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Hallucinogens for all: Bad for public health, Good for private wealth
A Final Analysis of the Massachusetts ballot question
Voters have plenty on their plates in the Nov. 5 election, including in Massachusetts the controversial ballot question 4, an overreaching proposal that would legalize five so-called “psychedelic” substances (psilocybin, psilocyn, mescaline, ibogaine, dimethyltryptamine), allow for-profit centers for poorly supervised use, and enable their unregulated homegrown bedroom-size cultivation.
The full ballot question takes up 16 pages but it can be summarized in a sentence: It’s not about mental health or public health, but private wealth and the perils of recreational use and abuse.
We psychiatrists are all in favor of improving mental health, and we would love it if some of these substances did so, and some indeed might. But we need to know, not guess, about that benefit, as I explain below. In contrast, we already know these substances have important harms, and we need to avoid worsening those harms by legalizing them in an unregulated recreational manner. This is not fear-mongering: it’s truth-telling in the face of for-profit misinformation.
This question really is not about mental health; it’s about home growth and unregulated distribution, supposedly above age 21, but we all know teenagers and young adults will abuse these substances more than they currently are. Even children will accidentally take them, as happens now with cannabis edibles, which leads to almost 10% intensive care unit hospitalization. It will be much worse with mescaline than cannabis. One of the agents on the ballot, ibogaine, even causes heart attacks.
The mental health crisis will not be solved by this unregulated recreational use, and public health will be damaged.
Let’s start by clarifying some misinformation:
The word “psychedelic” is vague, popularized by the 1950s novelist Aldous Huxley. It’s ironic that he is famous for science fiction, since that’s what the psychedelic advocates are selling now. The scientific term is “hallucinogens” – drugs that cause hallucinations, which can be pleasant or scary and dangerous. Paranoia, mania, and even worse depression can ensue, leading to emergencies and hospitalization, further burdening our overwhelmed hospitals, as explained below.
Also, you don’t need to legalize to decriminalize. The legislature easily can limit criminal penalties, which we all support. That doesn’t mean you should grow hallucinogens in your spare bedroom.
Further, the doses allowed for recreational use are not uniformly “low” as advocates claim. 18 gm of mescaline is allowed which is over 30 times more than the standard amount taken by users (usually about 500 mg). The effects of mescaline and psilocybin are very similar to LSD, which most people don’t consider a minor drug.
Turning to public health:
Unregulated legalization will lead to more crowded hospital emergency departments; we already know that hallucinogens lead to 50% more emergency room visits and hospitalizations, compared to much lower rates with alcohol and cannabis. People with medical emergencies will not get prompt attention as quickly as they should. This is already a problem, which will only get worse given the above statistics. That’s one reason the Massachusetts College of Emergency Physicians opposed the ballot question.
Public safety is another major concern. Think for a moment about driving in front of someone under the influence of a hallucinogen. Their vision is blurred, their perception of speed and distance is distorted, and they are struggling to differentiate reality from the drug. Hallucinogens make basic tasks like driving extraordinarily unsafe and, unlike alcohol, there is no reliable way to measure roadside impairment. 1/3 of regular hallucinogen users admit to driving under the influence in the past year; drugged driving has increased in Massachusetts by 65%; and fatal car accidents have increased in Massachusetts by 50%. That’s why the State Police Association of Massachusetts Troopers, about 20% of whom are veterans, opposes the ballot question.
This is not fear-mongering. It is rational concern based on known harms with current levels of hallucinogen use.
A commonly cited statistic is that about 50 veterans die daily by suicide. Besides the fact that none of these substances has been shown to prevent suicide, it’s important to note that about 100 persons die daily in car accidents. And about 2000 people, a person every 30 seconds, die daily from heart disease. And one of these substances causes cardiac arrest.
The known harms far outweigh the possible benefits of this ballot question.
And now we turn to mental health, which is what the advocates in Massachusetts claim to be curing.
Advocates tout the benefits of so-called psychedelics, but their claims are science fiction, not science. It would be great if some of these substances were vastly superior to current treatments, as advocates claim. But scientific studies so far show that these substances are at most as effective as currently available drugs that have been, unlike hallucinogens, proven safe. Further, everyone admits they cause psychosis (meaning delusions or hallucinations) especially in persons with mental illnesses, like bipolar illness or severe depression or schizophrenia, who represent hundreds of thousands of people in the state. They also lead to addiction and psychological abuse in some people. These hallucinogens are no panacea for the mental health crisis; they likely will make it worse.
Let me give you a personal example, which I could multiply with many patients who I see who have not improved with hallucinogens, but instead have been harmed:
A young woman, never previously diagnosed or treated, felt somewhat depressed. She received ayahuasca in a controlled environment, and got psychotic, with delusions and hallucinations. Her depression worsened: She became catatonic, unable to move or talk or eat, needing a feeding tube. After six months in a psychiatric hospital, she eventually improved with electroconvulsive therapy.
