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Monday, October 17, 2022

DECRIMINALIZE DRUGS
Alberta psychedelic regulations could limit patient access, critics say

Author of the article: Anna Junker
Edmonton Journal
Publishing date:Oct 15, 2022 •

Psylocibin mushrooms. Health Canada has said requests for psychedelics will be considered on a case-by-case basis for a 'serious or life-threatening condition' and where other conventional treatments have failed. 

Psychedelic therapy professionals warn new regulations set to roll out next year in Alberta could limit access and add hurdles for patients

Nick Kadysh, board chairman of Psychedelics Canada, a trade association for the legal, medicinal and for-profit segment of the psychedelics industry, said while it’s a good sign the province is making regulatory decisions, they lean heavily on the use of psychiatrists.

“Any clinic has to have a psychiatrist responsible,” he said in a recent interview with Postmedia. “Any patient has to talk to a psychiatrist before getting access to these therapies and we just know that there is an incredibly long wait time for psychiatry services in Alberta. So it becomes a patient access issue.”

The Alberta government announced the new rules on Oct. 5 for psychedelics such as psilocybin, psilocin, MDMA, LSD, mescaline (peyote), DMT, 5 methoxy DMT, and ketamine. The province says they are meant to provide safeguards and medical oversight, coming into effect next January.

While some clinical trials have shown promising results for the use of psychedelics as a treatment for mental health conditions, the drugs are illegal in Canada. However, health practitioners and researchers can apply for permission from Health Canada to use psychedelics in research or for therapeutic use in special circumstances. The same rules still apply in Alberta under the new regulations.

The provincial rules differ based on the level of risk involved. With few exceptions, clinics offering psychedelic-assisted treatment must be licensed and have the medical oversight of a psychiatrist.

With only psychiatrists providing oversight and not other professionals like anesthesiologists, neurologists, and general practitioners, access could be limited, said Liam Bedard, coordinator of Psychedelics Canada.

“There are a number of qualified practitioners that can oversee these therapies and by mandating that only psychiatrists can manage them, it’s creating bottlenecks in accessing these potentially very valuable therapeutic tools,” he said.

In a statement, Alberta mental health and addictions spokesman Eric Engler said the regulation does not limit the prescription of psychedelic drugs to only psychiatrists. Others can prescribe them, after and with ongoing consultation with a psychiatrist.

“A psychiatrist is required to oversee services for psychedelic-assisted psychotherapy, as they are the most highly trained and experienced regulated health professionals in the diagnosis and treatment of psychiatric disorders,” Engler said.

“Alberta is setting a deliberately high bar to protect patients, since the evidence for use of these drugs in the treatment of psychiatric disorder is still emerging and not without risk.”

At SABI Mind, intramuscular injections of ketamine are used to treat people for mental health conditions like trauma, depression, or chronic pain conditions, said Philippe Lucas, president and CEO of the psychedelic-assisted psychotherapy clinic group that has a location opening in Edmonton in November.

The new regulations do not apply to all uses of ketamine, since it is approved for use outside of psychedelic-assisted therapy, such as an anesthetic for pain management.

SABI Mind also has an in-house psychiatrist and therefore won’t be severely affected by the new regulations. However, Lucas said it can currently take between six and 18 months for a patient with a referral to see a psychiatrist in Alberta, a problem paired with the fact that only a handful in the province would be comfortable considering psychedelics as a treatment option.

“When we’re talking about hundreds, if not thousands, of patients needing to now line up to see one of those 10 or 12 psychiatrists that are willing to prescribe or consider psychedelic-assisted psychotherapy, you can see how this will inevitably create bottlenecks,” Lucas said.

Leah Mayo, the Parker Psychedelic Research Chair at the University of Calgary, said the regulations are like “putting the cart before the horse” since the field is still evolving with research still being done on who can be treated, the frequency of treatment, and dosing.

“While it’s good to kind of advance the field and increase access to these compounds, I still think we’re so early on that I mean, we don’t even know what populations should be getting these medications,” she said.

Dr. Robert Tanguay, a psychiatrist specializing in addiction medicine and vice-president of the Newly Institute, a network of medically-assisted psychotherapy clinics, attended the province’s announcement of the new rules on Oct. 5. He said they protect individuals from unregulated individuals providing non-evidenced-based treatment.

“I think at the end of the day, it moves us forward and increasing the amount of access and putting structure behind what we’re supposed to be doing, and most importantly, protecting those individuals who are under the influence while in treatment,” Tanguay said.

In a statement at the time of the announcement, the College of Physicians and Surgeons of Alberta supported innovative approaches to health care and noted protecting the public while guiding regulated members remains a focus to ensure safe, high-quality innovation.

Despite criticisms, the Alberta government is credited for trying to get ahead of the curve.

“I think that they are trying to get ahead of the eight-ball and trying to design regulations for these therapies as they progress, which is great. That’s actually very, very forward-thinking,” Kadysh said.

RECOMMENDED FROM EDITORIAL

Alberta to offer high potency opioids in clinics


Edmonton professor aims to treat mental illness with psychadelics through new company



New Alberta opioid program could increase barriers and harm, health professionals say

“We definitely need to watch the risks of diversion, it's very important to reduce diversion. But there's also a duty to ensure that our clients don't have any harm come their way and get destabilized.”

