The FDA has declared both psylocibin, or “magic mushrooms,” and MDMA , the psychoactive drug known as ecstasy, to be breakthrough therapy for treatment-resistant depression and post-traumatic stress disorder (PTSD), respectively. The breakthrough therapy designation means the protocol has already demonstrated greater efficacy than currently available treatments. So, the FDA can expedite approval.
In 2020, the results for MDMA-assisted therapy for PTSD were so good that the FDA granted Expanded Access approval, meaning that for the first time since being banned, ecstasy can be used for medical purposes outside of a research study. The results are that good.
Need further evidence of the growing movement to legalize psychedelic therapy? There are millions flowing into psychedelic therapy business ventures, which are expecting billions in market returns. People take notice when you get incredibly good results.
Many non-scientists around the country have turned to the street variety of these drugs for personal healing; or they’ve travelled to South America for psychedelic retreats using ayahuasca, mescaline, or other historically sacred plants in search of healing from trauma, depression, and other emotional ailments. In addition, Americans with money and access are taking various plant medicines at underground healing retreats here in the states. Pre-pandemic, thousands of these events were taking place across the nation on any given night.
At least one non-profit is dedicated to organizing trips to ayahuasca retreats in South America for U.S. military combat veterans seeking PTSD treatment. The non-profit has paid for hundreds of veterans to take the trips, with many returning to praise the medicine’s purported curative effects. PTSD, often associated with combat veterans, is a widespread, chronic, often severe mental health disorder found among survivors of emotional, physical, or sexual violence – none of which knows racial boundaries. Fortunately, MDMA-assisted therapy for PTSD is a promising treatment, and FDA approval is likely within the next few years.
The cities of Stanford, Oakland, and Denver, along with the state of Oregon, have decriminalized psychedelics – often referred to as plant medicines because of their long and extensive use by indigenous people for spiritual or medical healing. Archeological evidence suggests that plant medicines have been used ceremonially and safely in the Americas since before the birth of Christ.
The evidence of addiction or other harm from the use of psychedelics is scant. Plant medicine has shown no serious medical or psychological issues during its 3,000 years of use. I have never seen a single patient in a medical or psychiatric crisis due to psychedelics in twenty years of working in the mental health sector – including ten years in emergency medicine. Nor have I ever seen someone who was either psychologically or physiologically addicted. Plant medicines don’t work well if doses are taken too close together. In fact, most practitioners do not use these sacred plants more than three times a year. Riding a horse is more dangerous than the use of plant medicine or MDMA in a supervised clinical setting.
New Orleans is a city that knows violence, racism, poverty, trauma, and loss. Most of the psychotherapy patients in my private practice have survived terrible trauma. Many are victims of sexual assault, and many have witnessed a close friend or family member’s violent death. Some also suffer from PTSD related to surviving Hurricane Katrina and its aftermath. Others are combat veterans. Yet, I fear that many of my patients and those who look like them will be left out when the FDA eventually legalizes psychedelics for mental health purposes.
Traditional plant medicines and MDMA would be prescribed by physicians and only available to those who have access to health care and feel comfortable seeking traditional, western mental health treatment. All too often, this means well-to-do white people. This should be a concern to all Americans who care about mental and spiritual health.
This clinical use of plant medicine will keep psychedelic healing out of reach for Americans who lack the financial means to pay for mental health care. The medicalization of psychedelics will create two separate and unequal ways of accessing healing from trauma, and America’s disadvantaged communities may, once again, be left out.
It’s difficult to predict what will become of Americans who lack health insurance or mistrust mental health providers. Promising, life-changing treatments may be out of their reach; and, more than likely, they will do without the benefit of these valuable medicines. People of color, sexual minorities, immigrants, and lower income Americans will continue to suffer from debilitating depression, anxiety, and PTSD while their well-to-do, often white neighbors will benefit from these newly approved treatments.
Eventually, word will spread about the success in healing trauma, depression, and anxiety that is available to the well-heeled and the middle class. When that happens, the demand for street versions of psychedelics – which may be adulterated or not contain MDMA or the claimed plant medicine – will increase as people seek healing without the benefit of monitoring by a mental health doctor or an experienced Shaman.
This will mean legal psychedelics for the well-to-do, while the poor may be arrested and sentenced to jail for using the exact same medicines. If that happens, the burden from the criminalization of psychedelics will largely fall on underserved communities in New Orleans and other American cities. People of color and others who lack equal access to quality healthcare will suffer the most from our nation’s archaic drug laws. We must not allow the psychedelic renaissance to pass them by.
My goal is wellness for everyone. Ideally, anyone who experiences trauma, anxiety, or depression, should have access to care with a professional. But I know this is just not the reality of New Orleans. Sadly, people of color are often the victims of discriminatory health care practices, even when they have health insurance. We cannot ignore the historical role of racism and religious bigotry in outlawing the use of psychedelics, either. It is possible that psychedelics never would have been outlawed if they had been used by white Christians. But they were used in what was considered a foreign religion by European colonizers eager to force their religion on Native Americans. Decriminalizing psychedelics is one step we can take to reduce health care disparities and the burden of the unequal enforcement of drug laws on minority communities. It is not a perfect step, but one that is necessary, nonetheless.
Ron Hill is a psychologist who specializes in working with post-traumatic stress disorder (PTSD). He is a veteran of the war in Afghanistan and lives in New Orleans.
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