On the Legalization and Decriminalization of Psychedelic Substances in the United States

Introduction

Every year, countless individuals suffering from debilitating mental illnesses are left without viable treatment within the confines of conventional medicine. Picture a scenario where a young child or adolescent faces a rare and life-threatening disease leading to chronic seizures and the gradual deterioration of their body and mind. Despite the relentless dedication and expertise of medical professionals, a cure for such a condition eludes the realm of probability. While such scenarios are infrequent, they serve as bitter reminders that even in the face of modern medicine’s advancements, certain afflictions persist beyond the reliability and novelty of established medical practices. It is amidst this sentiment of stagnation and desperation that a few daring souls turn their gaze towards the use of psychedelic drugs, driven by the belief that unconventional approaches may harbor the potential to heal their afflicted minds. For numerous years, psychedelic drug users and some medical professionals have been pushing for a nationwide decriminalization and legalization of psychedelic drugs for medical use, yet there is much debate if the consequences of such drugs outweigh their risks. Moving forward, the United States should investigate the legalization and decriminalization of psychedelic substances as it had been used recreationally and religiously for decades, would allow the creation of novel and innovative medication, and possible medical benefits it may provide to those suffering from mental illnesses and diseases.

Background

Amidst the vast spectrum of pharmacological agents that have captivated human curiosity and sparked passionate debates, psychedelics stand as enigmatic entities, evoking both intrigue and controversy. Psychedelics, which include lysergic acid diethylamide (LSD) and psilocybin (the active ingredient in “magic mushrooms”), are a class of substances that has garnered significant fascination for their unique capacity to modify the fundamental brain processes that shape perception, emotion, cognition, and even the essence of one’s sense of self (Swanson, 2018). Common psychedelics affect the serotonin 2A (5-HT2A) receptor, which allows numerous different substances to elicit similar effects (Nicolas, 2016). Moreso, psychedelics significantly modify the brain’s activity and connectivity, leading to a more functional and connected brain when enduring a psychedelic state (Mason et. al., 2020; Rodríguez & Winkelman, 2021; Tagliazucchi et. al., 2016). These attributes to psychedelic substances made them a topic of further research on the treatment of mental illnesses and diseases.

During the late 1950s, investigations into the medical uses of psychedelics were undertaken due to its profound effects. For instance, the identification and isolation of psilocybin from fungi for psychopharmacological and therapeutic clinical research garnered an increase in popularity for psychedelics (Geiger et. al., 2018). However, after psychedelics were placed into the most restrictive drug category in the US (Schedule 1) through the Controlled Substances Act of 1970, research into psychedelics quickly diminished (Kyzar et. al., 2017). This stringent regulation has resulted in countless arrests and imprisonments for the possession of these substances. More importantly, it makes research nearly impossible for psychedelic drugs due to the difficulty of attaining approval from a governmental agency (the Drug Enforcement Agency, or DEA, in the US). Consequently, the scarcity of approved research projects hindered progress for decades, with only a slight increase in research emerging until the late 1990s and early 2000s (Kyzar et. al., 2017). Even still, research into psychedelics is largely limited due to both perceived dangers to humans and regulation through its classification as a Schedule 1 substance. The United Kingdom, for instance, provides a stark illustration of this limitation where only three hospitals managed to attain a license for Schedule 1 equivalent substances according to data released by the UK Home Office (Nutt et. al., 2013). This creates an environment where research into the benefits of these substances is very limited compared to studies which focus on identifying negative properties of psychedelic drugs, thus creating a possible feedback loop of negativity surrounding psychedelics.