Author of the article: Anna Junker
Edmonton Journal
Publishing date: Oct 16, 2022 
Mike Ellis, associate minister of mental health and addictions, left, listens to Dr. Robert Tanguay, co-chair, Alberta Pain Strategy and co-lead, Rapid Access Addiction Medicine Program, Alberta Health Services. The two were speaking at a news conference to announce new rules for the use of high-potency opioids on Oct. 5, 2022.
 PHOTO BY GREG SOUTHAM /Postmedia, file

Health-care professionals say new provincial regulations for high-potency opioids may increase barriers and harm to patients seeking treatment.

On Oct. 5, the Alberta government announced the narcotics transition services program where opioids such as hydromorphone, diacetylmorphine (heroin) and fentanyl are offered at licensed opioid dependency program (ODP) clinics run by Alberta Health Services.


The changes mean community health professionals can no longer prescribe and pharmacists will no longer be able to dispense high-potency opioids for treatment. Patients must instead be referred to the ODP clinics by a health-care professional or self-refer.

While the goal is to transition the patient to opioid agonist therapy medication, like suboxone, and provide access to other wraparound supports, a patient cannot be discharged from the program if they are unable to make the transition

The province estimates fewer than 350 people in Alberta are currently prescribed high-potency opioids for severe addiction and will be affected by the changes.

Elaine Hyshka, associate professor at the University of Alberta’s School of Public Health, said that means 350 people who are getting treatment and likely doing well will now be abruptly forced to alter their lives.

“You have to change to a new clinic, where you’re going to have to go likely multiple times per day to get your dose and structure your whole life around that new routine,” she said. “And best of luck to you that you continue to be stable and in your recovery. That to me is really fundamentally unfair to those patients.”

Dr. Monty Ghosh, an internist and addiction specialist at the U of A, echoed concerns that clients will have to travel to a brick-and-mortar facility, as opposed to a pharmacy or have a take-home option.

“That would pose a barrier for numerous individuals if they have cognitive concerns, behavioural concerns, developmental delay,” he said. “Having to come three times a day might be problematic for individuals.”

The new program is only for the most severe cases of opioid addiction and is an extremely specialized service, said Eric Engler, spokesman for the mental health and addictions ministry, in a statement.

“The medications that may be provided as part of this program can be extremely dangerous, especially if they are diverted into the community,” Engler said. “This service will only be provided to those with the most severe cases of opioid addiction, in a supervised setting, with no opportunity for diversion of dangerous opioids to the community. The risk of these drugs being diverted is simply too high to offer this service in any other way.

But Hyshka said it’s “very problematic” that the province is “cracking down” on prescribing high-potency opioids when there isn’t a lot of evidence it is causing problems.

Out of the 884 drug poisoning deaths recorded between January and July this year, 20 were from pharmaceutical opioids.

Diversion is still a real concern, Ghosh said. But the crux of the issue is the risks of diversion need to be weighed with the risk of harms associated with destabilization that the new rules may cause.

“We definitely need to watch the risks of diversion, it’s very important to reduce diversion. But there’s also a duty to ensure that our clients don’t have any harm come their way and get destabilized.”

Individuals who treat chronic pain with pharmaceutical opioids are an example of providing take-home high-potency drugs without concerns of diversion, Ghosh said. (Chronic pain patients are not affected by the new regulations.)

“There are some substance users who are more or less the same as well,” he said. “So where does this land for them? And does this create a system of more stigma for these individuals?”

Dr. Ginetta Salvalaggio, an associate professor with the U of A’s department of family medicine, said continuity and relationships help people stay on their medications long term.

“What we’re doing here is a very top-down approach, sending people to people they don’t know,” she said. “This is not the sort of program that would be designed by people who use drugs.”

Engler said clients are encouraged to maintain relations with their existing care team, and the new standards require AHS to take steps to maintain those connections, too.

There are some positives to the program. Hyshka said clinics providing diacetylmorphine is an addition that has not been offered before in Alberta.

For Ghosh, one of the positives is increased access to high-potency opioids, not just in Edmonton and Calgary, but across the provincial health zones.

“In addition to this, there’s a strong emphasis on providing wraparound services for clients,” he said. “So making sure they get access to other wellness supports to support their housing, their income support, their mental health issues. These are all being provided as part of the service, which is fantastic news.”

The framework also includes a process to protect individuals who can’t transition off the high-potency opioids to more stabilized versions like suboxone.

“That’s really helpful and it really moves us in the right direction and it provides an outlet in some respects for safe supply,” Ghosh said.

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Sunday, April 16, 2023

In ‘God on Psychedelics,’ Don Lattin offers a roadmap of congregational tripping

The veteran religion reporter investigates how various religious groups are using psychedelics to inspire chemically induced mystical experiences.

Author Don Lattin and his new book

(RNS) — Decades after being forced underground by the war on drugs, psychedelics are going mainstream. Researchers are rediscovering the possibilities of using psilocybin, ketamine, MDMA and LSD as tools in treating depression, addiction and psychological distress.

Oh, and they may spark a spiritual awakening, too.

In his new book, “God on Psychedelics,” Don Lattin, a veteran religion journalist, investigates how some religious groups are encouraging chemically induced revelatory experiences of human interconnectedness and unity.

Lattin, who for years covered religion for the San Francisco Chronicle and has written six other books, mostly about psychedelics, said things are changing fast. Though mostly illegal for recreational use, universities around the world are studying psychedelics in clinical studies, and some states are taking notice: Oregon last year approved the adult use of psilocybin, the hallucinogen in “magic mushrooms,” though it is still hammering out the rules for its production and sale.

Five years ago, people — and particularly clergy — didn’t want to be quoted about their experiences with psychedelics. Now they’re far more open. Lattin said tripping is being explored in congregational settings and in chaplaincy.

