Letter to Authors of CA State Bill 519

Thanks for the time on the phone today. As I shared in our conversation, I’m new to this space, having lost my son Will at age 21 in an accident that occurred due to a psychedelic-induced psychosis. My son had no personal or family history of mental illness, took moderate amounts, had previous experience with the substances, and was in his own home with his best friends. Yet things went sideways and now he is gone. Unfortunately, I now know other parents who have lost children to psychedelic hallucinations and delusions, from jumps or falls and other trauma.

Please know…

• I support the movement away from criminalization of drug use. I’m a progressive-minded public health professional and believe that drug use is a public health issue, and that we must end the war on drugs.

• I support the healing potential of psychedelics and am heartened by reports of desperately needed improvements in mental health. Though it’s important not to get ahead of ourselves,[i] as underscored by an editorial in last month’s New England Journal of Medicine.[ii]

From the same editorial: “The momentum to also legalize hallucinogens shares strategies in common with movements that were calculated to increase legal access to prescription opioids and marijuana in the United States. One such strategy is to minimize potential adverse consequences and dismiss evidence-based safety concerns for general use.”

Let’s not do that. Let’s have transparent discussions about risk and safety – and needed guardrails -- as we think about how to bring these powerful substances into society:

Psychedelics can produce hallucinations, delusions, and detachment from reality. These experiences can lead to unpredictable and, sometimes, tragic results. Emotional responses can range from euphoria to paranoia, terror, and fight-or-flight panic, which can result in adverse events such as psychological trauma, erratic behavior, accidental injuries, violence toward oneself or others,[iii], [iv] even death.

Furthermore, while under the influence of psychedelics, individuals are incapacitated, and become extremely vulnerable and suggestible in many unique ways.[v], [vi] This means that psychedelic therapists, guides, facilitators, ceremony leaders, etc., inhabit roles of great power and responsibility when working with clients, and that psychedelic dosing sessions create opportunities for clients to be manipulated or even sexually assaulted.[vii], [viii]

Finally, available research indicates that psychedelic use can produce longer-term adverse effects such as persistent psychosis[ix] and hallucinogen persisting perception disorder (HPPD).[x]

Currently, we do not know nearly enough about patterns of use or the individual or public health impacts of use, particularly for different populations (e.g., individuals with different health conditions, those taking other medications).[xi] There is no data tracking the incidence of adverse reactions, preventing us, at this stage, from determining how often such events actually occur when psychedelics are used outside clinical research settings. This lack of data tracking makes it easy for adverse events to fly below the radar, and for the public to underestimate the risks involved in psychedelic use.

My particular concern is young people, who are especially vulnerable to the psychedelic hype, and I have started the William G. Nash Foundation in honor of my son to support projects including psychedelic safety and harm reduction. Young people are primed for risk-taking,[xii] and have the highest rates of drug experimentation,[xiii] not to mention a mental health crisis along with the increasing popularity of self medication, particularly with psychedelic mushrooms.[xiv]

Perhaps unsurprisingly, this year’s Monitoring The Future (MTF) data showed hallucinogen use by young adults has increased significantly, reaching historic highs in this age group since 1988.[xv] This is concerning, because a systematic review of the literature on adverse reactions to psychedelics found that young people appear to experience these adverse reactions much more frequently than other age cohorts.[iii]

It's also important to understand how legalization shifts the perceptions of young people. An important study last year among young sexual and gender minorities showed that an increase in perceived decriminalization predicted a significant increase in odds of general marijuana use.[xvi] While not linking the findings to legalization per se, the same MTF data cited above showed marijuana use among young people reached the highest levels ever recorded.[X] I say this not to suggest prohibition, but to suggest a responsibility that efforts to legalize MUST include guardrails in the form of harm reduction, information, education and training.

I respectfully recommend you review the City of Berkeley’s “Responsible Psychedelic Drug Policy Reform Resolution” drafted by Berkeley Community Health Commissioner Joseph Holcomb Adams and his Commission colleague Karma Smart. Commissioner Adams will reach out to you directly, but the Berkeley approach prioritizes safety and harm reduction measures like public information, school-based drug education, peer support, and first responder training, and it incorporates the collection of public health data on psychedelic use and outcome patterns in the city to guide policy and services going forward.