Even with limited resources, numerous research studies into the therapeutic benefits of psychedelic drugs have occurred in recent times, bringing into question to why these substances were heavily restricted. This is evident in recent proposals to decriminalize and legalize specific psychedelic drugs such as LSD, psilocybin, and 3, 4-Methylenedioxymethamphetamine (MDMA). For instance, a recent paper published in 2023 by Siegel et. al. discussed findings on the annual increase of reform bills targeting psychedelic drugs and their decriminalization. Denver, Colorado became one of the first cities to embrace the legalization of psilocybin with 50.6% of voters approving the proposal in 2019 (Ducharme, 2021). The state of Oregon, too, joined the ranks of progressive jurisdictions by introducing psilocybin services in 2020 granting certain clinics the authority to administer psychedelic drugs (Oregon Psilocybin Services, n.d.). Moreso, investments into psychedelic pharmaceutical research and design have substantially increased since 2018, with a market in psychedelic substances projected to grow towards approximately $10.75 billion by 2027 (Phelps et. al., 2022). With this surge in research on psychedelics, numerous benefits have been attributed to these substances. For instance, several studies have discussed the promising use of MDMA for the treatment of severe PTSD (Marks & Cohen, 2021; Nutt et. al., 2013) and LSD for depression (Johansen & Krebs, 2018). However, even with mounting evidence of medical benefits and uses for some psychedelics, they remain unapproved by the FDA and heavily restricted. This restriction could be detrimental to those who have mental illnesses and diseases that are resistant to contemporary medicine, something a nationwide decriminalization and legalization of psychedelics for medical, and perhaps even recreational, purposes in the US would help alleviate.

Argument

For over a millennium, psychedelic substances have held a profound and enduring presence in the fabric of human cultures and rituals. Venerated for their mystical and transcendental properties, these substances have been embraced as gateways to the divine and conduits for spiritual exploration. Moreover, entheogens, psychoactive substances that are used specifically for spiritual and religious purposes, endured a long period of use across a diverse set of civilizations. One example can be found in Native American traditions, where entheogens such as Mescaline have been derived from the peyote cactus for up to 40,000 years to provide a basis of night long ritualistic prayer ceremonies for tribal worshippers suffering from personal and familial crises (George et. al., 2022). Additionally, archeological discoveries further substantiate the connection between psychedelic substances and cultural rituals. Pre-Columbian Mesoamerican civilizations, which thrived centuries ago, demonstrated evidence of significant knowledge and skills in the use of many entheogens and other psychedelic substances (Carod-Artal, 2015). Moreover, remnants of ancient Mesopotamian and Near Eastern civilizations contained potential traces of the use of psychedelic substances (Stein, 2014; Ivanov, 2022).

Moving forward, it becomes increasingly apparent that psychedelic substances have been an integral part of human existence for well over a thousand years. This prompts many to question the reasons behind the stringent control of these substances. The active and widespread suppression of psychedelics is a relatively new phenomenon that started around the late twentieth century with the enactment of the Controlled Substances Act of 1970 in the United Stated (George et. al., 2022). This pivotal legislation marked a significant shift in societal attitudes towards the use of these substances, ushering in a new era of regulatory control and sparking debates regarding their place in the domains of culture, spirituality, and medicine. In recent years, however, a growing body of scientific research has begun to shed light on the potential therapeutic benefits of psychedelic substances. Furthermore, the legalization and regulated medical use of psychedelic substances could address several pressing issues within the healthcare system. Many existent treatments for mental health disorders are often accompanied by significant side effects, limited efficacy, and high rates of relapse (Lake & Turner, 2017). By exploring the medical potential of psychedelics, novel and potentially more effective approaches to mental health treatments may be found. In addition to potential medical uses, the decriminalization and deregulation of psychedelics would also allow for more comprehensive research into their mechanism of action and therapeutic applications.

As stated before, the potential of psychedelic substances to revolutionize the treatment methods for major depressive disorders (MDDs) and other major mood disorders is a concept saturated with possibilities. Beyond their neurochemical effects, these substances possess the remarkable ability to elicit profound shifts in the human consciousness, thereby presenting an entirely new paradigm in the domain of mental health therapeutics. For instance, MDMA, commonly known as Molly, is currently in phase 3 clinical trials as a method of therapy for severe posttraumatic stress disorder (PTSD) due to its promising efficacy and lack of serious side effects (Mitchell et. al., 2021; Penn et. al., 2021). MDMA was shown to have the possibility to treat PTSD compared to previous medication which may only minimize its symptoms (Mitchell et. al., 2021). Besides offering numerous advantages, MDMA demonstrates a superior level of effectiveness when compared to a majority, if not all, of the FDA-approved amphetamines (Mitchell et. al., 2021).

