Drug Policy: The Barriers Faced by Psychedelics and Thoughts on Overcoming Them

Author: Iain Burgess is the lead researcher at Blossom. He studied Global Health (MSc) and Physiology (BSc) and has researched the various scientific, societal, cultural and political dynamics that have shaped our understanding of psychedelics throughout history.

Psychedelics have been classified as Schedule I substances since the passing of the Controlled Substance Act in 1970. The UN Convention on Psychotropic Substances in 1971 ensured a global blanket ban on psychedelic research followed. Over the course of the past fifty years, psychedelic science has come a long way. Despite the emergence of largely positive results from the ongoing proliferation of research surrounding the use of psychedelics as medicines, most psychedelics remain classified as Schedule I substances, the most restrictive category.

Under their current classification, substances like psilocybin and LSD are considered to have a higher potential for harm and abuse than cocaine, oxycontin and fentanyl which somehow find themselves categorized as Schedule II. Emerging research is continuing to contradict the parameters under which psychedelics are currently scheduled. There is a call to see the outdated laws and regulations surrounding these substances changed in the research community and beyond. This article explores the implications of this current scheduling, some of the barriers that are preventing widespread policy reform from happening as well as the reform initiatives that are underway.

Schedule I substances are defined as having no accepted medical value and have significant potential for harm and dependence. From a research perspective, Schedule I substances are difficult to work with as the laws and regulations which surround these substances makes procuring them both challenging and costly. Nonetheless, an increasing amount of research is taking place with psychedelics and contrary to their current scheduling criteria, this research is showing that psychedelics can be used both effectively and safely to treat mental health disorders like depression, anxiety, and PTSD.

If these substances can be used to alleviate symptoms of human suffering, you may be wondering why they remain illegal. Unfortunately, there is no one straightforward answer to this question. The relationship society has had with psychedelics makes the regulatory hurdles faced by psychedelics unique.

Unpacking the Cultural Baggage

Firstly, psychedelics come with a lot of cultural baggage as the epistemological and ontological nature of these substances has remained in conflict ever since their introduction into western society. Traditionally used by Indigenous communities for healing and religious purposes across the Americas and further afield, different ideas of how psychedelics ought to be used began to emerge as they made their way into western science and society.

Researchers in the 1950s and 1960s believed psychedelics could be used to treat mental disorders and did so with some success. A meta-analysis of studies from this era found 79% of participants showed improvements after treatment with psychedelics. Similarly, a meta-analysis of studies in which alcoholics were treated with LSD also reported positive outcomes. However, the U.S military believed these substances had the ability to control minds in their infamous MK Ultra experiments. Perhaps most notably, the hippie subculture of the 1960s which was to the fore of this eras’ counter-culture revolution believed psychedelics could help them achieve a future free from war.

As each of these groups sought to give psychedelics a place in society, psychedelics became entangled in the world of politics. Ultimately, psychedelics became political artefacts as their classification as Schedule I substances was largely based on the political ambitions of U.S politicians. Now researchers and regulators alike must contend with the fallout of this era.

As part of this cultural baggage, one hurdle faced by psychedelic medicine is the societal stigma associated with psychedelics. This stigma largely stems from sensationalist media reporting during the 1960s. In these articles, psychedelics became demonized in society as false reports such as LSD use leading to chromosome damage began to dominate the public discourse.

Now, in the age of mass media, reports of psychedelics in the media are overwhelmingly positive and are reaching a significant number of people. Nonetheless, the stigma surrounding these substances renders the idea of psychedelic-assisted therapy somewhat of an unfathomable concept for many. As a result, many politicians and those in power still do not want to consider the idea of advocating for rescheduling, never mind legalizing, psychedelic substances.

Threatening the Status Quo

Another prominent issue surrounding reforming the laws and regulations which deem psychedelics to be devoid of medical value is certain actors in this field may not want to see the laws changed. Many may not be willing to accept a paradigm shift in how we view mental health and illness. Such a shift has implications for medical professionals, the pharmaceutical industry, and regulators alike.

From a scientific standpoint, the paradigm of psychedelics as medicine threatens the legitimacy of the epistemological underpinnings which have come to dominate the western biomedical model of mental health. In the simplest sense, this model tends to ignore the complex social processes involved in illness and instead seeks to identify the underlying disordered physiological processes which can then be therapeutically targeted. Whilst psychedelics can be seen as therapeutics, the modality in which they are used sets them apart from conventional treatments.

The emphasis on therapy in psychedelic treatment models and the importance of set and setting overall accounts for the psychological and socio-cultural factors of illness as well as the pharmacological. Furthermore, the idea that the often-ineffable psychedelic induced mystical experiences is related to positive therapeutic outcomes stands at odds with a paradigm that tends to deal with the material and quantifiable.

