Episode 2: Ismail Ali & Jag Davies

Legalization, Decriminalization, & Medicalization

Transcript:

Inside Eyes n°2

Transcript by CHC & Nell

<Jingle>

Hi everybody, welcome to the second episode of Inside Eyes.

<Jingle>

I'm your host, Laura Mae Northrup. This series is several interviews with survivors of sexual trauma who are healing by using entheogens and psychedelics. However, these first two episodes are conversations with professionals who have some pretty interesting things to add to the larger conversation. 

For what you're about to hear, pre-warning: it's about to get very technical up in here. This episode has a lot of information about the current and future landscape of access to enthoegens and psychedelics in the United States. We talk of medicalization, the drug war, universal healthcare, psychedelic exceptionalism and so much more. 

So, in making the series, I was hoping to have a diverse group of voices in the interviews, because I want listeners to be able to hear someone who they can relate to — who, perhaps, share some life experiences. Though there are a variety of voices represented in the series, I wanna address part of why that was hard to do, and why it isn't more diverse. Obviously, speaking publicly about surviving sexual violence is, in itself, a very difficult endeavor. But, who is allowed to talk about entheogens and psychedelics without fear of legal repercussion is really impacted by issues of racism and classism. In the more mainstream conversations around the growing interest in the healing power of these medicines, there is a lot of talk about legalization. And that's sort of makes it seem like if these medicines were legal, anyone could get access to them. But the real story is a bit more complex. For the most part, all entheogens and psychedelics are currently illegal in the United States. There are strong and organized movements to change that. 

My first guest today is Ismail Ali, Policy and Advocacy Counsel for the Multidisciplinary Association for Psychedelics Studies, also widely known as MAPS. There are three main ways the general public could eventually gain access to these medicines and those are medicalization, decriminalization and legalization. The interview starts with Ismail explaining the difference and meaning of these three terms. 

Ismail Ali: They are terms that are sometimes incorrectly use interchangeably, and because there is some variance in people's own definitions of the terms, I'm sure, especially with decriminalization in particular, there is a variety of opinions about what that could possibly mean. But, from a kind of a conceptual perspective… I'll start with decriminalization first, because it is a response to the status quo, which is criminalization. So, the idea being that, as of now, because certain behaviors when done essentially can result in prosecution from a state or a federal or local government, the role of decriminalization is to, essentially, remove the power capacity of law enforcement to utilize that act, whether it's possession of a drug, or sale, or something else. It basically remove the right, or the possibility of that enforcement, from the state or local government, or federal government. And that can occur in a different... a variety of ways, but the core element is that is removes the criminality from that action. The reason there's some... maybe not disagreement, but, like, a kind of an expansion there is that, there's some disagreement about whether decriminalization means, essentially, less criminalization, like, you know, marginal change, so, for example, changing an offense from a felony to a misdemeanor, and some people believe that the word "decriminalization" means complete removal of criminal penalties or cessation of enforcement or prosecution for those crimes. So, there is a question about scope that might be kind of open. But that's decriminalization. So, removing the criminal element. 

So, legalization, on the other hand, essentially means that something is being put into a legal regulatory framework. In the case of drugs, which would be probably regulated as, like, a product, or medicine, or something that essentially crosses state's lines as part of interstate commerce... That basically means that there has to be some sort of regulatory system for the sale — for the manufacture, sale and distribution of that substance. It's the same with tomatoes, it's the same with chairs, it's the same with bicycles. Like, there is a system within which that regulatory thing occurs. So, legalization usually implies that there's a regulatory framework that's imposed on, or added to, the manufacture, sale, distribution of something — of a product. Which stand, kind of includes it within the larger commercial framework. 

Laura Northrup: Can you give an example of something... like, would cigarettes be something that would work with that example? 

Ismail Ali: Yes, cigarettes are a perfect example because there are a legal product, so, they have essentially been given permission — legal permission within the system — to turn that thing into a product. So, some might say that legalization, in some ways, is permission to commodify. Permission and protection from the local government — or from the government, excuse me — to allow it to participate in, kind of interstate global commerce. Yeah. 

