Making psychedelics into medicines: The politics and paradoxes of medicalization

Abstract

This commentary considers efforts to turn psychedelics into medications that can be administered through healthcare systems as examples of “medicalization.” I draw on ethnographic research both inside and outside of university-based clinical trials from 2014 to date, together with analogous examples from psychiatry and drug research and development. Rather than taking a normative stance on medicalization, I situate it in a wider political, economic, and cultural context to better understand its logics and effects. I begin by suggesting the resurgence of psychedelic science has been concerned with medicalization from the outset, recently prompting a crisis in the “psychedelics community” over its self-identity and values. Next, against the confident public messaging surrounding psychedelics, I consider how attempts to scale up and market psychedelic-assisted therapy could end up undermining the safety and efficacy of the therapy itself. I then outline the movements to decriminalize, legalize, and minimize the harms and risks of using psychedelics in their currently illicit therapeutic and recreational modalities. Finally, I explore how working toward psychedelic medicalization over the coming years may influence the movements toward decriminalizing and legalizing psychedelics use, focusing on the underarticulated ways in which medicalization may disregard or even hinder, rather than help, decriminalization and legalization efforts. I call attention to how the cost of gaining approval for therapies incentivizes the development of diluted-yet-profitable forms of psychedelic-assisted treatments, and how frameworks developed for “proper use” demarcate what counts as “abuse” and enable those with newly sanctioned access to psychedelics to condemn afresh their illicit use.

Psychedelic Communitas: Intersubjective Experience During Psychedelic Group Sessions Predicts Enduring Changes in Psychological Wellbeing and Social Connectedness

“…The same will likely also apply to the emerging field of psychedelic-assisted therapies, where emotional catharsis is seen as an important treatment mechanism while ethnic disparities rooted in exclusionary sociocultural narratives of Western individualism prevail ( George et al, 2020 ; Williams and Labate, 2020 ). Amidst the imminent pharmaceuticalization of psychedelics ( Noorani, 2020 ), we hope that the present study may thus draw attention to the specific capacities in which collective psychedelic use, historically prominent in underground, indigenous and sacramental contexts, may provide benefits for individuals and collectives, despite being mostly neglected by current research–emphasizing the inherent value in a pluralistic ecosystem of approaches to psychedelic use, as opposed to conventional one-size-fits-all medicalized treatment. In order for medical psychedelic use to accommodate the variability in individual needs and responsivity within a precise-personalized approach ( Kelly et al, 2020 ), we propose that innovative trial designs and methods will be necessary, including pragmatic trials collecting large real-world data and aggregated single-case studies based on idiographic and high-frequency assessment of outcomes, e.g.…”

Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey

“…Importantly, serotonin 2A psychedelics are not themselves physiologically addictive (105), yet they seemingly enhance processes often targeted by accepted addiction treatments such as insight, self-efficacy, and spirituality, which may underlie these lasting effects (93,94,96). While challenges remain for the development of psychedelics as medications (106,107), converging evidence reveals a compelling signal of efficacy. Given the current public health landscape and state of addiction treatment (1, 3), this potential demands rigorous clinical research efforts and federal funding.…”

2019: A year of expansion in psychedelic research, industry, and deregulation

“…Deregulation has been met with some resistance though as several Native American leaders have voiced concerns over gentrification of their sacred medicine and preserving natural resources of hallucinogenic plants (Sahagun, 2020). Others in the psychedelic community have noted that medicalization and/or deregulation of psychedelics may lead to profit-driven philosophical divides for the field, and that therapeutic efficacy could be compromised as psychedelic treatment is scaled up (Noorani, 2019).…”