Several states and other jurisdictions have led the way on decriminalizing psychedelics and facilitating therapeutic access. In Oregon and Colorado, psilocybin is legal to consume under the supervision of a therapist or licensed facilitator, while New Mexico is set to implement a medical psilocybin program specifically funding access for people on low incomes.

Ketamine, a synthetic psychedelic, is now widely available for prescribed use treating a conditions including severe depression and post-traumatic stress disorder. For several years, MDMA has been undergoing clinical trials for PTSD with promising results. And on April 18, President Donald Trump signed an executive order titled Accelerating Medical Treatments for Serious Medical Illness, to allocate funding and fast-track research on psilocybin, ibogaine, and MDMA for a variety of mental health conditions.

There is good reason for excitement. Many patients with seemingly insurmountable conditions see significant improvement when granted access to psychedelics. Scientific evidence on the efficacy of these medicines is still emerging, but shows great promise across a range of substances and a range of needs.

The people most affected by the relevant conditions are often the very people excluded from treatment, people who also face systemic barriers like poverty, racism and state violence.

Ronald Bowman, who participated in the 2021 Multidisciplinary Association for Psychedelic Studies (MAPS) MDMA-assisted therapy clinical trials for PTSD, told Filter that he noticed a “favorable” difference after just the first dose, which allowed him to “talk with sturdy confidence” about traumas he was unable to effectively communicate previously.

However, he also found that, due to the complexity of his trauma, he needed more than the three sessions allotted by the study. As a retiree, he was unable to follow through with a private practitioner because of cost.

As we celebrate the potential for change carried by these medicines, it is important to simultaneously examine issues of access. The people most affected by the relevant conditions—including severe depression, PTSD and addiction—are often the very people being excluded from research and treatment, people who also face systemic barriers like poverty, racism and state violence.

People impacted by the criminal-legal system, in particular, have been widely overlooked.

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 44 percent of people in jail and 37 percent in prison have a mental health condition, and that 68 percent of people in jail and 57 percent of people in prison have a substance use disorder. 

Moreover, a 2019 study found that parents with mental health conditions were eight times more likely to become involved with child services. And the National Center on Substance Abuse and Child Welfare reports that, according to data collected in 2021, 39 percent of children removed from their homes had a parent with a substance use disorder—which doesn’t include families whose children are not removed but remain under surveillance by the system.

Right now, most of these people do not have access to psychedelic therapies and are unlikely to receive it any time soon. Those that are legal tend to be financially inaccessible to the vast majority of people impacted by these systems. But income is not the only barrier to fair access to these potentially life-changing therapies.

“The courts just willy-nilly choose some medication that they think is less ‘abusable.’”

Sally Friedman, senior vice president of legal advocacy at Legal Action Center, has defended many clients involved with child services and the criminal-legal system. While she has not personally had a psychedelics case, she has seen many times how judges and case workers control or terminate people’s medication access, even when they have prescriptions and have demonstrated positive changes as a result of the therapies.

“I had a client on ADHD medications and she was forced off by a court,” Friedman told Filter. “I’ve had clients forced to switch from methadone or buprenorphine to naltrexone … the courts just willy-nilly choose some medication that they think is less ‘abusable.’”

When it comes to psychedelics or other novel treatments, she continued, “I just don’t think it would be a surprise for any medication developed for substance use disorder or [other mental health conditions], for one of these two huge systems—criminal-legal or family regulation—to discourage it because of lack of understanding, especially if it’s a controlled substance.”

The roots of exclusion go much deeper than systems involvement, noted Ifetayo Harvey, executive director of the People of Color Psychedelics Collective. “I would say for the most part, people who have been justice-impacted are a demographic of people that aren’t really considered in psychedelic research and therapy,” she told Filter.

Racism persists within psychedelic research, as well as in the legal system—something Harvey’s collective is working to dismantle. One report found that, between 1993 and 2017, psychedelic research participants were 82.3 percent non-Latino white. When the criminal-legal and family regulation systems have long disproportionately targeted people of color, multiple layers of discrimination combine.

