RESEARCH INTO PSYCHEDELICS
Disclaimer
This special issue, that includes all contributors, an editor and a supervisor of the project, do not endorse intentionally or otherwise the use of any medicine or substance outside of its legal and therapeutic context. The views, opinions, and proposals expressed by the students in this journal do not reflect the stance and position of the PPLE program, its management and academic staff.
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This digital publication was written by students of the PPLE college (UvA) as a part of the final assignment for the course Integrative Seminar IV: Societal Challenges (June, 2018, Amsterdam). If you have any questions about the publication or its parts, or would like to correct any factual mistake please email L. Mosemghvdlishvili (at) uva.nl
Main editor: Abigail Ceban Keane Design team: Alyssa Keretic, Michael Borgers, Nadiah Amoah, Viktoria Bergert, and Vincent Nalbach Contributors: Anna Andryeyeva, Astrid Esparza Sánchez, Clémentine Dècle, Chia-Wen Tang, Finn Reams, Giulia Roulet-Doria D'angri, Lute Wilhelm, Muhammad Musa, Nicholas Vos, Rebecca Blaxland Ferre, Solène Festor De Suremain, Tahrim Ramdjan Course coordinator and supervisor: Lela Mosemghvdlishvili
Acknowledgements We would like to thank Josephine Marchall, member of the Amsterdam Psychedelic Research Association (APRA), and Dr. Jos ten Berge, Lecturer in Art History, Vrije Universiteit Amsterdam, for partially inspiring and informing this issue.
The work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 International License.
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Contents Foreword ................................................................................................................... 4 Quick Quiz ................................................................................................................. 5 Theme 1: Scientific Research ........................................................................................ 9 How psychedelics affect the human brain: an introduction..................................... 9 Psychedelics in Therapy .......................................................................................... 11 Harm of psychedelics .............................................................................................. 18 Ethics ....................................................................................................................... 21 Theme 2: Arts and Culture .............................................................................................. 24 Set and Setting; what determines the experience of a psychedelic trip? .............. 24 The impact of psychedelics on creativity and their influence on art ..................... 30 Psychedelics and contemporary art using new technologies and media ............... 32 Interview with artist Iris Santamaria....................................................................... 34 Theme 3: Law and Policy............................................................................................. 38 Current Legislation .................................................................................................. 38 Punishment versus Care ......................................................................................... 45 The Countermovement of Organizations for Drug Policy Reform .......................... 49 Foundations of the psychedelic regulation............................................................. 55 Policy Recommendations ........................................................................................ 62 Quiz Answer Key ......................................................................................................... 66 Cited Literature ........................................................................................................... 71
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Foreword Dear Reader,
Though your mind may not have been affected by reality distorting LSD or spiritually revolutionary DMT, psychedelics have been rather influential in societies over the ages. While their roots may stem from the spiritual rituals of ancient shamanic traditions, these captivating drugs now appear in pop-culture, international laws, and medical research centers. Given that this is the case, it is important for policymakers, psychedelic-enthusiasts, and those simply curious, alike, to be acquainted with the basics of what is known about psychedelic drugs. We thus invite you to read (and hopefully enjoy) the intricacies of this multifaceted topic; you’ll be able to explore its depths through scientific research, policy perspectives, and artistic insights. You never know, you may be surprised by just how much information you know, you didn’t know, or have never even thought about up until today.
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Quick Quiz 1. Which answer best demonstrates the correct scale of harm posed to individuals by these substances? (most harmful to least harmful) A. Lysergic acid diethylamide, Cannabis, Cocaine, Heroin, Alcohol, Tobacco B. Heroin, Cocaine, Lysergic acid diethylamide, Tobacco, Cannabis, Alcohol C. Heroin, Cocaine, Alcohol, Tobacco, Cannabis, Lysergic acid diethylamide D. Cocaine, Heroin, Lysergic acid diethylamide, Alcohol, Tobacco, Cannabis
2. Is the following statement true or false? Psychedelic drugs such as ‘acid’ have been proven to cause schizophrenia. A. True B. False
3. Which of these drugs is the odd one out? A. Lysergic acid diethylamide (LSD) B. Magic mushrooms C. Cocaine
4. Which definition best describes attributes of psychedelic experience? A. “Mind manifesting”: Psychedelic substances are highly responsive to the environment, the settings and one’s expectations of their trip. They can give hallucinating visions, enhance creativity and make one be in a state of psychosis. They are referred to as mind manifesting drugs. B. Hallucinogen: Psychedelics substances are highly responsive to the physical environment, the social setting and one’s expectations for their trip. They can give hallucinating visions,
RESEARCH INTO PSYCHEDELICS and make one be in a state of psychosis. They mainly result in colorful and distorted visions and are referred to as hallucinogenic drugs. C. Psychosis: psychedelic is the unique experience of a state of psychosis triggered by the consumption of a drug rather than a mental illness. 5. Which of these art pieces was painted by an individual under influence of psychedelic substances?
Image 1 A. Cy Twombly, School of Athens, 1961
Image 2B. James Coignard, Homme aux raisins, 1960. Man with grapes
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Image 3 Oscar Janiger Kachina Doll, 1955
6.
Which medical condition have scientists not (yet) found treatments for using psychedelic drugs? A. Depression B. PTSD C. Schizophrenia
7. Which chemical do psychedelics mimic in your brain? A. Dopamine B. Serotonin C. Adrenaline D. Oxytocin Now that you’ve completed this short quiz, you may have realized that you know quite little about psychedelics. Of course, you may also already be an expert on the basics of these controversial drugs. In the following, we aim to inform you of some of the prevailing research and perspectives that fill current (and past) debates on the use and usefulness of psychedelics. Hopefully, by the end of this issue you will be able to answer more of these questions correctly; and if not, there is an answer key waiting for you at the end of the issue.
Happy reading!
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Theme 1: Scientific Research How psychedelics affect the human brain: an introduction
For the purpose of this issue, we will continuously refer to “psychedelics” (or any interchangeable expression such as “psychoactive drugs” or “serotonergic hallucinogens”) as substances that alter perception and mood, while affecting several cognitive processes.1 During psychedelic experiences, subjects often report effects on their mood, their cognition (i.e. their learning and reasoning capacities) and their external perception. This is the case because the human brain relies on a series of connections between neurons, through the release of chemicals that communicate information. When several neurons interact, they create a network specialized in a certain task. There is for instance, the default mode network (DMN) employed during “daydreaming” states and the executive network, focused on decision making and studying.2 To accomplish tasks effectively, the human brain usually switches from one network to the other, meaning that under normal circumstances there is high intra-network connectivity (i.e. high interaction within neurological networks) instead of low inter-network connectivity (i.e. low interaction between neurological networks). Interfering with that system, psychedelic drugs used in scientific research (such as psilocybin and LSD), work as “5-HT2A receptor agonists.”3 They target cerebral receptors responsible for transporting serotonin, a neurotransmitter commonly known as the “feel-good chemical” that is used to transmit nerve impulses.3,4 Serotonin is one of the most versatile physiological substances, as it influences various bodily functions such as sleep, memory, mood, behavior and even the cardiovascular system.4 After ingestion, psilocybin is broken down into psilocin, which travels through blood vessels; because of its small chemical composure, it passes through protective barriers in the bloodstream and penetrates the brain. Since psilocin has a similar chemical structure to the serotonin molecule, it locks in the 5-HT2A receptors designed for it.2 Considering that once the LSD (or psilocin) molecule is attached to the receptor,
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serotonin cannot transmit neural messages anymore, and taking into account the widespread functionalities of that neurotransmitter, one can understand why psychedelics have such a strong impact on a subject’s behavior and psyche.2,4 Impact on neurological connections & dynamic
A study conducted in 2015 stressed the difference between intranetwork and inter-network connections. As shown on the figure below, the study concluded that when subjects were given placebo, their brain networks (illustrated by the different colored hubs) were somewhat inter-connected but most of the interaction remained within-networks (figure a). On the other hand, subjects that took psilocybin experienced heightened levels of internetwork connectivity and lower intra-network interaction (figure b).5
Figure 1: “Simplified visualization of the persistence homological scaffolds”. Both figures show the intra and inter-network connectivity. Figure (a) presents results for placebo controls while figure (b) illustrates the effects of psilocybin.5
Under psychedelics, the brain’s entropy is modified. Here, entropy refers to the level of (dis)order with which the brain is organized; it applies to subjects’ level of consciousness and their “neurodynamics” under a psychedelic state.6 Under high entropy, cognition is very flexible, but the system is disorderly, whereas
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under low entropy, cognition is inflexible and the system is highly organised. 2 With psychedelics, subjects’ entropy can momentarily shift from a low state of entropy (which often characterizes depression) to a high level of entropy; this has important therapeutic implications that will be discussed further on in this issue. The Ego-Dissolution Theory
One of the main direct effects of psychedelics on the human psyche is explained through the ego-dissolution theory. It argues that the ego, meaning the subject's capacity to situate himself as part of an environment (minimal self) and to reflect on his personality (narrative self), is gradually hindered by the effects of psychedelics. In a study validating the Ego-Dissolution Inventory (EDI), researchers found that respondents often associated their psychedelic experience to feeling at “one with the universe” and of self “disintegration.”4 Psychedelics induce ego-dissolution by stimulating “high-level cortical association regions,” rich in 5-HT2A receptors; this increases inter-network connectivity but reduces intra-network connectivity, which explains subjects’ self-reported ego-dissolution. Consequently, psychedelics jeopardize the brain’s default organization and change subjects’ perceptual boundaries of themselves within their environment.7 This study showed that the effect of ego-dissolution on the human cortex (namely, the precuneus/posterior cingulate cortex) occurs through a decrease of the “alpha power,” which inhibits neural processes. Psychedelics allow the consciousness to “expand” depending on the subject’s relative cerebral entropy (i.e. the higher the subject’s cerebral entropy is, the more likely the subject is to experience ego-dissolution and therefore to broaden his consciousness).7 Altogether, ego-dissolution dysregulates the minimal self and the narrative self, effectively disintegrating spatial boundaries, relevance of emotional states, introspection capacity, and agency. Therefore, ego-dissolution can be perceived as a positive or negative experience depending on the individual, who may either feel united with his environment or undergo a loss of identity.2 Psychedelics in Therapy Clinical research into the therapeutic qualities of psychedelic substances is currently undergoing a renaissance, which has proven to be revolutionary in treating depression, anxiety, posttraumatic stress disorder (PTSD) and addiction,
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to name a few. This revival has come about thanks to the return of a paradigm that recognizes the importance of set (psychological expectations) and setting (physical environment) and the therapeutic doctor-patient relationship as crucial elements in ensuring curing experiences and positive effects.8
Substance
General effects and properties
LSD
Potential harms
Potential therapeutic uses
Legal status
5-HT2A
Panic reactions (“bad
Addiction, anxiety
Schedule I drugs
(serotonin)
trip”), temporary
associated with
under the United
agonist of
cognitive impairment, triggering psychotic symptoms, and HPPD.