So, that's legalization, which is really focused on, again, having a regulatory structure around it, beyond just removing the criminal penalties, which is decriminalization. And they work together but they're not... they overlap, but they're not the same thing, and they could happen separately or together. They're kind of different. So, a really good example is also pharmaceuticals, which are legalized — there are legal sale, distribution of pharmaceutical drugs — but the non-regulated sale is still criminalized. So, pharmaceuticals are decriminalized, or non-criminalized, in some contexts (prescribed use), but they're criminalized in other contexts. So, there's kind of a variation there. 

And then your last term was medicalization, which is, in some ways, the most specific one. But, also, kind of has some fluctuation of meaning. Medicalization really means to include that thing within the larger medical framework, which implies that is legal for sure, but also implies that is subject to the same, or similar, regulatory frameworks or expectations as other medical products. So, maybe that's a drug, maybe that's an actual, like, medical technology. There's different ways where medicalization, in the case of, for example, psychedelic substances, falls in the category of legalization through a federal medical framework, which, in this case, is the FDA. 

Laura Northrup: So, with certain psychedelics and entheogens, it's looking like medicalization is likely. Would you say that's true?

Ismail Ali: Yeah, with the rate that MDMA and psilocybin for sure are going at, the likelihood of there being FDA approval for both of those drugs for certain indications is pretty likely. With MDMA, as early as 2021, and with psilocybin, I think, within a couple of years of that. Again, through the FDA-regulated medical process, yes. 

Laura Northrup: So, since it's looking like medicalization is likely, how do you think that could affect a future decriminalization? 

Ismail Ali: There's a couple ways to look at that question. So, part of the strategy underlying medicalization in the first place is looking at how cannabis law and reform has occurred over the last couple of decades. So, with medical marijuana, one of the most significant indicators for whether or not someone changed their perspective about marijuana legalization or medical marijuana was knowing someone who used medical marijuana. When someone in your family or friend is suffering, and they are able to find relief from this particular medicine, it goes a really long way in persuading people, or at least showing people that, maybe, this drug or this thing is not as scary or demonized and criminalized as it should be — or, or, overly, excuse me. So, just from a strategic perspective and an ideological perspective, it is the case that when people learn that there are medical or, kind of, non "recreational" uses of a substance, it suddenly gets put into kind of into a different category. So, medicalization and decriminalization could happen simultaneously, in the sense of there could be FDA approval for medical access while also some other route, whether through Congress or through state initiatives getting passed or a legislation at the state level, decriminalization could occur simultaneously. However, the enforcement of a law, so the criminalization of a behavior, is not necessarily based on whether or not something has medical value. Some drugs have medical value, and, as I said earlier, are not being criminally — or are not causing criminal liability — because of the way that they're being used, but when they're pulled out of those contexts, then they suddenly kind of take on this criminal nature. In that way, medicalization most impacts decriminalization from an ideological standpoint, in the sense that it shows people that there are other uses for drugs that have otherwise been criminalized, and otherwise being demonized, which often results an inaccurate perception of that drug from the public. So, it's much more about, like, an ideological/cultural relationship, than it is about the way medicalization inherently means that a drug is less criminalized. 

Laura Northrup: Ok, so it's kind of like, if people start using these drugs as medicines, and see them as having value, then when something comes up on a ballot, or a politician is running on a certain platform, people are more likely to support, like "oh, yeah, I don't think of that as a drug, I think of that as a potential medicine", therefore are more likely to support decriminalization. 

Ismail Ali: Exactly, yeah. 

Laura Northrup: If medicalization is successful, which it sounds, like, very likely, who is gonna have access, and who won't have access? 

