I have a profound fear of death. It's not bad enough to cause serious depression or anxiety. But it is bad enough to make me avoid thinking about the possibility of dying — to avoid a mini existential crisis in my mind.
But it turns out there may be a better cure for this fear than simply not thinking about it. It's not yoga, a new therapy program, or a medicine currently on the (legal) market. It's psychedelic drugs — LSD, ibogaine, and psilocybin, which is found in magic mushrooms.
This is the case for legalizing hallucinogens. Although the drugs have gotten some media attention in recent years for helping cancer patients deal with their fear of death and helping people quit smoking, there's also a similar potential boon for the nonmedical, even recreational psychedelic user. As hallucinogens get a renewed look by researchers, they're finding that the substances may improve almost anyone's mood and quality of life — as long as they're taken in the right setting, typically a controlled environment.
This isn't something that even drug policy reformers are comfortable calling for yet. "There's not any political momentum for that right now," Jag Davies, who focuses on hallucinogen research at the Drug Policy Alliance, said, citing the general public's views of psychedelics as extremely dangerous — close to drugs like crack cocaine, heroin, and meth.
But it's an idea that experts and researchers are taking more seriously. And while the studies are new and ongoing, and a national regulatory model for legal hallucinogens is practically nonexistent, the available research is very promising — enough to reconsider the demonization and prohibition of these potentially amazing drugs.
Hallucinogens' potentially huge benefit: ego death
The most remarkable potential benefit of hallucinogens is what's called "ego death," an experience in which people lose their sense of self-identity and, as a result, are able to detach themselves from worldly concerns like a fear of death, addiction, and anxiety over temporary — perhaps exaggerated — life events.
When people take a potent dose of a psychedelic, they can experience spiritual, hallucinogenic trips that can make them feel like they're transcending their own bodies and even time and space. This, in turn, gives people a lot of perspective — if they can see themselves as a small part of a much broader universe, it's a lot easier for them to discard personal, relatively insignificant and inconsequential concerns about their own lives and death.
That may sound like pseudoscience. And the research on hallucinogens is so early that scientists don't fully grasp how it works. But it's a concept that's been found in some medical trials, and something that many people who've tried hallucinogens can vouch for experiencing. It's one of the reasons why preliminary, small studies and research from the 1950s and '60s found hallucinogens can treat — and maybe cure — addiction, anxiety, and obsessive-compulsive disorder.
Charles Grob, a UCLA professor of psychiatry and pediatrics who studies psychedelics, conducted a study that gave psilocybin to late-stage cancer patients. "The reports I got back from the subjects, from their partners, from their families were very positive — that the experience was of great value, and it helped them regain a sense of purpose, a sense of meaning to their life," he told me in 2014. "The quality of their lives notably improved."
In a fantastic look at the research, Michael Pollan at the New Yorker captured the phenomenon through the stories of cancer patients who participated in hallucinogen trials:
Death looms large in the journeys taken by the cancer patients. A woman I'll call Deborah Ames, a breast-cancer survivor in her sixties (she asked not to be identified), described zipping through space as if in a video game until she arrived at the wall of a crematorium and realized, with a fright, "I've died and now I'm going to be cremated. The next thing I know, I'm below the ground in this gorgeous forest, deep woods, loamy and brown. There are roots all around me and I'm seeing the trees growing, and I'm part of them. It didn't feel sad or happy, just natural, contented, peaceful. I wasn't gone. I was part of the earth." Several patients described edging up to the precipice of death and looking over to the other side. Tammy Burgess, given a diagnosis of ovarian cancer at fifty-five, found herself gazing across "the great plain of consciousness. It was very serene and beautiful. I felt alone but I could reach out and touch anyone I'd ever known. When my time came, that's where my life would go once it left me and that was O.K."
But Mark Kleiman, a drug policy expert at New York University's Marron Institute, noted that these benefits don't apply only to terminally ill patients. The studies conducted so far have found benefits that apply to anyone: a reduced fear of death, greater psychological openness, and increased life satisfaction.
"It's not required to have a disease to be afraid of dying," Kleiman said. "But it's probably an undesirable condition if you have the alternative available. And there's now some evidence that these experiences can make the person less afraid to die."
Kleiman added, "The obvious application is people who are currently dying with a terminal diagnosis. But being born is a terminal diagnosis. And people's lives might be better if they live out of the valley of the shadow of death."
Again, the current research on all of this is early, with much of the science still relying on studies from the '50s and '60s. But the most recent preliminary findings are promising enough that experts like Kleiman are cautiously considering how to build a model that would let people take these potentially beneficial drugs legally — while also acknowledging that psychedelics do pose some big risks.
