Psychedelic Safety, Cultural Narrative and Existential Risk

There are no solutions. There are only trade-offs.

Midjourney Prompt: Psychedelic Safety, Cultural Narrative and Existential Risk

The term “backlash” is often invoked in psychedelic circles to point to the threat of government action that would halt psychedelic scientific and policy momentum.

It alludes to the fragility of the scientific, political, and cultural progress made in recent years against the formidable obstacles of stigmatization, state-sponsored propaganda, and regulatory friction.

The implication is that such hard-won progress is at risk if we see a sufficient number of high-profile incidents of psychedelic use gone wrong.

Last week, we saw the first high-profile bad trip.

The story was picked up by nearly all the major news outlets in the US, all of which included “psychedelic” or “psilocybin” in the headlines.

From The New York Times:

“An off-duty Alaska Airlines pilot who tried to shut off the engines during a flight on Sunday told investigators that he thought he was having a nervous breakdown at the time and had consumed psychedelic mushrooms, court documents said.”

The details of this incident and the need for being honest about the risks of psychedelics have been well covered by Jules Evans and Andrew Penn in their respective publications.

A single sentence from Penn’s work succinctly captures the responsibility we, as psychedelic advocates, have as more and more people flock to psychedelic use:

“Psychedelic enthusiasts must grow into the responsibility of being taken seriously and stop pretending these compounds are without risk.”

Furthermore, auspiciously, the Challenging Psychedelic Experiences Project had just published peer-reviewed survey results on extended difficulties following psychedelic use.

I also spoke with Jules about the paper and the recent events, which you can find below. It is almost an hour long but goes pretty deep into matters of safety, messaging, and context for this event.

However, the thread I have been inclined to follow since this incident is about the meta-narrative and existential risk to the psychedelic movement more broadly.

Let’s see if we can get some clarity.

A Three-Headed Renaissance

In the decades since Congress, under the Nixon administration, passed the Controlled Substances Act (CSA) of 1970—making possession, consumption, and cultivation of psychedelics and other drugs felony-level crimes and halting virtually all psychedelic research—the predominant narrative about drugs in general and psychedelics, in particular, is that they are dangerous, addictive, and will ruin your life.

EDIT:

As a reader reminded me, the first clinical trial with psychedelics was the work of Rick Strassman at the University of New Mexico in the early 1990s. Subsequent to this, cannabis reform and further psychedelic trials resumed at Johns Hopkins and elsewhere.

In 1996, we saw the first fissure in this legal and narrative doctrine when California broke rank with the CSA with Bill 215—AKA the Compassionate Care Act—which legalized medical cannabis in the state.

This event was a significant shift in the Overton Window for the potential therapeutic value of Schedule I substances.

Just a few years later, researchers at Johns Hopkins and UCLA would initiate the first clinical trials with psychedelics since the 1970s.

Since then, there has been slow and steady scientific progress in psychedelic research and, at a certain point between 2015-2018, the “Psychedelic Renassaince” was upon us.

Web of Science psychedelic publication count by year.

But it would be inaccurate to think of the “Psychedelic Renaissance” as a singular thing.

As I see it, there are really three distinct—but highly interwoven—movements at play.

1. Scientific

2. Political

3. Cultural

To understand the threat of backlash, we have to understand the dynamics between these three distinct species as they are at times aligned and at times in competition, and each has a different risk profile.

Psychedelic Science: The Tail That Wags the Dog

Despite the long and colorful history, the modern “Psychedelic Renaissance” is built upon scientific findings of the last two decades.

Both policy reform efforts and the cultural intrigue in psychedelics are based on research results and their dissemination through mainstream media outlets and prominent people.

I say that it is the tail that wags the dog because, despite the power of science to influence society, when compared to almost any other field of clinical research, psychedelic science is minimal in funding, number of studies, number of researchers, and virtuality any other measure—and yet it is fueling cultural intrigue on a massive scale.

The backlash risk to psychedelic science is not necessarily that it gets “shut down” and somehow made illegal and ceases altogether, but rather that proper funding from federal agencies like the NIH and others is never allocated, and scientific inquiry will be limited to commercial drug development and relatively small amounts of philanthropic funding.

The fear is that wildly theatrical scenarios like the “mushroom pilot” incident will give politicians, agencies, and investors cold feet to approve such funding.

As Rachel Yehuda and Andrew Penn note in a recent paper (emphasis added):

“Asking and answering the important scientific questions will take longer, but eventually will yield useful tools for mental health, along with appropriate attendant regulation. Failure to first advance scientific and medical interests may yield a backlash due to adverse events, even if the negative outcomes are uncommon, especially if these adverse events are highlighted by the same popular press that is currently championing these drugs.”

In other words, the greatest threat to psychedelic science is successful psychedelic policy reform and the steep rise in naturalistic psychedelic use because of the heightened risk of adverse events.

Psychedelic Politics: Funding and Access

There are two mechanisms by which the politics category is exposed to the risk of backlash.

First, at the federal level, there are a handful of bipartisan efforts to allocate funding for research for veterans. Despite powerful stories of healing from this population, politicians are still beholden to their constituencies (and the pharmaceutical industry), and if public sentiment turns on psychedelics, then using tax dollars for such research may become politically untenable.

Second, questions of state and local legalization and/or decriminalization are, by definition, political efforts that are very clearly in the crosshairs of backlash in response to high-profile scenarios.

As Politico’s coverage of the recent incident highlighted, detractors are pointing to this event as justification for their advocacy against decriminalization in California:

“This sets back the conversation about legalizing psychedelics in the state of California,” said Brian Marvel, president of the Peace Officers Research Association of California, an 80,000-member law enforcement organization that opposed the bill. “Do you really want people that are tripping on mushrooms driving cars?”

As I alluded to in As California Goes, with the establishment’s preference for the medical model, high-profile bad trips become leverage against decriminalization and legalization frameworks.

Such efforts, in my estimation, are the first go when the narrative shifts.

Cultural Plasticity

If science is the tail that wags the dog, the culture is the dog. The overwhelming majority of psychedelic use, services, and commerce exist and will continue to exist outside of sanctioned research or legalized settings.

While there has always been a cultural niche that embraced psychedelics and related substances and used them sophisticatedly, it has been a tiny subset of the culture.

This niche is in rapid expansion.

Through retreats, underground guides, local psychedelic societies, entheogenic churches, and an increasing number of healthcare professionals who are taking interest, the opportunities for access and support are skyrocketing.

This “layer” of the psychedelic ecosystem is the most resilient to any backlash because of this decentralized, underground nature.

After all, the drugs are already illegal, and people do occasionally get in trouble; for the most part, operators in these niches have figured out how to evade penalties.

On the other hand, this is also the layer from which the next high-profile bad trip will originate and, therefore, is in competition with the scientific and policy aspects of the Renaissance.

There are no solutions. There are only tradeoffs.

Given the heterogeneity of the “psychedelic community” and the diversity of interests, ideologies, and beliefs about how this emerging should and will evolve, we should think of our own preferences through the lens of tradeoffs rather than solutions.

While I think there is a high likelihood that decriminalization and legalization reform cool off for a period, there is no stopping the cultural adoption.

People will use drugs as they have throughout all of human history.

The most important thing at this liminal place between prohibition and whatever the future holds is public education and further reserach.