The new Hulu series Dopesick is a dramatic reminder of the devastation that has been wrought by the opioid epidemic. Like the book on which it was based, and like other journalism about the Oxycontin crisis, the show makes it clear that members of the Sackler family, Purdue, unscrupulous doctors, and the FDA all played a part in causing the rampant overprescription of Oxycontin. Suddenly every kind of pain – not only physical but also psychological and social – seemed to have a single answer: Oxycontin. Opioids are one of the oldest drugs in the human pharmacopeia, but Oxycontin’s new patents made every person in pain a source of easy money for Purdue. This led to a wave of addiction and overdose. When regulators cracked down on legal pills, many people turned to the illicit drug market, putting them in even greater danger.
Yet even as America reckons with the aftermath of the Oxycontin disaster, it’s embracing a new class of supposed wonder drugs. Like opioids, these “new” drugs are long-time favorites: psychedelics. Ironically, one of their supposedly miraculous qualities is their power in treating substance use disorders. The FDA – whose lax oversight and close ties to corporate lobbyists played such a crucial role in the Oxycontin debacle – has placed MDMA and psilocybin on expedited approval tracks for the treatment of PTSD and treatment-resistant depression. MDMA-assisted therapy for PTSD is in advanced trials, and could receive FDA approval as soon as 2023.
Researchers and recently formed companies, many of them backed by venture capital, are tripping over each other to study and patent the use of psychedelics not only for PTSD, depression, anxiety, and substance use disorders, but also for Alzheimer’s, headaches, fibromyalgia, cognitive impairment associated with schizophrenia, traumatic brain injury, and more. This long list might be the result of laudable scientific curiosity – but it could also be an attempt to find the largest possible number of applications for a potentially profitable drug. Researchers are also exploring ways of administering psychedelics through patentable “tamper-resistant” patches like those that were used for fentanyl.
Opioids are vilified and increasingly hard to obtain legally – even for acute and end-of-life pain, when they are enormously valuable – while psychedelics are in vogue with venture capitalists, medical researchers, and psychonauts alike. No longer confined to the counterculture, psychedelics are celebrated as a panacea for the afflictions of modern life: depression, anxiety, distraction, apathy, loneliness, loss of purpose, insufficient productivity in the workplace. Michael Pollan, author of How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, is only the most famous of the many journalists and writers who have celebrated the beneficial effects of psychedelics.
These new alleged cure-alls are simultaneously being ensconced in the world of medicine and in the booming wellness industry. The New York Times recently ran a wellness story quoting a PR firm with the straightforward moniker “Ketamine Media”. The piece included photos of the ketamine lozenges, journal, and eye mask included in kits that can now be ordered online – albeit at a rather high price. There is a newsletter (Psilocybin Alpha) and a Reddit community (Shroom Stocks: Let’s Ride the Mush Rush!) aimed at investors in the burgeoning psychedelic industry.
Some of the organizations researching and advocating for the therapeutic use of psychedelics are nonprofits, and a number of these signed on to a recent statement promising to take an “open science” approach that does not involve patents. But other psychedelic-assisted therapy companies are traded on Nasdaq, eager to lock in profits through the use of intellectual property law. They are developing “proprietary formulations” and synthetic versions of plant medicines that have been used for centuries. Once treated as a mysterious gift of nature, psilocybin is being commodified, transformed into private property.
Not content with commodifying the drugs themselves, some in the growing psychedelic industry are even trying to profit from simple techniques familiar to anyone who has ever been a “trip sitter”. In 2020, Compass Pathways, which receives financing from Peter Thiel, applied for a patent for methods like providing psilocybin-assisted therapy in a room with soft furniture, muted colors, and a high-resolution sound system while a therapist “provides reassuring physical contact” and “holds the hand, arm, or shoulder”.
The Oxycontin story showed that the profit motive in medicine brings many dangers: overprescription, a loss of freedom of choice for patients, extortionate prices, the aggressive suppression of those who use or provide a drug outside of corporate pathways. We need to be wary of repeating the same mistakes with psychedelics. Dopesick shows how profit-driven companies can expand or simply invent diagnoses, creating huge new demand for the product they want to sell. A familiar drug – whether opioid or psychedelic – can be tweaked, granted a new patent, and bring enormous profits for the seller, at great cost to patients.
One of the authors of this article has performed more than 500 ceremonies with the psychedelic ibogaine, helping individuals safely and effectively detox from heroin. He has also performed hundreds of individual psylocibin ceremonies outside the country, and counseled thousands of people following self-administered trips, mostly in coordination with psychotherapists, following a professional pattern not unlike the typical coordination between psychiatrists and psychotherapists.
We know from our extensive professional and personal experience that psychedelics can be enormously useful in many situations. They can provide relief, transformation, insight, and profound moments of awakening. But their value is embedded in cultural practices and social relationships. They have unpredictable results and should never be forced on anyone. Court-ordered drug treatment with psilocybin, for example, would be a recipe for a very, very bad trip that could cause enduring psychological harm. Above all, psychedelics can’t solve the problems of a society in which so many people have been harmed by violence and inequality.
Despite the public pillorying of Purdue and the Sacklers, America is still plagued by the untrammeled greed of the pharmaceutical industry and healthcare lobby, by out-of-control drug prices and a deeply unjust medical system that often relies on coercion and control. Treating psychedelics as new wonder drugs risks yet another pharmaceutical disaster. We have to step back and question the foundations and assumptions of our approach to medicine. Otherwise, we risk making the same mistakes we saw with Oxycontin.
Ross Ellenhorn is a sociologist and psychotherapist and the founder and CEO of Ellenhorn. Dimitri Mugianis is a harm reductionist, activist, musician, poet, writer, and anarchist, with over two decades of experience as a psychedelic practitioner. Ellenhorn and Mugianis are the founders of Cardea