This is part four of a six part series on the intersection of psychedelics and capitalism, and the early investors making it happen. 

People attempting to bring psychedelics to market in a medical context have this refrain that they often fall back on: “Could you imagine where we’d be today if psychedelics had never escaped the lab?” There is a push, as Shlomi Raz—the founder of the psychedelic pharmaceutical company Eleusis—put it in a recent STAT editorial, that “the time has come to make psychedelics, once seen as ‘out there’ substances, mainstream and boring again.”

For a deeper dive into Eleusis’ specific attempts to make psychedelics “boring again,” read my Psymposia colleague David Nickles’ piece “Eleusis Benefit Corp: Taking the psychedelic out of psychedelics.” Nickles has also repeatedly pointed out that, “suggestions that suffering would have been ameliorated by preventing psychedelics from spilling out of clinical settings and into the real world seem unlikely. I would contend that the amount of global suffering stemming from the unchecked systems of American capitalism, imperialism, and militarism would have been far greater without the catalyzing impact of psychedelics on the psyches of those involved in resistance movements. To lament the loss of a mythologized ‘research monopoly’ is to turn a blind eye to the really-existing histories of suffering in the real world.”

The need to demystify these substances in order secure approval through government pathways is understandable (if questionable, given studies with titles like “Psilocybin Can Occasion Mystical-Type Experiences…”). But, to make psychedelics “boring again” completely strips them of their cultural contexts. They are inherently non-boring substances, with the ability to break through our ordinary consciousness. The reason that psychedelics have made their way back into the lab is because people are so enthralled that they just won’t stop using them. Even seemingly straight-laced researchers can’t ignore the questions they raise. At this point, there are centuries of mostly-anecdotal (but some clinical) evidence that psychedelics are incredibly safe and have positively affected people’s lives.  

Many business people, like Raz, are quick to use this to their advantage, pointing out that humanity has basically conducted inadvertent Phase 1 drug safety trials on psychedelics for thousands of years.

“I think 40% or 50% of all drugs fail at Phase 1,” Raz said at the 2020 Green Market Summit on the Economics of Psychedelic Investing. “And, the fact that we know these drugs will not fail at Phase 1, from an investor perspective, we think that is a very attractive profile.“

You’d be hard pressed to find a psychedelic pharma exec discussing the contexts in which psychedelics have been safely used, though: people’s homes, camping trips, music festivals, with or without sitters. Even when acknowledging the financial attractiveness of psychedelics based on their safety attributes, they would still have us conform to a new psychedelic medical industry of their making. 

But, should they have to conform to their own system? They certainly don’t seem to think so.

When discussing why he has invested millions into psychedelic medicine on the “Danny in the Valley” podcast, Apeiron Investments and ATAI Life Sciences founder, Christian Angermayer, said that it is because he has seen their results and he has used them, himself. 

“Because you were depressed?” Podcast host Danny Fortson asked—probably because Angermayer’s company, ATAI, is helping fund the largest-ever clinical trial for psilocybin and treatment-resistant depression. 

“No, actually,” Angermayer said. 

 “Or was it just a music festival?” Fortson asked.

“Thankfully it was not,” Angermayer said. “Because this is what I don’t believe in. I think psychedelics [are] very potent drugs and you need to have [them]—I just cannot repeat this enough—under controlled environment.”

Angermayer goes on to tell Fortson that he was lucky enough to have a very controlled setting. Not technically in a medical treatment center or for depression, but “in nature” with “professional people” around him. The risk he sees with movements which might make psychedelics more accessible outside the medical context, is that more people might take them in the “wrong” settings.  

“[These efforts are] driven by people with good intentions, who had maybe a personal experience, and they say, ‘Oh, why shouldn’t that be legal or decriminalized?’ But, they might have been completely healthy, they might have had a great setting, they might have been lucky that they had access to somebody who guides them,” Angermayer said. “But, somebody who is really depressive might not be that lucky, even might not be that daring, or sort of adventurous to say it that way. So, I’m always, like, cautiously saying, ‘Let’s not go from an individual anecdotal thing to: this is how 320 million people can be treated.’”  

To this point, just over 100 people have ever legally taken psilocybin specifically targeting depression—and that’s stretching it. This number includes studies dealing with end-of-life cancer anxiety and depression, which is a very specific issue and not all of the participants claimed to have depression. But, for treatment-resistant depression (TRD), which Angermayer is referencing and which is defined by having tried multiple depression treatments unsuccessfully, there is really only the research done by Imperial College and Beckley Research Foundation to point to. By my count, their two studies on psilocybin’s effect on TRD had a total of 31 people—12 in their 2016 study, and 19 in their 2017 study. 

One of Angermayer’s investments, COMPASS Pathways—a for-profit mental health company—is currently recruiting for a 216-person Phase 2 psilocybin dose-ranging study in the hopes of bringing psilocybin-assisted therapy for TRD to market. 

So, Angermayer isn’t totally off-base, here—there isn’t all that much published evidence. But, he seems to be using this information to usher in his restrictive medical-only model, and he is putting a lot of money into securing a place for this treatment in our medical systems. He is banking a lot on the idea that those small studies will scale. (And, hey, Big Pharma trends have started on even less academic evidence in the past…) If future studies prove what has been anecdotally reported—that psychedelics are a good solution—then those 320 million people with treatment-resistant depression should have access to treatment “in a proper setting,” Angermayer said.

