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Prescription Psychedelics are Almost Here—But Western Medicine Isn’t Ready

A paradigm shift needs to happen as psychedelics go legal. PEACH—Psychedelic Education and Community Healing—is the path forward.

Mike Margolies // Dec. 9, 2019

FDA approval for psychedelic-assisted psychotherapy is on the horizon, while a growing movement across the country seeks to decriminalize entheogenic plants and fungi. Unlike the drugs we’re accustomed to in Western medicine, the psychedelic therapeutic mechanism is not simply a biochemical reaction in a passive, pill-popping patient; it is experiential and participatory, and involves a type of healing that goes deeper than treating an individual in isolation. With this paradigm shift, we need to emphasize what I’ve dubbed PEACH—Psychedelic Education and Community Healing

Because the acute experiential effect is an intrinsic part of psychedelic therapy, the healing process calls for a level of active engagement and education that’s often absent from the mainstream medical model.

In the existing model, patients also typically have private relationships with practitioners, who diagnose and treat them individually. But our societal ills, many of which manifest in our mental health, are not isolated to individuals; they are communal and systemic. And so, collective and individual healing are equally vital to the process of getting well—as singular people and as a society. Psychedelic community maximizes the potential of psychedelic medicine.

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Many indigenous traditions appreciate these nuances. They understand the experiential nature of plant medicine and prepare accordingly. Psychedelic healing often takes place in group ceremony, while integration (i.e. processing your trip and incorporating the lessons you learned into your regular life) is woven into the fabric of the community. As western culture births its own psychedelic models and more people have access to these medicines, we’ll need to recalibrate our fundamental understanding of how medicine works altogether.

Psychedelic Education

Psychedelics operate differently than over-the-counter medications like SSRIs: The experience (and the integration to follow) is the medicine, which involves a radically different on-boarding process than the classic “take two and call me in the morning” approach.

Our current medical system often attempts to circumvent an acute psychoactive drug reaction, but that effect is integral to the modality of psychedelic healing. For example, Johnson & Johnson’s newly patented, FDA-approved esketamine nasal spray Spravato lists dissociation as a “serious side effect.” While low-dose ketamine arguably does provide relief from depression on a biochemical level, the dissociative effect itself is one of the main aspects of the ketamine experience that is leveraged therapeutically by providers who intentionally use a higher dose psychedelic range.

As western culture births its own psychedelic models and more people have access to these medicines, we’ll need to recalibrate our fundamental understanding of how medicine works altogether.

New psychedelic explorers need to understand the experiential nature of the medicine, an honest assessment of the benefits and risks, how to prepare, how to navigate challenges, how to make sense of (i.e. integrate) the experience, and the importance of set and setting.

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Of course, there is, and will continue to be, psychedelic use outside the medical model. Groups like the 2020 Psilocybin Service Initiative of Oregon and Decriminalize Nature are blazing alternative legal pathways, while long-standing indigenous and spiritual models have been in use for millennia. And let’s not forget about “recreational” or personal use outside any structured models.

Psychedelic education isn’t altogether different from sex ed, suggests Annie Oak, a board member of the nonprofit Women’s Visionary Council, which organizes risk reduction workshops. Just as effective sex education requires “frank conversations” about STDs, consent, birth control, and other safety factors, she says, “users of psychedelics need unapologetic training on skills such as how to effectively test substances for adulterants using reagent testing kits, and how to correctly use a milligram scale so they don’t overdose themselves or others.”

New psychonauts looking for a therapeutic, supervised experience should also understand what to look for in a guide. Historically, psychedelic facilitator training within underground and indigenous traditions has been based on apprenticeship and experience. “Traditionally, only after someone has cultivated the capacity to navigate these states and demonstrated a commitment to the process, are they allowed to guide others through complex healing rituals,” explains Françoise Bourzat in her book, Consciousness Medicine: Indigenous Wisdom, Entheogens, and Expanded States of Consciousness for Healing and Growth

This idea is reflected in modern research, too. “There’s a feeling that in order to really be empathetic and sensitive to what potentially is going on in the mind of the volunteer, you need to have some experience of these radically alternative states of consciousness, yourself,” Johns Hopkins researcher Bill Richards told me in a recent interview. During earlier psychedelic research of the 1960s, he recalls, “we wouldn’t allow a new employee, even a psychiatric nurse, in the room if he or she hadn’t had two LSD sessions, which was part of on-the-job training that we provided.” 

“There’s a feeling that in order to really be empathetic and sensitive to what potentially is going on in the mind of the volunteer, you need to have some experience of these radically alternative states of consciousness, yourself”

Today, however, though many facilitators have had their own experience with the medicine, it’s not a requirement for those being trained to do this work in a legal context. The MAPS MDMA therapist training program includes an opportunity to “receive MDMA-assisted psychotherapy if they choose to volunteer and are eligible,” but this experience is optional. Other entities like COMPASS Pathways, aiming to bring psilocybin to market for treatment-resistant depression, do not provide the opportunity for therapists to receive their own psilocybin-assisted psychotherapy. 

