Democratizing Psychedelics: Why Community Should Lead The Way

The Flying Sage Journal #7

Apr 10, 2023

Intro

The Flying Sage community was born with the mission to democratize transcendence. To me, this means making psychedelics, and other transformational technologies like breath, meditation and cold exposure, more accessible to everyone. As the psychedelic ecosystem has started to grow over the past few years, it has become more apparent just how important it is to ensure accessibility is at the heart of this movement.

What systems and processes do we need in place to ensure that psychedelics are accessible?

Clinical offerings will remain expensive in the majority of instances and inaccessible for most people seeking to work with psychedelics. Additionally, “underground” offerings will also remain expensive in a lot of scenarios because there is no regulation there.

Therefore, many people who want to access psychedelics but can’t, need a different way. I believe community is a big part of the answer to this question and I want to spend some time here outlining why.

Expansion on All Fronts

Through my work with MAPS Canada, I got to witness first hand the incredible importance that research has played, and continues to play, in the legitimization of psychedelic medicines. I had the privilege of working closely alongside Mark Haden and Rick Doblin who have spent decades collectively building the foundations for the psychedelic renaissance that we are experiencing today. If it was not for MAPS, our community, The Flying Sage, would not exist, and neither would Numinus and other publicly traded companies or any of the several psilocybin dispensaries that have opened here in Vancouver, BC. And of course, let’s not forget about the thousands of years of indigenous use when it comes to other plant medicines as well.

Being part of this work made me realize just how slow the process of legalization is; especially when you have strategically chosen to work within the military-industrial-pharmaceutical system. I commend Rick, Mark and everyone else who has made an impact in this particular area. The bureaucracy is immense and the stigma is poisoning and the fact that we are now seeing so much freedom being offered in these areas is thanks to the giant shoulders that we stand on and a testament to the human ability to do the seemingly impossible.

Despite this, I feel that we are now at an inflection point. The slow inch-by-inch progress and speed of previous years is being eclipsed by what many are calling the psychedelic renaissance. Growth is occurring now at a very alarming rate and I would argue that the old War on Drugs paradigm is starting to give way to something new altogether.

In addition to the rapid expansion of the psychedelic industry, we are faced with a rapid expansion of the mental health crisis. There have never been more people dealing with depression and anxiety than there are today. By the time Canadians reach 40 years of age, 1 in 2 have – or have had – a mental illness1. That's a lot of people! When I hear this statistic, I am curious to to know how mental illness is defined. The excessive pathologizing of the human condition represents an important underlying and systemic issue at play when discussing mental health. Perhaps it is important to mythologize instead of pathologize. Nevertheless, regardless of how you characterize the statistics around mental health, I would think it's safe to say we are in desperate need of better treatments. The current pharmaceutical and chemistry-focused "solutions" to healing are just not cutting it. It's time for a paradigm shift in medicine, and psychedelics might hold an iportant key.

The key word here is might.

Forcing Something to Fit

Right now, the primary advocacy efforts and legitimization of psychedelic medicine is being put into medicalizing psychedelics. Legalization through medicalization. This is the MAPS path and this is the narrative that is shaping most discourse around these medicines at the moment. I want to argue here that while it is very important to have this pathway developed, the process of medicalizing psychedelics is like trying to force a puzzle piece to fit in the wrong hole. The psychedelic elephant in the room is that many aspects of modern medicine, especially pharmaceutical treatments, are terribly ineffective. Big Pharma is in the business of keeping people sick, not making them better. Trying to embed psychedelic medicines within this blatantly corrupt and nefarious system is like trying to plant a flower in the middle of a wildfire.

I am of the mind we need to take some time putting aside the puzzle box altogether and look for innovative ways to embrace these transformational tools. This does not mean we need to burn the whole system down, but we need to take massive action towards improving how we approach healing and medicine.

I believe that harm reduction and education should pave the way forward empowering people to use psychedelics in community through safe and effective means.

Have you noticed the psychedelic elephant in the room?

Full Spectrum Use

Before discussing what effective community healing with psychedelic could look like, let’s chat a bit about language. Two years ago I published a video where I talked about three different ways people use substances. The intention behind this was to spark more nuance in the conversation around substance use and help people navigate the the stigma that makes it very challenging to have honest conversations about their risks and benefits. As Terence McKenna once said, “drugs is a word that has polluted the well of language”2.

Focusing on psychedelics, I shared that you could divide people’s use of these substances into three categories: Recreational, Intentional and Medical. Since then, I’ve had some conversations with my friend Dr.Ivan Casselman who likes to use the following, non-hierarchal categories…3

Free Form
- Recreational
- Intentional
- Therapeutic
Medical
- Therapeutic
Traditional
- Intentional
- Therapeutic

If you consider Free Form use to encompass recreational use and intentional use, I would argue that this category of psychedelic medicine has the potential to liberate and offer support to more people than medical use. In other words, the following settings have the potential to heal and liberate more people than the clinical pathway…

Journeys at home with your partner, best friend or family member
Going into nature with a close group of friends
Solo journeys
Festivals

I do not mean to say that medicalizing psychedelics is inferior to these other use patterns but just to say that more people can, and have been, positively impacted by free form use. And please note that therapeutic use of these medicines span all three categories.

If you have been part of the psychedelic scene for a while this should come as no surprise to you. However, one thing I am concerned about is that as psychedelics become legitimized, the therapeutic and medical pathway becomes the only narrative at play and the only narrative that the public forms sentiment around.

Cost Benefit Analysis

The psychedelic renaissance is built on a bedrock of research and clinical trials spanning decades and the main reason why therapeutic psychedelics have reached the point they are at today is because of the work that MAPS did with these trials. Of course there were many other individuals, universities, traditions and advocacy groups along the way but if I had to choose one lever that has moved psychedelics towards accessibility here in the West, that would be it.

