Psychedelics Normalization

by andzuck1 min read26th Apr 201926 comments

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Less-Discussed CausesMental Health (Cause Area)Intelligence and Neuroscience
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Hi everyone,

This is my first post on the EA Forum!

I'm one of the board members of Harvard College Effective Altruism. I also recently co-founded the Harvard Science of Psychedelics Club.

I'm curious why psychedelics aren't talked about more on the EA Forum and also why they aren't talked about very frequently as a potential EA cause area. I know Aaron Nesmith-Beck has made a powerpoint suggesting psychedelic research as an EA cause area. Yet, it seems like there are still only whispers and murmurs in the EA community about psychedelics.

There's a lot of promising research that shows how psychedelic drugs may benefit those with treatment-resistant depression, alcohol and tobacco addiction, and anxiety and mood disorders. Also, MDMA is beginning Phase 3 trials for the treatment of PTSD. And there generally seems to be a lot of low-hanging fruit in the field of psychedelics! Both within and outside of scientific research. Clarity Health Fund, which funds projects in the psychedelic space, actually has a list of projects they'd like to fund!

Although there seems to be a reawakening of psychedelics in the past 5 years, especially with the release of Michael Pollan's novel, How to Change Your Mind, I think there is still a lot of taboo around the subject.

Because of that, one of my small goals at the moment is to help normalize public conversation around psychedelics. And while I have avoided using the Harvard brand online in the past, I recently decided to make a YouTube video with the goal of using it to help normalize the discussion of psychedelics. You can watch the video here if you'd like.

Consider this post a gentle push for more discussion about the intersection of Effective Altruism and psychedelics.

And if you are also interested in exploring psychedelics as an EA cause area, shoot me a message! Even better, if you'll be at EAGx Boston this coming weekend, feel free to find me there to chat as well :)

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Hello and welcome! If I can be forgiven for tooting my own horn, I (with Lee Sharkey) wrote a detailed series of forum posts "High Time For Drug Policy Reform" back in August 2017, which primarily focused on the potential of psychedelics as a treatment for mental health. I also mentioned it a promising area in an EAGlobal talk in 2018.

To address your point, I think the reason more EAs don't pay attention to psychedelics is a combination of EAs not thinking mental health is an important problem (something I've also written about) and because psychedelics are weird and unfamiliar. Regarding mental health's importance, I think EAs are increasingly interested in the longterm (this would also explain a relative lack of interest in poverty and animal welfare) or they are focused on poverty but don't believe mental health treatments are comparably cost-effective with anti-poverty ones. I think mental health treatments are comparably cost-effective - at least in the same ballpark although it's unclear which is better on current evidence - when we use self-reported happiness scores to judge effectiveness. You might then doubt we can sensibly measure happiness, which I argue we can in this forum post.

Thanks for putting this all on my radar! I will be catching up on your posts and talk. Glad to see that you have already presented a lot of this in an EA context :)

To add to the chorus: I included a couple paragraphs on psychedelics (broadly construed) to Chapter 3 of the Global Happiness and Wellbeing Policy Report. http://www.happinesscouncil.org/

I'm not sure I should have said that the drugs are unpatentable. While strictly true, the delivery mechanisms and other aspects of treatment can be and have been patented, with the potential for raising costs and restricting availability.

https://qz.com/1454785/a-millionaire-couple-is-threatening-to-create-a-magic-mushroom-monopoly/

Imperial university has just launched the worlds first centre for psychedelics research.

"The new Imperial Centre for Psychedelic Research will build on over a decade of pioneering work in this area carried out at Imperial, including a clinical trial that has kick-started global efforts to develop psilocybin therapy into a licensed treatment for depression. "

I wrote a long piece on psychedelics for Current Affairs magazine diving into the history, economics, and potential political impact: https://www.currentaffairs.org/2019/04/make-america-trip-again. I don't spend too much time on the research on psychedelic therapies (these are well covered elsewhere, particularly Michael Pollan's book How to Change Your Mind). I also don't take an explicitly EA approach to the piece, although I do identify with EA.

I do think that psychedelics are a massively under-explored EA topic for reasons that have been mentioned. Their ability to increase psychological openness would probably prime them for EA in addition to all the mental health benefits.

You forgot ibogaine, which seems to be the most compelling example. According to lots of anecdotes across the internet, it reliably cures decades old addictions to heroin in a single sitting.

Still I don't think psychedelic use is necessarily a good thing. It makes people more open to experience, which for some will be a door to madness. See for example Scott Alexander's writings about it

It makes people more open to experience, which for some will be a door to madness.

Definitely agree that psychedelic use isn't for everyone.

Note, however, that the Openness result didn't replicate. Here's more detail on one failure to replicate: https://www.enthea.net/griffiths-2017-2.html

(More research needed, as always.)

You forgot ibogaine, which seems to be the most compelling example.

Psilocybin has also been very promising for treating addictions, including longstanding tobacco addiction (Johnson et al. 2017) and alcoholism (Bogenschutz et al. 2015).

MDMA is beginning Phase 3 trials for the treatment of PTSD.

Flagging that both MDMA & psilocybin have received "breakthrough therapy" designation from the FDA.

(MDMA through the work of MAPS; psilocybin through the work of Compass Pathways.)

As an aside: I just came across this disturbing critique of Compass Pathways. Sounds like they might not be as public-spirited as I'd initially assumed. But I haven't looked into it in detail. https://qz.com/1454785/a-millionaire-couple-is-threatening-to-create-a-magic-mushroom-monopoly/

Yeah, people have a variety of opinions about Compass.

Compass and the Usona Institute are independently pursuing FDA rescheduling of psilocybin. Compass is likely to have their product rescheduled first.

