Access to psychedelics: a human right?

Psychedelic drugs of all types have been widely stigmatised. This is largely due to war on drugs, which spread across the world in the 1970's and had, temporarily, put the kibosh on studies investigating the medicinal benefits of these substances.

But despite the wide use of LSD, ayahuasca and mushrooms in often unsafe rituals that can potentially result in adverse health consequences and even death, it's becoming increasingly evident, science now shows, that some of these drugs can function as potent tools to treat a whole slew of mental health issues.

International research groups have been digging into the benefits of psilocybin extracted from mushrooms to, among other uses, help treat people suffering from anxiety and depression and assist cancer patients with fear management.

LSD has also shown its potential in supporting palliative care, while ketamine has been proving itself a useful tool to mitigate suicide risks and MDMA has been studied as a treatment for post-traumatic stress and borderline personality disorders. 

And while the scientific consensus remains that none of these substances provide ultimate solutions on their own and that they should be administered under professional and rigorous medical supervision, some groups of scientists and activists argue that turning our backs on their potential to improve people's quality of life is no longer acceptable, and advocate for the expansion of psychedelics' use as a human rights issue. 

Wobbly progress on the global stage

Countries worldwide are cautiously beginning to examine these potential benefits more carefully, but psychedelics still face numerous barriers on the path to heterogeneous regulation and, even more so, to a fair distribution among those who could most benefit from alternative treatments.

Countries such as Jamaica, where psilocybin use is not prohibited, are the exception; elsewhere in the world, research around psychedelics is gradually advancing.

In Argentina, for instance, scientist Enzo Tagliazucchi, director of the Consciousness, Culture and Complexity Laboratory, has just celebrated last February the first postgraduate study grant funded by the National Council for Scientific and Technical Research for a project investigating the use of the psilocybin to treat depression or anxiety in cancer patients.

Even Uruguay, which is lauded for its progressive approach to drugs, has not significantly advanced when it comes to psychedelics. "Uruguay has positioned itself internationally as a pioneer in drug reform, not only for having been the first country to legalise the cannabis market in a comprehensive manner, but also for having done so in the search for an adequate balance between economic and health aspects, based on a regulation centred on state control," write anthropologist Juan Scuro and the former Secretary of the National Drug Board, Diego Olivera. "However, except in rather small debate nuclei, the issue of psychedelics has not acquired greater relevance."

Yet despite the lasting prejudice around psychedelics, which is prevalent among health professionals who generally receive little to no formal education about the potential medical benefits of plants, there is growing interest, both in the scientific community and in the media, in the benefits of psychedelics.  

"None of these drugs are miraculous"

According to historian and psychoanalyst Carmem Silvia da Fonseca Kummer Liblik, psychedelics can "ease the way" through one's mind, and lead a patient who suffers from certain conditions to a navigation beyond a point reachable under a normal state of consciousness.

"Someone in an altered state can understand and articulate [the different experiences while under the substance's effect] with their own lives," she told FairPlanet. "From this experience, a new panorama of thoughts and emotions can reveal itself, breaking previous states of rigidity and allowing emotions to be understood from another place."

But psychedelics, specialists warn, should not be recommended to any patient. Liblik explained that personality disorders such as borderline, paranoia or obsessive-compulsive constitute contraindications that need to be analysed by the health professional.

Dartiu Xavier, a professor at University of São Paulo and a pioneer in the psychedelics research in Brazil, said that heart conditions, too, must be taken into consideration before prescribing psychedelics, since some substances may pose a risk for patients living with cardiac diseases. 

Xavier further stressed that a strong bond between the patient and therapist is crucial for the success of the treatment, as are preparatory therapy sessions and a post integration phase when the experiences beyond consciousness are analysed together.

He also added that it is necessary to build a multidisciplinary team, with at least one man and one woman present at the session to ensure the patient's safety. Xavier highlighted that in cases where the patient suffers from pre-existing health risks, a hospital environment is recommended in order to monitor and manage them.  

But while acknowledging the effectiveness of psychedelics in treating depression, post-traumatic stress disorders, trauma and substance abuse, among other conditions, Xavier views these drugs as side tools, not an ultimate cure.