Reflecting on that, I would invite you to consider the following question…

Are the resources and direction required to run a successful research program or clinical trial the same as those required to scale a novel, paradigm shifting technology?

How about we first consider the answer is yes. In that reality, we would want to essentially scale the resources and economics of a clinical trial outside the confines of research and into practice. A recent paper on the economics of psychedelic assisted therapies helps to illustrate this…

A modeling effort by the Boston Consulting Group estimated that 22,000–40,000 MDMA-certified therapists would be needed to treat 400,000 PTSD patients by 2031. Considering psychedelic medicine more broadly, this implies that treating one million patients per year by 2031 would require 55,000–100,000 newly-trained therapists in 10 years, approximately 10–17% of the US mental health workforce. The rate at which practitioners can be trained and effectively deployed is also a function of the prevalence of skepticism and thus reluctance to participate. This skepticism remains substantial among key clinician groups such as psychiatrists and psychologists.4

That is a lot of therapists and a monumental task laying before us… and those estimates are just for MDMA-assisted therapy.

Returning again to this question of scaling from clinical trials, we can actually see this starting to play out now here in Canada. On December 5th 2022, Health Canada released their expectations regarding risk-management measures for clinical trials involving psychedelic-assisted psychotherapy5. Regarding the issue of properly staffing psychedelic sessions they stated that:

During the phase in which the drug is being administered to the participants, there should be a minimum of two therapists present. The therapists should remain the same throughout the clinical trial for each patient in order to maintain trust. There must also be a licensed physician to provide medical oversight of the clinical trial (as per section C.05.010(f) of the FDR), and to be involved in screening potential participants to ensure that they meet the eligibility criteria to be administered psychedelic drugs. The physician must also have the authority to administer a restricted drug, and should be readily available on site for the duration of the drug's effects to provide adequate access to medical care, if necessary, and to assess the need for change in dosage regimen or optional additional dose during a session, when such a change is allowed by the protocol.

While I am excited that we have reached a point where Health Canada is discussing therapeutic use of psychedelics, it is important to recognize that these expectations are quite restrictive and while that might be effective or even necessary for constructing sustainable clinical trials, I am not certain these constraints will scale to meet the needs we are facing. One important question that I am left with when when reading Health Canada’s recommendations is…

Are therapists the only ones that should be administering psychedelic therapy?

I would like to think in the future we could lean on a wide variety of wellness practitioners with whom we can trust to guide us through these powerful experiences, but if public policy is informed strictly by clinical trial practice, this might not be the case. We need everyone to participate and bring their unique gifts and offerings to this work.

So returning to the question I posed earlier again, my contention here is that I do not think the resources and direction required to run a successful research program or clinical trial are the same as those required to expand psychedelic healing.

The Essence

So what is required? I would argue we need to focus on empowering people to use psychedelics themselves. If we truly believe that the healing power of psychedelics comes from our inner healing intelligence6 then why is this not at the core of our treatments and programs? Why are we trying to fit psychedelics into an existing knot? We are creating a dichotomy.

We need to focus on creating expansive structures that facilitate this inner healing process. As much as the current clinical procedures and protocols do honor and speak to this, I do not feel that they are truly leaning into this idea of sovereign wellness because at the end of the day, sovereign wellness challenges capitalism. It obviously challenges big pharma but it also challenges clinics and health care centres. It challenges systemic beliefs we have about what it means to heal.

Safe and effective psychedelic use for healing is about creating the proper set, setting and dose criteria to allow for a transformational experience and I would argue this is something the average person can be taught to do with support of close friends and from the comfort of their own home or in nature. Most people don’t need a two-therapist physician duo to have a psychedelic experience.

Just like we can teach people to drive, we can teach people to navigate healing with psychedelics and the amazing ally we have is the medicine itself. As part of their healing mechanism, psychedelics direct people towards what they need in the context of their community and then effective integration resources help to further highlight this. We tell people they need to trust and surrender into the experience but then, as individuals and stakeholders actively shaping the psychedelic landscape, are we trusting? Are we surrendering?

This is where harm reduction comes in. By taking a harm reduction approach with education, we can empower people to learn how to create safe settings for themselves. I would argue this is a longer-term more sustainable alternative to medicalization.

Here are some practical steps that I suggest as part of this process:

Educate children about psychedelics from a younger age. Just like you would educate them about alcohol. Present the benefits and risks in a balanced way.
Fund community initiatives in your local areas that offer integration circles.
Embrace free form use as a legitimate means to access healing.
Lean more into the wisdom generated from the underground space and use the experience there to inform best practices.
Allow communities to develop relationships with these medicines based on the personal relationships formed by the individuals of those communities. A one size approach will not fit all.
Support compassionate use. Look at what TheraPsil is doing.
Fund healing spaces in different communities and empower people in those communities to hold space.
Figure out how to lean safely into the phenomena that many people develop a desire to serve medicine after participating. Understand this is a feature of psychedelics.
Decriminalize psychedelics.
Prioritize experience with psychedelics instead of experience with being a therapist.
Encourage and educate the public on what trip-sitting is and how it can be done effectively.

Towards Transcendence

I have been wanting to share some of my thoughts on this for a while so I appreciate the opportunity to do so. If you have comments, feedback or suggestions around what I have shared here, I would love to discuss with you. I am always learning and appreciate new perspectives on this topic that is very dear to my heart. Please shoot me an email anytime at michael@theflyingsage.ca.

With psychedelic love and gratitude,

- Michael 🤍