The two big risks of hallucinogens: accidents and bad trips
Hallucinogens aren't perfectly safe, but they're not dangerous in the way some people might think. As Grob previously told me, there's little to no chance that someone will become addicted to psychedelics — they're not physically addictive like heroin or tobacco, and the experiences are so demanding and draining that a great majority of people simply won't be interested in constantly taking the drugs. He also said that hallucinogen persisting perception disorder, which can cause the disturbances widely known as "flashbacks," is "uncommon, but you will see it, particularly among someone who has taken hallucinogens a lot."
Kleiman drew a comparison to marijuana to explain the risks. "The risk with cannabis is, primarily, that you lose control of your cannabis taking," he said. "The risk with LSD is primarily that you'll do something stupid to ruin the experience, or you'll have such a scary experience that it'll leave you damaged. But those are safety risks rather than addiction risks."
This gets to the two major dangers of hallucinogens: accidents and bad trips. The first risk is similar to what you'd expect from other drugs: When people are intoxicated in any way, they're more prone to doing bad, dumb things. As Kleiman explained, "People take LSD and think they can fly and jump off buildings. It's true that it's a drug warrior fairy tale, but it's also true in that it actually happens. People drop acid and run out in traffic. People do stupid shit under high doses of psychedelics."
Bad trips are also a concern. A bad psychedelic experience can result in psychotic episodes, a lost sense of reality, and even long-term psychological trauma in very rare situations, especially among people using other drugs or with a history of mental health issues. Just like psychedelics can lead to long-term psychological benefits, they can lead to long-term psychological pain.
These risks are why not many people are seriously discussing legalizing hallucinogens in the same way the US allows alcohol or is now beginning to allow marijuana. But the potential benefits of hallucinogens are leading some experts to consider how these drugs could be legalized in some capacity.
"I think it's a bad idea to treat hallucinogens like we treat cocaine or cannabis," Kleiman said. "They pose different risks and offer different benefits." He added, "But I don't think we're ever going to free these substances from careful legal control."
How hallucinogens can be legalized
So how can you maximize the benefits and minimize the risks? The most convincing idea so far is letting people take psychedelics in a controlled setting, in which multiple participants can be watched over by trained supervisors who ensure the experience doesn't go poorly.
So far, this is what the medical side has focused on: The typical medical trial involves doctors watching over a deathly ill patient or someone dealing with addiction who takes psilocybin. But if the concept is expanded to allow nonmedical users, then perhaps professionals who aren't doctors but are trained in guiding someone through a trip could take up the role. "I imagine someone who has training in managing that experience, and a license, and liability insurance, and a facility," Kleiman said.
Here's how it would work: A psychedelic user would go through some sort of preparation period to make sure she knows what she's getting into. Then she could make an appointment at a place offering these services. She would show up at this appointment, take the drug of her choice (or whatever the facility provides), and wait to allow it to kick in. As the trip occurs, a supervisor would watch over the user — not being too pushy, but making sure he's available to guide her through any rough spots. In some studies, doctors have also prepared certain activities — a soundtrack or food, for example — that may help set the right mood and setting for someone on psychedelics. Different places will likely experiment with different approaches, including how many people can participate at once and how a room should look.
Kleiman also envisions a potential system in which people can eventually graduate to using the drug solo. "It's like Red Cross water safety instruction," he said. "You start out, you're a newbie. You don't go into the pool without a trained, certified person to watch you, guide you, and keep you safe. After a while, your teacher gives you a test to certify that you're safe to be in the water alone. And you might even get certified to become a trainer, so you can guide newbies yourself."
If pulled off correctly, this would maximize the best possible outcomes and minimize the worst. Supervisors could help prevent accidents, and they could walk people through good and bad trips, letting users relax and get something meaningful out of the experience.
There are risks to the controlled setting. If a supervisor is poorly trained or malicious, it could lead to a horrific trip that could actually worsen someone's mental state. This is why regulation and licensing will be crucial to getting the idea right.
Ethan Nadelmann, executive director of the Drug Policy Alliance, argued for a looser model that could, for example, allow psychedelics to be sold over the counter. "You dramatically decrease the black market. So long as you have people who have to go through some sort of gatekeeper, or who can be denied, you're going to continue to have a black market," Nadelmann said. "Secondly, this means the percent of consumers who got a product of known potency and purity from a reliable source would increase."
But the black market demand for psychedelics is very small, with only 0.5 percent of Americans 12 and older in 2013 saying they used hallucinogens in the past month. So allowing over-the-counter sales would likely have a tiny benefit at best on public health and criminal groups' profits from the black market.
The debate about which model works best will likely go on for some time, especially if different places test different approaches. There's no doubt it will be tricky to hash out exactly how to legalize and regulate these drugs, as some states are learning with marijuana.
But if we know the benefits to public health and well-being are real, it's irresponsible to let the potential go untapped. It may soon be time for America to seriously consider legalizing LSD, magic mushrooms, and other psychedelic drugs.