RNS caught up with Lattin, who lives in the Bay Area, to talk about his new book. The interview was edited for length and clarity.

Your book introduces readers to the term entheogen — drugs taken for religious or spiritual purposes. Are psychedelics really God-enabling drugs?

They can be. “Psychedelic” means “mind-manifesting,” while entheogen refers to “the divine within.” I write about rabbis, priests and other clergy who do see entheogens as a way to renew the faith. Then there are the “nones” — people of no particular faith — who are consciously using psychedelics as a spiritual practice. Some are affiliated with new religious movements, including two originating in Brazil that use ayahuasca, a tea brewed from two plants native to the Amazon. A lot of ayahuasca or magic mushrooms churches based in the U.S. are underground, but some are going public as the legal situation shifts. They see sacred plant medicines as sacraments.

Another congregation I profile is called Sacred Garden Church. It seeks divine communion with different kinds of psychedelic drugs and sees itself as a “postmodern church” that follows the “path of least dogma.”

You point out that psychedelics don’t always induce feelings of unity with all humankind. They can also be terrifying, right?

Aldous Huxley, the famous British writer who wrote “Brave New World” and “The Doors of Perception,” called them heaven and hell drugs. They can give you a taste of heaven and they can send you right to hell, too. It really depends on the intention and context.

Even people who use these substances cautiously and carefully to open up to greater spiritual awareness or psychological insight may have very difficult experiences. You can have a bad trip. You can feel like you’re dying. You can feel like you’ve lost your body. You can feel you’re going crazy. These drugs can fuel feelings of unity, awe, compassion and gratitude. They can also induce paranoia, grandiosity and existential dread. But with an experienced guide, it can be fruitful. It’s like in therapy — trauma from your past can come up. Having someone help you through those feelings in a safe, contained environment can be really helpful.

Author Don Lattin. Photo courtesy Lattin

Author Don Lattin. Photo courtesy Deanne Fitzmaurice.

It’s been eight years since scientists at New York University and Johns Hopkins University recruited clergy for a study to see if psilocybin deepened their spiritual lives. Will it ever be published?

It’s taking longer than most people thought, but researchers expect to publish a paper sometime this year. I tracked down four or five people in the study who were comfortable talking about their trips. Some people, like an Episcopal priest I write about, saw his psychedelic experience as “a second ordination” — for the first time, he felt the power of the Holy Spirit as bodily energy. Before, his faith was all in his head, too intellectual. Psilocybin inspired him to start an organization called Ligare, which is already having church retreats where other clergy can have these experiences. Currently, they can only do that in the Netherlands or a handful of other countries with less repressive drug laws.

But now Oregon and Colorado have legalized magic mushrooms and are regulating supervised psychedelic sessions. Under federal law, hallucinogens are only clearly legal in clinical trials or among churches that get a formal exemption, such as the Native American Church, or certain ayahuasca fellowships. But more than 20 cities in the U.S. have directed their police departments to stop arresting people for using certain types of drugs and plant medicines, so the legal situation is rapidly changing.

Is ‘mystical’ really the right word to describe the experience of psychedelic drugs?

Researchers have surveys they give people to measure if they had a mystical experience: Did you feel a sense of unity with the cosmos or with nature or other people? Did you feel awe and wonder? Mystical experiences are not always positive, but they’re profound, soul-shaking experiences that can crack people open. Then there’s the question as to whether psychedelics produce just altered states of consciousness, or whether they encourage altered traits of human behavior. Do they make us more aware and compassionate? I think that’s an important question, but not everyone does.

Mysticism itself can be dangerous to religious orthodoxy, no matter how it’s induced. The mystic often challenges the religious authorities of the time. That explains the hesitancy that many Christian leaders have toward mysticism, especially when it’s drug-induced. Some may also feel that it’s too much of a “short cut” to God.

What are the chances of finding a church that does psychedelics?

I bet you could, or at least a spiritual retreat center where you could experience this. Informed insiders estimate there are hundreds of these psychedelic churches. Some are very small — maybe a dozen people. Others may have 100 members. Then there are people who go down to Peru or Mexico or Brazil and work with shamans or indigenous medicine people and come back and start their own groups. Some are sincere. Others are charlatans.

There are several national networks of people lobbying now to reform drug laws. In Oakland, the city council passed a law a few years ago directing the police department to make these drugs their lowest priority. Sacred Garden Church came out of that local campaign. But this is not just happening in pockets of woke enlightenment like Berkeley, Boulder or Boston. There are big psychedelic churches in Utah, Arizona, Florida. It’s happening all over.

A lot of these new psychedelic churches keep certain Christian elements, right?

Yes. Take Santo Daime, one of the syncretic religious movements I profile in the book. It’s a mixture of folk Catholicism, spiritualism, African and Indigenous religion. You’ll see a Christian cross in their ceremonies, but also the Star of David. Many people in Santo Daime still consider themselves Christian or Catholic. What I found interesting was the large number of people in these groups in the U.S. who were raised Jewish. They probably wouldn’t call themselves “Christian,” but might say they are connecting to “Christ consciousness.”

You tried to join a couple of these psychedelic churches, but in the end, you went in a different direction. Describe the group you belong to.