This person is one of my patients. After all this suffering and a tenuous recovery, her family knows that “psychedelics” can be harmful and dangerous. She can’t speak for herself; doctors like me have to speak for her.
Advocates claim success stories. In the privacy and confidentiality of our clinics, we doctors see the silent tragedies. That’s why we are speaking up to the public now.
There’s also the problem of addiction. Advocates and some psychiatrists speculate that these agents may help addiction. But I have had many patients with prior or current addiction to hallucinogens. When I told one of them about the ballot question, he said “That’s crazy! These drugs should be as hard to get as possible, not as easy to get as possible.” Another recovered addict wrote to me as follows:
“I am a recovering addict and psychedelics were my drug of choice. I used them because they allowed my escape from reality…I became suicidal and was admitted to the hospital. I feel that yes on 4 will be deadly for addicts….I wish that recovering addicts could get a voice in on this….My experience tells me that the mental health crisis can only get better from less prescribing and more seeking the source of the problem….”
About 10% of the population has used hallucinogens. Advocates claim this is a reason to make it legal, so they do not “hide” their use. But of these people who use hallucinogens, about half also use cocaine or opiates. Many try these agents experimentally, but some get hooked. In fact, hallucinogens users are 5 times more likely to meet full criteria for heroin abuse.
Some of the population uses these drugs, and is addicted and harmed, so let’s allow everyone to use them. That rationale isn’t likely to get a passing grade in Logic 101.
The ballot question supposedly limits use to age 21 and above. Who really believes that 20 year olds, or teenagers, will not use hallucinogens if legal? Right now about 5% of teenagers have used hallucinogens, but in Massachusetts about 30% have used marijuana in the past month, which is legal above age 21, a higher rate than alcohol. About 25% of teens who use hallucinogens abuse them. If legalized, we can expect a major increase in hallucinogen abuse in teenager above these numbers. No one can defend their use in this population, with known harms even with cannabis to the developing brain.
The Gavin Foundation, which is a long standing addiction center in Massachusetts, knows these risks and opposes the ballot question.
I’ve had troublesome conversations with reporters who were unconvinced with my concern about addiction risk with hallucinogens. They are influenced by psychedelic experts who minimize hallucinogen addiction risk based on lack of physiological tolerance or withdrawal or medical harm with overdose.
But you know what else doesn’t have physiological tolerance or withdrawal? Cocaine and amphetamines. Yet they’re still addictive, because addiction is not a purely physical concept: it includes psychological abuse.
Advocates emphasize that these substance are “natural”. You know what else is natural? Opium. Natural doesn’t mean non-addictive. Cyanide also is natural. Natural doesn’t mean safe.
Advocates say Native Americans have used these substances for millenia. We should learn from them. Interesting, coming from mostly middle class mostly White European-American advocates in Massachusetts. In fact, almost 90% of hallucinogen users are White European-Americans.
This is not the drug of choice of minority groups.
The cultural appropriation of this message is obvious. Native American groups use these substances as part of spirituality rituals, not to treat psychiatric diseases. They certainly don’t use them to create “therapy centers” where they can charge $1000 per visit, or, as with cannabis, eventually commercialize them for billions of dollars yearly. In fact, Native American groups have complained that Western hallucinogen advocates are misusing their culture for their own extermist Western ideology.
I’m with the Native Americans.
What about veterans and PTSD?
To be sure, we may get to the point, following some research, where we clearly understand that one of these psychedelic substances is better for a condition such as PTSD. If so, we would prescribe it in the medical system, just as we do now with the psychedelic ketamine for depression. We hope that ongoing research eventually proves that other psychedelics are effective, but as of now that’s not known or proven. And none of the five substances in the Massachusetts ballot question have been studied, much less proven, for PTSD.
Veterans need treatments for PTSD, and it would be great if these substances worked, and there’s an easy way to find out: Do the research. It could be done easily and quickly. I know: I’ve worked in the pharmaceutical industry and conducted these kinds of studies in 1-2 years, the same amount of time the venture capitalists have been wasting $5-10 million for public relations firms and electioneering in the Massachusetts ballot question. This is exactly the kind of money that easily would fund one or two large studies to test any of these substances in PTSD. Prove the treatments work, instead of trying to advertise your way to them.
Advocates repeatedly and falsely claim that the FDA process is too slow. They contradict themselves by congratulating the fact that psilocybin received a “breakthrough” designation from the FDA. That means it’ll be fast-tracked. That’s the opposite of being slow. The FDA is quite willing to approve a drug; you just have to spend about $5 million to show it is better than placebo in about 100-200 people. Two studies will lead to official approval to come to the market. That’s done all the time with many drugs. It may take 2-5 years at most, especially with a fast track. The venture capitalists spend much more than that on political advertising and paying the salaries of their psychedelic advocates. And they’ve already spent 5 years to try to convince voters in three states to make their drugs legal, rather than to prove that they work.
