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Bioethics, Psychedelic Therapy Abuse, and the Risk of Ethics Washing

By Tehseen Noorani and Neşe Devenot


The academic discipline of bioethics is becoming a prominent arena for the discussion of ethics abuses in psychedelic therapy. With this being a relatively new topic of research for bioethics, it may be opportune to consider blind spots in the discipline’s own gaze and operations, which can otherwise hinder effective engagement with the issues at hand. We write in the wake of an extensive search by Gather Well Psychedelics, a psychedelic therapy training organization, to contract professional bioethicists to conduct an ethics audit of their organization. We ask, what challenges arise for bioethicists offering professional services when taking on commissions to work for organizations such as Gather Well that are emerging out of the psychedelic underground?

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Person examining psilocybin mushrooms in lab.

Psychedelic Inequities and Unexplored Risk: Colonization, Commercialization, and Regulation

By Tegan M. Carr

As a researcher studying the psychedelic experiences of people of color in hopes of driving equitable psychedelic health care, I’m concerned about the ways in which Black, Brown, and Indigenous contributions have been excluded in the development of the psychedelic field and investigation of novel psychedelic therapies. By excluding diverse contributions to the psychedelic field, we risk establishing psychedelic practices that exacerbate racial health inequities (disparities) in which people of color experience worse health outcomes as compared to whites on a population level. These patterns are already emerging in therapeutic psychedelic outcomes.

This piece identifies three interrelated topics that warrant scrutiny as drivers of psychedelic racial health inequities: the colonization of psychedelics, psychedelic commercialization & rent-seeking, and regulatory processes.

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Let Go and Surrender: Considerations on MDMA Couples Therapy and Coercive Control

Note from Susannah Baruch, Petrie-Flom Center: Following this recent post in the Critical Psychedelic Studies symposium on the Bill of Health blog, two sets of researchers whose studies were described in the post expressed concerns that the post contained inaccuracies. As the Executive Director of the Petrie-Flom Center, which publishes Bill of Health, I made the decision to temporarily remove the original post to look at the issues carefully and to give the author and researchers more time and space for discussion. The original post is now back up [below] with an addendum from the author. My thanks to everyone involved for being helpful and patient while we gathered more information.

By Kayla Greenstien

From 2016 – 2022, I worked in client-facing community support work, focusing on domestic abuse and sexual assault. Throughout this time, I regularly witnessed how the mental health system struggled to respond to non-physical violence in the form of coercive control — an insidious form of abuse that involves intimidation, threats, and manipulation to restrict the autonomy of another person. On countless occasions, I saw coercive and controlling behavior entirely attributed to mental illness, resulting in missed opportunities and devastating injustices. Outside of work, I also started to notice how little of the content in my psychology coursework discussed domestic abuse. Little (if any) content focused on the psychology of people who engage in abuse and coercive control. Despite more open discourse on domestic abuse, it seemed like the mental health system was still deeply reticent to talk about power and control.  

At the same time, a new wave of research on psychedelic and MDMA therapy was underway. In 2021, I signed up for a psychedelic therapist training program, and the next year I started a PhD in Australia, studying the theoretical underpinnings of psychedelic therapies. I saw psychedelic therapy as a “paradigm shift” in mental health care. I wanted to believe psychedelics could get rid of the patriarchy, just like Ben Sessa said it did at raves in the 1980s. (Sessa is now facing medical practitioners’ tribunal in the U.K. for an alleged relationship with a patient.) But as I learned more about the theories and practices accompanying clinical trials of psychedelics and MDMA, I found misogyny, queerphobia, and alt-right New Age spirituality woven throughout. When multiple reports of sexual abuse emerged from underground, ceremonial, and clinical trial settings, I heard the same tropes that are used to discredit women in court: “It was a consensual relationship…She has BPD and manipulated him…This is all about a scorned woman seeking and revenge…”. Slowly, I started to see how historic and contemporary discussions on psychedelic and MDMA research largely ignored theories on power, control, and abusive interpersonal relationships, particularly in couples therapy.   

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Should a Psychedelic Therapist Be Able to Continue Therapy for Their Patients Beyond Formal Integration Sessions?

By Samuel Hatfield

Psilocybin and MDMA were recently rescheduled in Australia for clinical use, leading many mental health professionals to question how psychedelic therapy will work in practice. As part of a research team at the University of Sydney, I recently interviewed as number of experts in the field, with the aim of developing a comprehensive taxonomy of matters relating to psychedelic therapy that are or could be regulated. We also sought to identify where there was uncertainty or disagreement about the implementation of these matters. One point of contention was the provision of ongoing psychotherapy by the psychedelic therapist beyond the formal integration phase — which, given the vulnerability and suggestibility of patients undergoing psychedelic therapy, may give rise to important ethical considerations. With practitioners from a range of professions likely to act in the role of psychedelic therapist, this is an issue with cross-disciplinary relevance.

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A Brief Political Economy of Hype

By Maxim Tvorun-Dunn

Silicon Valley depends on boom-and-bust cycles, manufacturing a new wave of investments every few months by promising grand technological revolutions, whether through AI, cryptocurrency, metaverses, or any other buzzword of the tech industry. These bubbles are furnished by media narratives and tech journalism. Through uncritical reporting of press releases and overexaggerating claims, news outlets help tech industrialists inflate their stock portfolios, while regularly ignoring the politics of privatization and automation. Reporting on psychedelics has followed similar trends, regularly positioning research on psychedelic therapy or drug manufacturing as Silicon Valley’s latest panacea.