Ismail Ali: So, this question is around access, which is a big one. And, I just wanna start by framing it because of the fact that I'm currently speaking out of Oakland, California, which is in the United States, which is under a system which does not utilize single-payer universal healthcare. So, because healthcare in the United States is primarily determined by insurance coverage — specifically from mostly private insurance companies — the really big kind of gap that medicalization cannot fill is people who would not be able to afford a treatment, usually because they can't afford insurance, or are not insured for some reason or the other. So, there is a process of getting insurance coverage, and we're doing right now everything that we can to get as much insurance coverage as possible, so, for people who are covered, this treatment is not unfairly or unfathomably, you might say, expensive for someone who experiences PTSD symptoms or is, in one way or another, impacted by whatever is going on with their mental health, but also doesn't have the resources to do so. So, right now we're hoping for sure to start with that — with insurance coverage, because of the way that the system in the United States works. The limitation there again is how to do it, even for people who are not able to get coverage, or whose coverage can't actually cover it. And that means that there's a huge percentage of the American population who will not immediately have access to it because they will be priced out. So, that is a problem that we are taking really seriously and I think that especially because the nature of psychedelic medicine is so different than most psychiatric medicine — which is to say that the model of psychedelic medicines is not that you take a drug for the rest of your life, it's that you take a drug with the assistance of therapy for some time, or for a handful or fewer of experiences, and then you are done, with at least that cycle — we have an opportunity to, first off, have a dialogue with insurance companies about how coverage works, because they're used to covering drugs which they're like... you know... there's a certain amount that you're covering for the cost of the drug in the treatment over the course of... you know... however long they're on it, which could be indefinite, and also bringing the factor that with psychedelic therapy, one of the primary areas where the cost really incurs is with the hours of therapy required. So, the question of how to cover the drug is actually fairly straightforward because we can choose to sell drug at cost or very close to that, and we’ve already determined that the idea behind selling the MDMA would not be to profit by selling the MDMA. The place where most of the profits, or most of the cost, will actually be in therapist hours, and in that sense, the role that we're trying to take is giving the therapists as much support and as many tools as they can to determine how they would want to work with their community. We've kind of come to the conclusion at MAPS that it's not really our role to decide how the therapists work with their clients, because the variety of indications, the variety of people that can be impacted by psychedelic therapy is so broad, that's something... that's a decision that really has to happen between the therapist and their client. At the same time, we wanna be able to incentivize, and provide structure and support for, other ways to get therapy and these treatments funded outside of insurance, which may mean foundations, it may mean fundraising, there's a series of things that are kind of being discussed now to figure out how do you bridge that gap for people that aren't be able to get coverage under the current system, at least within the United States. 

Laura Northrup: Yeah, and this basically all in response to the fact that there is not a single-payer universal healthcare system? 

Ismail Ali: Yeah, that's why I start with that, because I... you know... There are a lot of ways to critique insurance coverage and the cost of care, and all of those things. But, ultimately, those are questions that we're only dealing with because we're operating in a framework that doesn't have a universal healthcare system. And just as an example, there's some psychedelic drug development and similar research going on in Europe right now, and in the UK, and one of the big differences between the two systems is that because countries in Europe set prices for drugs — or because they're the payer for the drugs, excuse me — the drug companies can only set their prices so high because the country, governments that are operating, that are administrating the healthcare system, won’t pay for something if the cost is too high. So, there's kind of a built-in price check in European healthcare, and in healthcare in universal systems, because, if you have a government that's a buyer, they have a lot of leverage. When you have, you know, dozens or hundreds of insurance companies, all of which are competing, then they have a lot more... freedom, and drug companies have a lot more freedom, to jack up the prices, or really just do a lot of different things that make access more difficult. We just don't have the same kind of leverage as, you know, consumers of insurance in the United States, because we're subject to this massive web of, you know, private insurance companies instead of something that's more unified, especially with this particular issue. 

Laura Northrup: Ketamine is being used, off-label, as a psychedelic treatment for people, with therapy, and a lot of people don't have access to it at this point because it's not covered by insurance. Is that because it's off-label use, and because there's not... so, it sounds like you're actually at MAPS going through a process to make it something that insurance companies will cover, specifically. Is that the what’s going on? 

