A new article published in Drugs: Education, Prevention and Policy discusses the importance, and challenges, of racial equity within the resurgent field of psychedelic-assisted mental health treatment. The authors express concern about the systemic underrepresentation of minoritized groups in psychedelic research, discussing the ways in which poverty, psychedelic medicalization, and public health contribute to this disparity.
“From a social justice standpoint, the rapid commercialization of formerly illegal substances for which many BIPOC have faced criminal penalties, while wealthy investors come along to profiteer, will require careful policy and regulatory rollout to ensure appropriate parity. Finally, with decriminalization initiatives around psychedelics gathering momentum, it will be important not to create further disparities by deeming some psychoactive substances primarily used in white communities worthy of decriminalization, while keeping others illegal.”
Research has demonstrated promise in the field of psychedelic-assisted mental health treatment for a variety of mental health disorders, including the treatment of depression, anxiety, drug and alcohol dependence, and even cancer-related existential crises. These promising results will likely lead to psychedelic-assisted mental health treatments becoming approved by the US Food and Drug Administration (FDA) upon completion of the ongoing clinical trials.
Recently, the first study of its kind focusing on psychedelic use outcomes addressing racial trauma for Black, Indigenous, and People of Color (BIPOC) suggested that the naturalistic use of psychedelics or MDMA were associated with significant reductions in traumatic stress, depression, and anxiety symptoms related to experiences of racism.
The authors write,
“Findings suggest that the use of psychedelics has the potential to reduce symptoms of mental distress experienced due to racism. While these findings should give us some hope for the future, the research community has a responsibility to make sure that promising psychedelic therapies are equally effective and accessible to communities of color.”
Currently, clinical trials on psychedelics comprise predominately white samples (>80%), therefore lacking generalizability of the findings to communities of color, and calling into question the equity of access to such trials. The authors share,
“Given the promise of psychedelic-assisted treatments, and the growing commercial interest in developing them, it is imperative to consider how we as a field can ensure research on psychedelic-assisted therapies is conducted equitably in diverse samples, and if approved, that these treatments are accessible and beneficial to those communities most negatively impacted by structural inequities.”
Some of the systemic reasons for the lack of diversity and underrepresentation of BIPOC participants includes a lack of cultural inclusivity and racial diversity within the research community overall, stigma related to mental disorders, and recruitment methods that fail to emphasize recruitment to BIPOC communities. Additionally, there are larger historic and systemic factors as play, such as the history of racist and unethical research practices which have led to mistrust in biomedical institutions. For example, the Tuskegee Syphilis Study, wherein Black men were deceived regarding their diagnosis and deprived appropriate treatment over the course of decades. Another high-profile case was that of Henrietta Lacks, a Black woman whose cells were taken without her consent while undergoing cancer treatment at John Hopkins Hospital in 1951. With these injustices, and many more, it is clear why many BIPOC might be disinterested in participating in such studies today.
An additional barrier to BIPOC participation lies in economic inequities. These trials are often time-intensive, and largely funded by non-profits that do not provide financial incentive for participation. Therefore, it is unrealistic to recruit individuals from lower socioeconomic status backgrounds who may be unable to take time away from work and family responsibilities, without compensation. With the median net worth of Black and Hispanic families being less than 15% that of white families, BIPOC face substantial barriers to research participation in psychedelic trials due to economic inequity.
While increasing diversity among psychedelic research remains a fundamental goal, it is important to note that these treatments will not solve all health disparities. The social determinants of health still hold a far greater impact than an individual-focused treatment approach, and dismantling systemic racism and social inequities remains of utmost importance. Further, should psychedelics reach FDA approval status, these treatments will almost certainly be expensive, difficult to access, and most easily available to those most economically well off.
Indigenous forms of healing have been utilizing psychedelics for centuries, and it is important that the medical adoption of psychedelics in the West not become yet another “discovery of America” by colonizing forces. Further, wealthy and predominately white investors have greatly profited off the rapid commercialization of formerly illegal substances for which many BIPOC have faced criminal penalties.
The recent decriminalization of cannabis in many states across the US is a relevant example of this, and the research community has a responsibility to make sure that promising psychedelic therapies are equally effective and accessible to communities of color.
In closing, the authors share:
“Considering the importance of the sense of unity or oneness that classic psychedelics can evoke in mediating their long-term benefits, the field should take this to heart in applying psychedelics constructively towards ensuring equity of access and reducing health disparities, and make this an urgent priority.”
Thrul, J., & Garcia-Romeu, A. (2021). Whitewashing psychedelics: Racial equity in the emerging field of psychedelic-assisted mental health research and treatment. Drugs: Education, Prevention and Policy, 28(3), 211–214. https://doi.org/10.1080/09687637.2021.1897331 (Link)