Higher Ground: Thoughts on Ethics in the Psychedelic Field

As I design my research project for my PhD and observe the landscape of the psychedelic field, I’ve been thinking quite a lot about ethics this week.

In a recent seminar, our teacher Pascal Michael led my peers and I in the Alef Trust Professional Certificate in Psychedelics, Altered States, and Transpersonal psychology in a good discussion about the implications of dark nights of the soul, challenging experiences, and personality changes resulting from psychedelic experiences.

Navigating the psychedelic renaissance brings forth profound ethical considerations, especially as these substances transition from underground use to mainstream clinical settings. As facilitators, practitioners, and researchers, our role isn't just about guiding individuals through altered states but ensuring this journey is safe, respectful, and equitable.

Honoring Indigenous Knowledge

Psychedelic substances like psilocybin and ayahuasca have deep roots in Indigenous cultures, where they are used for healing and spiritual purposes. As noted by Smith and Applebaum (2022), modern psychedelic practices must respect these traditions and avoid cultural appropriation. This involves acknowledging the source of these medicines, ensuring Indigenous communities benefit from their commercialization, and integrating Indigenous perspectives into training programs.

Informed Consent and Managing Expectations

Informed consent is more than a formality; it is a continuous dialogue. As psychedelic experiences can be profoundly transformative, patients must understand potential outcomes, both positive and negative. McGuire et al. (2024) emphasize the importance of transparency about possible personality changes, the range of experiences, and the risk of not achieving the desired therapeutic outcome. This process helps manage expectations and fosters a sense of safety and trust.

If psychedelic experiences can induce profound personality changes does the person you become also consent to these changes? Recent research suggests that not everyone is thrilled with the ontological shifts that can occur and the challenges psychedelic experience can induce (Argyri, Evans, Luke et al 2024, forthcoming).

Professional Boundaries and Touch

The altered states induced by psychedelics necessitate strict professional boundaries. The consensus is clear: while therapeutic touch can be beneficial, it must always be consensual and never cross into inappropriate territory. But who decides what is "appropriate"? Licensed psychologists have clearly defined legal boundaries, but non-clinical guides and coaches may not.

Practitioners should be well-trained in the ethical use of touch, ensuring patients' comfort and safety at all times (McGuire et al., 2024). Questions arose about this in the recent FDA advisory committee hearing considering the approval of MDMA-AT for the treatment of PTSD; this will an interesting question to keep an eye on as psychedelic substances become used in clinical settings more frequently.

Equity and Access

Historically marginalized groups, including Black and Indigenous communities, have faced significant barriers in accessing mental health care. The integration of psychedelics into therapeutic practices must consider equity of access. This includes making treatments and education accessible and affordable to all who can benefit and ensuring diverse representation in clinical trials and practitioner training programs (McGuire et al., 2024).

Personal Experience and Practitioner Training

There's ongoing debate about whether facilitators should have personal experience with psychedelics. While personal experience can enhance empathy and understanding, it is not a prerequisite for effective facilitation. Some argue that training programs should focus on developing core competencies, including knowledge of the substances, therapeutic techniques, and ethical guidelines, rather than mandating personal use (McGuire et al., 2024). Personally, I would not feel comfortable with a practitioner who did not have personal experience of the psychedelic state; I would love to hear more from others on this. Jules Evans recently published an excellent overview of the ethical challenges related to the proliferation of psychedelic training schools, including issue related to the clarity of career outcomes.

Moving Forward

The journey with psychedelics is not just about the individual; it's about the collective. It's about creating an industry and an academic field that respects the past, addresses the present, and looks forward to a future where these powerful substances can heal and transform in the most ethical and inclusive way possible.

References

Argyri, Eirini K. and Evans, Jules and Luke, David and Michael, Pascal and Michelle, Katrina and Rohani-Shukla, Cyrus and Suseelan, Shayam and Prideaux, Ed and McAlpine, Rosalind and Murphy-Beiner, Ashleigh and Robinson, Oliver, Navigating Groundlessness: An interview study on dealing with ontological shock and existential distress following psychedelic experiences (May 4, 2024). Available at SSRN: https://ssrn.com/abstract=4817368 or http://dx.doi.org/10.2139/ssrn.4817368

Evans, Jules. (2023). Ethical dilemmas facing psychedelic schools. Ecstatic Integration. https://www.ecstaticintegration.org/p/ethical-dilemmas-facing-psychedelic?utm_

McGuire, A. L., Cohen, I. G., Sisti, D., et al. (2024). Developing an Ethics and Policy Framework for Psychedelic Clinical Care: A Consensus Statement. JAMA Network Open, 7(6), e2414650. [https://doi.org/10.1001/jamanetworkopen.2024.14650] (https://doi.org/10.1001/jamanetworkopen.2024.14650)

Smith, D. T., & Applebaum, J. (2022). Novel ethical and policy issues in psychiatric use of psychedelic substances.