“We have data coming out that’s really compelling, but we are really not applying the more common-sense rules of drug use, set and setting.”

Besides the issue of access, there’s the added question of efficacy given the circumstances of vulnerable populations’ lives, as Michael Galipeau, a New York State LMSW, pointed out.

“We have data coming out that’s really compelling, but we are really not applying the more common-sense rules of drug use, set and setting,” he told Filter. “Where is the context for healing when you’re going to a shelter where you don’t know if you or your stuff are going to be okay, or you’re facing going to jail, or you don’t know if you’ll survive to the next day?”

To that point, a 2023 paper suggested that the overpolicing of Black populations could eliminate benefits of psychedelics use. But that’s a reason to work to end systemic injustice, not to give up on seeking equitable access.

“I would challenge, too, that there’s highly resilient people tangled in the system and more than able to lean into ketamine therapy,” Craig Salerno, a licensed professional counselor and licensed addiction counselor, told Filter.

Salerno offers counseling for ketamine-assisted therapy patients at his Boulder, Colorado, clinic. He feels that with proper discernment on the part of the practitioner, even some high-risk patients can benefit from psychedelic therapies.

“You don’t want to lean in with someone who’s not ready,” he cautioned. “If someone is unhoused, you may not want to do deep trauma work and throw them [back] into an unstable environment. But some are close enough to touch deep psychedelics work and still find ways to manage.”

Salerno works with people experiencing severe opioid use disorder, for example. “Some people say that’s too acute, but to me, with the likelihood of death and overdose, sometimes you need to go for it.”

“What concerns me is that the success of psychedelic medicine is amazing, but it doesn’t get us off the hook for deeper social issues, and access to basic human rights.”

We are at a unique point in the US history of psychedelics. These therapies are rapidly emerging into our cultural narrative, but are not yet established enough to be cemented in any particular nationwide policy. So we have an opportunity now to examine, acknowledge and repair the wrongs of our past, and implement psychedelic therapies with conscious equity.

This repair goes beyond psychedelics. It means following New Mexico’s example to break down the income barrier to psychedelic therapies. It means including system-impacted people, especially people of color, in psychedelics research, leadership and discussions—actively implementing their ideas—and funding grassroots efforts rather than relying solely on institutions.

It means creating and upholding laws that prohibit judges and caseworkers from making medical decisions. It means increasing funding for food, housing and other basic needs. It means dismantling systems of government oppression that keep people with and mental health conditions trapped in loops of imprisonment and surveillance.

“The psychedelics community has to stop seeing itself as a separate movement from the larger movement to end the War on Drugs,” Harvey said. And the movement to end the drug war itself recognizes that it is part of a much larger struggle against societal injustice.

“As a social worker,” Galipeau concluded, “what concerns me is that the success of psychedelic medicine is amazing, but it doesn’t get us off the hook for deeper social issues, and access to basic human rights. Those are fundamental to human health.” 

Photograph (cropped) via FreeRangeStock/Public Domain

The post The Time to Build an Equitable Psychedelic Landscape Is Now appeared first on Filter.

Rescue breathing involves repeatedly breathing into the mouth of someone who is unresponsive, until they are able to resume normal breathing. The need for this may last for just a few minutes or far longer, depending on various factors.

“The principle is that you’re breathing for the person while they can’t breathe for themselves,” harm reduction expert Dr. Mishka Terplan, medical director of Friends Research Institute, told Filter. 

Opioids affect the part of the brain that regulates breathing, and an overdose occurs when the brain has essentially forgotten to breathe while a person is unconscious. When a person dies from an opioid-involved overdose, lack of oxygen is the cause. 

Naloxone works to reverse this effect by knocking the opioids out of the brain’s receptors, which will eventually turn that part of the brain back on. It typically takes about 2-5 minutes.

 “At every overdose response training I do, I explain that it is the most important part.”