Expanding the spectrum of psychedelic-assisted therapy, LSD has emerged as a notable contender for addressing addiction, depression, and anxiety accompanied by a relatively low incidence of significant side effects (Johansen & Krebs, 2015; Kyzar et. al., 2017). Additionally, Johansen & Krebs (2015) noted that were no significant correlations between anxiety and suicidal ideation for lifetime and past year users of LSD, stating that LSD and psilocybin accounted for approximately 0.005% of emergency department visits annually in the United States. Psilocybin, the active ingredient in a family of mushrooms commonly designated “magic mushrooms”, also provided a strong potential for the treatment of depression and similar disorders with minimal to no long-term side effects (Geiger et. al., 2018; Johansen & Krebs, 2015; Mason et. al., 2020). Due to its innocuous nature, psilocybin has proceeded into phase II clinical trials exploring its many benefits and possible side effects while paving the way for the acceptance of psychedelic treatments (Carhart-Harris et. al., 2021; Johansen & Krebs, 2015). In addition to the aforementioned psychedelic substances, numerous more are currently being researched to evaluate their potential benefits such as dimethyltryptamine (DMT) (Barker, 2022) and mescaline (Uthaug, 2021). Moreso, the growing scientific understanding of the safety and potential benefits of psychedelic substances, combined with the careful regulation and guidance provided through decriminalization and legalization, holds the promise of ushering in a new paradigm in the era of medical innovation and improved well-being for individuals struggling with mental health challenges.

Finally, the legalization and decriminalization of psychedelic substances for medical use has the potential to catalyze a remarkable wave of innovation in the field of pharmaceuticals. By lifting legal barriers and enabling rigorous scientific exploration, researchers and pharmaceutical companies would be able to unlock the full therapeutic potential of these substances. Moreso, removing some, if not a majority, of the psychedelic substances from the Schedule 1 classification would help alleviate the perception that these substances pose a significant health hazard to humans (Nutt et. al., 2013). This newfound freedom could ignite a renaissance of drug discovery, catalyzing essential innovation for addressing various mental disorders that persistently lack sufficient treatment options (Oña & Bouso, 2020). The integration of psychedelics into medical practice could pave the way for novel pharmaceutical interventions that depart from conventional approaches, offering a transformative paradigm shift in how mental health conditions are understood and treated. Moreso, investment opportunities into psychedelic pharmaceutical research and design shows a promising future for the integration and use of psychedelic substances with the market projected to grow towards approximately $10.75 billion by 2027 (Phelps et. al., 2022). This confluence of evolving regulations, expanding research horizons, and burgeoning market opportunities lays the groundwork for a transformative era in medical innovation, highlighting the potential of psychedelics to reshape mental health therapeutics and provide new avenues of hope and healing.

Nonetheless, while the prospect of legalizing and decriminalizing psychedelic substances holds promise, it is essential to acknowledge and carefully consider unintended consequences. As with any medical intervention, psychedelic substances have the potential to induce adverse reactions in certain individuals, a facet that requires thorough investigation and documentation (Schlag et. al., 2022). This concern is compounded by the vast array of distinct psychedelic compounds, each potentially affecting different regions of the brain, making it imperative to investigate their effects on a case-by-case basis. Additionally, though the risk of addiction and drug abuse with psychedelic is relatively low when compared to other substances, it is not entirely absent (Mitchell et. al., 2021; Schlag et. al., 2022). While these considerations underscore the importance of meticulous regulation and guidance for their use, it is worth emphasizing that long-term significant side effects of psychedelics seem to be minimal, offering a promising contrast to many existing treatments (Johansen & Krebs, 2015; Schlag et. al., 2022). As research into these substances progresses and safeguards are implemented, the potential benefits of introducing psychedelics into medical practice for the treatment of mental disorders must be carefully weighed against these potential challenges, fostering a balanced approach that maximizes therapeutic potential while minimizing risks.