terminal illness,
Nations 1971
Understanding schizophrenia
Convention on
pyramidal neurons
Psychotropic Substances
Psilocybin
Addiction, anxiety associated with terminal illness, depression Addiction
Mescaline
Addiction, depression, anxiety
Ayahuasca (DMT)
MDMA
Serotonin, dopamine and noradrenaline agonist
Neurocognitive deficits (such as memory impairment), shortterm depression, sleep disruption
Depression, anxiety associated with terminal illness, PTSD
Table 1. Methodology
The two most prominent methodologies of the so-called “guided trip” are psycholytic therapy and psychedelic therapy. The psycholytic (“soul-dissolving”1) therapy involves the use of low to medium doses of psychedelic substances at
The name, coined by Ronald A. Sandison, literally meaning "soul-dissolving," refers to the belief that the therapy can dissolve conflicts in the mind. 1
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intervals of 1-2 weeks and is mainly used with neurotic and psychosomatic patients. The therapist is present at the time of the experience’s peak and whenever needed to provide support and help in the processing of the experience. This introspective state makes patients aware of ego defenses (projection, denial, and displacement) as they gain ability to react to themselves and their choices, while making them. Essentially, the goal of the therapy is to provide a safe and compassionate context. The therapist guides the patient through his/her highly introspective state and helps in creating a new life framework that recognizes personal responsibility for initiating change.9
Psychedelic therapy2 has the same purpose as the psycholytic one; however, it involves very high doses of psychedelic substances in order to reach transcendental, ecstatic or mystical peak experiences. Patients spend most of the psychedelic-induced time lying down with eye-shades, listening to non-lyrical music and exploring their inner experience. Dialogue with the therapists (one man and one woman) is sporadic during the drug sessions, but key for psychotherapeutic sessions before and after the experience.10
Mechanisms at work
The potential antidepressive effects of classic psychedelics such as ayahuasca (and DMT), LSD, and psilocybin seem to be caused by their activation of the 5-HT receptors, which are responsible for antidepressive effects. Psychedelic-caused changes in the DMN could also add to the effects. Ayahuasca and psilocybin, for example, have shown to reduce rumination - a central depressive symptom caused by high activity in the DMN. By changing the patient’s self-perception, psychedelics may lower attention to tiresome, pathological thoughts, reducing depression and anxiety symptoms likewise.11
A recent study by Sanchez and colleagues (2016) showed that administration of ayahuasca was linked to fast and extended antidepressive effects - with similar
The psychedelic therapy method was initiated by Humphry Osmond and Abram Hoffer (with some influence from Al Hubbard) and replicated by Keith Ditman. 2
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results across all 17 volunteers, regardless of the severity of depression symptoms. Well tolerated and reportedly enjoyed, administration of this drug was also linked to increased blood inflow in the brain regions responsible for the regulation of emotional states and mood - an increased activation linked to antidepressive effects.11
Another study by Carhart-Harris and colleagues (2016) found markedly reduced depressive symptoms in 12 patients with moderate-to-severe major treatmentresistant depression following two sessions of psilocybin administration (7 days apart). Depression was significantly reduced across all volunteers 1 week in and sustained 3 months after the treatment, with the maximum effect at 2 weeks. Eight of the 12 patients were in complete remission at 1 week, with five of them still in complete remission at 3 months.12 One year later, Carhart and colleagues (2017) bolstered their previous results by finding marked symptom improvements after just 2 psychotherapeutic sessions with psilocybin being effective now in 20 treatment-resistant patients, with significant effects even lasting 6 months later. As previously, treatment was well-tolerated and marked improvements were still observed at 5 weeks, with 9 and 4 patients, respectively, meeting criteria for treatment-responsiveness and remission; none of the patients opted for conventional antidepressants. The two studies provide support for safety and efficacy of psilocybin for treatment-resistant depression and provide support for the substance as new paradigm in treating unresponsive depression and urge for further research.13
The difference between psychedelics and conventional antidepressants Antidepressants are widely known to have more severe and more likely sideeffects, compared to LSD and other psychedelics reviewed here. The most common side-effects are: nausea, anorexia, anxiety, addiction, insomnia, reduced libido, akathisia ‌ it can even increase suicidal tendencies.14
The effectiveness of fluoxetine (active substance of Prozac and other commonly prescribed antidepressants) is also questionable as many independent studies
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have found it to be almost as effective as placebo, while most of the affirming studies were conducted by pharmaceutical manufacturers themselves, so most of them are not adequate enough even to consider.15
While it is safe to say that psilocybin has therapeutic qualities for people with depression, a recent study suggests that the reason for its healing effects is the drug’s ability to support the patient’s brain in reviving its emotional responsiveness. More interestingly, this mechanism is actually the opposite to the one of selective serotonin reuptake inhibitors (SSRIs) - the most commonly used group of antidepressants. As such, the substances have been found to relieve depressive symptoms, without the “dulling” of emotions commonly caused by Prozac and other antidepressants alike.16 Anxiety
LSD and psilocybin have also shown promise as an effective treatment for anxiety in terminally-ill patients.8 For instance, a randomized controlled study in Switzerland found LSD therapy to have the potential for reducing anxiety in terminally ill patients. Two months later, all 12 patients showed significant reductions in anxiety, with a sustained therapeutic effect for 9 patients one year later and no severe drug-related side-effects.17 Similarly to the effects of LSD, a study by Grob and colleagues (2011) found psilocybin to ameliorate endof-life anxiety in 12 patients with last stage cancer. They findings showed that assisted psilocybin induced therapy lessened anxiety and improved mood, without any significant (adverse) side effects.18
Though not a classic psychedelic, MDMA has shown to be promising in treating social anxiety in autistic adults. Danforth and colleagues (2016) found that all (out of 11) participants who were randomly assigned to MDMA treatment experienced marked decreases in their anxiety levels following two administrations of the drug. Even 6 months after the study, they continued to feel a lot less anxious in their social interactions and more socially adaptable. 19
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Understanding schizophrenia3
Schizophrenia is a chronic mental illness characterized by abnormalities in thinking, emotion and behavior.20 Several hypotheses establish a relationship between schizophrenia and excessive dopamine activity alongside deficiencies in glutamate.22 Patients present symptoms such as disorganized thoughts, bizarre behavior, delusion and hallucinations (known as positive symptoms), in addition to blunted affect, inattentiveness, apathy and anhedonia (known as negative symptoms).20
“I’m not much different than the rest of you. We all see, hear and feel things when we are dreaming. I’m just someone who cannot turn off my nightmares, even when I’m awake.” Cecilia McGough, witnessing about her delusions as a schizophrenic.21
Subsequently, individuals suffering from schizophrenia encounter difficulties adapting in social settings and acquiring basic social skills, while facing selfsufficiency issues (i.e. being unusually messy, malodorant and lacking basic hygiene living standards). Additionally, evidence suggests that about 10% of the individuals suffering from schizophrenia will commit suicide.20 Helping people suffering from schizophrenia appears to be a societal challenge that needs to be tackled through research. Treating schizophrenia
Schizophrenia requires a lifelong treatment; “transforming yourself is a journey that does not have an end” says a Reddit user in remission of schizophrenia.23 Antipsychotic drugs, hospitalization and therapies are the prevalent treatments against schizophrenia nowadays. Antipsychotics are expected to control symptoms by acting on the brain neurotransmitter dopamine. Such treatment aims at managing signs and symptoms of schizophrenia at the lowest possible dose. There are two generations of antipsychotics, where the first has more serious side effects than the second one, such as the development of an
Note that these are general trends established by research, however the manifestation and symptoms of schizophrenia are different to every patient and research still ought to be done due to the complexity of this illness. 3
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irreversible movement disorder, which includes muscle spasms and twitching similar to the symptoms seen in people suffering from Parkinson’s disease. 24 Thus, individuals suffering schizophrenia are sometimes reluctant to use such treatments. Psychoactive substances: A new hope for schizophrenics?
