By Erin Sharoni
Restricting access to microdosing, a low-risk intervention that may alleviate intractable pain, depression, and anxiety — obligatory requirements for human flourishing — is morally wrong.
Psychedelic microdosing involves the administration of a psychedelic substance in sub-perceptual doses — doses small enough not to provoke any intoxicating effects, but that potentially result in favorable physiological or psychological changes. Microdosing has emerged as a promising intervention for enhancing creativity and productivity, boosting mood, alleviating pain, and treating depression and anxiety with minimal risk of harm to the participant or society.
Many bioethical theories affirm that people should be free to pursue interventions that support their flourishing, so long as those interventions do not harm other individuals or groups. For example, this is supported by ethical frameworks that uphold commitments to human flourishing, reciprocity, and liberty, as well as by the traditional bioethical tenets of respect for persons, beneficence, and non-maleficence. It also comports with moral frameworks that promote well-being and harm reduction. When considered in this context, it seems clear that restricting access to microdosing is ethically unjustifiable.
Of course, the argument can be made that enhancement of creativity and productivity, and even temporary mood elevation, are not necessary interventions. Even if they were, there may be other ways to realize those benefits without microdosing. But needlessly restricting access to microdosing is not morally neutral.
A simple thought experiment may help to illustrate this view. Imagine that you are placed at the starting block of life, blind to the lot you will be given. From behind this Rawlsian veil, a blank and sightless void, you select the conditions for the future you would want to inhabit, not knowing whether your destiny is to be rich or poor, non-disabled or disabled, harmed or happy. You might be blessed with adequate serotonin levels and a life free of trauma. Or, you might experience intractable depression for which long-lasting, efficacious treatment is lacking. Not knowing your destiny, the rational choice would be to allow access to safe interventions that treat such a debilitating disease. In reality, 42% of American adults currently experience depression and anxiety, with 31% of medication-treated major depressive disorder being treatment-resistant. It is not improbable that this is your fate.
I am one of those people, and I employed microdosing to successfully alleviate my depression. I experienced an immediate benefit in response to the initial microdose and required approximately two months of microdoses, administered once or twice weekly, to confer a long-lasting effect. I experienced no noticeable negative side effects, and I have not required a microdose to maintain remission in the five years since. This is anecdotal evidence, but it is not an uncommon story, and it comports with emerging empirical data. Many people, like myself, have tried microdosing because they are desperate to alleviate their suffering; they have found other interventions to be unsuccessful and have run out of options. Other people are just curious. Some find psychedelics intuitively appealing and prefer them to traditional therapies like SSRIs, which have side effects and remission rates of 30 to 45%. Schedule I status notwithstanding (though it is worth mentioning that what is legal is not always morally correct, and what is morally correct is not always legal), why would anyone wish to withhold access to a low-risk intervention that can alleviate suffering?
As with all things bioethical, the picture is more nuanced than it appears. Microdosing reveals disparities in access, awareness, inclusion, and justice. These ethical issues are not unique to microdosing, but are highlighted by it, and we have an obligation to address them when we consider employing an intervention intended to support human flourishing. I was able to access microdosing as a therapy because I am privileged: I am a scientifically-literate person living in a major US city with access to healthcare and a therapist who was informed enough to recommend it. I come from a supportive family that encourages alternative choices. I could afford to invest time researching risks, benefits, and clinical outcomes. People assisted me in accessing the intervention; I was even able to join a citizen science project that provided microdosing protocols, although that came with its own set of challenges like quality control, dose control, frequency, and duration of use. It is fair to suggest that microdosing requires similar safeguards to other clinical interventions, and a critical step towards ensuring those safeguards is the removal of punitive laws for accessing psychedelics via legalization and regulation, Emergency Use Authorization, or a combination of approaches.
Because microdosing is so self-selective, ethical implications in the areas of equity, power, and participant diversity also should be seriously considered. Psychedelic-therapy programs, like microdosing “retreats,” may be considered racist and classist, due to the high, unregulated costs of participation and lack of racial diversity in participant groups. Oppressed social groups — those who are historically marginalized, exploited, and disempowered on the basis of sexuality, race, religion, or class — suffer from chronic, prolonged depression at higher rates and face greater barriers to treatment. Importantly, because of psychedelics’ Schedule I status, microdosing poses unique barriers to access and may evoke fear in marginalized groups who are disproportionately incarcerated for narcotics possession. They are less empowered to seek out illegal substances with promising benefits. But these concerns regarding access and inclusion are not reason to prohibit the practice; these are systemic issues that are not specific to microdosing, and they should be addressed in a systemic manner that broadly promotes fair access, inclusion, and distributive and structural justice.
If microdosing provides much-needed health benefits with minimal risk of harm, then restricting access is unethical. However, any frameworks for expanding access to microdosing must seriously engage with ethical concerns around access and fairness to ensure that going forward, we reduce, rather than perpetuate, existing injustices and allow equal access to flourishing.
Erin Sharoni is an MBE candidate at Harvard Medical School.