I think it's good that Usona is working through the FDA process, because they're a nonprofit and thus have a different incentive-set than Compass.

Just saw that Good Ventures continues to support Usona's research (separate from their involvement with Open Phil).

Interesting, thanks.

I wonder how the flow-through effects of psychedelics and their normalisation compare to other interventions. My intuition suggests that the flow through effects are large.

Some speculations:

  • people tend to make big decisions: this leads to larger consequences, especially if those people are influential. I expect psychedelics and other first-world interventions to have larger flow-through effects because more influential people are affected. Compare changing the life of an American politician vs. saving the life of a Ugandan farmer.
  • people come up with new and creative ideas. In Pollan's book there's a reference to the idea that psychedelics increase the rate of mutation of ideas. Yes, a lot of these are bad/useless ideas, but some are good/useful. Which ones spread depends on the selection filter (i.e. the epistemic hygiene of the community). But even useful ideas can be harmful. Do we really want general faster intellectual and technological progress; will the progress be general or will it affect certain domains more than others?
  • people seem to become more active and ambitious (and thus change more in their environment). I'm not sure how desirable this is. That depends on the difficulty of cooperating and coordinating with them, and also on the danger of a less stable system (I'm assuming more ambition leads to more change and less stability, but even this may be wrong if people act to increase resilience and enforce the current system. The latter seems unlikely in the case of psychedelics however.)

These flow-through effects may be bigger (and I'm already quite uncertain about this) but they are not necessarily positive. They also increase altruism, which is probably good, although ambitious and uninformed altruism is probably worse than doing nothing at all.

people seem to become more active and ambitious (and thus change more in their environment). I'm not sure how desirable this is.

Seems desirable to me on net, though you make a good point about how the sign of this isn't obvious.

Well, there are many more ways for things to get broken than to get improved, unless you think the world is currently particularly broken. Only if actions are sufficiently non-random do I expect the sign to be positive.

Makes sense. A claim I'd defend here is "properly administered psychedelic use increases the amount of non-random, positive-expectation action."

One mechanism for this is lessening the impact of internal blockers, e.g. depression & anxiety (Griffiths et al. 2016), e.g. PTSD (Mithoefer et al. 2018).

A separate-but-related thing is how psychedelics can induce mystical experiences. There appears to be a large amount of commonality in the subjective experience of psychedelic trips, across different people & settings (Griffiths et al. 2019).

Also there's some weak evidence that psychedelic use reliably increases nature-relatedness & decreases authoritarianism (Lyons & Carhart-Harris 2018), both of which seem positive in expectation.

There's some discussion of psychedelics as cause X on this comment thread.

I'm curious why psychedelics aren't talked about more...

For me, because I didn't know. Insofar as evidence exists, I'm interested. [Edit: to be an EA focus area, it would have to score well in the importance/tractability/neglectedness framework - might tractability be a problem here?]

I imagine drugs are a more political realm than EA usually goes for, but there are various reasons to build up expertise in political areas - communication, persuasion, lobbying - beyond this particular cause area.

If your worries about tractability are largely due to psychedelics being legally restricted, there might be reasons to be more optimistic:

Psilocybin mushrooms are now on the ballot to be decriminalized in Denver, there's a vote initiative in Oregon, and psilocybin is already legal in some form in at least 7 counties (including 2 in Europe): https://en.wikipedia.org/wiki/Legal_status_of_psilocybin_mushrooms

Ayahuasca is legal in at least 8 countries (including 5 in Europe): https://en.wikipedia.org/wiki/Legal_status_of_ayahuasca_by_country

"I'm curious why psychedelics aren't talked about more..." I see psychedelics as a depression or addiction treatment as interesting, but not competitive with, say, bednets. You're welcome to try to change my view.

I'm unsure what you mean by 'not competitive with'. Aren't all causes competitive with each other in the sense that one unit of resources (i.e. money or time) you spend on one isn't one unit you can spend on another cause?

I mean 'not competitive with' in the sense of 'can't beat'. For example, Peter Singer is not competitive with Usain Bolt when it comes to running.

Peter Singer is not competitive with Usain Bolt when it comes to running.

He's faster than he looks...

But more seriously, now I understand your point, I think it's plausible psychedelics could beat AMF (assuming we count the value of AMF the standard way, looking just at the self-regarding effects of saving lives, i.e. the value to the saved person) and more research would be useful to think through this. I had a go at comparing AMF to drug policy reform for psychedelics nearly 2 years ago. I think my model is not out of date but it's at least indicative. The main problem isn't the potential of psychedelics to be impactful, as that's clear - the idea is psychedelics could be much better treatments for mental health, which is huge in scale, and changing the law would improve treatments for huge numbers of people - but about what the mostly counterfactual things (for EAs) to do are. It's not obvious what the best leverage points for money/time are and I haven't been able to justify the time to look (I'm trying to finish a PhD in philosophy and this is not a philosophy topic).

It's not obvious what the best leverage points for money/time are and I haven't been able to justify the time to look

I've spent a bunch of time thinking about this.

Here are some leverage points:

  • Create opportunities for mainstream politicians to support psychedelics without risking their seats (pushes on the Overton window)
  • Build infrastructure to help the rollout of MDMA & psilocybin go as well as possible after FDA approval
    • FDA is likely to approve MDMA therapy for PTSD by 2021, and psilocybin therapy for depression by 2023
  • Academic research into the effects, mechanisms, and applications of psychedelics (especially cog sci, neuroscience, and psychology)

I recently gave a talk at Harvard about this; I'll share notes from that talk with anyone who shoots me an email requesting them.

I love how you start the video with the Mother of All Demos :-)