Research shows that psychoactive substances such as psilocybin and lysergic diethylamide (LSD) act as agonists at 5-HT2A receptors and that phencyclidine-like drugs can be used as schizophrenia models because they evoke the positive and negative symptoms with cognitive deficits similar to schizophrenia. When understanding such similarities, research attempts to discover which antipsychotics have the capacity to block the effects of LSD and other psychoactives.25
“The new approach is to try to understand specific symptoms: hearing voices, cognitive problems, or apathy and social disengagement. If you can identify the neural bases of these, you can tailor the pharmacology.” Franz Vollenwider, a psychiatrist and neuroscientist at the University of Zurich.26
Recent conclusions suggest that certain psychotic effects of psilocybin, such as visual hallucinations, can be prevented by buspirone that binds to serotonin 1A receptors, which then pair with and counteract the serotonin 2A (psilocybin) receptors.26 Understanding the mechanisms of hallucinogens leads to a better understanding of the basis for psychosis in this disease.25
To this extent, using psychedelics in research is considered a promising experimental system in which “the signaling and circuit mechanisms underlying psychedelics has been mapped using systems pharmacology and mouse genetic models.”25 By following such an experimental design, researchers are able to devise new types of antipsychotic drugs with less subsequent secondary effects, which currently remain a challenge for psychiatrist worldwide.25
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Harm of psychedelics While it is generally acknowledged in the literature that psychedelic compounds have little potential for harm comparative to other drugs,27 it is evident that the quantity of research into the toxicity and adverse effects of these drugs is lacking. The effects of an MDMA overdose have been better recorded and show clear potential for harm if abused (as will be shown). This section outlines the potential of these substances for three dimensions of harm: physiological, psychological, and social. For clarity, and permitted due to their comparable effects on mind and body, “psychedelics� will refer to LSD, psilocybin, and mescaline, unless differentiated. Physiological harm
Effects witnessed shortly after ingesting psychedelics have not proven to cause lasting physiological damage. There is evidence of increased heart rates, blood pressure, breathing rate, muscle tension, lightheadedness, nausea, weakness, vomiting and pupil dilation.28,29,30 Increased blood pressure, heart rate and pupil dilation is also witnessed after ingesting MDMA.31 These effects usually do not last and therefore pose no consequential threat.30 Psychedelics pose little risk of long-term physical harm. Deaths from psilocybin are extremely rare,32 LSD overdose is possible only at excessively high doses generally unavailable to the public,33 and no deaths have been reported from the direct physical effects of mescaline.34 There is also no proof for increase in birth defects from mothers who have taken LSD.35
MDMA carries more risks. One is hyperthermia, or overheating caused by the drug. Particularly when accelerated by party environments MDMA is typically taken in, this can in rare cases lead to organ failure and death.34,36 Repeated MDMA use has also been linked to chest pains, weight loss, exhaustion and, more severely, bleeding in the skull and impaired liver function.37 It is suggested that the rare cases of death from MDMA overdose are the result of interactions between the substance itself and the environment it is typically taken in, where
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physical activity, high ambient temperatures, low fluid intake and drug mixing all play a role.38 Psychological harm
Evidence suggests that some cognitive function is temporarily impaired by the use of psychedelics. Various conducted tests found a decrease in attention, concentration and motivation after ingesting LSD,30 decreased attention, memory, learning, and general intelligence from MDMA,39,40 and brain scans found a decrease in functioning of the right hemisphere on mescaline. 41
The most common adverse effect when using psychedelics is a “bad trip.” This refers to a state of high internal tension and anxiety that may cause severe panic reactions and abnormal behaviour.42 It is characterized by an intense negative experience, with elements of paranoia, delusion, fear and agitation.33 In severe cases, a bad trip may devolve into an extended psychotic state resembling schizophrenia.29 The unpredictability of these effects is exemplified by two separate cases of the accidental intake of an adult dose of LSD by a two-year-old boy and a five-year-old girl, respectively. Both children experienced visual hallucinations and showed signs of severe distress typical to a bad trip. The boy recovered with no noticeable effects the next morning, while the girl underwent psychosis and experienced impaired cognitive function for months.43,44 Permanent psychoses have been observed resulting from the use of psychedelics, albeit indirectly. Studies hold that psychedelic compounds only reveal or worsen existing psychotic conditions rather than create new ones.30 Individuals suffering from or with a genetic history of psychiatric disease are at particular risk of developing psychosis after consuming a psychedelic drug.32
A final observed long-term psychiatric effect of psychedelics is Hallucinogen Persisting Perception Disorder (HPPD) or “flashbacks”, the occasional re-living of the perceptual effects of hallucinogens for days, months of years after ingestion.45 These are most prevalent with the
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illicit use of LSD and is more rarely witnessed for psilocybin use or LSD administered in a controlled research environment.32
Social harm
Social harm is thought to arise from the behavioral changes that stereotypically accompany illicit drug use. However, psychedelics have been found not to cause violent behavior in users, where damage to others is mostly caused by accidents from disorientation or panic reactions to a bad trip.30 In fact, evidence points towards psychedelic use as a factor decreasing likelihood for property crimes and violent crimes,46 indicating it carries some social merit rather than harm. Nonetheless, the possibility of antisocial behavior does exist. A bad trip is often followed by a negative interpretation of the experience, which can enable paranoid and depressive thoughts even after the physical effects subside. 32 Antisocial behavior following MDMA is well understood, colloquially named “Tuesday Blues” or “Suicide Tuesday”, for the depressive, abnormal and unpleasant thoughts and feelings usually present two days after ingestion.47
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Ethics Scientific research into psychedelics is rife with important ethical considerations. First, the drugs in question are illegal in many places of the world, warranting careful licensing by governments to ensure they do not fall into the hands of the public. Second, discussion of informed consent is prevalent, as therapy and experiments involving psychedelics often require educated consent from those suffering from psychiatric conditions such as schizophrenia and addiction. Third, the subject is placed in a vulnerable position with unique risks and a real potential for harm. There is also the consideration that, like in the past, incautious, irresponsible or dangerous research can set a precedent jeopardizing the legitimacy of future research.48
Due to the unique and under-researched risks posed by psychedelics, it is essential that safeguards are set for the benefit of the research subjects and therapy patients. This is particularly important considering it has been found that persisting adverse effects are rarely witnessed from psychedelics consumed in a controlled research environment (as opposed to recreationally).32 An exhaustive list of guidelines for safety, established by Johnson, Richards & Griffiths (2008), identifies the following key safeguards to minimize the risk of administering psychedelics: 1. In-depth screening of volunteers for personal and family history of psychiatric health through interviews. 2. Establishing trust between researcher and subject, ensuring the researcher has a positive mood around the subject, sufficient interpersonal skills, and is knowledgeable on the adverse effects. 3. Having at least two supervisors, to ensure the subject is comfortable and never left alone. 4. Creating a comfortable, aesthetically pleasing environment unlike a typical clinical laboratory using furniture and decorations, void of potentially dangerous objects. 5. In-depth preparation of the subjects, including an extensive review of the consent form, preparatory meetings between subject and researcher to
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establish trust, and comprehensive education of the possible effects, their likelihoods, and how to manage them. 6. Nearby presence of a physician and blood pressure medication. 7. Post-session meetings to ensure psychological stability and persisting effects of the subject after the experience.48
Lastly, as with all fields of research, bias will exist. Various case studies attribute deaths directly to the ingestion of psychedelics, whilst not considering the presence of other drugs such as alcohol.32 It is also argued that the numbers constituting normal and fatal doses are warped in the existing literature, as they are extrapolated from experiments on animals in the absence of proof for overdoses from psychedelics in humans.33
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Theme 2: Arts and Culture Set and Setting; what determines the experience of a psychedelic trip? Over the past decades, there has been an ongoing debate on the question of whether it is possible to predict the effects of psychoactive drugs before taking them, or that the effects are unpredictable and can therefore vary from person to person, and even from experience to experience. Scholars that operate in the field of psychedelic research have remained divided over this interesting question.49 Proponents of the claim that the effects of drugs are fixed and predictable support their argument by emphasizing how psychoactive drugs lead to well-defined biochemical reactions in the human body.50 These biochemical reactions are responsible for the effects on the body and mind of the user and can be researched precisely. According to this theory, the effects of psychoactive drugs cannot vary greatly between users as the chemical reactions are inherently connected to the substance taken. This "medical" view on psychedelics is grounded in the rudimentary principle of pharmacology, namely that "drugs exert basically conform effect on their users."51 Hence, if effects differ between users, the reason for any variation can always be explained by a difference in substance.50
On the other hand, a different group of scholars claims that there is more to psychoactive drugs than a certain substance catalyzing a specific chemical process. These theorists offer a different explanation for the unpredictable effects. These scholars do not find the "pharmaceutical account" convincing, they even argue that it might occur that two people who use an equal amount of an identical psychedelic drug could still have fundamentally different experiences.49 Thus, one of the most influential theories that focuses on explaining the different responses to psychoactive drugs is the theory of set and setting. As the theory of set and setting is a key concept in the field of drug research, it will be given its own overview. Let it be clear that it is not the aim of this section to present this theory as the only legitimate or correct theory, as opinions still differ. The reason we will focus on the theory of set and setting is that it has gained significant
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importance during the last decades and that it has and still serves as a basis for the further development of scientific research, the creation of effective drug policies and the reduction of potential harm of drug use.49
The key assumption underlying the theory of set and setting is already revealed by its name: the theory holds that effects of psychoactive drugs are affected by the person's (mind)set and the setting in which it takes place. The set consists of the expectations, personality traits and intention of the person; if a person has negative expectations or a bad mood, the trip is more likely to be experienced as negative. The setting, however, is "the physical, social and cultural environment in which the experience takes places.�49 For example, a person using drugs in a cold empty room or surrounded by strangers, or in a society in which drug usage is strongly disapproved of, has higher chances of having a bad experience than a person who uses it in his/her living room, surrounded by friends, and in a society that is generally more open and tolerant towards the usage of psychedelics.
The concept of set and setting was officially introduced in the academic world by the controversial Harvard psychologist Timothy Leary in the 1960's.52 Yet, the roots of the concept can be traced back to the writings of early 19th-century French writers. This club of experimental and prominent French men explored the effects of hashish on the human mind and body. As time progressed, their experiences taught them that taking the exact same doses of hashish could lead radically different effects. One of the writers expressed how hashish sometimes enhanced his creativity, while at other times led to feelings of anxiety and even a psychotic state of mind.49
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Even though the aim of the French group of men was never to put psychedelics in a bad light, their reports on their personal experiences have formed the basis for a prevalent 20th-century view among academics: the psychotomimetic hypothesis of hallucinogenic drugs. This hypothesis regards that psychedelics could be used to "imitate the symptoms of mental illness.�49. The negative outlook of psychotomimetic researchers on the effects of psychedelics resulted in an experimental setting that was impersonal and cold, with patients expecting a negative experience, and with (almost) no preparation preceding the experiment, or support during it.49 As both set and setting were predominantly negative, it is not surprising that participants reported overwhelmingly negative experiences. At the same time, a contrasting school of thought developed, consisting of researchers that focused on the enhancing cognitive effects of drugs and their psychotherapeutic potential. Whereas psychotomimetic researchers believed that psychedelics caused people to temporarily go insane, researchers of the contrasting school believed that "a new sanity" could be instigated by the usage hallucinogenic drugs.49
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The participants of the psychotherapeutic experience were lavished with positive expectations, the experiments took place in comfortable rooms and there was continuous support from the researchers. In short, the setting and set were completely different from experiments conducted by psychotomimetic researchers.49 This resulted in a great discrepancy between reports of participants in the psychotomimetic and the psychotherapeutic experiments, of which the first were considerably more negative than those of the latter. This in turn opened the eyes of a large group of researchers, who started to incorporate non-drug variables in their experiments, such as personal data, the experimental environment, and activities during the experiment. Despite the fact that non-drug variables drew increasing amounts of attention in the academic world, researchers did not yet revise their research or conclusions by using non-drug variables to explain the variation in effects.49
Eventually, when the first group of researchers decided to utilize non-drug variables, they did so with therapeutic aims. As they believed that people could be helped by treatment with psychedelic drugs, they aimed at creating the optimal therapy conditions. These researchers
discovered
through
their experiments, that "preparation, expectation, expectation, intention, physical and social setting" largely determined the effectiveness of the therapy 49 - all key factors incorporated in the current set and setting framework.