But there are many situations—during the time naloxone takes to work, or if naloxone is not immediately available, or people don’t want to call 911—when rescue breathing can mean the difference between survival and death.

 “At every [overdose response] training I do, I explain that it is the most important part,” Nick Voyles, executive director of the Indiana Recovery Alliance, a grassroots harm reduction organization, told Filter. 

If necessary, he added,  “you can rescue-breathe someone for eight hours until the opioid metabolizes.”

People can be revived with naloxone alone, but rescue breathing adds a crucial component in the interim by reducing the risk of brain injury—which can occur in as little as 3 minutes when the brain is deprived of oxygen. 

Rescue breathing is also humane besides its ability to save lives. Because for people who are dependent on opioids, the mechanism by which naloxone can save a life—replacing the opioids in the brain receptors—can also lead to precipitated withdrawal, and a rapid onset of intense withdrawal symptoms.

Precipitated withdrawal can cause severe vomiting, diarrhea, chills, muscular pain, restlessness, agitation and panic, in addition to acute cravings for more opioids. It creates an additional risk factor of someone who has recently overdosed quickly seeking to use more opioids because they can’t stand the pain.

As a positive, evidence-based action after administering a dose of naloxone, rescue breathing can also mitigate the tendency to administer excessive naloxone.

All of this explains why overdose prevention centers (OPC) always have naloxone ready, but also employ strategies to minimize its use—including oxygen therapy as well as rescue breathing. OnPoint NYC, which operates two sanctioned OPC in Manhattan, reported that 83 percent of opioid overdoses in its first year of operations were resolved without the need for naloxone.

As a positive, evidence-based action after administering a dose of naloxone, rescue breathing can also mitigate the tendency—notable among law enforcement—to administer excessive naloxone. Multiple unnecessary doses can serve only to intensify a person’s precipitated withdrawal.

“The perspective of people who are not educated in naloxone and how it works in the brain, or often police or other officials, will just be that someone can’t overdose from [naloxone]—which they can’t—so you can give them as much as you need to until they wake up,” Courtney Peters, a board member for New Hampshire grassroots harm reduction group Insubordination Station, told Filter. “All that being technically true, the state that person wakes up in is going to be drastically different depending on how you handle the overdose.” 

Naloxone will always be a critical tool, one that’s very easy for most people to use. And precipitated withdrawal is better than dying. But the addition of rescue breathing can help someone revive both faster and more comfortably. Harm reductionists view it as more crucial than ever before amid the continuing polydrug overdose crisis. 

“There have been reports from almost everywhere in the country that their supply [of heroin or fentanyl] has been contaminated … most often by xylazine and benzodiazepines,” Peters said. Rescue breathing “is just basically trying to combat all of the substances that have been ingested, [including those] that are not opioids but are still going to depress your breathing or your ability to breathe.” 

“If someone took what they thought was fentanyl, but it was really a tiny bit of fentanyl and mostly xylazine and benzos and other cuts, when you administer the naloxone, it could be working but the person is still not waking up because they’ve got so many other substances going on,” she continued. “Rescue breathing basically just buys you time for … this person’s natural ability to breathe to kick in.”

“If anyone else on my team had been the one there and not me, he would be dead or severely brain damaged.”

Keri Ballweber, a harm reductionist who has worked at and run both grassroots and conventional harm reduction programs in the Midwest, said she has found that some larger organizations do not always stress the importance of rescue breathing in their overdose response trainings. She has even worked on teams where her coworkers did not know how to rescue-breathe—a major oversight.

She recounted one overdose reversal situation in which she gave the person two doses of Narcan over eight minutes, and had to perform rescue breathing for 10 minutes before he regained consciousness.

“If I wasn’t breathing for him, he would be dead or severely brain damaged,” she said. “If anyone [else] on my team had been the one there and not me, he would be dead or severely brain damaged.”

Voyles has made similar observations. “This is what happens when you have watered down harm reduction,” he said. “We go places where this happens all the time, we have to retrain constantly.” 