In other fields, it is understood that you want to be taught by somebody with personal experience. You cannot become a scuba instructor without intensive training and numerous dives under your belt. Since firsthand experience is not a requirement for psychedelic providers trained by some of the biggest players in the emerging medicalization, psychedelic education from the outside will need to help people understand what to look for in a guide. Sites like psychedelic.support will be increasingly important for finding and vetting therapists. Founder Alli Feduccia has plans to “add to provider profiles information on personal experience with medicines.” A big challenge in this endeavor will be making it safe for providers to disclose their experience, which is often not available in a legal context.

In a psychedelic community setting, new explorers could learn from seasoned psychonauts about what to look for in a guide. Just as elders share their wisdom within indigenous communities, experienced trippers could be a resource for beginners seeking a safe and beneficial journey.

Community Healing

It’s important to remember, too, as psychedelic therapy becomes more mainstream, that people do not exist in vacuums—and neither do their mental health conditions, which are often symptomatic of systemic, societal problems. This means that healing requires both communal and individual processes. Psychedelics are not a shortcut to a simple fix. They can show us the way forward, but we need to put in the work before and after the experience. And we need to do that work communally.

Let’s look at the “opioid epidemic,” for example, and the promise of ibogaine. Sourced from the African shrub iboga, ibogaine is uniquely suited to treat addiction. Not only does it occasion profound transformative experiences and insight, but it can also physiologically disrupt opioid withdrawal.

Although ibogaine is a powerful tool for addiction treatment, ibogaine alone is not going to solve the problem at large. “Many of the proponents of ibogaine are calling it a cure, but they’re looking at it in a linear way—with a beginning, a middle, and an end,” former underground provider Dimitri Mugianis said in a previous interview. “In my experience with iboga, it simply doesn’t work that way.” Some ibogaine patients have gone back to using opioids and some haven’t, Mugianis says.

Addiction is not the root cause of a person’s problems, but rather is symptomatic of deeper issues, many of them collective. The very existence of an “opioid epidemic,” for that matter, is indicative of a common denominator—systemic issues informed and perpetuated by the economy, the criminal justice system, the media, and a lack of human connection. If we’re to tackle opioid dependence at a societal level, then we’re missing the mark if we treat each case of addiction as an individualized disease—no matter how psychedelic a medicine we use.

Cultivating PEACH

In parallel to the clinical approach, I envision a world where we also have infrastructure that supports psychedelic education and community healing. We already have the seeds for PEACH, including conferences, publications like this, and my own project Psychedelic Seminars, which features free videos of nuanced conversations. Psychedelic Societies in cities around the world host community gatherings, educational events, and integration circles.

A “leveled-up” version of a Psychedelic Society might also include a brick-and-mortar community center—not altogether different from a church or a JCC (Jewish Community Center), where individuals can engage spiritually, build relationships, and seek advice from peers and community leaders. The UK Psychedelic Society has created one such physical home.

Instead of your first interaction with the psychedelic world being a private appointment, you could walk into a tea house environment where you meet informed peer explorers and get your feet wet learning about this new paradigm of experiential medicine. You could get a “psychedelic buddy” to show you the ropes, or spend weeks or months attending seminars and socials before ever taking a psychedelic. If you do journey, be it in ceremony, FDA-approved therapy, with friends, or solo, you would have access to community support beforehand and integration circles afterwards.

I would love to see more group therapy models for people working through similar issues, like the UCSF study investigating psilocybin-assisted group therapy for long-term HIV survivors. This study exemplifies community healing put into practice, where half a dozen patients bond and provide support through four preparatory group therapy sessions, followed by individual psilocybin treatment (simultaneously with one other participant), then six more group therapy integration sessions.

Access to psychedelics isn’t enough. Proper context is critical. Education and supportive community are essential to psychedelic healing.

As another example of community healing, some participants in MAPS’ MDMA-assisted psychotherapy studies have self-organized peer support calls. Call organizer John Saul describes them as “critical” to the healing process, which entailed acting on “several major life changes, which were overwhelmingly difficult to carry out.”

Cohort healing models could become standard, providing peer support and collective engagement in preparation, integration, and accountability. At the same time, psychedelics could help families and communities solve complex, interconnected issues that transcend any one person in the group (like couples therapy, for example, and beyond). Connectedness may even prove to be the key to psychedelic healing.

Access to psychedelics isn’t enough. Proper context is critical. Education and supportive community are essential to psychedelic healing. And, who knows, once we build the cultural infrastructure to maturely hold space for psychedelics, we might not even need them anymore. Our culture will have adopted the psychedelic ethos, which, in and of itself, would offer much of the healing we seek.

Mike Margolies is the founder of Psychedelic Seminars, an educational conversation series where he has interviewed a range of leaders including Michael Pollan, Dr. James Fadiman, and Dr. Raquel Bennett. Mike is a community builder who founded the Baltimore Psychedelic Society and has sparked and mentored similar groups around the world from San Francisco to DC to Portugal.

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