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Notwithstanding the progress made, one crucial question remained unanswered in academic literature: how does the greater culture in which the experience takes place affect a drug’s manifestations? This question was first answered by a Canadian anthropologist who compared the different manifestations of mescaline (a specific type of psychedelic drug) between Westerners and native Americans. This innovative research showed great differences in the perceived effects. On the one hand, Caucasian people exhibited aggressive behavior, displayed symptoms that mimic psychiatric disorders and suffered from extreme mood swings. On the other hand, their native American counterparts remained calm and displayed almost no negative phenomena. According to the researcher, this striking discrepancy could be explained by a difference in "greater culture." Whereas the use of mescaline is viewed as a valuable part of native American culture, Western culture is generally less accepting or open to psychedelic drugs.49
In the course of the 1950's, the foundations for Leary's theory in which the concept of set and setting was introduced were already laid by both psychotomimetic and psychotherapeutic schools of thought. Thus, in his article, Leary did not invent a completely novel theory. Leary did, however, put all the different concepts into one coherent and comprehensive framework, which made explicit the great importance of non-drug factors. As Leary's research was profound and extensive, his theory has strongly influenced the psychedelic movement.49
Even though the stricter rules imposed on scientific research hindered further development of psychedelic research post-1960's, the concept of set and setting has not left academic literature. Researchers up until today build upon Leary's original research by investigating the effect of non-drug variables that have not yet been researched. Something that is important to mention, is that this sociological and anthropological view on psychedelics is not accepted by all scholars. Just like in the 1950's, there is still a large group of researchers and scholars who focus solely on the immediate effects and chemical processes that
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are catalyzed by the drugs, rather than taking into account the sociological and anthropological dimensions to the research.49
After having read this summarized history of the theory of set and setting, one can see how influential it has become. An argument that can be made in favor of this theory is that it can reduce the harmful effects of drugs by making people aware of the importance of creating the right preconditions and by addressing risk factors that might lead to negative manifestations of the drugs, before its consumption. According to theorists that focus on the influence of the collective (greater culture), legalizing drug usage would decrease drug-related harm as a more accepting culture generally leads to more positive experiences.49
Therefore, the theory of set and setting can be valuable for policymakers in societies in which legalized use of drugs is more and more seen as a legitimate option, as they ought to be knowledgeable about the potential pitfalls and benefits of drug legalization.49 An argument that can be made against the "set and setting theory" is that it neglects the pharmaceutical/medical aspect of psychedelic drugs. When solely focusing on the set and setting, people might not sufficiently realize that hallucinogenic drugs do trigger certain processes in the brain.53 This could potentially lead to an attitude in which taking drugs is considered acceptable if the set and setting are taken into account, which is something people might find undesirable and dangerous.
To conclude, there will always be competing ideas and views on how to theorize the effect of drugs. But, what has been proven over the past decade, is that the theory of set and setting has become prominent in scientific research and is all but likely to disappear.
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The impact of psychedelics on creativity and their influence on art This part of the special issue will focus on the impact of psychedelics on creativity and their influence on art. To explore this relationship, two theoretical frameworks, analyzing the possible connection between psychedelics, creativity, and art will be discussed. Although both analyses come to the conclusion that the use of psychedelics can impact creativity and the work of artists, they reach it using two completely different approaches, situated in vastly different fields of studies. The first perspective is the neurobiological one, examining the chemical properties of psychedelics and their impact on the human brain. This approach suggests that psychedelics cause increased inter-network connectivity between the “three core brain networks, the central executive network (CEN), the default mode network (DMN) and the salience network (SN),” whose “dynamic interplay” forms the “biological base underlying creativity.”54 In combination with a decrease in intra-network connectivity, especially in the DMN,55 and a variety of other processes in the brain, the use of psychedelics (here ayahuasca) can “result in more cognitive flexibility and consequently potential enhanced divergent thinking.”54
However, most creative activities involve two different modes of thinking. On the one hand, divergent thinking is the activity of generating new ideas and finding answers to problems with more than one solution, for example in brainstorming. Convergent thinking, on the other hand, is the process of finding a single optimal solution to a particular problem, relying on high accuracy and logic.56 Using a quasi-experimental set-up, Kuypers found that under the influence of ayahuasca, “divergent thinking was enhanced and convergent thinking distorted.”56 As divergent thinking is usually seen as the more creative mode, being associated with “thinking out of the box,” these findings are in line with the hypothesis that being under the influence of psychedelic drugs can enhance creativity.
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While the neurobiological perspective mainly tries to explain these results with the chemical properties of psychedelic drugs, researchers like Jos ten Berge take an entirely different approach to the topic. As an art historian working in the field of the humanities, he argues that exclusively focusing on the chemical aspects of psychedelic drugs neglects the importance of expectations.56 As mentioned in the previous section on set and setting’, the expectations about a drug and the environment it is consumed in can heavily impact how it is experienced.
Furthermore, Jos ten Berge analyzed different studies about the impact of psychedelics on art. While artists often described being under the influence of psychedelic drugs as being either "possessed" or "liberated," ten Berge argues that these opposing reactions can partly be explained by expectations and partly by the evaluations of the trip, which “tend to conform to either side of the cultural dichotomy that categorizes [psychedelic] experiences.”56 Following his analysis, these opposing views can mostly be ascribed to the “settings” used in the studies - ranging from being filmed in a clinical set-up to being in an atmosphere of intimacy at an artists’ studio - and to the different “sets” of the participating artists, including the “personality characteristics, cultural beliefs and expectancies they brought to the experiment.”56 As ten Berge argues that the artists’ experiences were only positive and enhanced their creativity if they felt “liberated,” his conclusion is that psychedelics can increase creativity; however, only to a limited extent and through an indirect relationship. In contrast to the strictly neurobiological view and the chemical aspects of psychedelics, he argues that the experience of using psychedelics is highly dependent on “set and setting” and the artists’ general belief that psychedelics will enhance their creativity and not threaten their artistic credibility by drastically altering their established style.56 However, ten Berge acknowledges the limitations of this explanation (dependent on the dosage of the used drug), but nonetheless adds an interesting additional perspective to the discussion about the impact of psychedelics on creativity and art.
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László Mátéfi, Basel 1951, portraits made before, during and after LSD Psychedelics and contemporary art using new technologies and media Event Report ‘Cyberdelic Incubator’ As part of the Amsterdam Psychedelic Weekend, the Psychedelic Society of the Netherlands, in cooperation with the Cyberdelic Society, hosted the event Cyberdelic Incubator, connecting psychedelic experiences to contemporary art forms using new technologies and media. At a waterfront, warehouse-style location in the east of Amsterdam, multiple
artists, creators and guest speakers showcased their projects around mixed and virtual reality experiences. The event included a series of guest speakers, talking about different topics in the sphere of the perception of reality, and influenced by the varying media and novel technologies we use to perceive the world, as well as the impact these technologies have on us. Like the use of psychedelics, or in addition to them, technologies like virtual reality (VR) experiences can help to enter an altered state of consciousness, “extending the possible realities we can reach.”57 According to the Cyberdelic Society, “perceptual technologies […] have the potential to expand our perception of ourselves and the reality we live in,” which can lead to “transformative experiences within these immersive technologies” where the “mind/body/consciousness itself becomes the medium.”58 Their goal for these “new forms of experience” is to investigate whether they can “lead to cognitive and creative insights about the nature of reality.”58
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After the guest lectures, the artists presented their current projects including VR experiences by Dutch artists Sander Bos and Julius Horsthuis, using computer programs for the creation of explorable, abstract new worlds. Other projects like the Brain Machine by Luciana Hail were measuring, visualizing and responding to brain wave activity during meditation or were, like the artwork Pandora Star, using flashing, white strobe lights on the participants’ closed eyes to induce an altered state of mind. What exactly the event and these contemporary art projects looked like is best captured with some pictures
. Virtual Reality Experience by Sander Bos (LEFT) Artwork “Pandora Star” shown by Luciana Haill (RIGHT)
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Interview with artist Iris Santamaria To further investigate the relationship between psychedelics and creativity in art culture, we interviewed a young artist living in Amsterdam. Although she hasn’t made her professional debut as an artist yet, she is studying in fashion school and has a deep love for painting. She is skilled in oil pastel paintings and elaborate pencil shading art. Iris Santamaria is 21 years old and she often takes psychedelics to inspire her artwork. She celebrates nature and abstract scenes in most of her work, paying particular attention to colors and shading; she incorporates the same themes in her fashion work. Iris has taken magic mushrooms and LSD in the past and claims that they help boost her artistic mood. She was thus interviewed to provide insight into an artist’s opinion on the relationship between psychedelics and creativity in art.
Iris claims that she doesn’t take psychedelics too often, but when she does she likes to be surrounded by nature, and mostly consumes psychedelics in the summer time to be inspired by the vibrant natural color schemes. We can understand this personal opinion of hers based on the set and setting theory discussed earlier. The theory itself states that the effects of the psychoactive drug are primarily affected by the person’s mindset and the setting in which it takes place. Iris also seems to think the setting is crucial for psychedelics.
Prior to taking psychedelics for the first time, Iris says she did have expectations of creative properties in psychoactive substances. She reckons this is due to the prevailing pop culture references. Additionally, being in fashion school where she sees her colleagues having their own rituals to boost creativity, she sees psychedelics as her mantra in the world of arts. This generally positive disposition toward psychedelics can be linked to the notion of set within the theory of set and setting discussed earlier. According to that idea, an opportunity-seeking, happy individual like Iris would most likely welcome new ideas and be comfortable with an increased imaginative scope when under the influence of psychedelics.
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We were surprised to discover however that even though Iris expected to be enlightened with new spawning creativity, she does not believe that psychedelics have such an effect on the human brain. She concurs with ten Beerge’s view in that psychedelics do not generate new ideas or creativity.59 Instead, she claims that the experience of a psychedelic trip is so strong and intense that it leaves a lasting impression on her artistic mood. She explained that the environment in which she experiences her trip, and what she feels or discovers about herself, has an impact on the sort of art she creates for the following few weeks. Giving an example she said, “Last time I did truffles [...] I had a very dark and emotional experience. It wasn’t a bad trip other than like 20 minutes in the middle. But because I was indoors the whole time it was different and kind of more inward looking because I’m normally more comfortable doing psychedelics in nature. So yeah, after that my artist mood was kind of gloomy for a couple of weeks and I just really wanted to do a lot of pencil shading and didn’t use much color.”
While Iris claims that psychedelics do not impact a person’s creativity, she has provided a different frame in which to view the effects of psychedelics, saying, “No, psychedelics doesn’t spawn creativity in me at all. It’s more like that it motivates me, you know? Like I see all these amazing things and feel so close to the environment around me, which just sort of projects my ‘art mood,’ but I wouldn’t say that it’s made me any more creative than I was before.” Her argument is that the core creativity of a mind is always present, that, in her case, psychedelics bring to the surface selected ideas from her wide idea pool. It is reasonable to imagine that such an intense experience would allow the human brain to set what Iris calls an “artistic mood.” When I asked whether she thinks this effect is solely in the case of taking psychoactive substances or should it be possible as a result of other strong and intense experiences, she firmly believed it could be as a result of any experience a person believes to be that significant.
