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On February 9, 2024, Lykos Therapeutics, previously known as MAPS (Multidisciplinary Association for Psychedelic Studies) Public Benefit Corporation, provided a news release announcing they received acceptance from the FDA for the use of MDMA-assisted therapy for Post-traumatic Stress Disorder (PTSD) (2024). After more than 30 years of research, education, and advocacy, MAPS/Lykos stands at the threshold of a medical model of clinical care and psychedelic access via prescription.
Stepping back from the fanfare with a critical eye, the medical model is likely to help many people affected by PTSD and its associated debilitating symptoms. But who is eligible? Those who have been diagnosed with PTSD, those who can afford to take time from work for preparatory sessions, a multi-hour medicine session, and the appropriate time for integration for a new treatment that is unlikely to be covered by most insurance plans.
While the medical model provides exciting access for those who can afford it, where does it leave the rest of us? This essay explores concerns about who and what is left behind when the medical model is our only access point for psychedelic medicine.
The Shadow of the Medical Model
In a scathing critique of the contemporary psychedelic gold rush, Devenot et al. (2022) observe the shadow aspects “at the nexus of university research and the emerging psychedelic medicine market.” (p. 479). Their Dark Side of the Shroom (2022) algorithm (practiced by current psychedelic startups) strips indigenous and countercultural ceremonies of sacred elements, spirituality, and traditions. Instead, it replaces the sacred with the medical, focusing on treating symptoms and molecules that may be isolated, patented, and owned (2022).
The authors note that by sterilizing and medicalizing psychedelic care, the medical-industrial complex is replacing one biomechanical brain model with another. Instead of locating a mental health disorder in an imbalanced or diseased brain, new psychedelic science sees rigid, hardened neural pathways made more plastic with the help of psychedelics (2022). Additionally, when patients have been conditioned to accept magic bullet cures, particularly for treatment-resistant conditions, there may be severe disappointment when the promised solution doesn’t measure up to the hype (Noorani, 2019).
Hyperfocus on the Medical Model
As psychedelics continue to emerge from indigenous and underground use, the primary media attention has been on clinical trials, university research, Big Pharma, and investment capital. These investments of time, institutional reputations, and money certainly provide medical legitimacy to psychedelics but also limit their use to sanctioned, expensive, two-therapist-for-every-client models and standards of practice. Red flags abound for corporate interests in psychedelics. For example, COMPASS Pathways has filed patents for ‘set and setting,’ ’a room with a high-resolution sound system,’ and a couch or bed where ‘the therapist provides reassuring physical contact.’ (Devenot et al., 2022, p. 479).
Noorani (2019) observes that medicalization exists on a broad spectrum, from faster, profit-driven models to more participatory community models. However, the fast track is occupied by capital-intensive parties that dominate public discourse and absorb large amounts of money as they follow modern pharmaceutical drug development models (Noorani, 2019; 2022).
The medical model also tends to minimize (or overlook altogether) the time, energy, community, and therapy often needed to help voyagers integrate their experiences into their lives. Senior Hopkins Study Guide Mary Cosimano observes that post-clinical trial integration is ongoing at the six-month and one-year follow-ups (Noorani, 2019, p. 35). Integration circles, psychedelic societies, and in-person and online communities are being built and grown by clinical study participants, psychonauts, and entheogen enthusiasts to provide the support needed for explorers. Therapists and counselors are also increasingly offering integration support in addition to more standard therapeutic offerings.
Accessibility Concerns
Psychedelics are in the process of being rebranded as medicine, as “something to be owned and controlled, bought and sold, with no guarantee that those who need it most will be able to afford it.” (VICE News, The battle over psychedelic therapy’s future, 2022, January 11, 4:53).
Since Oregon psilocybin service centers opened in the summer of 2023, hundreds of seekers have traveled to the state to sit with psilocybin at approximately 20 centers located in metropolitan areas around the state (Oregon Psilocybin Services, 2024; Stringer, 2023). Most clients have traveled from out-of-state, providing a new tourism income stream to the state—psychedelic healing tourism (2023). Current prices for medicine sessions are between $1,000 to $3,000 (2023).
Those willing to travel out of the country also have retreat options, primarily in Jamaica, Europe, and Central and South America, where four to seven-day retreats cost between $2,000-10,000 (Leonhardt, 2020). For 2023, the median American’s savings account is $1,200, clearly placing either path of legal psychedelic access well out of reach for most (Caporal, 2023).
An individualistic psychedelic treatment focus using a 2:1 or 1:1 therapist-to-participant ratio may promote healing for the individual. When viewed through a social justice lens, we may help heal the voyager and show them “somewhere else, fresh with the experience of clarity, purity and/or simplicity, only to be thrust back into the intractable cruelties of mundanity, and everyday systemic injustice: the rat race, social alienation, discrimination, and so on.” (Noorani, 2019, p. 36). Psychedelics also have the power to heal the community via collective, group experiences and societal systemic change and healing (Devenot et al., 2022).
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Spiritual and Peer-Supported Models
Archaeological evidence indicates ceremonial use dating back to about 8600 BCE, indicating cultural and spiritual use for nearly 10,000 years (Psychedelic Times, n.d.). For those critics who resist open source access and decriminalization as dangerous, spiritual and community models may provide a safer container of ritual, support, and indigenous wisdom (Devenot et al., 2022).
Churches that use plant medicines as sacraments are sprouting up like (ahem) mushrooms around the nation. Some operate as dispensaries, openly selling mushrooms and psilocybin products, while others provide sincere religious practices, community, and legal protections under the Religious Freedom and Restoration Act (RFRA).
