Psychedelics have great medical promise. That doesn’t make them safe.



Psychedelics have great medical promise. That doesn’t make them safe.

By Leana S. Wen, Columnist

Sept 06, 2023




Hallucinogenic drugs known as psychedelics have generated great enthusiasm within the scientific community for their potential to treat post-traumatic stress disorder, severe depression, and other mental health diagnoses. In no way, however, does that justify their recreational use.


Early studies into the therapeutic benefits of psychedelics have been so promising that the Food and Drug Administration has designated two such drugs, psilocybin and MDMA, as “breakthrough therapies,” a coveted label indicating their possible superiority over other treatments. These drugs are on track to being FDA-approved as soon as next year.

But at the same time, voters and state lawmakers have rapidly been expanding access to the drugs for recreational purposes. This is a mistake.

Advocates pushing for widespread psychedelic access point to how mind-altering substances have been used throughout human history. Indeed, psilocybin is found in many species of mushrooms, which are often referred to as “magic mushrooms.” MDMA, also known as ecstasy or “Molly,” has long been associated with raves and music festivals. 



People taking these substances can experience visual and auditory hallucinations and develop a distorted sense of reality. In clinical trials, mental health professionals combine psychedelic use with talk therapy to unearth past traumatic encounters. It’s believed psychedelics alter brain connections to expand awareness and break cycles of depressive thoughts.


But those properties also pose substantial risks. People high on drugs can accidentally harm themselves or others. While some “trips” induce euphoria, they can provoke negative emotions, too, making some people paranoid and even suicidal.

There is also the possibility of long-term consequences. A case study in the American Journal of Psychiatry described a 32-year-old woman, a senior associate at an accounting firm, who ingested magic mushrooms with friends. For weeks, she had paranoid delusions, mania, and psychosis. She became so depressed; she could not take care of herself. It took months of intensive psychiatric treatment for her to complete basic errands.



Joshua Siegel, a psychiatrist at Washington University, has seen this firsthand. He told me he recently cared for a patient who experimented with psilocybin and had to be hospitalized because of persistent thoughts of ending her life. While such negative experiences are uncommon, if psychedelics are used at a scale like that of marijuana, many more people will need treatment for these terrifying side effects.

Siegel, who studies psychedelics’ medical uses, is quick to clarify that they appear safe in controlled clinical studies. Subjects in these trials typically receive one or at most three doses spaced months apart. They are carefully screened to make sure they don’t have a history of psychosis and closely monitored for six to eight hours after taking the drugs. They also receive intensive psychotherapy before, during and after administration to help them process the experience.

Recreational use has no such guardrails. Yet two states have already passed ballot initiatives to legalize psilocybin, even though the FDA has yet to approve it for any use. Oregon limits the drugs to supervised centers, but users do not need proof of any medical condition and the centers do not require oversight from a health-care professional. Colorado goes even further and allows private citizens to grow mushrooms. In the Denver area alone, dozens or perhaps hundreds of entrepreneurs have started offering psychedelic “services.”



Siegel, in a JAMA Psychiatry study he co-wrote, found that as of last September, 25 states have considered bills to increase psychedelic access. “I was shocked at the legislative momentum,” he told me. Less than 1 in 4 bills mandate psychedelics to be restricted to medical environments, his study found. Only about 1 in 10 required physician involvement.

This follows the same playbook as marijuana. Once people became aware of that drug’s possible therapeutic benefits, the popular narrative changed. Cannabis use became normalized, and its risks — such as addiction and its impact on judgment and brain development — were downplayed. Now, 23 states and D.C. have legalized recreational cannabis.

To me, the state-by-state efforts to legalize psychedelics have two major negative impacts. One is the harm to people taking the drugs in unregulated settings. As psychologist and addiction researcher Julian Somers from Simon Fraser University said to me, “Any time we increase the availability of drugs in a population, the rate of problems involving drugs goes up.” Patients are already struggling with accessing mental health care. The last thing we need are substances that create new risks.



My second worry is that legislative fights over recreational legalization will impede legitimate biomedical treatment. This is what happened in the 1960s when promising studies into psychedelics were shelved in part because recreational access became a political battleground.



The attention and resources around psychedelics should be directed to where they are needed most: to help patients with serious mental health diagnoses who could truly benefit from these breakthrough therapies.





Nature provides Us with Everything We need


Opinion by Leana Wen

Leana S. Wen, a Washington Post contributing columnist who writes the newsletter The Checkup with Dr. Wen, is a professor at George Washington University's Milken Institute School of Public Health and author of the book "Lifelines: A Doctor's Journey in the Fight for Public Health." Previously, she served as Baltimore’s health commissioner.




Repurposed Content from The Washington Post | September 06, 2023

With additional editing by Zuleger-Thyss, Garden of Healing LLC

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