Rollout

Where do psychedelics fit in our culture?

Big question. Let's assume that they have a role to play – helping us unwind our trauma, helping us heal, helping us see our situation more clearly. Giving us a vision to orient towards. Something like that. (Here's an essay backing this up; start at Section 3 to skip the throat-clearing.)

So how do we work towards that?

My model is that there are three kinds of work to be done:

1. Drug discovery – finding novel compounds that seem likely to be safe, interesting, and helpful. Sasha Shulgin is archetypal of one approach here; high-throughput screening is an alternate route.

2. Drug development – shepherding a promising compound through clinical trials and bureaucratic approvals. MAPS is currently doing this with MDMA; Usona and Compass with psilocybin.

3. Rollout – building infrastructure to scale the safe administration of a drug once it's approved.

My current take is that rollout is the thing to focus on.

We know that psilocybin & MDMA can be used in safe + interesting + helpful ways. And they're powerful enough that discovering alternative substances doesn't seem critical (though a less toxic MDMA would be no small thing, as would a psilocybin with fewer bad trips but all the benefit).

The clinical trials are already proving out safety & efficacy across hundreds of people, and it seems likely that these results will hold up during Phase 3.

But what happens after FDA approval? The thinking here isn't as developed. Dropping acid on the playa doesn't seem like quite the right model, and neither does ketamine IV drips in a fluorescent-lit clinic.

And the complicating factors pile on fast:

• So much of the hands-on knowledge of how to work with psychedelics is carried by underground practitioners, but most of the underground doesn't have therapeutic licensure. How to incorporate this knowledge and these practitioners into mainstream practice without unjustly penalizing them?

• The holistic nature of the psychedelic experience doesn't play nicely with the taxonomy of the DSM-5, but the medical system is the primary vehicle we're using to bring psychedelics into the mainstream.

• There are obvious frictions between the for-profit capitalistic model and the radically unifying, liberating, surrendering vision of a psychedelic society. It's too early to say whether public-benefit corporations are enough to bridge the distance here (I'd be surprised if PBCs were sufficient – any structure can be corrupted).

• Every indigenous society with a longstanding psychedelic tradition carefully controls their use. Maybe there's a selection effect here: the societies that didn't control use didn't last long enough for us to notice them.

• As with anything that's gaining cultural capital, there is an increasing incentive to act as if you care about the thing, even if you don't actually care about the thing.

... and there's more! It's a big tangled knot, and we don't know how to unwind it yet.