In summary

Before decriminalizing psychedelic substances for personal use, California should allow them for therapeutic use, argues the founder of a community clinic in San Francisco.

Guest Commentary written by

David E. Smith

David Smith

David E. Smith is the founder of the Haight-Ashbury Free Medical Clinics and past president of the California and American Societies of Addiction Medicine.

When I founded the Haight-Ashbury Free Clinic in 1967, psychedelics were all the rage. 

Research at Johns Hopkins University and elsewhere had uncovered that these substances had mind-altering qualities. At a gathering in San Francisco that summer, Timothy Leary famously said, “Turn on, tune in, drop out.” 

Many young people followed. They rode the wave of psychedelic journeys, until they didn’t. The federal government classified hallucinogens as Schedule 1 controlled substances, concluding that they had no medical benefit, and prohibited their possession, sale or use.

Fifty years later, researchers at UC San Francisco began studying these substances again in carefully controlled clinical trials. They discovered, as their scientific predecessors had before, that taken in a therapeutic setting, these drugs were potentially beneficial for some confounding mental health conditions. MDMA (commonly known as ecstasy) is now on the precipice of FDA approval for post-traumatic stress disorder and psilocybin for treatment-resistant depression

Unlike what occurred before, however, these drugs have been glorified in the press. Some people have begun experimenting with them – for the sheer hallucinogenic experience, spiritual enlightenment or help with mental health struggles. Yet their risks have not been as widely publicized, and as a result, have been largely ignored. 

Senate Bill 58, which is now on the governor’s desk, attempts to capitalize on this wave of popularity for psychedelics. It would decriminalize four hallucinogens: psilocybin, psilocin, mescaline (except peyote) and DMT. Decriminalization for therapeutic use would be delayed until a panel of experts has determined an appropriate regulatory framework and safeguards for use.

This makes sense.

But decriminalization for personal use would go into effect in January 2025 with no guardrails or safety precautions in place. This is premature and misguided. It threatens once again to derail important, life-saving research.

Decriminalization for personal use should come after – not before – decriminalization for therapeutic use. The scientific research underway should inform and guide how these substances should be used by the general public. 

Psychedelics produce mind-altering results because they create physiological changes in the brain. They can create panic, anxiety or a fight-or-flight response. They can cause delusions and distort thinking. For some, they can trigger psychological or emotional trauma and encourage self-harm. 

Many of these effects can be moderated or mitigated if taken in an appropriate setting with a trained guide or facilitator. But taken alone, or in unsupervised or unstructured settings, with no instruction or guidance can result in adverse consequences.

As with all medicines, psychedelics are not appropriate for everyone. None of these substances should be used without adequate guardrails and safety precautions in place. Widespread public education needs to occur so that potential users can evaluate the risks, as well as the benefits. First responders need to be trained to deal with psychotic episodes. A regulatory framework needs to be implemented to ensure these substances are not adulterated and used in the right amount, in the right place and with adequate supervision and therapy. Data tracking needs to be deployed to understand who has adverse reactions and why.

Some in the medical and scientific community studying these drugs fear that decriminalization alone will increase access and use. Without safeguards, there could be more unintended consequences. These, in turn, will create adverse publicity, which could pressure regulators and authorities to crack down once again. 

We already have lost 50 years of learning how these substances can ameliorate mental health conditions. Let’s not lose 50 more.

A bill that would decriminalize certain naturally occurring psychedelic substances was sent to the governor’s desk last month. A retired New York firefighter who supports the legislation says psylocibin mushrooms helped address chronic migraines and mental health issues he developed after 9/11.

more commentary on senate bill 58

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