4 visionaries on the history and future of psychedelic medicine

PSYCHEDELICS are having a moment. This past spring, Netflix’s How to Change Your Mind documentary series introduced the binge-watching masses to the concept of using trippy substances to reboot troubled brains. Numerous startups offer at-home ketamine therapy in glossy ads on Instagram. And in 2020, Oregon became the first state to vote to legalize psilocybin for therapeutic use.

The world of scientific research is buzzing too. Clinical trials on the use of MDMA to treat post-traumatic stress disorder have shown promising results and could lead to FDA approval in the next year or so. A recent study in the Journal of Affective Disorders suggested that administering ketamine before a cesarean section might mitigate postpartum depression in some patients. And in August 2022, a small study on substance use disorder in JAMA Psychiatry showed that when combined with therapy, two psilocybin sessions were associated with a sharp decrease in days of heavy drinking among participants.

While science is still homing in on why this works, we’re starting to form a preliminary understanding: Trippy compounds seem to affect how the brain regions responsible for mood, cognition, and perception respond to the neurotransmitter serotonin. Early research suggests this can lead to a boost in neuroplasticity—gray matter’s ability to learn things and adapt to change.

Though our clinical understanding of psychedelics is in its infancy, the drugs themselves are not. Even their therapeutic use is ancient. Mushrooms have been involved in the spiritual ceremonies of the Mazatec people in what’s now Oaxaca, Mexico, for thousands of years. Ibogaine, now touted as a therapy for substance use disorder, is derived from a plant that hunters in West Africa have long chewed for stimulation and focus while stalking game. Peyote has served as both a spiritual tool and a medicine in North America since at least 1000 B.C.E. And MDMA is derived from safrole, a compound in the oil of sassafras plants, whose recorded use by Native Americans dates to at least the 16th century.

Many Indigenous groups maintain an unbroken lineage of plant medicine use, while others now seek to reconnect with practices made difficult or impossible in the wake of colonization and other pressures. Federal drug policies in place since the 1970s, which many public health experts now agree to be misguided, have led to disproportionate punishment of BIPOC people and slowed or stopped research into the therapeutic benefits of compounds like LSD, mescaline, and psilocybin. Though decriminalization laws like Oregon’s are unwinding the war on drugs, some advocates also see trouble in the latest wave of enthusiasm.

They warn that psychedelic medicine’s renaissance, fueled by media hype and venture capital, could make the substances less accessible to the people who stand to benefit from them the most. That group includes Indigenous and other marginalized populations, who have disproportionately high rates of trauma and resulting illness but who lack equal access to basic treatment—let alone expensive clinics or drug tourism retreats.

The future of fair drug use in the US is a puzzle that will take many perspectives to solve. But these four visionaries—therapists, activists, educators, researchers, and entrepreneurs—are listening, learning, and changing minds.

Protecting resources during a boom

As a Newe—a member of the Shoshone-Bannock Tribes of Fort Hall, Idaho—Dawn D. Davis has many identities that share a common goal. As a researcher, educator, mother, farmer, fainting goat herder, and peyote user, she embodies a lifelong commitment to reciprocity with the substances that give us life. In her current postdoctoral work at the Idaho National Laboratory’s Energy Systems department, that means studying resource management, particularly as it pertains to water access and energy resilience in marginalized and rural communities. It has also meant laying the research groundwork for Lophophora williamsii, the squat cactus commonly known as peyote, to be treated with care both inside and outside Indigenous cultures.

The plant has recently caught the attention of psychedelics enthusiasts for containing the hallucinogenic compound mescaline, which studies suggest might help facilitate therapy for issues like addiction and trauma. But Davis’ ancestors and many other Indigenous North Americans have used it for spiritual ceremonies and general health applications, from soothing toothaches to treating wounds, for thousands of years. “It’s always been a part of my life,” she says.

As Davis grew up, however, she saw less and less available—and the cacti that were around appeared to be shrinking. L. williamsii also grows slowly, sometimes taking more than a decade to mature, and most of what is out there sits on private land. She and her family, like most traditional peyote users, access it through the ceremonies of a diffuse religious group called the Native American Church. After receiving degrees in museum studies and Native American studies, Davis began pursuing a doctorate in natural and water resources from the University of Idaho in 2013 to understand the scope of the problem. She’s since spent nearly a decade collecting data on where the plant grows to home in on its preferred vegetation and soil.

She hopes that her findings on peyote’s current distribution, which she earned a Ph.D. for in 2021, will help landowners and Indigenous users better understand the conditions in which the plant can thrive. While she’s still working to confirm and publish her data, it does indicate that the potential habitat for the slow-growing cactus in Texas and Mexico is “quite extensive,” suggesting that in situ conservation is entirely possible. But she cautions that bringing traditional knowledge into such efforts is key. In conducting her field research, she interacted with landowners and the earth in ways she didn’t learn in grad school: by sharing her intentions, introducing herself to the environment, and getting the permission of everyone and everything involved. To keep the plant’s population from dwindling further, she says, Western science will have to make room for people who engage with the earth in this way.

