The concept of psychedelic-assisted therapy is now steadily gaining traction. What isn't immediately evident is how a person’s race or income level could prevent access to treatments that involve Schedule I drugs. Psychedelic research is super white, and that means access might be, too.
Last year, when researchers at the University of Connecticut reviewed 18 studies on psychedelic-assisted psychotherapy, they wanted to know how many people of color were being included in psychedelic research worldwide. The studies they reviewed were conducted in eight different countries. Of the 232 participants, a full 82.3 percent of them were white.
The research is open to people of all races, so why are participants overwhelmingly white? Mistrust in both the judicial and medical systems is a huge factor keeping non-white participation in psychedelic research low. Seven of the 18 studies reviewed by UConn researchers were based in the US, where psychedelics are making their way to Phase III clinical trials, the last step before FDA approval. Reminder: The US is also a country where African-Americans are 12 times more likely to be wrongfully convicted of drug crimes than white people.
"It's not even safe to talk about drugs if you're black," says Monnica Williams, a clinical psychologist professor of psychological sciences at the University of Connecticut who is spearheading the first MDMA study to focus on treating racial and sexual traumas in minority populations.
Further, Williams says the lack of therapists who specialize in both psychedelics and minority communities creates access barriers for people of color who may benefit from psychedelic-assisted therapy. She’s working with the psychedelic research non-profit Multidisciplinary Association for Psychedelic Studies (MAPS) to redesign protocol to make sure that future studies will include more people of color. These changes—some subtle, and others as powerful as the language used in the research itself—focus on creating culturally-aware study set-ups that work to foster trust in the medical system. They recognize the nuances of race-based trauma and eliminate access barriers such as language. But the first step is to diversify research teams.
Historically, psychedelic research has been conducted on white people, by white people. To draw participant pools that are more reflective of what society actually looks like, research teams need to include more therapists of color. “The life experiences for people of color are often so different than those of white people. By having another person of color, they’re much more likely to empathize appropriately,” Williams says.
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Psychedelic drugs can potentially help treat all type of mental health issues—but they don’t do the job on their own. Genuine empathy from a therapist is crucial to the process since talk therapy works in tangent with psychedelics. It’s vital to the process. "If it wasn't, anyone who took MDMA at a rave would be cured of PTSD," Williams jokes.
Training therapists of color in psychedelic treatments can also help ease deeply-rooted medical mistrust in communities of color. The US has a horrific history of using minority groups in unfair medical experimentation, from performing gynecological surgeries without anesthesia to injecting people with diseases just to see what would happen. To this day, research has found that physicians are more likely to be verbally dominant with black patients than white patients. The Institute of Medicine identified 13 groups of people most likely to face health care inequalities. Five were racial minorities.
“It’s so valuable to have therapists who understand the history of medical mistrust. Many people of color are re-traumatized by white therapists in standard therapy and that could be emphasized when in a vulnerable psychedelic state,” explains Natalie Ginsberg, MAPS policy and advocacy director.
And then there’s the fact that psychedelic drugs are still illegal, a huge barrier specific to people of color. When people of color make their illegal drug use known, rather than being rewarded with a book deal, they’re statistically more likely than white people to face jail time.
Before MAPS solicited her help, Willams’s work as a therapist had never included psychedelics. She focused on racial trauma and race-based PTSD, something she’s now trying to treat with the assistance of MDMA. “The challenge with healing race-based trauma is that the environment we’re sending people back into is still a racist world,” says Will Siu, a clinical psychiatrist and researcher on Williams’ MDMA study team.
Williams used her own MAPS-funded MDMA study to set an example of how psychedelic studies could do better. Her research team included therapists of color who work with communities of color—a profoundly rare situation in her field.
Williams stresses the importance of these therapists learning from each other. “I think there’s an assumption that just because you’re a person of color that automatically qualifies you to understand all cultural issues. It does not. I am African-American, I can tell you a lot about the African-American experience but I can’t speak to the Korean-American experience,” Williams says.
During her MDMA study, therapists changed the music and decor used during treatment to be, well, less white—on one wall hangs a framed print of a Latina mother holding her baby, and on another, an impressionist map of the world in multicolor, decorative jade beads. Williams even tweaked the language on informed consent documents given to participants: “Experimental session” was changed to “overnight session.” Williams says this was to eliminate words that may make some participants question their safety.
For Latinx people, Williams says, the word “investigation” can be very triggering to those who face immigration stigma, so they called it a ‘project’ or ‘study.’ “We aren’t hiding anything from anyone, we’re recognizing that past trauma surrounding people of color and the medical and legal systems can create an access barrier,” Williams says.
Next year, MAPS plans to train 150 mental health professionals on incorporating MDMA into psychotherapy. Scholarships will be available for therapists who work in low income or minority groups. “We don’t want finances to be a barrier for people receiving the help they need,” says Williams.
Left unchecked, the lack of racial diversity in psychedelic research will be reflected in access, which likely isn’t too far away. Set to start Phase III clinical trials by early 2019, MDMA is on track to be the first psychedelic approved by the FDA for medical use. This could happen as soon as 2021.
“I hope that it’s available to everyone who needs it and that a person’s race, income level or preferred language is not a barrier to them getting the help they need," Williams says. "We need more therapists who work with minority communities getting trained in this therapy so they can go back to those communities and ensure this treatment isn’t just offered to wealthy white people."
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