For whom is the research really done?
Though some revel in the transformative power of of psychedelics, the way we're administering them only maintains the status quo.
This week we were looking up studies, from the last few years, on the efficacy of psilocybin-assisted therapy in treating a whole range of issues: OCD, substance abuse disorder, end-of-life anxiety, treatment-resistant depression. Keeping abreast of these studies and the truth behind the headline hype is part of our job, as science-based psychedelics writers and mushroom grow book authors, but we would encourage you to get into this habit too: to look at the research, and read the papers (don’t get us started on moral imperative of bypassing scientific journal paywalls…), and figure out for yourself what’s true and what’s false.
In the course of this week’s research we came upon a paper that shook an assumption we didn’t realise we’d been making. If you aren’t engaged with the practicalities of running clinical studies (as we aren’t), it’s easy to assume that the sample of people who make it through to these studies is broadly representative of the demographics within that particular country. Though the participant groups in these studies are almost always small, we had been resting on the assumption that they would at least be properly representative. It seems this is actually far from the truth.
The paper we stumbled upon was from a 2021 edition of the journal Drugs: Education, Prevention and Policy, and it was written by the Johns Hopkins-affiliated researchers Johannes Thrul and Alberto Garcia-Romeu. It’s title was ‘Whitewashing psychedelics: racial equity in the emerging field of psychedelic-assisted mental health research and treatment’—which might give you some indication of the content within. For the headline news, we’ll quote direct from the paper itself:
Pooled analyses of contemporary clinical trials on psychedelics have found that white individuals comprise large majorities (>80%) of study participants, substantially underrepresenting BIPOC, and calling into question the generalizability of findings to non-white populations and equity of access to such trials.
To decide whether these numbers are representative of the US, let’s look at the demographics of that country, according to the most recent data (2022):
White (non-Hispanic): 58.9%
Hispanic/Latino: 19.1%
Black (non-Hispanic): 12.6%
Asian (non-Hispanic): 6.1%
Multi-racial (non-Hispanic): 2.4%
American Indian/Alaska Native (non-Hispanic): 0.7%
Native Hawaiian and Other Pacific Islander (non-Hispanic): 0.2%
From this broad data we can see that white people are over-represented in these studies, by a fairly huge 20%; this means that all other populations are under-represented, a major issue for both accurate testing data and accuracy of the resulting guidelines or therapeutic techniques that arise from these studies. Simply put, if you are not testing a properly representative sample of your population, the resulting information does not properly serve the population as a whole.
But the issue here is not just one of accurate representation. Because the substances we’re discussing have been historically used by certain groups of people, and the knowledge that we have about the efficacy of these substances for mental health, recovery from addiction and a range of other issues comes originally from those communities. If it wasn’t for the Mazatec people of Mexico, from whom R. Gordon Wasson took (and we mean that in the ‘stealing’ sense) information about the ritual use of psilocybin-containing mushrooms, we wouldn’t have knowledge of psilocybin’s effects or its potential uses for the very conditions we’re now studying. If it was not for the Native American population in the US, we would not know about the potentials of peyote. We simply cannot allow the use of these substances to shift so it more greatly benefits a white population, to the detriment of the very communities who have been using them for centuries.
There is another racial justice angle too, and it is one that Thrul and Garcia-Romeu highlight clearly in their paper: in reference to a 2020 paper by Williams et al., they point to largely self-reported data from Black, Indigenous, and People of Color (BIPOC) in North America, “which suggests that naturalistic use of classic psychedelics or MDMA is associated with significant reductions in traumatic stress, depression, and anxiety symptoms related to experiences of racism.”
This is a good time to ask ourselves what we hope for, in a broad sense, from the mainstreaming of psychedelics and particularly psilocybin-assisted therapy. From our perspective, as people who have been changed (for the positive) by the use of psychedelics and from the community we have gained through them, our hope for this emerging therapeutic use is similar: we hope that psilocybin is finally legitimized, medically, and accessible legally for all people who might be helped by its use. But more than this: we hope that the accessibility of psilocybin leads to societal change and a betterment of us as a people, a tool to be used in a greater equality as we move forward into a challenging future.
If this is what we want, isn’t it incumbent upon us to ensure that those with the greatest need for psilocybin’s potential help are the ones who get to access it? If our societies have created racial trauma, or chronic depression, or anxiety, or addiction issues, isn’t it only fair and just that we allow those most affected to have access to a substance that has proven to help them heal? And if we see that those very communities are being under-represented, and left out of testing, isn’t it up to us to raise that as an issue? As Thrul and Garcia-Romeu put it:
The disparities in substance use patterns and clinical trial enrollment, coupled with Williams et al. (2020) findings on psychedelics’ impact on race-based trauma, raise important questions regarding the sociocultural status of psychedelics, systemic reasons for the underrepresentation of BIPOC in this research, and the potential role of psychedelic-assisted treatments in ameliorating mental health disparities among diverse populations.
The under-representation of BIPOC communities is an issue not just in this research, but in clinical research as a whole—itself a symptom of a racial disparity in representation at the higher levels of institutional and educational power. This is a significant issue with all research—but when we are discussing therapies that have the ability to support communities most affected by social inequalities, it becomes even clearer that we are under-serving a large part of the population.
If we truly believe in equality of access to psilocybin and other forms of psychedelic therapy, this is an issue we have to address.
We will leave you with the words of Thrul and Garcia-Romeu:
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.
What content would you like to see from us? We are considering a more regular ‘Journal Corner’ feature, where we highlight interesting papers and articles from psychedelics-related publications. Let us know below if that interests you!