How should we sell psychedelics?

After Colorado became the first state to legalize the sale of recreational cannabis to any adult in 2014, it took just 10 years for about half of the country to follow suit. More than 100 million adults in the US went from having no legal access to the drug to being able to waltz into their local dispensary, buy some weed, and take it home to get as stoned as they please. Now, Beau Kilmer, co-director of the RAND Drug Policy Research Center, sees the same kind of early activity in state psychedelic policy, including budding legislation to legalize sales, that he saw in cannabis right before the wave of legalizing commercial sales took off. While the medicinal use of psychedelics gains more attention and as states allocate funds toward research, the prospect of retail psychedelics has quietly landed on our doorstep. “State policymakers, whether they like it or not, are going to start confronting these conversations,” said Kilmer. And yet, public conversation about how a retail psychedelic market might actually work has been all but nonexistent. So far, most debate over how to expand legal access to psychedelics has focused on segmented approaches like therapy, religious exemptions, or supervised retreat centers. But even in a world with all these models firmly in place, plus more general drug decriminalization across the board, there would still be plenty of people who would not be able to access psychedelics. Not everyone will or can get a prescription for their psychedelic of choice. Most people won’t be able to afford supervised programs, which run for a minimum of about $1,800 for a single, low-dose session in Oregon’s state program, or thousands more in luxury retreats abroad. Neither will everyone want to join a literal church in order to get religious exemption. And for anyone who doesn’t happen to have a friend who knows a guy who grows mushrooms and wants to share, decriminalizing psychedelics won’t do much to expand access on its own, either. If ending psychedelic prohibition means all adults should have reasonable access, retail sales — being able to simply buy the drugs from a store — could help fill the gaps. But it’s easy to understand why even ardent psychedelic advocates might balk at the idea. Psychedelics do come with risks, and more access means more exposure to those risks, which is an area where psychedelic research is lacking. Plus, there’s a real concern among advocates that if psychedelic legalization moves too quickly, or too imprudently, one wrong step can plunge the whole project back into prohibition. Because it’s so easy to imagine how commercializing psychedelics could go awry, blithely selling powerful experiences that can run what seems like an infinite spectrum from revelation to terror is often dismissed. But our options are not limited to either the worst forms of commercialization — what some see already playing out with cannabis — or continuing in the restrictive legacy of prohibition. There is a very wide terrain of possibilities for how to design a retail market for psychedelics that can both broaden access while retaining some regulation and safety measures. This uncharted terrain was the subject of a recent report published by RAND — a think tank whose research has had major influence on government policy since its inception as a branch of the US Air Force in 1948. Of all places, I did not expect a think tank that still works closely with the government to be advancing the conversation around how to sell psychedelics to people outside of therapy clinics. RAND’s report joins Transform Drug Policy Foundation’s “How to Regulate Psychedelics,” published late last year, as some of the first major pieces of policy research to begin mapping the possible policy options for designing a retail psychedelics market. “The federal government currently has multiple options when it comes to the supply of psychedelics, but it does not have unlimited time,” the report states. Legislation for retail psychedelics is already getting off the ground in some states, like the California Psilocybin Initiative. “Now is the time for US federal policymakers to decide whether they want psilocybin and other psychedelic substances to follow in the footsteps of the for-profit cannabis model.” Psychedelic therapy isn’t enough to put an end to the restrictive legacy of prohibition. And while it’s easy enough to say that psychedelics should never have been fully outlawed, as they were in 1970, thinking through how to make them legal and accessible for everyone is to confront a thicket of questions that we’ve only just begun to grapple with. The varieties of retail psychedelics So if we’re going to consider the retail sale of psychedelics, how can we go about it without, you know, plunging society into a psychedelic nightmare fueled by abundant corner-store mushrooms, Juul-branded DMT vape pens in young people’s innocent hands, and flooded emergency rooms with no idea how to help people whose perceptions of the world have melted into an all-consuming, pulsating void? Kilmer explained that the logistics of retail psychedelics fall into one of two categories: supply architectures and design considerations. Supply architectures come first. Who gets to sell psychedelics? The RAND report lays out a taxonomy of options, including sales by a government authority, sales by nonprofits, sales by for-benefit corporations, and full-on for-profit sales. In this view, the most modest step in retail would be letting the government have a monopoly on distribution. That’s how many US states handled the end of alcohol prohibition in the 1930s (and some states still do). It’s also how a number of Canadian provinces, like Quebec and Nova Scotia, do cannabis sales today. A government monopoly on psychedelic sales has a few benefits. A single government supplier would make monitoring product safety easier (as in, no MDMA laced with fentanyl, which is increasingly a problem on the black market, or sketchy mushroom chocolates that actually make you sick). The absence of retail competition would mean the incentives for irresponsible marketing that pushes psychedelics onto new consumers — a problem with the cannabis market — would be turned way down. I do not imagine the government would erect billboards advertising their LSD products. (In the 1950s, for instance, they kept pretty quiet about their LSD experiments for mind control and military uses). That said, giving the government the sole power to legally sell psychedelics after President Nixon’s government drove them underground in the first place would be an irony to behold. And RAND’s report noted that even in the cannabis legalization realm, the idea of sticking to state-run stores didn’t gain much traction in the US. One step further would be legalizing sales through only certain types of organizations, like non-profits or for-benefit corporations. For example, when New York handed out its first wave of retail licenses for cannabis, they went to either non-profits or equity applicants (mostly people with past