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Beyond the Psychedelic Competitive Moat: Chasing the Patent Dragon

By Amanda Rose Pratt and Shahin Shams

In the last five years, the granting of overly broad psychedelic patents led to the creation of the nonprofit online psychedelic prior art library Porta Sophia. As Porta Sophia-affiliated researchers with expertise in psychedelic science, patent law, archival history, and rhetoric, we have come face to face with the way psychedelic hype manifests within the world of psychedelic patent documents.

Here, we examine hype in the context of a perennial tension at the heart of patenting communication: between advertising innovation and keeping it secret. Given the fact that innovators cannot disclose their technological innovations if they hope to gain patent rights over them, and that they simultaneously need to attract investors—often on the merits of their intellectual property portfolios—what public communication strategies emerge? We look closely at the patenting strategies of the psychedelic biotech company MindMed here because their case reveals important insights about the rhetorical dynamics related to tensions around public psychedelic patent communication.

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When the Promises of a Policy Do Not Meet the Reality of Its Practice: Ethical Issues Within Oregon’s Measure 109

By Tahlia Harrison

As a practicing therapist in Oregon working with complex trauma survivors, I was optimistic at first about the passage in 2020 of Measure 109 and its promise of legalizing psilocybin-assisted therapy. Psilocybin has been shown in small samples to be an effective intervention for many challenges my clients face; I was excited about this option to further support their healing. As a bioethicist and researcher examining topics related to psychedelic-assisted therapy, and a former faculty member at one of the psilocybin facilitation programs, Measure 109 also brought feelings of trepidation and a flood of questions such as: Would my national associations be amenable to this intervention? Would my liability insurance provide coverage? What about the ethics of engaging clients in a treatment involving a federally illegal substance? What about informed consent and other ethical issues? While the current informed consent form used by facilitators does address some aspects of concern (like the use of touch, 333-333-5040 (9)), it does not address other aspects like suggestibility or power dynamics within the facilitator/client relationship. Additionally, the form states “I understand that psilocybin services do not require medical diagnosis or referral and that psilocybin services are not a medical or clinical treatment,” yet it is reported that many are still seeking this as part of treatment for a medical diagnosis. How do multiple licensures apply to understanding scope of practice? Three years later, many of these questions remain unanswered, and the option of offering psilocybin-assisted therapy remains illegal and off the table.

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Should Sacred Plant Medicines Have Standing? The Original Instructions and Western Jurisprudence

By Keith Williams and Ariel Clark

The resurgence of interest in psychedelics, or sacred plant and fungal medicines and their psychoactive constituents, has been described as a kind of “renaissance” much like the European renaissance that blossomed between the 14th – 17th centuries. The comparison is apt—for, in addition to a flowering of learning and human achievement, the psychedelic renaissance, like its namesake, is only possible because of the underlying extractivist colonial logic informing activity in this domain. We are both writing as people with ancestry from Indigenous communities, and we have a profound interest in respecting, honoring, and becoming-with our more-than-human kin. A business-as-usual approach to the so-called psychedelic renaissance will only reinforce the harmful extractivism inherent in contemporary global capitalist culture and will foreclose the kind of collective healing possible with reciprocity as an orienting principle. This post offers a brief sketch of the potential for Rights of Nature legislation to safeguard these sacred medicines by recognizing them as rights holders unto themselves and by embedding into law a relational positionality of respect and responsibility with our plant and fungal kin.

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Common Problems in Psychedelic Science, and How to Fix Them

By Eiko I. Fried and Michiel van Elk

Much optimism has been expressed about the potential of psychedelics to treat mental health problems such as suicidal ideation, depression, and post-traumatic stress disorder. This optimism goes hand in hand with a notable increase in research publications, investments from pharmaceutical companies, patent filings, media exposure, as well as shifts in political and legislative landscapes. In the U.S., hundreds of ketamine clinics have emerged in the last years, and Australia just recently acknowledged psychedelics as medicines.

In our new paper in print in the journal Therapeutic Advances in Psychopharmacology, titled “History repeating: Guidelines to address common problems in psychedelic science,” we critically discuss whether this optimism is warranted, given current empirical work. One of us (Dr. Eiko Fried) is an Associate Professor in Clinical Psychology who studies and teaches conducting and evaluating clinical trials for mental health problems such as depression, with a focus on the question what valid inferences can be drawn from empirical data. The other (Dr. Michiel van Elk) is an Associate Professor in Cognitive Psychology, with a long-standing interest in the topic of altered states of consciousness (including, but not limited to, states induced through psychedelics), who, together with the PRSM lab, uses a multi-method research approach, open science practices and replication studies to study these experiences in the lab and in naturalistic settings.

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History Rhymes with the Psychedelic Boom

By David Herzberg

As a historian of psychoactive pharmaceuticals in the 20th century U.S., I see history rhyming in potentially dangerous ways in the current psychedelic boom. After decades of being associated with insanity, violence, and social disorder, psychedelics are now being embraced as potential wonder drugs. What appears to be a radical, 180-degree shift in reputation, however, masks an underlying similarity: both of these mirror-image stories belong to the mythologies of the consumer culture, which attribute broad transformational power to individual acts of consumption. Seeing drugs through this mythological lens prevents us from accessing their potential benefits, while exposing us to the real possibility that they could make things worse.

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