One psilocybin sacrament church that is growing and thriving is Psanctuary, an online church based in Louisville, Kentucky (n.d.). Psantcuary is a 508(c)(1)(A) faith-based organization that hosts regular Sunday services, weekly support groups, minister trainings, and in-person events for their congregants. Members must become ministers before they may be gifted sacrament, and the basic minister training also includes training and support for growing your sacrament (Psanctuary, n.d.).
In an article published by the Cato Institute (2023), the author notes that religious psychedelic communities will likely continue to grow in the absence of federal legalization. Increased demand, media coverage, and limited legal sources leave explorers with few legal and illegal options: clinical studies, retreats, expensive service centers, churches, or grow-your-own methods.
Peer support is a valuable aspect of substance use and mental health recovery communities. It is also used to support struggling first responders who want the assistance and guidance of a trained peer. According to SAMHSA (2017), research shows that peer support increases social function, community engagement, and quality of life while decreasing self-stigma, hospitalization, and costs to the mental health system. With basic psychedelic first aid training, the peer support model could easily be adapted to psychedelic communities or integration groups.
Colorado Leads Again
A decade ago, Colorado (and Washington) led the country as the first state to legalize adult-use sales of Cannabis. In July 2023, Colorado again led the nation by instituting the Natural Medicine Health Act (Vicente LLP, 2023). Under Colorado law, adults 21 and over may cultivate, use, possess, and share natural medicine, including psilocybin, dimethyltryptamine (DMT), mescaline (except peyote), and ibogaine (2023). The Colorado law also comes with robust civil protections. Users or facilitators of natural medicine are not subject to arrest, seizure of assets, probation violations, or the loss of professional licenses (2023).
Colorado Regulators are also currently involved in developing healing centers that provide regulated access to plant medicines, beginning with psilocybin but expanding to other plant medicines in 2026 (Psychedelic Alpha, 2023).
Conclusion
While the establishment of medical service or healing centers for regulated psychedelic access is cause for celebration, many casualties of the war on drugs are currently incarcerated or will be arrested in coming months and years for the use or possession of plant medicines. As various decriminalization and legalization models emerge, politicians observe public support for these measures (Noorani, 2019).
Noorani (2019) notes that a both-and approach (decriminalization and legalization) satisfies those explorers who can afford to engage in the two-therapist medical model while also permitting community and peer-supported groups and individuals to engage with psychedelics in a variety of safe containers without fear of legal consequences.
References
Caporal, J. (2023, October 18). Study: Median American's saving account balance is $1,200. The Ascent: A Motley Fool Service. https://www.fool.com/the-ascent/research/average-savings-account-balance/
Devenot, N., Conner, T., & Doyle, R. (2022). Dark side of the shroom: Erasing indigenous and counterculture wisdoms with psychedelic capitalism, and the open source alternative. Anthropology of Consciousness, 33(2), 476–505. https://doi.org/10.1111/anoc.12154
Leonhardt, M. (2020, January 24). Here's how much 'magic mushroom retreats' like goop lab's actually cost. CNBC. https://tinyurl.com/5n74mua3
Litman, V., & CATO institute. (2023). Psychedelics, the DEA, and regulating religion. CATO Institute. https://www.cato.org/regulation/spring-2023/psychedelics-dea-regulating-religion?utm_source=social&utm_medium=facebook&utm_campaign=Cato%20Social%20Share
Lykos Therapeutics. (2024, February 9). Lykos Therapeutics announces FDA acceptance and priority review of new drug application for MDMA-assisted therapy for PTSD [Press release]. http://tinyurl.com/fkmhhsmt
Noorani, T. (2019). Making psychedelics into medicines: The politics and paradoxes of medicalization. Journal of Psychedelic Studies, 4(1), 34–39. https://doi.org/10.1556/2054.2019.018
Oregon Psilocybin Services. (2024). OPS license directory [Directory]. https://psilocybin.oregon.gov/license-directory
Psanctuary. (n.d.). About us. Psanctuary.org.
https://www.psanctuary.org/
Psychedelic Alpha. (2023, November 29). Psychedelics legalization & decriminalization tracker - psychedelic alpha. https://psychedelicalpha.com/data/psychedelic-laws
Psychedelic Times. (n.d.). Psychedelic timeline. https://psychedelictimes.com/psychedelic-timeline/
Stringer, G. (2023, November 29). Oregon's legal psilocybin clinics draw hundreds — mostly from out of state. OPB. https://www.opb.org/article/2023/11/29/psilocybin-mushrooms-oregon-service-centers-price/
Substance Abuse and Mental Health Services Administration. (2017). Value of peers infographic [Infographic]. https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/peers-supporting-recovery-mental-health-conditions-2017.pdf
(Vice Media). (2022). The battle over psychedelic therapy's future [Film]. Vice Media.
Vicente LLP. (2023, May 29). Legal guide to decriminalized natural medicine in Colorado. https://vicentellp.com/insights/guide-to-decriminalized-natural-medicine-in-colorado-QRcode
I run into the same thing in my hypnosis practice. A $1200-2000 price tag for six sessions is a bit steep for many and hypnosis has much less sex appeal than psychedelics. Just like with psychedelics, I'm sure the aftercare is just as important as treatment, especially in a culture that believes it can solve a lifelong issue with a single experience or pill. As you said, where is the relationship between the 'medicine' and resolution. . . and the honoring of what we know to be sacred in a capitalist system hell bent on profit, control and false guidance. It's almost like those who constructed the system don't want us to heal. . . then we might wake up and. . .
How might we develop an accessible system for holistic remediation, regardless of modality? Certainly, the need is present and great.
What structures and conditioning might have to be sloughed off in order to see that pathway? What does an authentic, expansive healing experience look and feel like? A corporate whitewashing of medicine cannot fake that, it is felt from our spirits and into our bones.