"God on Psychedelics: Tripping Across the Rubble of Old-Time Religion," by Don Lattin. Courtesy Lattin

“God on Psychedelics: Tripping Across the Rubble of Old-Time Religion,” by Don Lattin. Courtesy Lattin

It’s just a meditation group that I started working with about a dozen years back. We meet at a retreat house in Oakland run by a Catholic religious order. But it’s not Catholic. It has nothing to do with psychedelics. We employ a mix of contemplative prayer and Buddhist meditation. Many of us — but not all — are also involved in 12-step recovery groups. On some days, we’ll hear a dharma talk from a teacher from the San Francisco Zen Center who is also a recovering alcoholic. On another day, we’ll employ a lectio divina reading, perhaps a passage from the gnostic Gospel of Thomas, or a Rumi poem.

This is something I was already involved with before I started experimenting with psychedelics again as part of my research for my previous book, “Changing Our Minds — Psychedelic Sacraments and the New Psychotherapy.” I joined these psychedelic fellowships as a reporter, as a participant/observer who was sincerely open to the possibility of becoming a member. In the end, I decided none of them were for me.

I don’t really see psychedelics as a lifestyle. A lot of people may have one or two experiences with psychedelics. They will call it one of the most significant experiences of their lives. But it’s not like they want to do this every weekend, or even every month. I’m in that camp. There’s a famous line by the spiritual commentator Alan Watts, “Once you get the message,” he said, “hang up the phone.”

LA REVUE GAUCHE - Left Comment: Search results for PSYCHEDELIC 

LA REVUE GAUCHE - Left Comment: Search results for LSD 

Monday, January 01, 2024

 

Bringing psychedelic medicine from the margins to the mainstream 

Getty Images

Research into the therapeutic benefits of psychedelic drugs is nothing new. In fact, research extends back 80 years with the discovery of lysergic acid diethylamide (LSD), when the Swiss chemist Albert Hofmann, looking to synthesize a migraine treatment, created the derivative of the ergot fungus. It wasn’t until several years later that he accidentally dosed himself and realized LSD’s psychedelic effect.  

This initial research kicked off a wave investigating the therapeutic potential of psychedelics, but with the emergence of the secretive and unethical research by the Army and CIA and the rise of the counterculture, the federal government stepped in. The Controlled Substance Act subsection of the Comprehensive Drug Abuse Prevention and Control Act of 1970 classified LSD, heroin, marijuana and a few other drugs as having “a high potential for abuse, no current medical use, and a lack of safety for use under medical supervision,” classifying them as Schedule I substances and effectively killing research because of the hoops scientists would need to jump through, with both the U.S. Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA).

It would be nearly three decades before psychedelic medicine research re-emerged in a meaningful way, when researchers at Johns Hopkins obtained regulatory approval to reinitiate research in healthy, psychedelic-naïve volunteers. A subsequent study examining psilocybin administered in a supportive setting is widely recognized for igniting the current period of psychedelic research. This seminal study, which demonstrated long-term benefits of psilocybin (e.g., positive mood, life satisfaction, prosocial behavior) in healthy participants, is just one of many studies that have since confirmed the low toxicity and minimal addiction potential of psychedelics.  

In the intervening years, legislative reform regarding psychedelics began to gain momentum. According to a study in JAMA Psychiatry, from January 2019 to September 2022, 25 states considered 74 bills to reform existing laws restricting access to psychedelic drugs or proposed further research into reform legislation. Ten of those bills were signed into law by seven states, with the vast majority (90 percent) specifically referring to psilocybin and 36 percent of the bills also including 3,4-methylenedioxy-methamphetamine (MDMA). 

The foundation laid by Johns Hopkins has, over the last 20 years, spurred a wave of interest — and progress — into the benefits of psychedelic medicines.  

In October 2022, mental health company Compass Pathways announced initiation of the first Phase 3 program of psilocybin therapy globally for treatment-resistant depression. Initiation of the program followed positive results from the company’s Phase 2b study, presented at the American Psychiatric Association annual meeting in May 2022. Likewise, earlier this year, the Multidisciplinary Association for Psychedelic Studies announced results of its Phase 3 clinical trial of MDMA-assisted therapy, which demonstrated statistically significant improvements in PTSD symptoms after three sessions.  

This past June, the FDA published a new draft guidance to highlight considerations to researchers investigating the use of psychedelic drugs for potential treatment of medical conditions. This represented the first draft guidance that presents considerations for designing clinical trials for psychedelic drugs. It recognizes the interest in exploring their therapeutic potential, but also the unique challenges throughout the drug development process, including clinical trial conduct, data collection, subject safety and new drug application requirements. 

Further, the draft guidance notes that, for psychedelics that are currently Schedule I controlled substances, activities associated with investigations under an Investigational New Drug Application must comply with applicable DEA regulatory requirements. Importantly, in providing a pathway for the research, this is a tacit signal that the FDA is also indicating to the biopharmaceutical industry that there is ultimately a pathway to approval. With the first approval possibly coming as soon as 2024, there will surely be increased interest in the space, even if it doesn’t translate into an immediate wave of approvals.  

Yet, challenges remain.  

These challenges are often logistical in nature. Given the psychedelic experience that accompanies treatment, which can last up to 12 hours in some cases, conducting clinical research is labor and resource intensive. FDA’s guidance requires two people to monitor clinical trial participants. One of these monitors needs to be at least a Ph.D.-level researcher and the secondary monitor still needs to have experience in the mental health space. This is something that will likely extend into treatment once these medicines are approved. Uptake could be a similar challenge, as it could require two people to guide patients through their psychedelic experience to make sure they remain safe, and if there are any adverse effects, that they can support them along their journey. 