cannabis-related convictions). By concentrating retail licenses with organizations that have goals other than profit, some of the potential excesses of commercializing psychedelics, from excessive marketing to skirting regulations in search of more revenue, could potentially be counterbalanced by emphases on public health or equity. Applying a bit more restriction, some countries, like Uruguay, Spain, and now Germany, have allowed a non-profit collective model for cannabis that could be adapted for psychedelics, through what are known as “social clubs.” These provide on-site locations where members can purchase and use drugs with varying degrees of community and peer support built in. And finally, the approach that now dominates cannabis in the US: for-profit sales. In theory, a for-profit approach could benefit consumers by enlisting competition to push prices down. But it also creates an incentive for companies to push against regulations in search of a financial edge, while both advertising and innovating to seek out as many new customers as possible. THC gummies are one thing, but LSD-infused ring pops? Psilocybin bubble tea? This leads down a slippery slope that makes even advocates uncomfortable. Although cannabis parallels are abundant, there are major differences when thinking about following the same model for psychedelics. Kilmer explained that retail cannabis was driven by two major motivations: to reduce arrests and generate state tax revenue. But he thinks that neither will really factor into psychedelic policy reform. Both the number of arrests and the amount of revenue associated with psychedelics (according to RAND’s survey of psilocybin users) are far less than with cannabis. And he expects the actual market dynamics to have at least three major differences, too. First, he thinks psychedelic consumers will be far less sensitive to changes in price than cannabis. Cannabis users can always turn to its robust black market if they balk at the price of a blunt, but someone hunting for LSD will likely have a harder time. Second, the question of supervised use is basically non-existent with cannabis, which is essentially consumed much like alcohol, but is a big part of psychedelic use, where even recreational consumers may want to keep someone around to watch over them. And third, while many people use cannabis frequently, RAND’s survey data found that infrequent users drive the psychedelic market as it exists today. Among any of the supply architectures, success or failure will come down to the massive list of design considerations. Who gets to manufacture (or grow) the drugs, and how can we ensure quality control? How should we regulate the packaging of retail psychedelic products? How can we effectively communicate informed consent? What strategies for public education can help create models of responsible use? What kinds of advertising are acceptable? Should doses be restricted at all? What kind of harm reduction information should come with purchases? I could go on for a very long time with these sorts of questions, which will need more than two lengthy think tank reports to navigate. The reports from Transform and RAND have at least started the important work of taking them seriously, rather than turning away at the first depiction of psychedelic capitalism gone awry. But we’ll need much more data and analysis to make sense of what prudent steps forward might actually look like. “Once I really started digging in and crunching the numbers, I realized that a lot of the data we need just doesn’t exist,” said Kilmer. And with retail legislation already in the works, we’ll need it fast. New York proposes a potentially reasonable way forward: psychedelic permits Advocates for psychedelics access have been hearing that “we need to wait for more data” for quite some time. And in many cases where psychedelics could help, like for people suffering from debilitating chronic pain or PTSD, every day spent waiting is another day in pain. Which is part of what makes the bill introduced in May by New York State Representative Amy Paulin, who chairs the Assembly Health Committee, so interesting. It offers a way forward that doesn’t require waiting for policymakers to figure out how to whip up and regulate an entire retail market before offering access. The other part is that among the options for actually stepping into retail psychedelics, it strikes me as by far the most reasonable approach to balancing expanding access while keeping an emphasis on safety. The bill would essentially take our approach to driving licenses, and adapt it for psychedelics. People 18 and up would have to go through a health screening, take an educational course, and pass a test, after which they’d receive a permit to buy psychedelics (in this bill’s case, only psilocybin) from licensed vendors. They could then take the drugs home and use as they please. They could also then grow the mushrooms at home, and share them with other permitted adults. Whereas approaches outlined in Transform and RAND’s reports focus on licensing the supply of psychedelics, the permit model adds another layer of protection by focusing on who’s licensed to purchase and consume them. There will be, no doubt, people upset by the idea of requiring a government permit to purchase or consume psychedelics. But the same is required of other activities that pose a reasonable threat to oneself and others, like driving. If the alternative is no retail access whatsoever, let them holler. The bill tries to fill in some of the missing logistics around how to actually pull this off, specifying that licensed mushroom cultivators could sell psilocybin directly to permit holders via a system managed by the Department of Health, which would also oversee the content of the permit course. Of course, questions abound. What will the health screenings screen for? Should permitting include a guided trip as an experiential component? How will permit holders be connected with support services, should something go wrong? What goes into becoming a licensed cultivator? Still, an approach that requires licensing at each step of the commercial journey, from production to distribution to consumption, builds in plenty of opportunities for regulation, while still filling the gaps in supply left by therapy, supervised programs, or religious exemptions. And by requiring permits for consumers, it leans deeper into harm reduction than the for-profit cannabis model that is coming under increasing criticism. There is no approach to retail psychedelics that’s without risk. But cars killed nearly 41,000 Americans last year alone, and we keep licensing people to use those. “Obviously, there are a number of concerns, especially if you were to unleash a commercial industry,” said Kilmer. “But at the end of the day, you can have the best empirical evidence out there with minimal uncertainty, and a lot of it still just comes down to the values and risk preferences for the people making decisions.”

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How should we sell psychedelics?