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Relating this interview back to the literature, we can definitely see certain points of concurrence with ten Berge’s ideas, such as that psychedelics do and do not spawn creativity at the same time.59 We can infer this from Iris’s stance that she does not feel any new ideas rushing into her brain as a result of using psychoactive substances. While at the same time the very fact that she feels that psychedelics have an impact on her creative mood shows that there could possibly be a link between psychedelics and creativity after all.
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Theme 3: Law and Policy Current Legislation To fully understand the legal and policy implications of the psychedelics debate, it is essential to review current legislation and legal remedies regarding psychoactive substances. To do so, we will provide an overview comparing various legal stances towards psycho-active substances, specifically focusing on the drug policies of Portugal, the Netherlands, Germany and the United States of America, as well as on the general approach within the European Union. This section will first provide a definition of psychoactive substances / psychedelics, which are interchangeable terms. Although the same substances are often classified using different metrics, with varying degrees of sanctions (or absence thereof) related to their consumption, it is still possible to comparatively analyze them in the previously mentioned jurisdictions. Considering each of the nations listed above have public data available regarding general behavior related to drug use, these statistics will later allow us to take a legal stance on the psychoactive substances. Definition The American Society for Pharmacology and Experimental Therapeutics define psychedelics (or serotonergic hallucinogens) as mood- and perception-altering substances.1 However, this definition is rather vague, as using this definition allows other substances such as marijuana (which is generally not regarded as a psychedelic) to also be included. Therefore, the legal definition that will be used from now on in this issue will include all substances listed in schedule I (marijuana) and II (LSD) of the annex to the 1971 Convention on Psychotropic Substances (UNCPS).60 However, it should be noted that schedule III and IV also include substances (such as Benzenediamine) that would otherwise generally be regarded as a psychedelic.61 These are excluded however as including schedule
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III and IV would necessarily lead to the inclusion of substances that are not regarded as psychedelics. International approach to psychedelics
In terms of drug related policies, the United Nations plays a crucial role, as many countries and international organizations base their legal stances on the 1961 UN Single Convention on Narcotic Drugs (UNSCND). This convention is insofar problematic as it is based on the premise that the distribution and consumption of psychoactive substances are a menace to society at large and should be considered illegal. For instance, the second amendment (Resolution II) to the convention states that “measures to be taken against drug abuses must be coordinated and universal.”62 Furthermore, Resolution III states that all Parties to the Convention are “concerned with the health and welfare of mankind and are conscious of their duty to prevent and combat the evil of drug addiction.”62 This language, in connection with the focus on the establishment of an international prohibition mechanisms on psychedelics, shows the clear disposition of the Convention against even the most limited use of psychoactive substances. Given that the majority of nations base their general drugs policy on UN policy (given the international character of drug trafficking), this means that any analysis into the legal position of psychedelics must assume an international system that is actively hostile towards their use.63
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The United States of America
Being a federal republic, the United States has various drug policies across federal and individual state levels. This is best demonstrated by the differentiated legalization of recreational marijuana, which is now legal in 9 states as well as the District of Columbia.64 However, unlike marijuana, which finds at least a modicum is support, the US takes a staunch approach to illicit substances. Since the enactment of the Federal Controlled Substances Act (CSA) in 1970, the federal government has passed various legislation such as the Comprehensive Crime Control Act of 1984 and has created various federal agencies for enforcement such as the Office of National Drug Control Policy.64 This tandem of increased regulation, as well as harsher enforcement, has often been generally referred to as the start of the “war on drugs�.61 In the U.S., most psychedelics (such as MDMA and LSD) are listed under Schedule I/Class A, which means they are regarded to have no therapeutic use and their possession, distribution or consumption carry heavy sanctions with a maximum of 30 years imprisonment for repeated offences involving even a small amount.63 This
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aggressive approach has garnered the U.S. a reputation of being “tough on drugs,” with general bipartisan support for the current prohibition regime. The implementation of this policy was officially targeted at reducing the use of these drugs, as well as reducing connected health concerns, such as overdoses and addiction. However, new national statistics show that lifetime use of psychedelics in the U.S. has remained fairly consistent since their initial popularization in the 1950’s.63 This shows the general lack of effectiveness of the current regime. Furthermore, drug overdoses have increased exponentially since the commencement of the war on drugs, jumping from just under 20,000 deaths annually in 1999 to over 64,000 annual deaths in 2017.64 However, only a very small number of the 64,000 annual drug related deaths (around 1%) can be accounted for by psychedelics as defined by this paper, which can be explained by the difficulty in overdosing on most widely used psychedelics (such as Psilocybin and MDMA).63 Furthermore, most psychedelics overdoses do not result in death (though can still be detrimental to the individual’s health).63 This disconnect between policy and statistics shows a schizophrenic drug policy in the United States, that focuses on prohibition rather than a nuanced and informed policy. The European Union (EU)
While the role of the EU in drug policy is rather limited, it is nonetheless crucial in explaining the stark differences between Europe and the United States in relation to psychedelics. In contrast to the U.S., the EU has tasked the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in order to collect “factual, objective, reliable and comparable information” regarding the use of illicit substances.65 This means that a much richer pool of data is available, making an analysis into the matter simpler. In terms of enforcement, the European Commission has defined minimum rules on sanctions in order to reach a certain extent of minimum harmonization amongst member states.66 Criminal prosecution at large falls to the member states and shall therefore remain the focus. It should be noted however, that the EU has generally committed itself to
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the UNSCND, which in itself speaks for the general disposition of the EU institutions against psychedelics.65
Germany
The German government interprets general EU policy based on the UNSCND rather strictly, and in comparison, to the U.S., applies it centrally, that is, without the distinction between federal and state law. Federal law – in from of the Betäubungsmittelgesetz – prescribes that any kind of psychedelic falls under Annex I (Anlage I) of drugs and therefore may not be used medically or recreationally.67 However, in a controversial ruling in 2002, the Federal Constitutional Court (FCC) ruled that the possession of very small doses of Annex I drugs may not be illegal.68 In practice though, German police is active in controlling and prosecuting drug offences. In total, the year 2015 saw 292,227 drug related offences recorded by the German police.67
When broken down into offences recorded against individuals for use/possession and supply, the ineffective nature of the German drug policy is revealed. Over 77% of offences were recorded for the use/possession of drugs, which speaks to a large-scale focus on the consumption end of the spectrum.67 However, as the example of the United States has shown, demand for psychoactive substances and other drugs remains constant over time, even when faced with harsh legal sanctions. In essence, a policy that is directed to the demand side of any drug has proven to be futile, while bringing about more negative consequences than remedies for existing issues.61 Harsher sentences in Germany have led to increased incarceration, higher court costs due to litigation, and an increased strain on social services that must support affected families, and therefore has caused a detriment to German public health.67 While a laxer policy in relation to psychoactive substances might seem paradoxical in reaching a goal of increasing public health, recent examples in Europe have shown that this approach is based on concrete data.
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The Netherlands
While the fact that the Netherlands has a very liberal relationship to drugs such as marijuana and magic mushrooms, the approach of the Dutch is much more pragmatic than that. The view in the Netherlands is the “conviction that hiding social negative phenomena does not make them disappear. On the contrary actually making them worse”.69 This goes hand in hand with the issues reported in the American and German approach. Making drugs illegal, placing higher penalties on their consumption, and prosecuting individuals fully will not improve the overall situation. Rather, the effects of such policy are detrimental to public health as individuals feel stigmatized to seek help when they are dealing with substance abusers.70 In the case of psychedelics, individuals in harsh jurisdictions will seek substances through unofficial channels, increasing the risk of overdoses or side-effects due to the lack of purity of the drugs.70 While the Netherlands has a strict anti-psychedelic policy – rendering them effectively illegal as in Germany and the U.S. – they are far more lenient in their application.68 Drug prosecution rates for users in the Netherlands is significantly lower, with police operations rather focused on the supply/smuggling of drugs.68 Furthermore, individual Gemeente (cities) operate testing centers in which individuals can get drugs such as LSD, MDMA and DET tested in order to establish their purity.71 What’s more, this process is completely anonymous and does not store any user data, which allows individuals to establish that the drugs they are in possession of are indeed pure. This has severely undercut the drug dealing business as individuals have become more aware of the dangers of street dealing. In terms of education, the Netherlands has invested heavily in a transparent and honest educational approach towards drugs (which stands in stark contrast to Germany and the U.S. which follow a no-mentioning policy in public schools).71 This is meant to increase awareness of the effects of drugs, more specifically psychoactive substances, on both the body and others around you.
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Portugal
Out of the various jurisdictions covered, Portugal has the most liberal drug policy of all. Having had historically high addiction, overdose and relapse rates, Portugal decided in 2001 to decriminalize the possession and use of all drugs for the amount of a 10-day supply.69 This means that the country treats drug offences as “minor administrative offences” - akin to a parking ticket – instead of a criminal offence.72 This has massively decreased the cost of litigation and court hearings, which in turn has led to increased investment in treatment and education. Following the reform, treatment numbers increased significantly, which can be explained by the fact that “the most substantial barrier to offering treatment to the addict population was the addicts fear or arrest.”70
While some commentators initially feared an increase in general drug use, Portugal has seen overall below EU average drug consumption rates.68 As outlined by the example in the United States and Germany, this furthermore cements the fact that there is no correlation between overall drug consumption and the legal status attached to drugs. Rather, “public health policies were followed by dramatic reductions in drug related harms and Portugal has experienced a perceived decline in drug use among some of the most vulnerable populations, including problematic users.”72
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Conclusion
What the American and German experience has shown is that the state is wholly inadequate in managing drug consumption by declaring it illegal and vigorously prosecuting offences. Drug suppliers will nonetheless want to profit from constant supply by virtue of the unregulated and dangerous black market. Meanwhile, consumers will still seek the drugs, finding them through different means. Portugal, and the Netherlands to a certain extent, have shown that an organized and well-funded legalization program can allow for better administration of psychoactive substances and drugs in general. The significant investment in public education and pragmatic approach to consumption in these countries have shown a decrease in consumption, overdoses and prosecution/incarceration. While we don’t suggest that policies in Portugal and the Netherlands are one-size-fits-all solutions, further investigation into legal measures to regulate drug consumption should be explored.