He also emphasized that rescue breathing, which can be done by anyone capable of performing the motions, is not the same as CPR, which involves chest compressions and can cause physical injury if done by someone who is not properly trained.

The National Harm Reduction Coalition website includes a step-by-step description of how and why to utilize rescue breathing when responding to an overdose. SAMHSA includes rescue breathing in its Opioid Overdose Prevention Toolkit for first responders. And Terplan is among experts who teach rescue breathing in all the overdose response trainings they conduct. 

But despite this level of visibility, the grassroots harm reductionists who spoke with Filter said that they are not seeing rescue breathing implemented enough on the ground—particularly among first responders and staff of some of the larger harm reduction organizations.

“I think not only education is important, but also just trying to promote a culture where people can look at people who use drugs as human beings.”

Asked about a solution, Peters and Voyles agreed that it is necessary to increase education about rescue breathing among first responders and the general public, and also to reduce public stigma against people who use drugs.

“I think not only education is important,” Peters said, “but also just trying to promote a culture where people can look at people who use drugs as human beings, as human beings that deserve not only to be alive but not in horrible pain.” 

Rescue breathing involves pinching the nose shut and breathing into the mouth every five seconds. Ballweber noted that while mouth-to-mouth breathing is ideal, it is also possible to perform rescue breathing by breathing into a person’s nose if their jaw is locked shut, which can sometimes happen during an overdose. 

In certain circumstances, the modified jaw thrust maneuver (for which proper training is required) is recommended over the standard chin-tilt before commencing rescue breathing.

Terplan added that, “911 [operators] can walk you through rescue breathing and how to assess if somebody is breathing, which sounds simpler than it sometimes is in an acute situation.”

Here are the steps for using rescue breathing during an overdose, as written on the National Harm Reduction Coalition website:

1. Place the person on their back.

2. Tilt their chin up to open the airway.

3. Check to see if there is anything in their mouth blocking their airway, such as gum, toothpick, undissolved pills, syringe cap, cheeked Fentanyl patch (these things have ALL been found in the mouths of overdosing people!). If so, remove it.

4. Plug their nose with one hand, and give 2 even, regular-sized breaths. Blow enough air into their lungs to make their chest rise. If you don’t see their chest rise out of the corner of your eye, tilt the head back more and make sure you’re plugging their nose.

5. Breathe again. Give one breath every 5 seconds.

Photograph (cropped) by Naval Surface Warriors via Flickr/Creative Commons 2.0

The post Rescue Breathing, a Crucial Overdose Response, Is Still Underused appeared first on Filter.

As a teenager, I was abused for four years by an older man. I nearly died. I developed full-on PTSD, with flashbacks and nightmares and crippling anxiety and suicidal depression. I used heroin to cope. I nearly died several times from overdose. I tried therapy. I tried medication, for the PTSD and the addiction. Sometimes those things helped a little, but nothing really worked. I was told the PTSD would never go away, that I could treat it and feel a little better here and there, but I’d always have it. That the rest of my life would be a long recovery from those four terrible years. And so I lived, for over a decade.

But I don’t remember having PTSD. Not really. Not anymore. I can’t feel it in my body now. That constant feeling of shaking just beneath my skin. The unending desire to scream. The snarling rage that would turn upon anything it could, even myself. I remember the story, like a script I read again and again until it became rote. But the PTSD itself? It’s gone.

What finally helped me, when nothing else worked? Psychedelics.

Alright, it wasn’t just popping random psychedelics at parties, though I’ve done that too. And it wasn’t only psychedelics. It was a combination of self-prescribed interventions, including yoga, meditation, creative writing, practicing gratitude, and taking selected psychedelics with intention. 

I have written about how I used ketamine to taper off buprenorphine, a partial opioid agonist commonly prescribed for opioid use disorder. I have not yet found the words to describe my breakthrough experience drinking ayahuasca—a shamanic brew made from two Amazonian plants containing DMT and an MAOI—at a ceremony in upstate New York, officiated by a Colombian taita. 