Conservation efforts may soon grow more pressing, as some psychedelics enthusiasts are pushing to have peyote widely decriminalized. Groups that include the Native American Church of North America, where Davis serves on the Legislative Committee, and the National Congress of American Indians, where she co-chairs the Peyote Task Force, argue that this will make the scant wild population even more vulnerable to outside parties, and have asked that peyote not be mentioned in any decriminalization efforts.

Some members of these and other advocacy groups have pointed out that there are other, faster-growing cacti, such as the San Pedro plant, that also produce mescaline and could be cultivated instead. While it is less potent, the tall cactus can grow all over the world. In the US, it’s a common sight on arid front lawns, where it’s legal to have but not legal to use for its mescaline. Davis, for her part, would prefer mescaline get left out of decriminalization bills entirely; she worries that such a loophole could mask peyote harvesting.

Davis emphasizes she’s one person from one tribe, so bringing many Indigenous voices into the conversation about psychedelic use is crucial. That’s as true for protecting a plant in peril as it is for respecting the reasons why tribes used specific flora and how they combine them. “I may be the only Native American peyote researcher,” she says. “I don’t know of any others. But that’s a hard space to be in, because I don’t consider myself a psychedelic researcher. I consider myself a medicine researcher. I see things from a very different perspective.”

Finding the sacred side of therapy

Danielle Herrera’s ketamine patients at Sage Integrative Health don’t get a very clinical experience. The Bay Area psychotherapist takes people for walks while they’re high, gives them sensory objects like feathers and bowls of water, and even sings with them. “That’s something that happens a lot in ayahuasca circles,” she says of the ceremonies involving the psychoactive South American brew. “Humming together can be really powerful.”

While Herrera, who identifies as mixed-Indigenous and part Filipino, tells people that her therapy is informed by traditional rituals, she doesn’t mean she treats every trip like a ceremony in the Amazon basin. She has at least two beliefs that buck the medical establishment: First, that every recreational drug has the potential to be beneficial, given the right therapeutic guidance and exploration. And second, that the process should look different for every patient—and for every therapist.

Her first work out of graduate school focused on treating children, though she was reluctant to turn her own childhood trauma, which stemmed from her parents’ struggles with substance use disorder, into a career. That is, until she found herself drawn to the Harm Reduction Therapy Center in San Francisco. The mobile clinics Herrera worked at would welcome people high on anything and give them whatever help they needed. Someone might be hungry, or have a wound that needed dressing, and she would also offer mental health support.

During that time, Herrera started training in ketamine therapy at the Sage Institute clinic. “Noticing what was happening in the intersection between harm reduction and psychedelic therapy allowed my relationship with my family to deepen,” she says. Her mother, who is now sober but used methamphetamines for years, opened up about her initial experiences with meth, which were intensely positive and spiritual. “Even drug counselors would just shame her,” Herrera says. “She told me, ‘If there was just one person who I could have talked to about my spiritual awakening on meth, I might not have fallen into the chaotic use and depression that followed.’”

Herrera has now facilitated integration—the thoughtful unpacking of insights gained while high—for “every drug you can think of.” And each session, she says, can be profound and unique. She pushes back against mainstream stereotypes of the psychedelic experience, which she feels can make patients think they should expect to find peace, that the drugs will calm their inner demons. Many of the people she treats, especially those who have endured lifelong racial aggression, actually become more in tune with their inner rage.

Perhaps most crucially, Herrera is always entirely herself. “When I was learning to become a therapist, I was really resistant to the colonialism I knew was entrenched in these systems,” she says of the perspectives that have typically informed modern psychiatry. “I was a real pot stirrer.”

Putting a new spin on pharmaceutical development

Jeeshan Chowdhury often reminds folks that his startup’s technology isn’t actually new. Mescaline, the compound Journey Colab recently synthesized, is best known as the psychedelic component of peyote. “While it feels like this is a new trend, it’s validated by thousands of years of use by Indigenous communities,” Chowdhury says.

The recent psychedelic boom has inspired a race to find—and patent—new chemical compounds that pack the same punch as ancient plant medicines. That sprint, of course, comes with the typical Big Pharma fears, from making treatments more expensive to leapfrogging traditional users by stamping trademarks. Journey Colab, which is exploring mescaline as a tool to treat substance use disorder, set itself apart from its beginnings in 2020: 10 percent of its founding equity is held in a perpetual trust overseen by representatives of Indigenous communities. “It’s actual ownership,” Chowdhury emphasizes.