Punishment versus Care There are two paradigms underlying the current legislation on (psychedelic) drugs: punishment and care. As explained in the previous part of this issue, most international policies targeted at (psychedelic) drugs are still based on the 1961 UN Single Convention on Narcotic Drugs, the 1971 UN Convention on Psychotropic Substances and the 1988 Convention Against Illicit Trafficking in Narcotics and Psychotropic Substances, all of which, generally, focus mostly on punishment for drug-related offences. While national drug policies of course differ in their priority-setting, we will focus on the similarities in their rationale.
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Recently, new steps towards progressive drug policies have been taken. Countries such as New Zealand and Portugal took first step to establish a system based on decriminalization and care for drug users and the addicted. 73 In the following, these paradigms will be explained and illustrated by using examples from different countries. The global drug prohibition, here illustrating the punishment approach, can be exemplified by the “War on Drugs,” started in 1968 under Nixon that has been and is raging most strongly in the United States and Mexico. 74 This approach focuses on deterrence brought about by coercion and prohibition and increased criminalization of drugs.75 It is based on the view that drugs are wrong and, most importantly, harmful, both to the user and his environment. This “deterrence hypothesis” asserts that people respond significantly to the deterring incentives created by the criminal justice system. If so, increasing the resources that society devotes [to the latter] . . . may be the best policy prescription for reducing the amount, and social costs, of crime.76 This strengthens the mistaken belief that the more resources and energy are dedicated to law enforcement (policies, police force, military, incarceration), the higher the deterrence and thus, the less drug-related crimes take place. For example, during the American “war on Drugs”, the federal government immensely increased their expenditures on drug control, however, only with moderate success.77 In this paradigm, law enforcement is used to minimize the harmful effects of drugs on the users and society at large by aiming for reduction of demand and supply of illicit substances through application of criminal law.75 To this end, it is believed that first health and welfare are promoted and, secondly, that controlled drugs are available for medical purposes, such as pain relief, but not beyond that. In pursuing these aims, strategies such as incarceration and punishment of the offender, deterrence, and rehabilitation are practiced.75
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While the punishment approach is presumed to lack efficiency,79 it still underpins many international policies on (psychedelic) drugs that are based on the belief that only rigorous law enforcement and a “no-tolerance stance” are the right tools for deterrence, and therefore decreased drug distribution, consumption and trading. It is often reasoned that through this decrease, economic benefits are created - an argument happily used by policy makers.75
Another perceived benefit of this strategy is increased state legitimacy: the state obtains more control by strict policies and thus has the mandate to enforce the laws; in consequence, its actions are legitimized. State interventions are justified because the state is bestowed with additional supervisory power in the face of crime and fear during times of crises.75 Again, the “war on drugs” example demonstrates how the state’s power has been reinforced and increased, allowing it to further intervene into drug control to a point where the justification for the enormity of this reach has become questionable. On the opposite end of drug policies, we see policies focused on care for drugusers, for example those recently established in the Netherlands, Portugal or New Zealand. These new policies conform to the core goal of harm-reduction
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and introduce new methods to achieve this objective. This approach does not follow the aim of eradicating drugs once and for all, instead promoting regulation and improvement of the market for drugs “in a way that increases social cohesion and minimizes harm.”80 One of the overarching objectives is to reduce the risks of drug use, such as the transmission of hepatitis or AIDS, which are possible dangers if using injectable drugs. Furthermore, this approach strives to ensure that the drug is used appropriately and safely to minimize the harm possible. This entails using the drug in a way that minimizes its harms, for example by injecting it with clean needles and in a safe environment or consuming the drug in supervised facilities. In pursuing public health goals, the approach of harm reduction “encourages policy makers to shift drug policies away from punishment, coercion, and repression, and toward tolerance (…) and regulation.”81 While not the opposite of drug prohibition, the punitive effects of this prohibition necessarily need to be reduced in order to allow for the harm reduction of drug use.81 This approach is based on the realization that the current system of international drug prohibition is failing because sanctions merely seem to be a negligible factor in reducing drug use. Furthermore, drug prohibition is not encouraging safer use of drugs or minimizing the risks associated with their consumption. Therefore, the care paradigm focuses on the normalization of drug use and the inclusion of currently marginalized groups, drug users and addicts. By increasing social cohesion through inclusion, individuals are believed to more easily achieve a “more balanced and constructive life,”80 which benefits public health and the individual. To protect individuals from negative health effects when using drugs, the care paradigm offers different solutions. Differing internationally, examples include prevention programmers, treatments for dependence, and supervised centers that offer needed tools (syringes, disinfectant), drug maintenance, prescriptions, education, rehabilitation and pill testing. Therefore, the human being is placed at the center of drug policies, which previously revolved around macro-economic or military considerations.
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The goal of the care approach is to improve public health and to achieve societal progress. By decriminalizing drugs, society can move towards a healthier communal climate, with less crime, a smaller black market, professional supervision of users and addicts, and set standards of quality for drug-use tools, and maybe even for the drugs themselves. Overall, this leads to more control because there is a higher transparency of drug use and because when fostered by official organizations, or like in Portugal even by the state, the stigma surrounding drugs is removed.
The Countermovement of Organizations for Drug Policy Reform Demand for drug policy reform grows daily but change is plagued by two key challenges. These challenges are the powerful myths and misconceptions over the effects and dangers of illicit substances, and the embedded economic interests that have little incentive to advocate for reform. Recently, in an era coined the Psychedelic Renaissance, drug policy reform advocates are successfully meeting these challenges head on as promising scientific breakthroughs emerge, bolstering their efforts. This article chronicles the various tactics, both top-down and bottom-up, as employed by certain advocates of drug policy reform. The Challenges to Drug Policy Reform
The decades-long War on Drugs is fundamentally rooted in myths and misconceptions regarding the facts surrounding the harmful effects and dangers posed by illicit substances. This is made especially apparent in the statistics on the harm of these illicit substances as compared to the evidently greater hazard of legal substances like alcohol and tobacco, which, taken together, account for 90% of substance-related deaths in the UK.82 To a great extent, the tactics of notable early advocates of psychedelic drug use (none more important than the flamboyant Timothy Leary, with his infamous proclamation to the youth culture of mid-1960’s America to “turn on, tune in, and drop out!�)83 are responsible for the propagation and spread of these myths and misconceptions. Indeed, many cast indirect responsibility to figures like Leary for the government crackdown
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on psychedelics and cannabis that began in the late 1960s and led to the suppression of research into substances such as MDMA, LSD, and psilocybin.49,83 These myths and misconceptions continue to be a major impediment to rational policy making. Drug policy reform is challenged further by an array of embedded and powerful special interests, such as the pharmaceutical, tobacco and alcoholic beverages industries, whose incentives are often to maintain the status quo rather than to pursue and support progress and innovation.82 Indeed, Boland argues that the irrational, dichotomous classification of certain substances as legal and others as illegal is the basis for both the formal economy made up of industries, such as big alcohol and big tobacco, and for the informal economy that can feed on drug prohibition, from which “police, customs, prisons, media, judiciary, health services, rehabilitation clinics, surveillance companies� can benefit.82 The development of these economies over the decades has resulted in a strong institutional bias against change, and, particularly, against scientific research that could imply ruin for the status quo. Approaches to Drug Policy Reform Advocacy
Faced with these challenges, drug policy reform advocates are adopting varying approaches, dependent on their differing policy objectives and resources. For example, some human rights actors and organizations are primarily concerned with the structural human rights violations that are the result of international drug prohibition,84 and, thus, approach their advocacy primarily through legal platforms and international treaties.85 Organizations seeking clearance and government funding for medical research must combat the embedded interests and institutional bias by working closely with policymakers and regulators to achieve reform from the top-down. Other organizations who aim to achieve complete legalization, direct their efforts towards altering public opinion directly using a bottom-up approach. This article examines the latter two types of organizations.
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The Aims and Tactics of Successful Advocacy
The aims and approaches of four particular organizations that are working to achieve change in some form are outlined here. These organizations are the Multidisciplinary Association for Psychedelic Studies (MAPS), the Psychedelic Society of the Netherlands (PSNL), the Beckley Foundation, and the Law Enforcement Action Partnership (LEAP). MAPS, headquartered in Santa Cruz, California, was formed in 1986 by Rick Doblin, and operates as a non-profit research and educational organization that sponsors and funds scientific studies and advocates for the safe and legal usage of psychedelics and cannabis. MAPS’ approach focuses on demonstrating the potential therapeutic attributes of psychedelics and marijuana by training therapists and encouraging the opening of treatment centers that specialize in their use.86 MAPS relies on the more recent development of the increasing confluence of ideas involving spirituality, personal growth, creativity and neuroscience in making its case for the legalization and safe use of psychedelics. Their efforts to influence policymaking are conducted mostly at the regulatory level as they work with the US Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) to achieve clearance for medical research.86 MAPS is particularly involved with research into the potential of MDMA as a treatment for post-traumatic stress disorder. In fact, MAPS obtained approval from the FDA to sponsor Phase 3 trials of MDMA in 2017.87 In addition to this top-down approach, MAPS also conducts community outreach through publicity campaigns that are aimed at shifting public opinion towards acceptance of legalization by countering the non-factual demonization of psychedelics and cannabis.86
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PSNL, headquartered in Amsterdam, NL, was founded in 2016, by Martha Skvarchu and Jules Marshall, as a “platform for the dissemination of information, promotion of evidence-based advocacy and connection with an informed community and support network.”88 The ultimate aim of PSNL is to achieve legalization of psychedelics to enhance cognitive liberty, as well as to gain access for medical and spiritual usage. The organization’s primary efforts focus on a bottom-up approach to increasing public awareness on the benefits of psychedelics, mostly by hosting public events for both the informed and uninformed through mediums such as “lectures, film screenings, music events, art classes, and discussion groups.”88
The Beckley Foundation, headquartered in Oxford, UK and established in 1998 by Amanda Feilding (an eccentric historical character in her own right),83 operates as a think tank and NGO advocating for the broad adoption of reforms to the regulation of drug use. Beckley focuses its efforts on expanding scientific research into the benefits and potential hazards of psychedelic drug use. 89 Beckley’s pioneering evidence-based research is considered to be seminal in the research area.83 Their lobbying work focuses on persuading policymakers and regulators to lift historical bans on research that constrain validating studies, as well as on pushing for ultimate legalization.89 Beckley was a key actor in the
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lobbying of the UN General Assembly Special Session on Drugs in 2016 to abandon the 1961 Drug Convention, and for the adoption of a resolution to allow every country to implement common sense drug policies that are “costeffective, harm-reductive and respect human rights.”90 Beckley’s efforts to lift the ban on research include the enlisting of support from neuroscientists that study the beneficial use of psychedelics and cannabis extracts in the treatment of addiction, cluster headaches, PTSD, brain cancer and other neurological maladies.89
LEAP, founded by Jack Cole in Medford, Massachusetts in 2002, operates as an NGO that represents the interests of law enforcement and policy reform proponents seeking to achieve criminal justice reform in the US and abroad. The organization’s mission is to unite law enforcement voices in favor of effective and merciful drug policy that protects and enhances communities in opposition to the War on Drugs, which punishes individuals and hurts communities. 91 The organization works from both a top-down approach with efforts to change drug policy on the city, state, and federal level as well as a bottom-up approach that focuses on informing the general public on the substantial human and economic costs of the War on Drugs. In 2017, among countless other highlights, LEAP supported the introduction of a new landmark bill in the US Senate to end the federal prohibition on marijuana. LEAP also utilized “live presentations, interviews, social media, letters to the editor, and op-eds” to inform the public.92 While LEAP does not focus particularly on psychedelics, their influential oppositional stance towards the War on Drugs holds great implications for the decriminalization and legalization of psychedelics as well.