This is also new ground for the FDA, and the agency will likely take a very cautious approach to safeguard patients and minimize the risk for unforeseen treatment-emergent safety concerns. Compounding the challenge of uptake is that manufacturers and investigators will need to go through the process of securing DEA clearance to be authorized to administer these drugs in the research setting. 

Despite decades of research, the FDA’s draft guidance is finally bringing psychedelics research into the light. As the space continues to progress, there could be a move toward fine tuning the experience for patients. That may mean minimizing the psychedelic effects of these drugs without compromising their therapeutic benefits or being more selective in the receptors researchers target to reduce their adverse potential. Along with this evolution, a meaningful step that could bring us closer to realizing the full potential of these important therapeutics would be for the Department of Health and Human Services (HHS) to initiate a review to consider recommending rescheduling of the individual drugs or the entire class. The precedent for such a move was recently set when HHS recommended in August 2023 to have cannabis moved to Schedule III from its current Schedule I. Doing so would greatly ease access for further research and eliminate the administrative burden on prospective researchers and the DEA that is currently required to review the paperwork from each researcher for each trial they plan to conduct.  

Robert Bauer is executive director of operational strategy at Precision for Medicine. 

The daughter of multi-millionaire oil tycoon Charles Koch thought she had to be liked to deserve to exist, until MDMA therapy


Rachel Nuwer
Dec 30, 2023, 
Psychedelic clinical trials focus on a myriad of hallucinogenic drugs. 
Elizabeth Koch is a proponent for MDMA in therapy.
Shayanne Gal/Insider


Elizabeth Koch, daughter to right-wing oil magnate Charles Koch, struggled to find joy in her life.

Using MDMA therapy, she broke through the feeling that she needed to be perfect to deserve to exist.

Author Rachel Nuwer tells the story of how Elizabeth overcame her pain in the new book "I Feel Love".


One organization has been largely responsible for bringing psychedelics into the mainstream, the Multidisciplinary Association for Psychedelic Studies, or MAPS.

In researching her new book, about the therapeutic applications of MDMA, author Rachel Nuwer dove into MAPS. She discovered the group was supported by some surprising benefactors.

This includes Elizabeth Koch, the daughter of Charles Koch of Koch Industries, which is one of the largest private American companies. Besides their massive fortune, Charles Koch and his brother David are known for funding conservative movements, like the Tea Party.

Nuwer explained in her book that though it may be counterintuitive, many public figures with conservative ties, like Elizabeth Koch, invest in socially liberal groups like MAPS.
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Read below for the story of how Elizabeth Koch came to support psychedelic therapy in an excerpt from Rachel Nuwer's new book "I Feel Love."

The following is an excerpt from Rachel Nuwer's new book, "I Feel Love: MDMA and the Quest for Connection in a Fractured World."
When it's sold on the street, MDMA is sometimes distributed in pills like these. 
Reuters/ DEA

The moment I walked through the door of the loftlike space, the slender forty-five-year-old greeted me with a hug, a blanket, and not one but two very LA-appropriate canned drinks ("energy booster" and "prebiotic popping soda") from the office's meticulously organized fridge. Elizabeth's bubbly enthusiasm and disarming warmth immediately put me at ease, and within minutes I felt as though I were chatting with an old friend.

Elizabeth's uncanny ability to endear herself to others is a skill she has been cultivating nearly her entire life, and it's actually a symptom of her trauma. In hearing her story, I would learn that MAPS's fundraising success doesn't just boil down to Doblin's prowess as a salesman, or to wealthy people simply loving MDMA, but to the fact that trauma and suffering are universal.

Not even the most privileged individuals in the world are immune to mental anguish, and they can face the same limitations as the rest of us in finding relief for that pain. Elizabeth's "fall from Eden," as she described her index trauma, occurred when she was five years old.

After a close friend of her parents severed his spine by diving into a shallow pond, the family went over to pay their respects to the now wheelchair-bound man. The atmosphere in the house was oppressively somber, so to lighten the mood for her little brother, Elizabeth began singing the Humpty Dumpty song.

In one refrain, though, she absentmindedly replaced "Humpty Dumpty" with the name of the paralyzed man. Suddenly, all the tension in the room was directed at her. "I see my dad looking over his shoulder and giving me this death stare," she recalled.
Charles Koch, Elizabeth Koch's father, who owns Koch industries. At the time of writing, his estimated net worth is $62.5 billion USD.
Wichita Eagle / Contributor / Getty Images

When the family got home, Elizabeth's father sat her down. "You kids don't get it," she recalled him saying. "You have everything that everyone wants, and you'll be hated for it your entire life. Your job, always, is to be the nicest person in the room, and the hardest worker in the room — the one who picks up garbage that everyone leaves behind. You have to be aboveboard because if you aren't, you'll not only be hated by everyone else but also by yourself."

Looking back on this incident with an adult's perspective, Elizabeth now understands that her father was trying to protect her. "He was absolutely terrified that my brother and I would grow up to be spoiled, piece-of-shit monsters," she said. As a five-year-old, however, she interpreted his lecture to mean that she could only be loved if she were good.

That pivotal message came to hold sway over nearly every facet of her personality and life.

In "The Myth of Normal," Gabor Maté wrote, "A child who does not experience himself as consistently and unconditionally lovable may well grow to be preternaturally likable or charming" — which was exactly the path Elizabeth followed.

It started with a nightly ritual: before bed, she would review everything she had said and done that day to make sure she had been the nicest person and the hardest worker, and that she hadn't accidentally hurt anyone's feelings. If something bad happened to her — say, she tripped and skinned her knee — she would tell herself that it was because the universe was punishing her for not being good enough.