There is a risk with these studies though: If the substances don’t work, then you have to admit it. Maybe the advocates don’t want to know. So they’re spending the money instead to advertise and misinform rather than to find out the truth.
That possibility is suggested by the fact that the guru to much of this movement is not a scientist, but a PhD in political science, the psychedelic extremist Rick Doblin. He has admitted that he is using veterans for public relations purposes to legalize hallucinogens. It is generally accepted that the largest group of people with PTSD are women who experience sexual assault, but he explicitly chose to focus on veterans because the public will be more sympathetic to them.
Here are his exact words from the linked 2022 article:
“‘Most of the people that have PTSD are women who’ve been sexually abused or raped or domestic violence, and they’re sympathetic,’ he told Marianne Williamson last year on her podcast, but ‘not quite as much as the veterans.’ ‘Interpersonal violence and trauma,’ he elaborated to us this month, ‘are uncomfortable subjects for many people, whereas combat-related trauma is widely recognized as a national responsibility to address.’”
There should be no need for commentary on that troubling admission of motivation. Doblin is an extremist: he claims that the whole world should take hallucinogens, and once billions of people take them, we’ll have world peace. He has raked in massive donations from donors of dubious provenance, and he is spending that money to buy the votes of the public. Just this past week, his group MAPS sent $500,000 more to the hallucinogen advocates in Massachusetts to hire a few more public relations firms to influence voters.
As for the proposed for-profit “therapy centers”, they would cost over $1000 per session and would not be covered by insurance. Most importantly, they are required to NOT be limited to medical or mental health professionals, who will not be able to participate because of federal medical licensing restrictions. Instead, high school graduates with equivalent of a one month full time course on hallucinogens will be the so-called “licensed facilitators.” This is practicising medicine without a license, which will harm people seeking help.
Advocates say hallucinogens will be “transformative” for mental illnesses. If proven effective, psychiatrists of course would support such use. But when not proven effective, we could be giving ineffective drugs with many side effects; this would only harm people. In PTSD, for instance, where advocates claim veterans would benefit, the psychedelic MDMA, which is not one of the five substances in the ballot question, was better than placebo short-term for 18 weeks, but nothing is studied or proven long-term, and no psychedelic has been compared to current available medications in PTSD, much less proven better. Further, the MDMA studies, funded by activist Doblin’s group (Multidisciplinary Association for Psychedelic Studies, MAPS) was retracted by one scientific journal and rejected by the FDA in part due to data manipulation, as well as unethical sexual conduct by psychedelic researchers. In depression, a recent analysis found that low dose psilocybin, as in this ballot question, is equal to placebo, which means it’s simply ineffective. Other randomized trials, including one from just last month, repeatedly have found that psilocybin is NOT more effective than a standard antidepressant for depressive symptoms, which was the primary outcome of those studies. These studies show that current treatments, which are safer, are as effective. That hardly sounds “transformative”, and certainly nothing like a cure of anything.
The medical system exists to safely and effectively provide such treatments. In fact, we already have “psychedelics”, ketamine and esketamine, available by prescription. While expensive, so are the “therapy centers”, costing likely around $1000 per treatment. Any future hallucinogen proven effective could be provided by prescription more safely and effectively.
The reality is that Question 4 would burst open the door to widespread use of risky hallucinogens, harming public health to increase private wealth. Unfortunately, not everyone realizes that profit motives – not concern for public health – are the driving force behind this ballot question. Biotech companies and venture capitalist investors are eying a projected multibillion-dollar market for hallucinogens. Right now cannabis produces about $30 billion yearly nationwide in states in which it is legalized. The same people invested in that huge industry are funding the hallucinogen ballot questions, seeking to add another $30 billion yearly.
The deep-pocketed backers of Question 4 have poured over $6 million so far into their campaign. Our opposition at the Massachusetts Psychiatric Society is volunteer-based, with no outside funding. If there was no money to be made, there wouldn’t be a vote. Unregulated legalization would generate an industry profiting from making these potent drugs easily available to vulnerable people, followed by commercialization, making billions for the venture capitalists.
Everybody matters: Veterans matter, but so do people with mental illness, teenagers, people in cars, and people whose medical emergencies will not receive attention in our overcrowded hospitals.
As voters, there is a lot to consider on the ballot – including the personal and societal implications of legalizing hallucinogens. It’s in everyone’s interest to vote No.
Maybe then we can continue with rational scientific analysis to see which substances work, and which do not work, for people with PTSD or other conditions, and then clinicians in their offices can safely and effectively and affordably give these treatments. That’s how it should be: Doctors and patients making difficult medical decisions together. That’s how we do it with all other medications and illnesses. That’s what we do in oncology and cardiology. Why is psychiatry different?
It’s not. No one is advocating that a promising treatment in oncology be made available to the entire public instead of being proven scientifically and marketed after FDA approval. But that is what is being claimed here for psychiatric medications, and that’s because this debate is really not about mental health; it’s about private wealth and recreational use and abuse, at the expense of public health.