Conclusion The consequences of the War on Drugs are well-documented, both in terms of its structural effects on human rights across the world84 and the stifling of potentially life-improving, if not life-saving, research. These nonsensical, harmful effects are beginning to overwhelm the challenges of the persistence of myths and misconceptions around illicit substances, as well as the challenges
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posed by the embedded interests in the status quo. Crucially, advocates have modified their tactics and learnt from the earlier mistakes of figures like Leary who disregarded and underestimated the powerful effect of misconception on the prospects of achieving support from the public and the political and bureaucratic elite. It is unlikely that the revival of research into the potential of psychedelics for medical, spiritual and other uses over the past two decades would have occurred if it were not for the efforts of organizations such as those highlighted above. The adoption and execution of both top-down and bottomup approaches will continue to be vital for achieving much needed reform.
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Foundations of the psychedelic regulation Currently, the use and possession of psychedelic drugs is largely prohibited. This section will identify four arguments that lay the foundation on which the majority of these regulations are based, as well as provide a critical stance on the strict status quo. The health argument – Firstly, it has been argued that drugs in general require strict regulation in order to minimize the adverse effects as “drugs are not harmful because they are controlled, but they are controlled because they are harmful.”93 In the case of psychedelics, the arguments about adverse effects are often related to scientific studies that stress that “despite increasing research into the acute effects of psychedelics and the growing interest for their potential use as therapeutic agents, little is known about the impact of sustained psychedelic use on the human brain.”94 Thus, one of the main reasons policymakers have decided on strict regulation of psychedelics is due to the uncertainty regarding the long-term effects of psychoactive drugs. For example, some scientific studies suggest that psychedelic drugs could potentially lead to structural changes in the brain within the areas connected to attention and selfreferential thought,94 as well as induce HPPD4 94 or trigger psychotic disorders in individuals that already possess a genetic predisposition.96,97 Furthermore, Antonio Maria Costa5 has argued in the UNODC6 World Drug Report of 2009 that global liberalization of drugs in general (thus also including psychedelics) would not be feasible as regulations over substances (in terms of purity and toxicity) demand thorough controls that less economically advantaged states would not be able to afford.93 Consequently, in order to prevent harmful drug epidemics in less fortunate states, Costa is not in favor of liberalizing the current status quo.
HPPD is the term for hallucinogen persisting perception disorder (mostly associated with LSD use), which defines the condition of individuals that “reexperience perceptual effects induced by a hallucinogen at some later time, after the acute drug effects had worn off” (Nichols, 2016, p. 277). 4
5
Executive director UNODC at the time
6
United Nations Office on Drugs and Crime
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The economic argument – Under the pressure of economic crises, an argument that gained popularity holds that the legalization of drugs (including psychedelics) would be favorable as it would generate more tax income. However, opponents of this argument have highlighted the uneconomical consequence of the liberalization of drugs. They argue that any reduction in costs in regulating the prohibition on drugs would be “offset by much higher expenditure on public health.”93 For example, it has been speculated that HPPD symptoms are not easily recognizable and therefore can create high consultancy costs, as well as additional costs for medication and possible psychotherapy. Therefore, opponents argue that liberalization of psychedelics would not be favorable as it could increase costs related to medical care, treatment and possibly even time lost from work.98 It should be noted, however, that there is no robust research currently supporting this hypothesis. The socio-political argument – However, there are also scholars who argue that the criminalization of psychedelics is not as much based on the health effects or economic impact of psychedelics, but rather on the socio-political influence that psychedelics are perceived to have on society. A frequently cited statement in relation to this argument is the message of clinical psychologist Timothy Leary to “turn on, tune in and drop out,”99 which, according to Cottrell (2015) was interpreted in the context of the 1960s as “an anti-social message linking psychedelics with disconnection from mainstream society.”99 For instance, the desertion of conventional norms and the anti-war attitudes towards the Vietnam war were “often perceived by mainstream culture to be a consequence of drug use […] perverting the minds of [the] youth.”95 As a result, psychedelic drugs were mainly portrayed as threats to the political and social status quo, triggering strict regulatory mechanisms as a response to control deviant behavior.99 Moreover, other political justifications for the current prohibition on psychedelics often relate to the public opinion. American professor on drugs and criminal justice policy Mark Kleiman stresses that, currently, legalization is not a feasible path for most nations because there is no public support for liberalization at the foundation.100 His statement is supported
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by public opinion data from 2014 (see graph 1), which displayed that only a small percentage of Americans supported legalization of psychedelic substances such as LSD, MDMA or Ayahuasca,101 and there is no current data suggesting that this is any different in Europe. Consequently, one can see how this “silence on change” in current drug policies is related to a widely shared belief that without any support from the public this would be “political suicide.”102
Graph 1- Support for drug legalization under Americans The moral argument- Yet, even though most of the arguments presented above are based on empirical research or evaluations, there are also scholars who have identified the significance of the moral arguments in this matter. Lovering (2015) presents the argument that there is often a “moral wrongness” to the recreational utilization of any drugs, providing a basis for the strict regulation of (psychedelic) substances.103 Lovering argues that this is especially visible when one considers that there are other substances, such as tobacco, sugar and caffeine, that have been proven to be more harmful for one’s health, yet are not prohibited. Furthermore, according to Lovering “the answer [does not lie] in any difference in the potential for harm posed by these products, but merely their
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perceived [immorality].”103 Even though Lovering acknowledges that it is hard to uncover why certain substances are considered morally impermissible,103 he does introduce two popular philosophical justifications. Firstly, it is often argued that by utilizing drugs recreationally, the user loses his ability to optimally exercise their rational moral agency, as they might not be able to analyze moral reasons clearly and act on these deliberate considerations. Secondly, it is often argued that by utilizing these substances an actor can diminish their autonomy, as there is a risk of addiction.104 With these “morality-based defenses,” Lovering displays that the current regulations on psychedelics are also based on philosophical interpretations and values. Now that the foundations of current regulations on psychedelics have been discussed, this section will continue with providing a critical analysis of the status quo. The health argument – Even though opponents of liberalization of psychedelics stress the potential of them causing harmful adverse effects, scientific research actually highlights the relatively low risk that is associated with the usage of these substances.96 According to Gable (2006 & 1993) this low risk is mostly due to the psychedelics’ relatively non-toxic nature, as well as their “low dependence potential.”99 Additionally, more recent studies have also shown that there is no link between the use of psychedelics and mental health problems.105 In support of this line of thought, harm assessments scales, taking into account physical harm (to the individual and others), dependence, and social harm, have displayed relatively low ratings of harm for psychedelic substances such as LSD and mushrooms.106 These results have also been graphed by the Independent Scientific Committee on Drugs(see graph 2).107
Additionally, it has also been stressed by Haden and colleagues that the criminalization of psychedelics might increase the harm related to its use, as the illegality of the substances enhances the difficulty for governments to regulate the “quality and potency [of the psychedelics], [which can result] in unpredictable toxic effects.”99
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Finally, besides studies displaying that psychedelics are not that harmful to one’s health, one can even find a lot of empirical studies that suggest that “psychedelics have the potential to significantly improve wellbeing” by treating mental problems such as anxiety and addictive disorders.96 Consequently, one can argue that the contemporary scientific evidence does not support the “stringent drug laws” currently in place,96 as the regulations seem to lack proportionality to the known risks and harms of the substances.
Graph 2- Drugs ordered by overall harm scores
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The economic argument – In line with the idea that psychedelics are generally not harmful and supposedly do not display “addictive properties,” 96 it is also argued that therefore the health care costs connected to the use of psychedelics remains very limited. Furthermore, UNODC has argued that “on average the proportion of people with cannabis and opioid use disorders remains larger than the proportion of people with disorders related to the use of other substances,”108 with the proportion of people in treatment for the use of hallucinogens, specifically, being very low (see graph 3). Additionally, it has been argued that the prohibition of drugs7 could be harmful for the economy in the long term, as criminalization gives organized crime groups a resourceful market to supply to. Over time, the influx of illegal drug money could negatively affect the economy because it would make it more difficult for legitimate businesses to compete with businesses using illegal funds. As a result, this could foster unfair competition and increase corruption, which are associated with lower levels of foreign investment, lower economic growth rates, and less economic stability.109 Furthermore, it has been argued that the current criminalization of psychedelics is economically inefficient because it leads to the crowding of courts110 and causes high budgetary costs since the expenses of incarceration are generally very high.111 Moreover, MacCoun, Reuter and Schelling identify more subtle economic costs; for example, the “reduced availability for medical research” could hinder future economic benefits from scientific insights.110 Thus, critics of the status quo (focused on the economic perspective) argue, foremost, that the current regulations are not supported by data on the health care costs of psychedelics and that prohibition might do more economic harm than benefit in the long run.
Refers to all substances under the control of the international drug control conventions (UNODC, 2017a, p. 7), and therefore also include psychedelics. 7
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Graph 3 – Proportion of people in treatment for different drugs, global averages The security argument - It is widely recognized that drugs in general are a “source of revenue for organized crime networks” through corruption, organized crime, illicit financial flows and terrorism.109 In the case of psychedelics, illicit drug trafficking prevails mostly through the “darknet.”