In classrooms, during extracurricular activities, or on sports teams, she would always beeline for whichever kid she thought would hate her the most — usually the one who appeared to have the least money, or the one who looked the least like her — and try to win them over by telling them funny stories about her family's dysfunction.

Over the years Elizabeth rose to the top of her class, won competitions for her writing, and made many friends, but she lacked joy. "I have to do this to prove that I deserve to be alive," she would tell herself each time she accomplished something.

"I have to earn my existence."

Her paranoia about what others thought of her intensified, as did her unhappiness. She realized she needed help and began trying various mental health solutions, including yoga, silent meditation retreats, and, briefly, medications.
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She read books about Buddhism and neuroscience and gained glimpses of insight. But no amount of knowledge, learning, or practice brought genuine relief.

MDMA, also known as ecstasy, initially became popular as a club drug. 
luckakcul / Shutterstock

When a friend suggested in 2016 that she try psychedelic-assisted therapy with a "consciousness cowboy" he knew — an ex-military man who called himself Doug the Lovebunny — she agreed. Doug filled a silver balloon full with "some kind of vapor smoke," Elizabeth recalled, and instructed her to breathe in and hold it.

She had no idea what she was in for: he had given her 5-MeO-DMT, a short-acting but incredibly potent tryptamine. The ego-abolishing drug dissolved Elizabeth in totality. It was terrifying.

Doug the Lovebunny hadn't prepared Elizabeth for this harrowing and destabilizing experience, and he did not provide any support or integration for her afterward. For weeks, she would wake up in the middle of the night, she said, "scrambling to try to grab hold of my body."

She wanted to know more about what she was going through, and research led her to MAPS. She attended a psychedelics conference in Los Angeles, where she was moved and inspired by the firsthand accounts shared by war veterans who had taken part in the MDMA-assisted clinical trials for PTSD.

"I Feel Love" by Rachel Nuwer was published in June and describes the fascinating transformation of how we've come to use the psychedelic drug MDMA. 
Bloomsbury Publishing

MDMA sounded a lot more user friendly than 5-MeO-DMT — and perhaps, Elizabeth thought, it could help her, too. So in spring 2018, she found "someone off grid" who agreed to give her MDMA-assisted therapy following the MAPS protocol.

Elizabeth wound up doing three sessions, and through that process, she saw the vast amount of pain she had been harboring throughout her life.

"I had been terrified of joy," she said. "The medicine showed me the degree to which all this buried stuff that I hadn't even been able to see was causing me to be reactive and feel constantly trapped, overwhelmed, and miserable."

The MDMA sessions (one of which she also paired with psilocybin) helped Elizabeth let go of the "intense self-hatred" she had been burdened with since she was five years old, she said, and to feel sympathy and love for herself. She's since become one of MAPS's top five donors.

"MDMA is not going to save the world," Elizabeth said. "But together with conversations and experiences of going inward and self-investigating, I think it can help."

Following that thread, in 2018, Elizabeth founded a company, Unlikely Collaborators, that aims to bring people together who seem like they're on opposite sides of an issue, and then work with them to reveal their shared humanity and commonalities.

If and when MDMA-assisted therapy gains FDA approval, Elizabeth also envisions Unlikely Collaborators providing community-oriented group integration services.

"We each have our own relative hell realms that we have to learn to crawl out of," she said. "The only way to bridge divides out there are to bridge the divides within."

From "I Feel Love: MDMA and the Quest for Connection in a Fractured World" out now from Bloomsbury Publishing. Copyright © 2023 by Rachel Nuwer. All rights reserved.


Peyote is the darling of the psychedelics renaissance. Indigenous users say it co-opts ‘a sacred way of life’



Flowering peyote plant (Photo: Hans B | CC BY-SA 3.0)

On the first day of autumn, evening temperatures near Window Rock, Arizona, were brisk. Beneath the late September sky, a traditional round hogan in this remote corner of the Navajo Nation was enveloped in darkness. Ten tribal members gathered inside.

This article was originally published in The Guardian and is used with permission. 

After a dinner of mutton and fry bread, the group settled in a circle around a wood stove radiating with burning juniper, preparing to ingest what the Diné (Navajo) call azeé – the medicine.

Most people know aze̩ as peyote: a small, button-like cactus famed for its powerful psychoactive and healing properties. The cactus is extremely rare in the United States Рit grows wild in only one part of Texas Рand has been integral to traditional Indigenous American practices for thousands of years.

The goal of this ceremony was to guide Diné college students on their spiritual path. One young man struggling with alcohol abuse was especially in need of the medicine.

“When this is over, you will feel like a washrag with all the gunk wrung out of it,” the man’s grandmother told him.

Tonight, the ritual would be no different from what it was a century ago. There would be peyote songs and drumming. Margie Whitney-Silva, a certified spiritual leader known as a roadman, would supply the peyote in the form of a tea brewed from the cactus, carried in a large pickle jar. Eagle-feather fans and gourd rattles would be used as the jar was passed around.

During the 19th and first half of the 20th centuries, Indigenous Americans risked being thrown in jail for participating in such ceremonies because peyote was illegal under US law. Today, it is just the opposite. Peyote and mescaline – the hallucinogenic substance found inside the cactus – have become a darling of the psychedelic renaissance.

Peyote, mescaline and other hallucinogenics such as LSD, MDMA, ayahuasca and magic mushrooms are being touted for their capacity to revolutionise the treatment of PTSD, addiction and other health problems. In recent years, progressive politicians, doctors, community groups and Silicon Valley investors alike have thrown their weight behind decriminalization bills in dozens of US states and cities.

