Across the United States, a tide is turning. It is becoming clear that widespread legal access to psychedelic medicines will be a reality in our lifetimes.
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