E 109
Consequently, it has been argued that strict drug regulations have “generated a criminal market of macro-economic dimensions that uses violence and corruption to mediate between demand and supply.”93 As these organized crime groups are often said to fuel corruption, as well as
The darknet allows users to buy drugs with a cryptocurrency, such as bitcoin, and have their purchases delivered to them in a concealed manner (UNODC, 2017b, p. 15) E
have possible connections to non-state armed groups,109 proponents of the liberalization of psychedelics argue that legalization and government control of these substances will interfere with the work of organized criminal groups.93 In
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the end, this approach is often seen as protecting society more efficiently than the current policies in place. Thus, while there is certainly relevance to the arguments supporting the status quo, one can observe that many of the arguments used can also be applied to support further liberalization of psychedelics. While proponents of legalization rely heavily on empirical research (especially concerning the health costs and economic impact of psychedelics), this section has highlighted the importance of considering the socio-political and moral conceptions surrounding this active debate, which are significantly harder to bring into focus. Therefore, the following section will introduce our recommendation Policy Recommendations Based on the examination we conducted on current policies concerning psychedelic drugs, the recommendations that can be extrapolated are twofold. First, it is desirable for policymakers to increasingly act from the perspective of the “care paradigm” and human rights law, instead of focusing merely on policing; second, it would be beneficial to partially decriminalize psychedelic drugs, so that the market can be regulated.
The Care Paradigm
The care paradigm is focused on the minimization of risks and harm, and serves to shift the instruments used in drugs policy away from a predominantly “repression” and “punishment” focus.81 Basing policy on the care paradigm means that policymakers should no longer perceive the use of psychedelic drugs as something that should be fought against and/or prevented, but rather as something that is very real, requiring policy that serves to ensure the safe use of those drugs. Various concrete measures can be taken when departing from the care paradigm, and a number of them are highlighted here. •
The provision of open information and education about drugs is crucial. This means that there should be information available to anyone regarding the effects of drugs, but also the risks. It is very important that
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such information is written in a neutral, but accessible manner (even if/when sponsored by a state’s government). •
The government can promote the safe use of drugs by opening centres with certified staff to help drug users. For example, the Municipal Health Services of Amsterdam provide centres that anonymously test pills or strips of LSD;119 such a testing service can be part of a center, which can also provide disinfectants or serve as an emergency service for negative drug-related experiences. Preferably, due to the still present stigma on drugs in many regions, the treatment in those centres should occur as anonymously as possible.
•
For people who use psychedelics in such a volume that it negatively impacts their wellbeing, the government could focus on aiding those people and restoring their health, rather than invoking punitive measures. The government can then also, through public campaigns, play an active role in decreasing the stigma and barriers for addicted people in order to increase help-seeking behavior.
Decriminalization and Regulation
There is a permanent tension between the enforcement of antidrug law and human rights law, as drug control can easily pave the way to violations of human rights. For example, it can lead to human displacement in regions where drug control is strictly enforced, such as in Colombia.84 Therefore, it could be beneficial to partially decriminalisation of psychedelic drugs. This would essentially enable governments to establish strict regulations on matters such as drug quality and assistance (instead of policing), and therefore, through a regulated market, diminish the possibility for organized crime groups thriving on the drug black market. The following could be controlled: •
Various characteristics of the product: preferably, drugs would be sold in standardized volumes and at specific shops and times, without flashy packages or adverts (which would be similar to what is currently practiced with cigarette packaging in Australia).112,120
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There should also be regulation on who has access to the market. 80 This could be based on a number of factors, for example age113 and volume rationing, to prevent minors and drug dealers from becoming active in the market.
•
It could also be possible to implement licensing or registration requirements, whereby a buyer could only obtain psychedelic drugs with a permit .
Conclusion Based on the extensive overview of current perspectives and research in the field of psychedelics that has been presented in this issue, we’ve now listed some ideas regarding the steps that could be taken toward a safer and more transparent drug-using environment. Though public support for the liberalization of psychedelics is relatively low, it would still be beneficial to provide basic education and grounded information on this topic in order to promote a more open discourse among governments and citizens, alike. Given what is now known about psychoactive substances, it is hard to deny the important role that they do and can play in the daily lives of regular people (especially those that suffer from tough-to-treat mental illnesses). At the end of the day, what will be the future of these curious drugs, dear reader, is up to you.
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1. Correct Answer: C A study by Professor David Nutt was conducted in order to determine the harmful effects of different substances and their misuse. The purpose of the study was to evaluate the validity of the “Misuse Drug Act Classification,” which is used by the legal system to condemn the sale and taking of these substances. The research took into account several parameters of harm, namely physical effects (tendency to induce dependence) and effects on family, community and society in order to determine the amount of harm substances were causing. Through this study it was demonstrated that alcohol and tobacco, two substances that are legal to those above 18 and that have no social stigma attached to their consumption, accounted for 90% of all drug related deaths in the UK at the time of the study. Therefore, when looking specifically at physical harm it is clear that the current legal framework and the classification of substances within the Misuse Drug Act Classification are allowing for some of the most harmful substances to be legal and readily available whilst condemning others that are not responsible for as many deaths. The study took into account all these parameters of harm and using scientific backing determined classification into A,B,C arbitrary. Beyond this, they created a scale ranking the harm of substances based on all the parameters used within the study.27 2. Correct Answer: False
A study conducted by Pal̊ -Ørjan Johansen and Teri Suzanne Krebs investigated the links between psychedelic drugs, mental illness, and suicidal behavior, specifically focusing on the US. The researchers made use of the annual National Survey on Drug Use and Health (NSDUH), which collects data on substance use as well as the mental health of a population. Through this analysis they were not able to find any causality between prolonged use of psychedelic drugs; in fact, what they did find was that those consuming psychedelic drugs had decreased psychiatric treatment, which may point to positive effects of the substances, rather than the harmful side portrayed.115 3. Correct Answer: C
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The difference in categories for LSD or Mushrooms, and cocaine is that the latter one is a stimulant, while the first two are hallucinogenic. The key component of magic mushrooms is psilocybin. LSD and Mushrooms both contain psychoactive components, while cocaine does not. Although cocaine is a psychoactive drug, it affects different brain receptors than psilocybin. Cocaine triggers dopamine, which in turn leaves one with a high level of confidence after consuming it. The effect of cocaine lasts for about thirty minutes, while psychedelic trips can last up to twelve hours. The major difference with psychedelics is the altered state stage one experiences. In brief, ego dissolution is the disappearance of selfcentered thought processes and reflects the feeling of being in unity with the surrounding environment. While psychedelics result in ego dissolution, cocaine enhances self-consciousness.49 4. Correct answer: A Psychedelic substances do indeed have attributes of all definitions stated above,
however, are most accurately defined though the “mind manifesting” idea. Psychedelic substances can create a state of psychosis as stated in “C” but this occurrence is not an essential factor but rather a part of the experience that can occur but does not necessarily have to. Furthermore, psychedelic substances can trigger hallucinations, but similar to the state of psychosis mentioned above, this is not essential. On the other hand, the first definition includes all of these possibilities, including the core factor “mind manifesting” which hints towards the ego dissolution effect born by psychedelic drugs, these factors contribute to the differentiation of psychedelic substances from other substances. In conclusion, leaving out this factor does not differentiate sufficiently from other substances such as cocaine or alcohol and leaves out a core component of the unique psychedelic experience of ego dissolution and mind manifestation.49 5. Correct Answer: C Only the third painting of Oscar Janiger has been made under the influence of psychedelics. The usage of psychedelics drugs, or drugs in general, in the art scene existed for a very long time. It is hard to pinpoint when it clearly started. Already in the 1800’s, authors have touched upon the practice in their writings about hallucinogenic creativity, and sometimes created their own schools of art. The “hallucinogenic writing” school created by Baudelaire reflects the fascination some painters or authors started to show for psychedelic substances. The study of creativity and psychedelics is founded on the study of narratives and discourses rather than on neuro scientific explanations. The cultural component of psychedelics usage is of relevance for this matter since one should grasp the belief that
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psychedelics can help trigger or modify creativity. The paradox lies in the assessment of creativity itself. Research has failed in measuring creativity because of the very subjective nature of the concept. As for now, what has been shown is that psychedelics do not provide one with creativity, but unfold ideas that are already existing in one’s consciousness. In short, the belief that one would be rendered really creative by using psychedelics is not exactly true. The expectations of the results of a drug intake play a major role in the piece of art that will be produced by a writer or painter. In that sense, the style of the painter will never be drastically different when psychedelics are consumed than when they’re not. If one is a painter, they might notice that they would paint in a more frenetic manner during the altered state. The creativity at stake is not assessing the aesthetic but rather the intensity with which one would work during the artistic phase. Oscar Janiger is famously known for experimenting with art works under psychedelics, and the third image is a production influenced by LSD.116
6. Correct answer: C Research has shown positive results for the treatment of depression and Post Traumatic Stress Disorder (PTSD) with the use of psychedelics. However, psychedelics are of no help to patients with schizophrenia, and are not recommended for this illness. Major depression and PTSD result from the overload of the Default Mode Network (DMN) in the brain. In short, this network is the one responsible for introspection, anxiety and over questioning of one’s self. This network is responsible for the ego narration of a person - his or her identity. In cases of depression, this network in over active. This over activity leads to an ambush of the activity of other brain networks that can be responsible for “task positive” networks. We speak of too much intra-connection of the DMN in cases of depression, and thus a diminished inter-connection of other networks that should regulate each other. By mimicking serotonin, the “hormone of happiness,” together with breaking the barriers among the networks, psychedelic substances can reboot the networks altogether. The observed ego dissolution experienced, that of the disappearance of self-introspection and increased connectedness to the environment, reflects the increased interconnectivity of all brain networks and the slowing down of the DMN. On the
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other hand, schizophrenia is an illness where one experiences a feeling of overloading possibilities - thoughts are very disparate and overwhelmed by the outside world. The use of psychedelics does not cure these types of symptoms and would probably reinforce them. All in all, research has shown that depression and PTSD could potentially be cured by psychedelics, but research is still in its early stages and thus, findings shouldn’t be taken from granted yet.117
7. Correct Answer: B
The psilocybin chemical found in psychedelic drugs is shown to mimic the serotonin component in the brain. Psychedelics researchers have confirmed with using brain scanners that psilocybin sticks to the serotonin receptors in brain cells. Serotonin is considered a mood stabilizer of the brain, with low levels having the potential to result in anxiety, depression, or insomnia. Because the chemical structure of psychedelics, such as LSD, is similar to the one of serotonin, they trigger the serotonergic system in the brain and allow the brain to release high amounts of serotonin, disallowing other brain networks to over regulate them. Due to this dynamic in brain mechanisms, this is the most steady explanation of why psychedelics can be used to treat depression with increasing the responsiveness of the “happiness hormone.”118
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