Lastly, the psychedelic experience does not fully align with the methodological gold standards we have come to rely on: randomized controlled trials. The experience makes blinding in these trials notoriously difficult and the current costs and regulations that accompany these substances mean sample sizes tend to be small. Therefore, how can the laws and regulations be changed when psychedelics don’t exactly align with the status quo but instead are set to disrupt it?

Other actors in the field deem the use of psychedelics to be confined to the medical context. These actions are reflected in the actions of a certain for-profit company that opposed Measure 109 in Oregon. This ballot sought to legally permit licensed service providers to administer psilocybin-producing mushroom and fungi products to individuals 21 years of age or older. Other companies in the emerging psychedelic industry share this notion as widespread legalization can disrupt the chances of a monopoly emerging. Thankfully, voters thought otherwise as in 2021 Oregon became the first state to legalize psilocybin-assisted therapy and decriminalize the personal possession of drugs.

These actors tend to raise concerns surrounding the safety of psychedelics in order to provide sustenance to their argument. While issues surrounding safety should not be taken lightly, psychedelics have raised little reason for concern as they are generally considered safe. Adverse events can occur when using psychedelics which emphasizes the need for adequate supervision. These events tend to be mild and transient in nature and include nausea, anxiety, and paranoia, among others. David Nichols details how psychedelics can be safely used under supervision in his seminal review, Psychedelics. Furthermore, a vast number of resources are available online which seek to help people minimize any risks associated with the use of psychedelics.

Whilst the status quo of the medical establishment may be threatened by a paradigm shift in mental healthcare, the opposition of companies to policy changes surrounding psychedelics who are helping to drive this paradigm shift raises ethical concerns. At the centre of this debate should the patients for whom these therapies hold promise, a perspective which can sometimes be overlooked. Maintaining psychedelics as Schedule I substances decreases patient accessibility all while simultaneously ensuring the costs of these therapies remains high. Additionally, researchers will continue to pay extortionate prices to work with these substances unless the regulations surrounding these substances are changed.

Perhaps these actors who advocate for use in the medical context only are primarily motivated by the potential profitability of psychedelics as opposed to their healing potential. Further research is needed before psychedelics can reach legitimate markets. However, unless the policies surrounding these substances are changed, the necessary research cannot take place on a wide scale, and it is patients who are set to lose out on potentially life-changing treatments.

Change is Coming

The movement to reform the policy surrounding psychedelics is well underway. Just as the socio-cultural set and setting of the 1960s led to psychedelics becoming illegal, the global rise in mental health advocacy and the changing public perception regarding the war on drugs could provide the cultural setting to reform drug policy and get people the treatment they need. Advocacy groups have established themselves across the globe with the common goal of seeing the laws which deem psychedelics to be devoid of medical value changed for the better. While success in Oregon remains unmatched thus far, it is estimated that other states will follow suit in the near future.

In the U.S, cities including Denver, Oakland and Santa Cruz have decriminalized psilocybin while states like New Jersey and Washington have reduced the penalties for possessing psilocybin for personal use. Other states like Texas and Connecticut have passed legislation to allow research into the therapeutic potential of psychedelics. The efforts of advocacy groups such as the Washington D.C.-based non-profit, the Plant Medicine Coalition, have been paramount to changing these laws which surround psychedelics. On a more global scale, the recently launched International Therapeutic Psilocybin Rescheduling Initiative is seeking worldwide policy change in order to facilitate research into the therapeutic potential of psilocybin.

Widespread legalization should be the ultimate goal but perhaps rescheduling should be the first point of call. Interestingly, Matthew Johnson and his colleagues at Johns Hopkins found that when using the very same structure of the eight factors of the Controlled Substance Act, psilocybin would be more appropriately placed in Schedule IV if a psilocybin-containing medicine was to be approved. In their review, Johnson and colleagues acknowledge the potential harms associated with psilocybin use. However, these harms are low compared to other commonly abused drugs. Furthermore, supervised use of substances like psilocybin minimizes these concerns.

Perhaps it is time for biomedicine to widen its lens and embrace the traditional knowledge of Indigenous communities who have long used psychedelics. Moreover, embracing the idea of medical pluralism, in general, may be necessary for the therapeutic potential of psychedelics to become widespread.

Ultimately, changes to policy take time. It is worth noting that cannabis reform in the U.S started slowly and although it is still classified as a Schedule I drug at the federal level, cannabis is accessible for medicinal purposes in 37 states. Furthermore, the introduction of the Drug Policy Reform Act to the U.S senate in 2021 would lead one to believe that the tide is changing for drug policy in general as drug use is being increasingly recognized as a health issue and not an issue for the law.

Thus, with some decriminalization and legalization initiatives underway in the U.S, it might not be long before the rest of the country, and the world follows suit. If psychedelics are truly going to impact global mental health, as many investor decks would lead you to believe, the policy surrounding psychedelics needs to change to ensure widespread access in a manner that is cost-effective.