I believe the inclusion of such “safety scaffolding” is vital to a responsible psychedelics policy proposal. I'm wondering if Senator Wiener might be open to a conversation about including these provisions in his bill?

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[i] Yaden DB, Yaden ME, Griffiths RR. Psychedelics in Psychiatry—Keeping the Renaissance From Going Off the Rails. JAMA Psychiatry. Dec. 2, 2020. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2773734

[ii] Madras BK. Psilocybin in Treatment-Resistant Depression. New England Journal of Medicine. Nov. 3, 2022. https://www.nejm.org/doi/full/10.1056/NEJMe2210975

[iii] Strassman RJ. Adverse Reactions to Psychedelic Drugs. Journal of Nervous and Mental Disease. Oct. 1984. https://wiki.dmt-nexus.me/w/images/5/5c/psychedelic_adverse_effects.pdf

[iv] Carbonaro TM, Bradstreet MP, Barrett FS, MacLean KA, Jesse R, Johnson MW, Griffiths RR. Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology. Aug. 30, 2016. https://pubmed.ncbi.nlm.nih.gov/27578767/

[v] Anderson BT, Danforth AL, Grob CS. Psychedelic medicine: safety and ethical concerns. Lancet Psychiatry. Oct 2020. https://pubmed.ncbi.nlm.nih.gov/32949507/

[vi] Carhart-Harris R, Leech R, Hellyer P, Shanahan M, Feilding A, Tagliazucchi E, Chialvo D, Nutt D. The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Frontiers in Human Neuroscience. 2014. https://www.frontiersin.org/articles/10.3389/fnhum.2014.00020

[vii] Brennan W, Jackson MA, MacLean K, Ponterotto JG. A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing. Journal of Humanistic Psychology. Sept. 16, 2021. https://doi.org/10.1177/00221678211045265

[viii] Goldhill, O. MDMA on Trial: Psychedelic Therapy Has a Sexual Abuse Problem. Quartz. March 3, 2020. https://qz.com/1809184/psychedelic-therapy-has-a-sexual-abuse-problem-3

[ix] Patel A, Moreland T, Haq F, Siddiqui F, Mikul M, Qadir H, Raza S. Persistent Psychosis After a Single Ingestion of "Ecstasy" (MDMA). Primary Care Companion for CNS Disorders. 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304680/

[x] Perception Restoration Foundation. https://docs.google.com/document/d/1xIvb041-RhaAyrUiCfau9H7o_Eez4VhJl_I_e8RAzQA/edit

[xi] Johnstad PG. Who is the typical psychedelics user? Methodological challenges for research in psychedelics use and its consequences. Nordic Studies on Alcohol and Drugs. Oct. 20, 2020.https://journals.sagepub.com/doi/10.1177/1455072520963787

[xii] Shulman EP, Smith AR, Silva K, Icenogle G, Duell N, Chein J, Steinberg L. The dual systems model: Review, reappraisal, and reaffirmation. Developmental Cognitive Neuroscience. 2016. https://www.sciencedirect.com/science/article/pii/S1878929315001292

[xiii] United Nations. Drugs and Age. 2018. https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_4_YOUTH.pdf

[xiv] Matzopoulos R, Morlock R, Morlock A, Lerer B, Lerer L. Psychedelic Mushrooms in the USA: Knowledge, Patterns of Use, and Association With Health Outcomes. Frontiers in Psychiatry. Jan 2022. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.780696

[xv] National Institute on Drug Abuse (NIDA). Marijuana and hallucinogen use among young adults reached all time-high in 2021. Aug. 22, 2020. https://nida.nih.gov/news-events/news-releases/2022/08/marijuana-and-hallucinogen-use-among-young-adults-reached-all-time-high-in-2021

[xvi] Morgan E, Dyar C, Hayford CS, Whitton SW, Newcomb ME, Mustanski B. Perceptions of Marijuana Decriminalization Among Young Sexual and Gender Minorities in Chicago: An Initial Measure Validation and Test of Longitudinal Associations with Use. Cannabis and Cannabinoid Research. April 15, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064955/