He has essentially taken the harm reduction advice of having a good set and setting for a psychedelic trip, and denoted that the only “proper setting” is in a medical context alongside a doctor of some kind, specifically for treatment of a mental issue. 

Not that there is anything inherently wrong with taking psychedelics in a medical setting. I think one of the most important things we can do for the mental health industry is teach therapists how to work with people who have taken psychedelics. Could you imagine being able to walk into your therapist’s office on mushrooms and her just being cool with it? The issues arise when—all of a sudden—your “proper” drug, set, and setting all become dictated and sold to you by corporate actors.

It seems disingenuous that the people creating this framework have generally either experienced psychedelics outside of a medical model, or traveled to a separate country in order to do so—only to attempt to force everyone else into a medical model they would profit from. It is apparently OK for investors like Angermayer to travel around doing psychedelics, admittedly not for the medical indications they are being tested for in clinical trials, or within the frameworks they are building their companies around. But, he can then say things like, “I actually don’t believe that these drugs are for recreational or party consuming…They have always been used in ceremonial religious settings with a guide. And, in our world, where we live today, this will be a doctor or a psychotherapist.” (Fact check: psychedelics have been used for a lot of things outside of ceremonial religious settings).  

Keep in mind, Angermayer was literally on a yacht when he first dosed. 

Possibly… 

If we go by what he told the “New Health Club,” STAT, and Fortune it was after crossing some maritime border into the Caribbean that made it legal to use psilocybin (“Make sure you make it clear that it’s legal in the Caribbean,” he told Fortune). Or, maybe it was “in nature” in the Netherlands, as he said on “Danny in the Valley.” His origin story flip flops, depending on where you hear him tell it. Though, he always points out that it was somewhere “legal” and, most importantly, not because of any struggle with depression.

This reminds me of a recent anecdote from an episode of the tech podcast “Reply All.” The hosts were speaking with journalist Casey Newton, who writes for the Verge and covers Facebook. He shared a story that made him cringe, about the preferential treatment Facebook CEO Mark Zuckerberg afforded himself.

“A couple years ago either Zuckerberg, himself, or his corporate risk people said, ‘You know, you’ve sent a lot of messages on Facebook Messenger. And, we think that there is just risk with you having all these messages out in the world. So, what we’re going to do is we’re going to unilaterally delete every message you’ve ever sent that is older than—I don’t know—six months or something like that,’” Newton said. “And so, instantly, people around the world who had messaged with Mark Zuckerberg went to go open up their Zuckerberg chat window, and what they saw was a one-sided conversation. Because Facebook had deleted all of Mark Zuckerberg’s messages, and none of theirs…So, it’s like Zuckerberg understood the value of privacy and disappearing messages for himself and presumably for other people. But, ultimately, he only gave himself that privilege.”

All this to say that the people pushing for a “medical-only” model for psychedelics seem to think that the privilege to take psychedelics however and for whatever reason they want is theirs alone. And, the rest of us should have to traverse the “boring” channels of our tumultuous, expensive medical system in order to access these substances. Thus Spoke Capitalism. 

This scratches at a larger critique which was raised by psychologist Geoff Bathje at the 2019 “Cultural and Political Perspectives on Psychedelic Science” symposium. He cautioned that, as we fight this battle for medicalization—defined as the ways that human problems or conditions are defined or treated as medical problems—we should be cautious not to lose sight of the battle against the drug war, in general. 

Historically these drugs, which have been used for a plethora of non-medical practices, have been demonized and their users have been penalized. Bathje points to the marijuana industry as an example of medicalization of a drug taking precedence over the community which has long used the drug and suffered at the hands of drug war authorities for it. 

“Look at the marijuana industry, where there was this blind spot that, I think there was this major focus on, ‘Let’s get to the point of medical, or decriminalization, legalization.’ But, there wasn’t a lot of thinking about, ‘Where’s this headed?’ and ‘What’s next?’ So, as a result, in many states, it’s still illegal to grow marijuana. So, if you grow it, even though it’s legal, you might go to jail,” Bathje said. “In many states, only the rich can own growing and dispensing facilities because you need massive deposits to have the rights to open one of those. And then, on top of that, people remain locked in prisons for decades for possession of something that is now legal in their state. These are not just oversights, but injustices due to power. That the people at the top of the hierarchy didn’t have the same priorities and perspectives as those lower in the hierarchy.”

We can see parallel issues arising with well-funded players in the nascent psychedelic pharmaceutical industry. At the 2020 Green Market Summit, ATAI Life Sciences CEO, Florian Brand, said that he is generally skeptical about psychedelic drug policy models outside of a medical context, because psychedelics are “too powerful” to be given outside of a safe and therapeutic clinical setting.

“For us it’s really about getting better treatments for patients, not so much what policy will look like five years from now,” Brand said. 

Bathje said that he believes that most psychedelic use will always occur outside of a medical context. And, in order to do right by the people who use these drugs, it is necessary to democratize psychedelic knowledge and not lose sight of the human rights issues that people “lower in the hierarchy” are having to deal with, presently. 

“If we talk about integrating psychedelics into Western culture in any meaningful way, we’re talking about cultural change,” Bathje said. “And for any project that big, we can’t rely on the hierarchies and the people at the top to figure out what that’s going to look like. It’s a discussion that everyone has got to be involved in.”