Until about five years ago, Chowdhury, who was raised in a devout Muslim home, had never had much interest in drugs. But he eventually realized they could save him. “I was living these two very parallel lives,” he says. In 2017, he’d already earned an M.D. from the University of Alberta and a Ph.D. in health informatics as a Rhodes Scholar at Oxford and had dropped out of a medical residency to found, build, and sell his first startup—a digital platform to help coordinate care in hospitals.

But he was in the midst of a mental health crisis. “I felt like I was drowning,” he says. Offerings like antidepressants and talk therapy helped, but felt like life preservers. By the time he sold that first company, he says, “I wanted to let go and drown.”

Out of desperation, he tried psychedelic therapy for the first time. “In that state of consciousness, it was like the muddy waters I’d been drowning in my whole life cleared up,” he says. He decided to get training in psychedelic integration—the process of folding insights gleaned from the thoughts and feelings of a trip into one’s conscious, everyday life—and grew fascinated by how much work still needed to be done to marry centuries of tradition with new scientific insight.

Journey Colab’s focus on mescaline could help refine our understanding of why the compound works so well. Previous studies in mice have indicated that the substance increases neuroplasticity for around five or six weeks; ketamine’s effects, by comparison, taper off after a couple of days, and those of MDMA and psilocybin in a fortnight. Journey Colab now wants to quantify how mescaline could help grease the wheels of alcohol use disorder therapy specifically.

Despite such promising signs, Chowdhury prefers to call Journey’s offerings “psychedelic procedures” as opposed to straightforward therapy sessions. Given their risks, he thinks they should be taken as seriously as surgery—and that they require tailored support and therapy to be effective. “It’s incredibly important for us to learn from the people who successfully integrated these very powerful tools into their individual lives and cultures and societies,” he says. “It’s done with ritual, and it’s done with respect.”

Making ketamine accessible and sustainable

Courtney Watson is supposed to be working on her dissertation. But a chance encounter in 2018 sent her on a detour. A licensed marriage and family therapist, Watson was moderating a panel at a conference for BIPOC techies when a stranger—who’d shown up thinking the meetup was about techno—asked her if she’d like to be introduced to the psychedelic therapy community.

She was intrigued. Watson had learned about the practice in grad school around 2011, when the drugs had yet to see their modern resurgence. In a class about addiction, a professor had pointed out that many illicit substances had once been used as medicine, and that they’d even been studied by modern scientists, but the war on drugs had shut those inquiries down.

On the advice of her new techno-loving acquaintance, Watson attended a conference on psychedelics. She was interested in the cultural perspectives of BIPOC and marginalized communities, but was surprised to hear a lot of chatter about LSD and psilocybin. “Those are white people drugs,” she remembers thinking. “We don’t do that stuff.” But then presenters talked about the power of such medicines to help treat PTSD. Watson knew that research increasingly showed members of marginalized communities had higher rates of the condition—one 2016 study, for example, indicated that more than one-quarter of Black women with depression in Oakland, California, had PTSD—but no one onstage was talking about that. She signed up for psychedelic-assisted therapy training not long after the conference ended. “I was like, ‘There’s an opportunity for healing here, and no one that’s here is going to be able to do that.’”

She opened Doorway Therapeutic Services, a ketamine clinic in Oakland designed by queer and BIPOC people, in 2020. There she relishes opportunities to challenge the status quo of one-on-one therapy. For instance, she and many other practitioners point out that traditional use of mind-altering drugs, like an ayahuasca ceremony she participated in in South America, tends to involve whole families and communities who spend generations learning to facilitate the rituals together. She also wants to see more opportunities for traditional herbalists to get the same recognition and legal validation as mainstream therapists. “It might be a mess in the beginning,” she says of shifting the paradigm around drug use and access, “but I believe we can do it.”

Watson is quick to point out that psychedelics need a lot more change—from including more BIPOC leaders to taming the high costs of therapy—than one person can kick-start. Under the leadership of sci-fi author Ayize Jama-Everett and activist Kufikiri Imara, she participated in an inaugural plant medicine conference called A Table of Our Own in the hopes of helping address these and other issues. The program gathered a couple dozen Black artists, academics, clinicians, cultivators, and spiritual leaders to re-imagine how psychedelic spaces can look with Black people at the helm.

For now, she’s doing what she can with Doorway. She works to make the organization as collaborative as possible and prioritizes employee well-being. That means sustaining the clinic by charging market rate for ketamine therapy in the Bay Area: more than $5,000 out of pocket for a full course of treatment.

Understanding that high cost limits accessibility, Watson, who’s still a Ph.D. candidate at Widener University, started a nonprofit. Access 2 Doorways helps fund clinics run by and for BIPOC people to facilitate access to psychedelic therapy. “We need this,” she says. “And we’re not going to get it if we don’t offer it.”

This story originally appeared in the High Issue of Popular Science. Read more PopSci+ stories.