Conclusion

The prospect of legalizing and decriminalizing psychedelic substances in the US represents a pivotal juncture in the evolution of mental health care. The mounting and compelling body of evidence surrounding these substances underscores their profound potential to revolutionize treatment paradigms for a spectrum of debilitating mental disorders. Moreover, a deep-rooted historical and cultural backdrop, combined with recent strides in scientific understanding, illustrates the intricate interplay between psychedelics and human consciousness. As demonstrated by the profound effects of substances like MDMA and LSD in carefully guided therapeutic contexts, the integration of psychedelics holds the promise of delivering innovative solutions to treatment-resistant conditions such as severe PTSD, MDD, and addiction (Kyzar et. al., 2017; Mitchell, et. al., 2021). Furthermore, the potential effects of legalizing such substances extend beyond the confines of therapy rooms. A growing interest in psychedelic medication, coupled with expanding investment opportunities, foreshadows a substantial market growth within the foreseeable future (Phelps et. al., 2022). By embracing a forward-looking approach that encompasses the legalization and regulation of psychedelic substances within a robust medical framework, we open doors to exploring the full therapeutic potential of these substances. This extends not only to the realm of psychedelic drugs, but also to pioneering medication that meets unmet needs and elevates the quality of life for countless individuals who have long grappled with the burdens of mental illnesses. This transformative trajectory encapsulates the promise of a future where the power of psychedelic substances is harnessed to forge innovative paths towards healing and well-being.

References

Barker, S. A. (2022). Administration of N,N-Dimethyltryptamine (DMT) in Psychedelic Therapeutics and research and the study of endogenous DMT. Psychopharmacology, 239(6), 1749–1763. https://doi.org/10.1007/s00213-022-06065-0

Carhart-Harris, R., Giribaldi, B., Watts, R., Baker-Jones, M., Murphy-Beiner, A., Murphy, R., Martell, J., Blemings, A., Erritzoe, D., & Nutt, D. J. (2021). Trial of psilocybin versus escitalopram for depression. New England Journal of Medicine, 384(15), 1402–1411. https://doi.org/10.1056/nejmoa2032994

Carod-Artal, F. J. (2015). Hallucinogenic drugs in pre-Columbian Mesoamerican cultures. Neurología (English Edition), 30(1), 42–49. https://doi.org/10.1016/j.nrleng.2011.07.010

Ducharme, J. (2021, April 30). Denver residents approve Magic Mushrooms Measure. Time. https://time.com/5585635/denver-magic-mushrooms-vote/

Geiger, H. A., Wurst, M. G., & Daniels, R. N. (2018). Dark classics in chemical neuroscience: Psilocybin. ACS Chemical Neuroscience, 9(10), 2438–2447. https://doi.org/10.1021/acschemneuro.8b00186

George, D. R., Hanson, R., Wilkinson, D., & Garcia-Romeu, A. (2022). Ancient roots of today’s emerging renaissance in Psychedelic Medicine. Culture, Medicine, and Psychiatry, 46(4), 890–903. https://doi.org/10.1007/s11013-021-09749-y

Ivanov, K. V. (2022). Existential therapy of the Sumerian-Akkadian civilization: what the ancestral experience teaches. Bioethics, 16(1), 6–11. https://doi.org/10.19163/2070-1586-2023-16-1-6-11

Johansen, P.-Ø., & Krebs, T. S. (2015). Psychedelics not linked to mental health problems or suicidal behavior: A population study. Journal of Psychopharmacology, 29(3), 270–279. https://doi.org/10.1177/0269881114568039

Kyzar, E. J., Nichols, C. D., Gainetdinov, R. R., Nichols, D. E., & Kalueff, A. V. (2017). Psychedelic drugs in biomedicine. Trends in Pharmacological Sciences, 38(11), 992–1005. https://doi.org/10.1016/j.tips.2017.08.003

Lake, J., & Turner, M. S. (2017). Urgent need for improved mental health care and a more collaborative model of care. The Permanente Journal, 21(4). https://doi.org/10.7812/tpp/17-024

Marks, M., & Cohen, I. G. (2021). Psychedelic therapy: A roadmap for wider acceptance and Utilization. Nature Medicine, 27(10), 1669–1671. https://doi.org/10.1038/s41591-021-01530-3

