Anyone who's ever been walked back from an acid-induced existential cliff can appreciate the benefit of someone who knows what to do when you're having a bad trip. What if this person, perhaps knowledgeable about soft lighting and gentle music, was trained by a special branch of the government? What if they had a legal mandate to spritz pleasant scents, offer you smooth rocks, and hold your hand while you talk about your family of origin?
While this might not sound like everyone's best case scenario, it's a starting point in a conversation about the regulation of psychedelics and their uses, and what several researchers in BC see down the road as we hurtle towards a culture with increasingly lax attitudes about altered states.
Mark Haden, chair of Canada's leading psychedelic research organization, has a bold plan not only for licensed trip sitters and shamans, but goes so far as to imagine tax collection from the sale of mushrooms and MDMA, sold in plain packaging. In a paper published in the Journal of Psychoactive Drugs last week, Haden and coauthors found there is no reliable way to know who is a good or bad spiritual guide, and suggest a government commission could help us separate sham healers from the real deal.
VICE caught up with Haden to talk about the growing body of research into psychedelic therapies, and his vision for how they'll be used in a post-prohibition world.
VICE: Psychotherapists and shamans have been using psychedelics with clients, under the radar, for a long time. There's a lot of anecdotal research out there that these therapies are successful. But your paper is suggesting a Psychoactive Substance Commission. What does that look like?
Mark Haden: The four options really are: a for-profit running it, a not-for-profit running it or the government running it, and so we looked at all of those and thought no: it needs to have some kind of government level of authority but it needs to be hands-off, at arm's length from government so that it can have a stable mandate and vision. The idea that we proposed was to have a commission responsible for all currently illegal drugs. There would be essentially public health folks at the top—people who really understood that that was the vision that needed to be implemented—but then there's different streams.
There would a cocaine stream, a smokeable/injectable stimulant stream, a heroin stream, a cannabis stream, and then a psychedelic stream. So within the psychedelic stream you would have some content subject matter experts. Some people who have experience with psychedelic psychotherapy. You would have some Aboriginal groups to acknowledge that psychedelics have been used by Aboriginal groups for centuries. So maybe the peyote folks would be in there. You'd have an ayahuasca person. So you'd have the cross-cultural wisdom sitting at the table.
From a public health perspective, what are psychedelics effective at treating and what are they less effective at treating?
With the psychedelic renaissance, researchers are grabbing the low-hanging fruit and trying to understand what they are useful for. The ones that are of interest now, because that's how the research is unfolding, is psilocybin for end-of-life anxiety, MDMA-assisted psychotherapy for post-traumatic stress disorder, depression—high dosages for significant depression, microdosages for lower levels of depression. Addictions of all sorts. Psilocybin for tobacco dependency, ibogaine for heroin dependency. Spirituality from a number of different perspectives.
There's another person who looked at recidivism. What prevents people from going back to jail? Now, normally in our society we see things like stable family, housing and employment. If you have that when you come out of jail you don't go back to jail. But then he looked at drug use and he found much to nobody's surprise that if you smoke crack cocaine, you go back to jail more frequently. But then he looked at psychedelic use, and it was an outlier in its protective effect. People were more protected against recidivism if they use psychedelics than if they had stable family, employment and housing.
Shamans, for instance, who might be Indigenous, or not, but are experienced in these kinds of states, it seems hard to accredit them. How do you judge the quality of a shaman?
We dealt with that explicitly. We had a long discussion around that, as to what to write, and we basically said we wanted to acknowledge that history. These people have been doing it for a long, long time and they need to be at the table, and the language that we used is that we would grandfather them into the process. Yes, they would be sitting at the table with us in this process, it wouldn't just be all old guys with suits who are old psychologists. No, it would be mixture of people who represent the diversity of people who are involved today and bring their wisdom to this process.
The paper also specifically mentions festivals, can you tell me how that ended up in your paper? Festivals and recreational use? It seems like shamans and psychotherapists and trip sitters can be lumped together because they all deal with psychedelics, but they seem very different to me.
Our intention was to demonstrate the range of skills that people would need to work in this world. And certainly I know people who go into festivals and provide essentially emergency psychiatric services. There's a real talent to it because people come in really messed up. And so the skill of providing a zendo tent is not insignificant. Those people would be brought under this umbrella as well.
And you mention that there is also the potential for abuse with this because people are vulnerable when they do drugs. They're out of their normal minds. They are not necessarily being vigilant themselves.
Oh absolutely. I mean having worked in the addiction services I'm aware that predators get attracted to vulnerable people, and part of my job as a supervisor in the addictions services was managing folks who came and were attracted to the fact that that's our population and we have an enormously vulnerable population.