"None of these drugs are miraculous," he said. "I think that the use of psychedelics is more something that catalyses, that facilitates transformation [in an individual's life]."

In Brazil, two types of psychedelics are currently legally used in therapy: ketamine and ibogaine. Ayahuasca is permitted only in certain religious ceremonies by indigenous communities - which differ from a therapeutic use.

Other substances under scientific studies in Brazil are psilocybin, which is extracted from mushrooms, LSD, MDMA, ayahuasca and one of its derivatives, dimethyltryptamine (DMT). 

Professor Xavier pointed out that while any substance can pose a risk when abused or misused, it can nonetheless be administered in a beneficial manner. He referenced opioids as an example, which can be highly addictive and from which heroin is extracted, but are also highly effective in acute pain reduction (in the form of morphine and codeine).

"It is not because there is a potential for abuse that you stop considering it a good medicine," Xavier said. "There are no good drugs and bad drugs, there are well-used and badly-used drugs." He further stressed that psychedelics are under constant evaluation by scientific investigatory bodies in order to provide people the most safe treatment possible.

Physician Alexandre Liblik, who dedicates part of his time to the study of psychedelics, told FairPlanet that another aspect that should be considered in the fight to legalise psychedelic-based treatments is the issue of sustainability. The large-scale extraction of some substances, particularly if done in preserved areas and without full collaboration with local populations, he said, could result in negative socio-environmental consequences.

In this respect, Liblik bets on mushrooms as "the stars of psychedelic therapy," due to the relative ease of their cultivation in small areas. 

Will psychedelics be available to everyone who needs them?

The debate surrounding the legalisation of certain psychedelics is progressing slowly in Brazil due to a schism between conservative and progressive-leaning cohorts of society, despite the fact that the country is a leader in psychedelic knowledge production on the global stage, according to the specialists interviewed by FairPlanet.

The incredibly prolonged legalisation process of cannabis in Brazil, whose medicinal benefits are well-known by the international scientific community, is another case in point. Despite some recent victories in the states of São Paulo and Paraná, a national regulation of marijuana still awaits approval.

Activists and scientists maintain that this is primarily a discriminatory and racist policy, since the use of marijuana is associated with Afro-Brazilian traditions. 

Under these circumstances, regulating the use of psychedelics and offering them through the public health system might be a tall order, even under a more progressive administration, as the support of the National Congress, which is in dialogue with regulatory agencies, is necessary and difficult to obtain.

The recently nominated general coordinator at the National Secretariat for Drug Policy of the Ministry of Justice, Diogo Busse, said that attaining this goal will surely fill part of his work schedule over the next few years.

But even if all tested psychedelics were approved, however, the cost of this alternative therapy could remain prohibitive.

An account by Brazilian journalist Vanessa Barbara published in The New York Times revealed that each ketamine session cost her about 1,700 reals (USD 325) - roughly 30 percent more than the current national minimum wage. She needed six sessions - a total of more than 10,000 reals.

The exceedingly high cost of these drugs is attributed by Diogo Busse to cumbersome bureaucracy and the Byzantine regulatory process in Brazil, seeing as the extraction of the substances in itself does not account for their exorbitant price. 

Expanding public access to psychedelics could be an important resource for a more humanised health system, said professor Dartiu, as many hospitalisations in therapeutic communities and psychiatric hospitals would be avoided if all people with predispositions had access to these alternative therapy methods.

In Brazil, a law instituted in 2001 states that, whenever possible, mental health treatment should be carried out without hospitalisation in order to allow patients to remain in close proximity to their support network and avoid isolation. Lately, however, public spending has drifted from mental health facilities espousing psychiatric reform guidelines towards more traditional models of asylums.  

Thus, making psychedelics available - with adequate structures and professional medical oversight - within Brazil's Unified Health System (SUS) is a project that motivates Diogo Busse in this new position.

"This is how I see the future of psychedelic science within SUS," he said. "A democratisation of access to these treatments, with significant improvement in the mental health of the Brazilian population."

Image by Mari-Liis Link.