Managing the Hope and Hype of Psychedelics

Author

Keisha Ray, PhD

Publish date

Managing the Hope and Hype of Psychedelics
Topic(s): Editorial-AJOB Psychiatric Ethics

This editorial appears in the January 2025 Special Issue on Psychedelic Ethics of the American Journal of Bioethics.

Psychedelics are having a moment. This moment is a good time to assess the story of psychedelics. Psychedelic substances like psilocybin, LSD, and others are at the center of FDA regulation, spiritual retreats, academic research centers, scholarly research, psychological treatment, concerns for Indigenous communities, mental health advocacy, and mainstream media. But with the spotlight also comes misunderstandings, scrutiny, misconduct, unethical, and sometimes illegal behavior, all of which have also been a part of psychedelics’ story. Stigma about drug use in general as well as negative views about psychedelics, specifically, are also a large part of psychedelics’ recent spotlight. But from what we have seen so far, the story is far from complete. There’s still work to be done in psychedelics research and in developing psychedelic ethics and even determining if a singular psychedelic ethics is possible and desirable.

Underlying all of the good and bad of psychedelics, and a desire by so many to get the ethics of psychedelics right, however, is hope. A part of the attraction of psychedelics is their potential to help us heal our bodies and minds in ways that medicine, health care, clergy, and religion haven’t. Many people are hopeful that clinical uses of psychedelics can offer people health and wellbeing in some of the ways that spiritual and religious uses of the substances have already offered people and in new ways that have yet to be fully recognized, such as psychedelic assisted therapy (PAT) for trauma victims.

There is also a substantial amount of hype surrounding psychedelics. There is a lot of discussion about what psychedelics in a clinical context could do for our health since some of their therapeutic benefits have not been realized in clinical settings. It could of course be argued that this is only true for psychedelics in clinical contexts, not in non-clinical settings. However, for clinical purposes, we need to know more about their capabilities and limitations. At this point in the story of psychedelics we have to manage the hope and the hype they inspire despite our academic, clinical, Western, European, and capitalistic created desire to move full speed. One way to manage our hope and the hype of psychedelics is to learn from other clinical interventions that inspired the same kind of hope, hype, stigma, and even fear—medical cannabis.

Despite pervasive anti-drug campaigns and America’s “war on drugs,” research into the medical use of cannabis thrived in the latter half of the twentieth century and still continues. Although its public image has drastically changed due to legalization and decriminalization in parts of the United States and in some other countries, cannabis was once thought of (and sometimes still is) as a deadbeat, “burner,” or hippie drug that unproductive members of society indulge in for recreational purposes. Some researchers and clinicians pushed narratives that it was severely addictive and caused a host of health problems while others lamented its healing capabilities. Even now, cannabis continues to be the subject of clinical research, politics, law, and some stigma.

We are still learning lessons about medical cannabis but there are some aspects of its treatment in clinical and ethics spaces that can help us think about psychedelics. First, for medical cannabis to become more accepted the stigma of drug use had to be addressed. A large part of addressing the stigma was conducting research and gathering empirical evidence, including its limitations and possible clinical benefits to people such as those undergoing cancer therapy. Essentially, we had to get to the point of allowing the research to speak for itself, whatever that may be. Setting aside stigma for research allowed us to balance the hope and the hype of the cannabis and turn to what it can actually do and not do for consumers.

The stigma associated with some drugs stops us from performing the research needed to develop a realistic view of what they can actually do for our health. This is what psychedelics are currently facing; we need to set aside stigma to have more robust clinical and ethical research. We don’t know the extent of their clinically therapeutic benefits so it’s hard to determine how much of our attitude about psychedelics is hopeful wishing and how much is just overblown hype for their potential. If we removed the stigma of psychedelics and stopped thinking of them as hippie drugs of the 1970s, free love era or a drug only done at retreats somewhere deep in mountains and rainforests we could pursue more research to reveal its clinical truths.

Another lesson from the story of medical cannabis that we can use to manage the hope and hype of psychedelics is cannabis’ legal history. The legality of cannabis in the United States includes proposed changes to its level of controlled substances, decriminalization in some states, legal recreational and/or medical uses in some states, and its status as a banned substance either being completely eliminated from some professional sports leagues (e.g., National Basketball Association) or some leagues softening its stance.

The legal status of cannabis has undergone many changes and is still the subject of rules and regulations at the local, state, and federal level. Psychedelics will likely have a similar story in that its legally accepted status will undergo many different changes, some that psychedelics researchers will agree and not agree with but will be required to abide by to continue doing work in this ethical and clinical space. Because of the differing nature of psychedelics and cannabis, namely psychedelics’ hallucinogenic effects, however, we can likely expect psychedelics to have a much longer and tumultuous legal story. But this will just be another part of their story that we will have to accept and contend with to manage the hope and hype of psychedelics.

Clinical uses of psychedelics likely scare some people and inspire a healthy amount of skepticism in other people. The clinical and ethical issues of medical cannabis do not map perfectly onto psychedelics but there is some similarity in that cannabis also inspired fear and skepticism until clinical and ethical research slowly chipped away, and continues to chip away, at some of the negative attitudes people have about the drug. Fear and skepticism are also barriers to moving forward with uncovering the full therapeutic benefits of psychedelics. There is potential for psychedelics to help us be healthier people and help us address the ways that social living can make us mentally, physically, spiritually, and emotionally unwell. But to get to the possibilities, we have to better center ourselves in the current actualities of psychedelics and not let our unfiltered hope and hype cloud how we operate in this space. Having hope can drive psychedelic innovation, but hype can stifle it before it even really takes off, which could keep the therapeutic benefits of psychedelics unfulfilled for many who stand to benefit.

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