Mostly the people who show up are compassionate, caring, wise, skilled people but occasionally the predators come in the door. And certainly if you look at the world of ayahuasca, some shamans are fabulous and some shamans are completely predatory. And they are predatory because they can be. That's one of the reasons that you need to set up a system that is accountable and managed professionally and people would be allowed to complain.
I've certainly met a lot of weirdos in the world of psychedelics in general.
Weirdos are different from predators. I mean there's a lot of colourful people who aren't predators, but there's also predators. People can be allowed to have a certain amount of colour and that's not a problem. But the predatory aspect of doing harm to others is certainly a concern.
So that's where the College of Psychedelic Supervisors would come in?
Yes. It would be accountable. It would be managed by best practice and the people in it would be accountable, and people who experienced it [abuse] could complain. If you don't like what your doctor did to you, there is a way of getting your doctor fired. The College of Physicians and Surgeons has taken great care to manage that quite skillfully. So there are models out there of how to manage it that would reduce the risk.
So because these substances are illegal, you're saying there is probably a lot of abuse going on because people who have had negative experiences don't have anywhere to go for help?
Absolutely. There's a greater potential for abuse. It's an unaccountable system happening out there. How do you complain about a psychedelic psychotherapist who is doing it under the radar? Well, you can't.
What's the timeline for something like this and how feasible is it?
The timeline, if you think about what we are doing with the MDMA-assisted psychotherapy. We're doing that within the context of Health Canada and we are about four or five years away. So we will have MDMA as a legal prescription drug in five years. The Heffter group will have psilocybin in about the same time frame. We are about to start our stage three clinical trial. When we finish our stage three clinical trial, it is agreed by both the FDA/DEA, the IRB and Health Canada that this will become a prescription drug. So we're about four to five years away.
So this proposal is about getting a jump on the regulation part?
What's going to happen... I'm gazing into my crystal ball when I say this... is we will succeed, so our phase-three clinical trial will come to an end, and we will submit all our data to Health Canada and they will say, "Yes, this is now a legal prescription drug." Then the question is what do we do? What do we do with it? Do we say that now it's available to anyone who's a psychiatrist? How do we manage that?
And psychotherapists can't prescribe, so how does that help them?
We don't know yet. That's what we're proposing. It could go wrong, it could be commercialized. There are all kinds of models that would be unfortunate. Because we need a long discussion about how that profession gets managed and regulated and structured. Let's start the discussion now, because we can see it coming down the pipe.
You mentioned youth access, and it's mentioned because of the Indigenous histories of including youth in ceremonies, but we don't have a culture that includes youth in these kinds of things, at least not explicitly. That seems like a thorny issue.
We had a lot of debate as to whether or not to put that paragraph in there or not. And decided eventually we want this to stand. We want this to be a statement, that is a statement, quite frankly, of truth. And just because it's thorny and controversial doesn't mean we can't actually see the way through this.
Because youth have always accessed psychedelics, they are available to the youth community if they want to use them. And so if we created a system that was 21 and above, what we are still going to have is prohibition for youth beneath the age of whatever the cutoff is. And they will still use them in uncontrolled, unregulated and unstructured ways and they will have all the problems they've always had.
Really, youth need to be included in some way. What we said is youth need to be allowed to access these experiences but they need to access them from trained adults who have this knowledge.
They seem especially vulnerable to the kinds of abuses that we've talked about?
Well that's why it would be guided by professionalism and best practice. And again, there's huge history with this. I dug through literature trying to find how youth were included in the different traditions, and peyote folks sort of get included in specific times through rites of passage (puberty, etc.), but the ayahuasca folks, women show up when they're pregnant, they show up with their newborns, they show up with their toddlers. So youth have always been a part of psychedelic communities in Aboriginal groups but in very different ways. Looking at that and making wise decisions about that would be logical and reasonable. As opposed to doing prohibition for youth and this other thing for adults.
But having a legal age is the way our society does deal with these things. This is something of a radical departure.
Yes, and we need to allow wisdom to apply here.
Is there anything like this proposal anywhere else in the world?
We've taken elements that exist already and we've pulled them all together into one package. The elements of Aboriginal use of psychedelics is in there. We went and dug and found that 21 states have legislation on the books that allows alcohol to be served to minors at the dining room table as long as parents have a guiding hand at this. So with parental approval and supervision, youth can access alcohol. Which is interesting. So you have a young person accessing a drug that would be illegal unless the parent is there. We have the health care system which in BC distinguishes between mature and immature minors. There is a point at which youth become mature and accessing health care at that point, when they are able to make that decision, they show up at the doctor's office and say I want to be on the birth control pill and I don't want you to tell my mother. That's an existing access to healthcare model. So we kind of put all of those together and came up with the statement we came up with.
It seems unique. You're in uncharted territory with this.
Well, we're not doing it very well and we need new models.
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