framing no longer tracks.

Evidence for this can be found in editorials from two local newspapers leading up to the Governor’s decision: the Left-leaning Sacramento Bee opposed decriminalization, while the Right-leaning Orange County Register supported decriminalization.

Instead, psychedelic policy reform is an issue that falls along establishment vs populist fault lines rather than conventional party allegiances.

Local Democrats—at the city and municipal level—and populist Republicans share the view that large and powerful institutions are not to be trusted, while at the National level, Democrats have become more aligned with powerful establishment institutions, especially in academia, finance, and healthcare that view psychedelics as tools they—and they alone—are capable of stewarding.

The Revolution will be Medicalized

Too many people view this whole psychedelic thing as “Cannabis 2.0,” but this is wrong in two meaningful ways.

1. Very few people are imprisoned for psychedelics, compared to cannabis.

2. Because of the more extensive scientific literature that psychedelics have compared to cannabis, the medical establishment has been—and will be— more involved in the on-ramping of psychedelics by orders of magnitude.

A little more than a week before Newsom vetoed Bill-58, an opinion piece from Dr. Leana Wen in the Washington Post—a national publication which, along with the New York Times, The New Yorker, and The Atlantic, sets the tone for Democrat opinion on such issues—warned of psychedelic use outside of strictly controlled clinical trials and stressed the need for medical oversight and further research.   

“Psychedelics have great promise for treating mental illnesses among carefully selected patients, as multiple studies have shown. But as these substances become increasingly accessible to the public, I fear more people will self-medicate with them in place of evidence-based therapies…

This is dangerous, and it could seriously undermine the potential of these drugs…

This is no different from any other form of medical care. No one would think it’s appropriate for patients with cancer to purchase their own chemotherapy drugs on the street to use without follow-up care. And no one would support states trying to pass laws that preempt the FDA’s medication approval process for heart disease or blood pressure treatment.”

This is the message that will come to dominate state and federal policies from now on.

Despite several initiatives in play, unfortunately, I think we’ve seen the end of state initiatives that create legalized or decriminalized frameworks for the non-medical use of psychedelics.

We’ll still see progress in places like Portland, Maine—where the city council voted to deprioritize prosecution for natural psychedelics—but for legislative efforts that seek to change state laws, I think the message has been made loud and clear.

So what should we expect to see instead of decrim and legalization attempts?

TREAT California & the East Coast Approach

There is only one thing that people from all corners of the psychedelic ‘space’ can agree upon—we need more research.

The Controlled Substances Act prevents federal funding of Schedule I substances, thus making the field nearly 100% reliant on philanthropy—until the advent of venture-backed psychedelic drug development startups.

But creating the type of reserach, treatment, and care delivery environment for substances as powerful and stigmatized as psychedelics requires much more.

Promising scientific research can usually count on the federal government to fund early research, but this hasn’t been the case for psychedelics.

The TREAT California Initiative is the pinnacle of what I described as an ‘East Coast psychedelic policy approach:

“We might even say two distinct approaches to state-level psychedelic policy reform are emerging along the stereotypical East Coast—West Coast dichotomy that has characterized the differences between cultural, business, and power centers of the respective coasts.

Tradition, legacy institutions, and prestige codify the East Coast ethos, while West Coast boasts innovation, experimentation, and novelty.

This schism is representative of the two (general) approaches to state-level policy reforms, with the Western states aiming at progressive legalization efforts. In contrast, the more reserved East Coast approaches seek to work within the previously established frameworks erected by the federal institutions.”

I say the TREAT California Initiative is the pinnacle of an East Coast approach because rather than decriminalizing or legalizing psychedelics in the state, if approved, it would create a $5 billion fund to support a wide variety of psychedelic research.

From a recent press release:

“The measure will approve $5 billion in funding for clinical research on mental health treatments using psychedelic-assisted therapies, or PATs… the TREAT California Institute would become a state agency with the ultimate aim of obtaining the FDA approvals and training models needed to safely introduce PATs into mental healthcare paradigms.”

Unlike Bill 58, the TREAT California Initiative is a ballot initiative. This week, the TREAT California Initiative began gathering signatures to move the initiative to the 2024 ballot.

Organizers must collect 874,641 valid signatures by June 27, 2024, to make it to the November ballot.

In the absence of federal funding for psychedelic research, such initiatives are intended to fill the void to create the type of evidence base, best practices, and guidelines that a mature psychedelic medicine field should have.

The TREAT California Agency is by far the most ambitious of any of the measures that would allocate state funds for psychedelic research (Connecticut, Texas, Pennsylvania), with an allocation of $5 billion over ten years for a wide variety of reserach and programs development, including therapist training and education in addition clinical trials.

Ambitious programs like this that fill the gap left by the federal government and limitations of commercial and philanthropic funding will be the model for states from now on that are serious about supporting psychedelic therapies—not legalization or decriminalization—for better and worse.