But before either of those experiences—at a time when I was no longer shooting heroin but still experienced unwelcome cravings, and still felt crippled by trauma—I began my healing with psilocybin microdosing.

It wasn’t the same as a psychedelic experience in which colors pop and trees take on patterns. It was more like a fog had been lifted from my eyes.

Psilocybin is the main active compound in “magic mushrooms.” At higher doses—think up to 4 grams of dried ‘shrooms—people can expect to experience visual distortions or visions, altered perceptions of sound and other senses, strange thoughts, and euphoria if things are going well; paranoia if not. Doses higher still might prompt out-of-body experiences, or the temporary loss of all sense of identity. Some may find such journeys deeply transformative or expansive; others may find them terrifying, or triggering of trauma symptoms.

The good news is, those of us who don’t want to risk forgetting who we are or falling into another dimension can experience the benefits of psilocybin in a much calmer way.

Microdosing is defined as a sub-perceptual dose, meaning not enough to trigger a psychedelic experience. A microdose of dried psilocybe cubensis—the psilocybin mushroom species most commonly found on the unregulated market in the United States, and the only one permitted under Oregon’s legal model—typically consists of about 50-100 mg, though some people have reported microdosing at up to 400 mg. Actual psilocybin dosages will vary, because individual mushrooms contain different amounts.

The first time I microdosed, I had not used psychedelic mushrooms at all for nearly 15 years. I was at an outdoor festival bedazzled with sunlight and trees. Almost immediately, I felt a heaviness lift from me, and I was able to recognize the beauty in the world around me. It wasn’t the same as a psychedelic experience in which colors pop and trees take on patterns. It was more like a fog had been lifted from my eyes, and I could notice what had always been right in front of me.

“In small amounts it’s much more subtle. It’s not shocking you.”

I was fortunate enough to find a pair of unauthorized mushroom growers who sell a line of purpose-built microdosing capsules and tinctures. One of them—we’ll call her Emily—agreed to speak with me for this story.

“Each capsule [or tincture] contains between 50 and 60 mg  [of psilocybin mushrooms],” she told me. She and her partner add a variety of non-psychedelic mushroom species to the mix, saying these also bring health benefits in a number of areas.

“With the microdosing, being consistent is key,” Emily said. “Three days on and two days off is what we recommend… the reason is it’s an adaptogen, so your body will adapt quickly. Taking that break resets the system so it will work again. It will work regardless, but it works better that way.”

I microdosed on Emily and her partner’s regimen for about three months in the summer of 2021, before detoxing from all substances to prepare for my first ayahuasca ceremony. They’d told me that, unlike antidepressants, I wouldn’t necessarily have to keep taking them long-term, although they do have clients who report seeing significant benefits from continuing the regimen for months or years. 

Emily also believes that high doses of mushrooms can be beneficial for some, but recognizes not everyone is ready for that experience. “In small amounts … it’s much more subtle … It’s not shocking you.”

I began taking the microdose in the morning on an empty stomach, as Emily and her partner suggested. I began to feel better in just about every area of my life almost immediately.

Morning sluggishness was replaced with energy. Hesitance to sit down and work on the novel I was writing was replaced by excitement and inspiration. When I visited or spoke with family members on the phone, I was overcome by feelings of warmth, love and a desire to share my excitement about my book or other plans, instead of just wanting to harp on past grievances. I started going outside more. Anxiety fell away into a serene, hopeful happiness.

The fear extinction study “has a clear analogy to PTSD,” said Woolley, a psychiatrist working with veterans living with PTSD.

Western medical models are slowly beginning to integrate some psychedelic medicines into care plans, especially ketamine, which is now widely prescribed for treatment-resistant depression and some other mental health conditions. But psilocybin is still classified as a Schedule I substance in the US, not recognized as having medical use.

Joshua Woolley, director of the Translational Psychedelic Research Program at the University of San Francisco, told Filter that mushrooms themselves are unlikely to gain research approval from the Food and Drug Administration any time soon. “They are too variable,” he said. “Different batches of the same mushroom or different parts of the same mushroom are too variable in psychedelic content … which the FDA hates … It has to be the same every time.” 

