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Psychedelics
By Katelyn Lee, LCSW

Restricting the use of psychedelics for treating psychological disorders is an injustice as research is evolving and supportive of psychedelic assisted therapy for symptom reduction. The FDA has approved medically supervised ketamine treatment, but research on the potential benefits of other psychedelics remains ongoing. This treatment modality is stigmatized due to political efforts such as the War on Drugs initiative and the Controlled Substances Act, Public Law 91-513 of 1970. Criminalizing the use of psychedelics has not only limited access to potentially effective and efficient treatment intervention but has also infringed on historical, cultural, and sacramental practices.

The most recent data released by Substance Abuse and Mental Health Services Administration (SAMHSA) does not categorize hallucinogens under perceived great risk of harm associated with selected substance abuse. In 2020, only 0.2% (or about 493,000 people) older than the age of 12 had a hallucinogen use disorder in the past 12 months.1 According to SAMHSA, only 2.6% of the population older than age 12 used hallucinogens in the past year (7.1 million people).1 Additionally, hallucinogen use does not have withdrawal syndrome associated with discontinued use. According to the National Institute on Drug Abuse, a study published on psilocybin, N,N-dimethyltryptamine, and mescaline suggested weak reinforcement with these drugs, indicating their use is not likely to lead to a substance use disorder.2

According to the US Drug Enforcement Administration, “Many hallucinogens are Schedule I under the Controlled Substances Act, meaning that they have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.”3 There are fallacies in the categorization or scheduling of substances based on this definition. For example, the FDA has indicated medical cannabis for the use in treatment of several chronic illnesses and impairments while cannabis in its natural form remains a Schedule I drug according to the Drug Enforcement Administration.4 This indicates that although research is growing to show the positive effects of substances such as cannabis or hallucinogens for the treatment of chronic issues, they’re not being reconsidered due to legal regulations outside of the medical realm.

Some argue that legalizing psychedelic treatment results in risks to the individual and society. However, research continues to indicate that although psychedelic use is associated with risk, it shows promise in medically supervised settings. In addition, Holoyda completed a study that found that lifetime psychedelic use was associated with 27% decreased odds of past-year larceny or theft and 12% decreased odds of past-year assault, while other lifetime illicit substance use led to significant increase in odds of such offenses.5 Additionally, lifetime psychedelic use was not associated with past-year drug-related crime. In fact, the researchers argue that there’s high likelihood that psychedelics can play a role in reducing recidivism rates.5,6 Although data presented by SAMHSA shows an increase in hallucinogen use by 1.4 million from 2021 to 2022, the literature suggests that changes in individual perception of risk and expectations of the benefits of microdosing may have led to an increase in use.1,7

Considering emerging research and evaluating current statistics pertaining to the prevalence of abuse, it would be unjust to disregard the potential healing capacity of integrating psychedelic medicine into our current psychotherapeutic and psychopharmacological approaches to the treatment of mental health disorders, particularly for treatment-resistant and chronic conditions such as PTSD, depression, and anxiety. As evidence from clinical trials continues to emerge, the medical community must consider the implications this can have on practice. Likewise, it’s important for legislators to consider the impact this would have on the current drug policy and encourage a shift toward decriminalization of substances. Rather than using public funds to punish others for use or possession of such substances, it might be useful to consider redistributing funding from punishment toward treatment of underlying conditions. More individuals within the medical, psychiatric, and social work professions should consider these implications and contribute to the literature through clinical trials and research to provide enlightenment and shift attitudes and assumptions toward the use of psychedelics in treatment.

— Katelyn Lee, LCSW, is a licensed clinical social worker in Tennessee. She works full-time at a federally qualified health center/rural health center in Campbell County, Tennessee, and recently started a small private practice. She’s pursuing a Doctorate of Social Work through the University of Kentucky College of Social Work. She’s fully trained in eye-movement desensitization and reprocessing as well as a variety of other psychotherapeutic modalities and specializes in the treatment of attachment/developmental and complex trauma.

References
1. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: results from the 2020 national survey on drug use and health. https://www.samhsa.gov/data/sites/default/files/reports/
rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf. Published October 2021. Accessed July 3, 2023.

2. Psychedelic and dissociative drugs. National Institute on Drug Abuse website. https://nida.nih.gov/research-topics/psychedelic-dissociative-drugs#experience-withdrawal. Updated April 2023. Accessed July 3, 2023.

3. Department of Justice/Drug Enforcement Administration. Hallucinogens fact sheet. https://www.dea.gov/sites/default/files/2023-04/Hallucinogens%202022%20Drug%20Fact%20Sheet.pdf. Published March 2022. Accessed July 3, 2023.

4. Drug scheduling. Drug Enforcement Administration website. https://www.dea.gov/drug-information/drug-scheduling. Updated July 1, 2018. Accessed July 3, 2023.

5. Holoyda H. The psychedelic renaissance and its forensic implications. J Am Acad Psychiatry Law. 2020;48(2):87-97.

6. Jones GM, Nock MK. Psilocybin use is associated with lowered odds of crime arrests in US adults: a replication and extension. J Psychopharmacol. 2022;36(1):66-73.

7. New study estimates over 5.5 million U.S. adults use hallucinogens. Columbia University Mailman School of Public Health website. https://www.publichealth.columbia.edu/news/new-study-estimates-over-5-5-million-u-s-adults-use-hallucinogens. Updated August 18, 2023. Accessed July 3, 2023.