Editor’s Note: Gabriel Lake Carter continues his commentary on a series of Borghesi-Mellon workshops titled ‘Psychedelic Pasts, Presents and Futures‘, funded by UW-Madison’s Center for Humanities. The second of these, below, reflects on discussions that took place during the ‘Psychedelic Baselines’ roundtable. Points’ Pharmaceutical Inequalities feature is funded by the Holtz Center and the Evjue Foundation.
What are the implications of the rampant media coverage, public awareness, and hype occurring about psychedelics? How is it possible to address the medical needs of people who want psychedelic therapy given the systemic impediments that deny access to medications? What is the most ethical way to promote psychedelics when they remain criminalized? How can current biomedical research be operationalized to help increase access to psychedelics for those in most need? During a recent panel for the “Psychedelic Pasts, Presents, and Futures” Borghesi-Mellon workshop at the University of Wisconsin-Madison, audience members raised these questions to the panel. The aim of the panel was to offer an overview on the current state of psychedelics in order to set a baseline for further discussions. In my reflections on the event, the panel and the subsequent discussion demonstrated a distinct need for transdisciplinary research and education on psychedelics, as well as more critical discussions about the best ways to improve access to psychedelics for those most in need.
The panel was facilitated by Dr. Lucas Richert and Amanda Pratt and consisted of three speakers: Dr. Cody Wenthur, pharmacist and director of the new Psychoactive Pharmaceutical Investigations (PPI) program in the School of Pharmacy at UW-Madison; Graham Pechenik, patent lawyer and founder of Calyx Law; and Dr. Neşe Devenot, literary studies scholar associated with the University of Cincinnati and Ohio State University, as well as the Medicine, Culture, and Society Fellow at Psymposia, a non-profit watchdog of the psychedelic space. Both panelists and audience members raised numerous issues of inequality related to psychedelics, most notably the aggressive patenting practices of psychedelic companies and the lack of diversity in psychedelic science.
Dr. Wenthur kicked off the panel with a reflection on how alcoholism in his family history drove him to consider how small molecules change human behaviors in the long term (for good or for ill). What brought him into studying psychedelics was the fact that so many people cited psychedelics as one of the five most meaningful experiences in their lives. Dr. Wenthur began to study numerous drugs from a pharmacological perspective, namely psilocybin, ketamine, and DMT. A central focus of Dr. Wenthur’s research is on the extra-pharmacological “setting” of psychedelics that influence the psychedelic experience, leading him to work on an interdisciplinary project called “POIESIS” that attempts to “quantify how perceptions of the psychedelic study room environment are modified by racial and ethnic self-identity” and to “determine whether culturally-adaptive art selection and training protocols enhance recruitment and experience of minority participants.”
A major issue in biomedical studies on psychedelics, according to Dr. Wenthur, is that they lack diversity insofar as many psychedelic trials involve mainly white middle-class people but not people from different racial, ethnic, and economic backgrounds. The risk of this situation is that psychedelic research gets stuck in a feedback loop since the trials only involve a narrow group of the broader population. A related issue that nags Dr. Wenthur is how, as access to psychedelics expands, there will not be enough practitioners with culturally- and ethically-informed training to handle the influx of people seeking access to psychedelics, which could lead to more harm than healing.
The second speaker, Graham Pechinik, got involved in psychedelic patent law due to his own personal experiences with psychedelics that catalyzed an interest in drug policy and cognitive liberty arguments. As a law student, however, Pechinik still needed to pay the bills, which led him into patent law. Pechinik eventually founded Calyx Law, a firm focused on intellectual property (IP) in cannabis and psychedelic products. A major issue, in Pechinik’s view, is that patents were designed to help foster innovation but, at least in the current boom of psychedelics, the patenting process has become a battleground for control of psychedelics to the point that it stymies innovation in order to secure profit for one pharmaceutical company over another. For instance, many companies now file hundreds of patents on different psychedelic compounds in the hope that they can control a corner of the burgeoning psychedelic pharmaceutical market. And many of these pharmaceutical companies even engage in evergreening–the process of chaining patents together in order to keep a compound under control longer than the allotted 20 years. The problem with this situation is that low-quality and bad patents might be granted, leading to the monopolizing of specific drugs.
A glaring oversight regarding psychedelic patents, according to Pechinik, is that many psychedelics are based in traditional and indigenous knowledges that do not always fit or align with patent law. Additionally, despite the fact that a statement on open practice/science was signed by numerous researchers and organizations, many of those same groups went on to work for companies that went into exclusionary patent practices–many of them even submitted patents themselves. Battle lines are being drawn in the psychedelic patent space, specifically around who has the exclusive rights to certain compounds and the capital that can be earned from them.
Dr. Devenot rounded out the panel discussion by attending to the ways in which literature offers a storehouse for various frames of understanding how different cultures interact with psychedelics. Since the effects of psychedelics vary depending on who uses them and in what setting, Dr. Devenot advocated for a context-specific approach to psychedelics to account for the different cultural framings of these complex chemicals. For instance, Dr. Devenot cited the famous books, PiHKAL and TiHKAL, written by Alexander and Ann Shulgin, to point out how they are split into two halves: a narrative and a chemical cookbook. The narrative portion of the books, in Dr. Devenot’s view, is just as important as the cookbook part because it describes a way of sharing information about psychedelics through mutual aid that helps make sense of the experiences, which a strictly pharmacological understanding lacks.
Dr. Devenot also offered insights from her recent co-authored article, “Dark Side of the Shroom: Erasing Indigenous and Counterculture Wisdom with Psychedelic Capitalism, or the Open Source Alternative,” in order to deconstruct neoliberal capitalist narratives and assumptions about healing, specifically how people are told to change themselves rather than change society. Dr. Devenot asked the audience to consider the recent article published in Nature that critiqued the chemical imbalance view of mental health and suggested that current society is hostile to mental flourishing. What this highlights, according to Dr. Devenot, is that the use of psychedelics should be an option in the mental health toolkit but that psychedelics are insufficient to address the mental health crisis on their own if the effects of capitalism and the inequalities it creates are ignored in the process. Mental health and flourishing are inextricably linked to the cultural, political, economic, and societal “setting” in which each person operates–addressing only the individual is insufficient.
I also cannot help but notice how decriminalization seems to haunt these discussions regarding access to psychedelics, even though it was not explicitly discussed by the panelists or the audience members. Decriminalization, in my view, would create more accessible routes to psychedelics than medicalization. However, decriminalization would raise critical questions about how to limit the harms–and increase the healing potential–of psychedelics. I wonder, expanding on Pechinik’s fears about exclusive patent rights, what access to psychedelics would look like if they were fully decriminalized and widely available without a prescription? I wonder, echoing Dr. Wenthur’s concerns about practitioner training, how practitioners could be trained to address the influx of people seeking access in a way that does not perpetuate harms but instead amplifies the healing possibilities of psychedelics? And, building on Dr. Devenot’s perspective, I wonder what a mutual-aid and community-based approach to psychedelics would entail?
I do not have all the answers to these questions yet, but my hunch is that medicalization mainly serves to further biomedical research and pharmaceutical profitability but does not live up to its stated aims of addressing the mental health crisis. If psychedelic advocates–whether biomedical researchers or underground practitioners–want to address the mental health crisis, then it is time to consider the implications of different routes of access to psychedelics, such as decriminalization, in order to make sure it is done in an equitable manner.