Their goal to spread the benefits of psychedelics may be well-intentioned, but for Indigenous Americans, the boom has a dark side that rarely comes up in venture capital pitches. Many Diné tribal members are describing this moment as a “peyote crisis” that threatens to appropriate and commodify their sacred way of life.

Their concerns are multifold. Decriminalizing peyote could fuel poaching and a black market for the slow-growing cactus, whose limited habitat is already threatened by climate change and development. A sudden surge in demand might completely wipe out peyote from its natural environment, traditional practitioners say.

Then there are the deeper concerns about turning peyote and mescaline into an on-demand drug. Members of the Native American church of North America, an inter-tribal religion that revolves around the ancient practice of peyotism, are alarmed by pharmaceutical ventures seeking to create mescaline in a lab, in much the same way opium from the poppy flower was synthesized to create fentanyl.

Non-Indigenous leaders in the psychedelic space insist they are respecting Native American spirituality by using synthetic mescaline instead of the real thing. Dozens of Indigenous Americans interviewed for this story see it otherwise.

“How would Christians feel if Jesus Christ was cloned?” asked Justin Jones, a Diné peyote practitioner and legal counsel for the Native American church of North America, a non-profit organization that advocates for more than 300,000 members. “And while the real Jesus is protected, people could do whatever they wanted to the clone.”

At its core, the push to medicalize and mass-produce peyote and mescaline goes against the Indigenous American worldview of interconnectedness. There are no English words that describe how the spiritual character of peyote is inextricably intertwined with its hallucinogenic properties, the land where it grows and the Indigenous Americans who consume it, says Jones. In the Navajo language, Jones describes this harmonic oneness as azee’ hinááh biníłch’idiyin, be’adínídíín.

Creating synthetic mescaline in a lab or growing peyote in a greenhouse is a violation of natural law, and interrupts the unique symbiotic relationship with the plant. “What western scientists call mescaline is for us the essence of the medicine,” said Jones. “It is the soul of it and what makes it holy.”

Traditional peyote practitioners emphasise that they are not against the use of all psychedelics to innovate new treatments for addiction and PTSD. After all, their experiences prove just how powerful a healing tool these substances can be.

But they question why peyote and mescaline need to be used when a variety of other tools – especially psilocybin and MDMA – have proven effective. In rushing to medicalize peyote, which has a unique history and a sacred role for tribes, the decriminalisation movement risks perpetuating more harm in the name of doing good, they say.

“I’m all for healing,” said Cora Maxx-Phillips, a social worker, member of the Navajo Nation human rights commission and board member of the Council of Peyote Way of Life Coalition, a grassroots group in the Navajo Nation.

“But don’t do it at the expense of our people, who are trying to survive the multigenerational trauma inflicted upon us. Please, leave us alone.”

A fight for tradition

The ceremony near Window Rock was a private, emotionally grueling ritual that lasted all night.

Before the ceremony, Boyd Tsosie, another roadman who led the ritual, said the experiences of ancestors from three or four generations prior might surface. There would be little discussion; the goal was for each person to embark on their own inner journey in a kind of spiritual vision quest where the plant itself was the guide.

Tsosie emphasized that the practice of peyotism is as much about the ceremony as it is about the psychological effects. “We don’t view peyote as a substance the way non-Natives think about drugs,” said Tsosie. “There is no hallucination, no trip. The medicine is not used to numb the body like with other drugs, but to teach us.”

The gathering was sponsored by a local Diné chapter of the Native American church. Diné peyote practitioners and church members across the west describe peyote as one might a beloved family member. For them, peyote is a sentient being, a wise elder, a savior. They say the medicine is a gift from the creator that has made it possible to survive the traumas of colonization.

Fear and anger about what outside forces might do were palpable inside the hogan. Synthesizing, commodifying and enriching oneself at peyote’s expense is no way to treat a relative.

“We just have a sliver left of what we hold dear,” said Tsosie. “And we are praying and fighting to hang on to it.”

The way modern tribal members tell it, their ancestors were drowning in sorrow as a result of federal policies to seize their homeland and sacred sites, force their children into boarding schools and forbid the practice of traditional ceremonies. Peyote was sent by the creator as a kind of life raft that traveled from tribe to tribe, and those who jumped on, survived.

Radiocarbon studies of peyote buttons have dated the ritual use of Lophophora williamsii by Indigenous peoples back more than 5,000 years, but peyotism did not reach the Diné and other Plains tribes until the mid- to late 1800s.

Then in 1883, Congress passed the Religious Crimes Code, outlawing Indigenous American spirituality on the grounds that it hindered the federal policy of forced assimilation. In addition to peyote ceremonies, the sun dance and ghost dance were only practiced in secret, with violators subjected to jail time and the withholding of food rations.

Frank Dayish, 65, grew up on the north-western corner of the Navajo reservation and is descended from generations of peyote practitioners. He remembers how, when he was a young boy, tribal law enforcement would show up at his home and seize his community’s supply of peyote.

“The Navajo Nation police put all the peyote in a pile and poured gasoline on it and burned it,” said Dayish. “After they left, my father and his brothers would try to salvage what was too green to burn.”

The religious crimes law would not be repealed until 1978, when Congress passed the American Indian Religious Freedom Act (Airfa). But Airfa did not specifically address the use of peyote, which the federal government still classified as a highly addictive, schedule 1 drug. To distinguish themselves from the experimental hippies in the 1970s, Indigenous American peyote practitioners banded together to form a religion called the Native American church, demanding the same protections for their religious beliefs as anyone else in the US.