Mason, N. L., Kuypers, K. P., Müller, F., Reckweg, J., Tse, D. H., Toennes, S. W., Hutten, N. R., Jansen, J. F., Stiers, P., Feilding, A., & Ramaekers, J. G. (2020). Me, myself, bye: Regional alterations in glutamate and the experience of ego dissolution with psilocybin. Neuropsychopharmacology, 45(12), 2003–2011. https://doi.org/10.1038/s41386-020-0718-8

Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., Ot’alora G., M., Garas, W., Paleos, C., Gorman, I., Nicholas, C., Mithoefer, M., Carlin, S., Poulter, B., Mithoefer, A., Quevedo, S., Wells, G., Klaire, S. S., van der Kolk, B., … Doblin, R. (2021). MDMA-Assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 27(6), 1025–1033. https://doi.org/10.1038/s41591-021-01336-3

Nichols, D. E. (2016). Psychedelics. Pharmacological Reviews, 68(2), 264–355. https://doi.org/10.1124/pr.115.011478

Nutt, D. J., King, L. A., & Nichols, D. E. (2013). Effects of schedule I drug laws on neuroscience research and treatment innovation. Nature Reviews Neuroscience, 14(8), 577–585. https://doi.org/10.1038/nrn3530

Oña, G., & Bouso, J. C. (2020). Psychedelic drugs as a long-needed innovation in psychiatry. Qeios. https://doi.org/10.32388/t3em5e.2

Oregon Psilocybin Services. Oregon Health Authority: Oregon Psilocybin Services : Prevention and Wellness : State of Oregon. (n.d.). https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Oregon-Psilocybin-Services.aspx

Penn, A., Dorsen, C. G., Hope, S., & Rosa, W. E. (2021). CE: Psychedelic-assisted therapy. AJN, American Journal of Nursing, 121(6), 34–40. https://doi.org/10.1097/01.naj.0000753464.35523.29

Phelps, J., Shah, R. N., & Lieberman, J. A. (2022). The Rapid Rise in Investment in Psychedelics-Cart Before the Horse. JAMA psychiatry, 79(3), 189–190. https://doi.org/10.1001/jamapsychiatry.2021.3972

Rodríguez Arce, J. M., & Winkelman, M. J. (2021). Psychedelics, sociality, and human evolution. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.729425

Schlag, A. K., Aday, J., Salam, I., Neill, J. C., & Nutt, D. J. (2022). Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. Journal of Psychopharmacology, 36(3), 258–272. https://doi.org/10.1177/02698811211069100

Siegel, J. S., Daily, J. E., Perry, D. A., & Nicol, G. E. (2023). Psychedelic Drug Legislative Reform and legalization in the US. JAMA Psychiatry, 80(1), 77. https://doi.org/10.1001/jamapsychiatry.2022.4101

Stein, D. (2014). Ane today - 201407 - psychedelics and the Ancient Near East. American Society of Overseas Research (ASOR). https://www.asor.org/anetoday/2014/07/psychedelics-and-the-ancient-near-east/

Swanson, L. R. (2018). Unifying theories of psychedelic drug effects. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.00172

Tagliazucchi, E., Roseman, L., Kaelen, M., Orban, C., Muthukumaraswamy, S. D., Murphy, K., Laufs, H., Leech, R., McGonigle, J., Crossley, N., Bullmore, E., Williams, T., Bolstridge, M., Feilding, A., Nutt, D. J., & Carhart-Harris, R. (2016). Increased global functional connectivity correlates with LSD-induced ego dissolution. Current Biology, 26(8), 1043–1050. https://doi.org/10.1016/j.cub.2016.02.010

Uthaug, M. V., Davis, A. K., Haas, T. F., Davis, D., Dolan, S. B., Lancelotta, R., Timmermann, C., & Ramaekers, J. G. (2021). The epidemiology of mescaline use: Pattern of use, motivations for consumption, and perceived consequences, benefits, and acute and enduring subjective effects. Journal of Psychopharmacology, 36(3), 309–320. https://doi.org/10.1177/02698811211013583