Waiting is not always the safe play. It certainly isn’t with psilocybin.
In a recent opinion piece, Dr. Terry Sellers admitted that “It is indeed likely that, at some point, psilocybin could become a valuable intervention” but ultimately concluded that the time is “not yet.”
This is ironic given that he administers the hallucinogen ketamine for non-FDA approved, off-label mental health indications. Presumably he does so because, in his estimation, the benefits to his patients outweigh the risks, even though the FDA has not officially sanctioned the use of ketamine beyond its use as an anesthetic.
What he recognizes in the case of ketamine, but apparently not psilocybin, is that the FDA is neither omniscient nor omnibenevolent. Rather, it is a federal bureaucracy charged with overseeing the drug approval process. In that role, it is primarily concerned with preventing another children-of-thalidomide type disaster than with getting effective medications into the hands of patients in a timely manner. People complain about babies born with deformities. They can’t complain about not having access to a drug they’ve never heard of, no matter how many people suffer and die for lack of it.
The FDA approval process is flawed, not only from a motive perspective but from a monetary incentive perspective. It costs tens or even hundreds of millions of dollars to bring a drug through clinical trials. These costs can be recouped if a drug is patentable, but you can’t patent naturally occurring psilocybin mushrooms. To get psilocybin through the clinical trials process, organizations will have to rely on donations and grants or create a synthetic, patentable derivative. One has to wonder if penicillin, found in naturally occurring mold, would receive FDA approval were it discovered today.
And FDA approval is just the beginning. Even once it is obtained, the DEA or Congress will have to reschedule or de-schedule psilocybin before doctors can prescribe it to patients. This is likely to be a highly politicized process with no guarantee that the outcome will be based in science. Indeed, if this decision were based in science, not politics, psilocybin would already be a schedule IV substance, and your doctor could prescribe it like Valium or Xanax.
While we wait on multiple federal agencies, people will continue to suffer for lack of supervised access to psilocybin. People will continue to obtain it on the black market and use it without oversight. At best, they will get less benefit than if they used it under the guidance of a trained therapist. At worst, they will do things that endanger themselves or others while under its temporarily mind-altering influence.
Citizens who are unwilling to ingest illegally will continue to needlessly suffer while a potential avenue to relief is at hand. For some 648 Utahns per year, the suffering will prove beyond endurance, and they will choose to end their own lives.
Certainly, caution is warranted whenever we put a substance into our bodies. But we know enough that this choice should now rest with patients and their doctors, not law enforcement. We know that psilocybin is nontoxic, we know that it does not cause long-term impairment, we know it is not addictive, and we know that for many people it works when nothing else has.
Given the rates of mental illness and suicide in Utah, given that the status quo is not working, and given that people are using and will continue to use psilocybin in unsupervised settings, the safe path forward is to permit medical use of psilocybin, not to continue the experiment of prohibition.