After decades of lobbying by Native American church groups, a 1994 amendment to Airfa finally gave protections to Indigenous American peyote users by stipulating that peyote can only be consumed by a “federally recognized tribal member” and “in connection with a traditional Indian religion”. The amendment also authorized tribal members to legally transport peyote across state lines.

“That was a huge victory for us,” said Dayish, who was president of the Native American church of North America at the time and heavily involved in lobbying for the amendment.

However, the hard-won exemption soon had unintended effects. Non-Indigenous New Age groups, such as James Mooney’s Oklevueha church and the Peyote Way Church of God, began offering access to the sacred cactus by claiming to follow the Native American church religion or their own brand of peyote religion.

In a precedent-setting 2004 case, the Utah supreme court ruled that Mooney was allowed to distribute peyote to his church members under the Religious Freedom Restoration Act. The result was to embolden psychedelic activists, who established plant-medicine churches on the grounds of religious freedom and to invigorate the decriminalization movement.

Today, one of the largest groups behind this movement is called Decriminalize Nature. The organization has 50 chapters across the United States, each comprising grassroots plant-medicine activists who advocate for legislation at state and local levels. Their logo features a peyote button, with a website that urges humanity to “draw upon the ancient wisdom of all our ancestors who lived from the Indigenous Worldview upon this Earth”.

Aikutzi Valadez, a member of Decriminalize Nature’s board, believes anyone should be allowed to grow peyote in private greenhouses for their personal use in order to increase supply and protect the cactus from being depleted in its native habitat. Valadez resides in California but is a member of the Huichol tribe in Mexico, which practices peyotism. She said that because she is not enrolled in a federally recognized tribe in the US, current drug laws prevent her from being able to engage in traditional peyote rituals where she lives.

“Native American church members need to look at the big picture,” she said. “If they are concerned about peyote becoming commodified, the solution is to make it widely available so it’s not just the pharmaceutical companies that have access. We are trying to liberate peyote because it is Mother Nature’s plant and should not be criminalized.”

This anti-corporate, nature-based ideology is appealing to many liberal-minded activists. But the philosophy of Decriminalize Nature, and groups like it, illuminates a tension at the heart of the peyote debate. Native American church leaders say groups describing themselves as culturally progressive are not only ignoring the requests of tribal governments but have done little to consult them on how peyote should be used by non-Indigenous people – if at all.

Valadez confirmed that Native American church leaders were not involved in developing Decriminalize Nature’s policy on peyote.

While the group’s policy is positioned as a “working plan” to help Native American church members and other Indigenous peyote practitioners protect their sacred medicine, Kevin Feeney, a cultural anthropologist at Central Washington University, sees echoes of the US’s colonial past in such efforts.

“There is the sentiment within the movement that decriminalizing these plants will result in this rosy, kumbaya situation where we all get to take peyote,” said Feeney, who has written extensively on peyote issues. “They are saying, let bygones be bygones … But, really, they are only asking Native people to be OK with this history.”

An $11bn industry

The psychedelics drug market is expected to be worth more than $11bn by the end of the decade. And while the use of psilocybin and MDMA in a clinical setting are farthest along, mescaline is the dark horse that some of Silicon Valley’s biggest investors are betting on.

One company riding the wave is Journey Colab, a pharmaceutical startup that’s developing psychedelic drugs and therapies. Since its founding in 2020, the company has raised more than $12m from high-level investors including Sam Altman, the founder of ChatGPT and an avid psychedelic proponent.

Journey Colab’s founder, Jeeshan Chowdhury, says people describe him as a “Silicon Valley tech bro”. He’s also a physician and the son of Indian immigrants.

He says he was intrigued by mescaline when he started the company. “The elders and respected leaders in the psychedelic space all told me mescaline was their favorite,” he said.

Peyote has long had a certain cachet in the psychedelics world. The English writer and philosopher Aldous Huxley first coined the term “psychedelic” in his 1954 essay The Doors of Perception to describe a mescaline trip. The perpetually intoxicated gonzo journalist Hunter S Thompson further popularised the drug in works like Fear and Loathing in Las Vegas.

While mescaline was studied for its therapeutic benefits in the 1950s and 1960s, it became overshadowed by LSD, which was cheaper and more accessible. Today, multiple companies, including several in Canada – where there are fewer restrictions on mescaline – are developing mescaline-based products and growing peyote in greenhouses.

The Canadian company Lophos Pharma, for instance, describes itself as “North America’s largest cultivation and research facility for peyote cactus” and is working on genetically modifying peyote to “decrease the peyote growth timeline from 13 years to as low as 3 years”.

Chowdhury says he set out to do things differently, and was influenced by Altman’s OpenAI model, which strives to share technological benefits with society at large. Alongside its drug development, Journey Colab set aside 10% of its founding equity for Indigenous groups, such as the peyote practitioners in the Native American church, as part of what it calls the Reciprocity Trust. Journey Colab has also signed a “patent pledge” that promises to use only synthetic mescaline in its products, and to not directly utilize any Indigenous resources.

Chowdhury says the fund is about respecting Indigenous American use of peyote and sharing financial benefits with Indigenous populations. “I believe if you have used any psychedelic personally or they are in any part of your professional career, we all owe our relationship to these medicines to the Indigenous communities who have stewarded this knowledge for generations,” Chowdhury said.