However, relevant and highly promising studies have been conducted using synthetic psilocybin, as well as data gathered from people who self-administered mushrooms. An animal study currently in preprint found that larger doses of psilocybin helped enhance fear extinction: Essentially, when rodents associated a certain tone with pain, they began exhibiting fear responses every time they heard that tone; when given doses of psilocybin while hearing the tone, they no longer displayed the fear response. 

Such evidence hints at how psilocybin might have helped me.

“PTSD is the difficulty in unlearning that association. The idea is that [psilocybin offers] some sort of enhancement of the learning process.”

The fear extinction study “has a clear analogy to PTSD,” said Woolley, who is also a staff psychiatrist at the San Francisco Veterans Affairs Medical Center, working with veterans living with PTSD. 

“You go to Afghanistan and there’s an explosion,” he explained as illustration, “and you link the smells and the sights and the different things around at the time of the explosion, and you get fearful when you smell diesel fuel for example, even though when you come back to America, diesel fuel isn’t actually a dangerous thing for you.”

“PTSD is the difficulty in unlearning that association,” he continued. “The idea is that [psilocybin offers] some sort of enhancement of the learning process. The dendrites are sprouting, it’s a time of plasticity… That’s the hypothesis … that’s the working model for how psilocybin for PTSD could work.”

“We have worked with people that were severely suicidal that have taken our products and they now feel like life is worth living,” Emily said. She also related apparent impacts on other conditions. “We have seen people with severe alcoholism who, within six months come back and say [they] don’t even feel like drinking anymore … There was another girl [who was addicted to heroin] and has been microdosing for about a year. After the fourth month, she stopped doing heroin. She said because she continued with the microdosing, it has changed her life.”

Some research does support psilocybin’s positive impact in areas like alcohol use disorder, smoking cessation and opioid use disorder, among others. But so much of the information out there remains either preliminary or anecdotal, and there are reasons for that.

 “Psychedelic work is hard to do across the board,” Woolley explained. “You have to get all this regulatory approval from the FDA and the [Drug Enforcement Administration]…The government hasn’t been funding psychedelics. Now that is kind of changing and they are beginning to fund it [but researchers are still] are having to rely largely on philanthropy and companies.”

When it comes to psilocybin and PTSD, he added, most studies “have been really focusing on MDMA for PTSD so there hasn’t been much appetite [for other psychedelics]. There hasn’t been much funding… It’s political or [financially] strategic; it’s not based on evidence or efficacy.”

Outside of clinical settings, however, humans have been eating mushrooms and experiencing their radical benefits for thousands of years.  

Psychedelics were only one of many contributing factors. But I can’t neglect gratitude for the slow, happy shift that took place during my time with microdosing.

What I know is that my experiences with mushrooms and other psychedelics have changed my life, and that I’m not alone in that. I used to be someone who lived under the constant pressure of suicidal ideation, who could not function without injecting opioids, who felt permanently marred by trauma and isolated from everyone. I now enjoy a large community of friends, and spend my days storytelling and making art. Sometimes I feel sad, of course, but I’m able to recognize that as a passing emotion and not something I need to attach to.

Psychedelics were only one of many contributing factors to the change in my life. And I’ll admit that a lot of that change came from breakthrough experiences on high doses, when I was able to catch glimpses of other realities that allowed me to detach importance from my past trauma. 

But I can’t neglect gratitude for the slow, happy shift that took place during my time with microdosing. The trauma energy that was stored in my body slipped away; I found myself able to go out and experience life without the constant terror that nagged at me for over 10 years. Now, I can engage with the art of living in this reality without being inundated with reminders of my past. 

Photograph (cropped) by Patrick Ullrich via Wikimedia Commons/Creative Commons 3.0

The post With Psilocybin Microdosing, My PTSD Slowly Slipped Away appeared first on Filter.