Ismail Ali: That's exactly right. So... Insurance generally only cover therapies or treatments that are FDA-approved. And that's why the FDA approval key is so crucial. It's crucial because it means that the use of that drug in that context is federally legal, so it's protected everywhere. So, like, a state government, a rogue state government couldn't go after someone who was legally practicing under the FDA and the DEA authority if it was legal. So... It's correct that because the ketamine for depression practice, right now, is not regulated by FDA, because FDA didn't approve ketamine for depression, it approved it for anesthesia, and it is off-label use, right now, insurance companies are not covering it, which is why ketamine therapy right now, ketamine infusions are so expensive, most of the time. That could change and it's... if ketamine became medicalized, or if there were a medical indication for ketamine that was accepted at different level, in theory, insurance companies could still choose to cover it, but generally speaking, insurance only covers drugs or therapies that have been FDA approved, which is why that piece of the puzzle is necessary to get the coverage. 

Laura Northrup: Ok, so this question is less about medicalization, because I'm assuming that as medicalization happens, nothing is going to happen for people who have been incarcerated for "criminal use of drugs". But, if and when decriminalization occurs, or forms of legalization occur, what would that mean for people who are currently incarcerated for drug-related charges? 

Ismail Ali: That is a very good and very important question. Unfortunately, neither decriminalization nor medicalization would necessarily mean something for people who are currently incarcerated. It would have to be up to the people who write the laws and, kind of, more often, the local district attorneys to determine whether or not there would be a retroactive kind of impact of a change in law. So, this is really visible right now in California, where you have retroactivity not built into the law, in the sense that the law that legalized marijuana in California did not include within it that people who have been incarcerated for crimes that were now legal would be released, and that means that we have this really unfortunate and complicated patchwork where district attorneys in some cities are deciding whether or not they want to include retroactive provisions. So you have places like San Francisco and San Diego that have decided that every marijuana-related crime, for example, between now and, like, 1975, are all gonna get wiped and everyone's records get expunged, which is great. And, you know, sometimes you have really great examples like that, but, unfortunately, for now, with few exceptions, the retroactivity provisions are really only added in some cases and they're really not very well supported by the larger legalization conversation yet. This is definitely not because people who are pushing for legalization don't care. I know for a fact, especially, that many advocates in California who come from criminal justice policy reform backgrounds, and who came to marijuana legalization from a social justice / racial justice framework, did want to include, and would have absolutely included, something like this if it was possible, but I think that's one of those bargaining chips that's often lost and, unfortunately, maybe one of the first ones that's lost because the reality is, that especially when people are incarcerated and would otherwise remain incarcerated, they continue to be sources 

of revenue for the state or for the prison system and, until there is something that could incentivize prison systems and law enforcement in the same way that continued criminalization or continued incarceration can, that is not a bargaining chip that a lot of these entities are willing to part with. However, I would say that any ethical, forward-thinking, compassionate drug policy moving forward would really have to seriously critically think about what it would mean to keep a provision like that out. I think it's absolutely crucial that, any time that policy or law change is on the table, and that that is done in a way that's meant to actually create legal access to a substance through whatever format, that it's critical that reparative and restorative processes and justice is built into that which, at bare minimum, means getting people out of incarceration who are currently incarcerated for crimes that are, not only legal, but are actually now profitable. 

Laura Northrup: Do you think that capitalism and potential for profits play a role in medicalization versus decriminalization? 

Ismail Ali: That's also a really good question. I think at least some of the answer to that can be seen in the cannabis industry. The unfortunate reality is that, a couple of years ago, the conversation about cannabis in the United States has started to shift from being led mostly by activists and advocates, to being led mostly by lobbyists and people who are coming at it with corporate interests. Now, the reality of an industry — and making cannabis legal, as I said earlier, y’know bringing it into the legal commercialized framework, means inherently that there are going to be business interests. So it is definitely the case that in a decriminalized or legalized context there would be room for profit. The thing about psychedelics which I really don't know the answer to, but I'm very interested in knowing more about, and learning more about as, kind of, we get more above ground and more mainstream and more part of kind of this larger system, is whether or not the sale and distribution of psychedelics outside of a medical context, or outside of some sort of framework, would be as lucrative as something like cannabis. The interesting thing about psychedelics is that they kind of have somewhat built-in mechanisms that make it very difficult for them to become habitual, or even addicted, use. Which makes me wonder if the model for the sale of other substances like tobacco, or alcohol, or even cannabis, could be applied to something like psychedelics. I really don't know. At this point, it seems like taking a risk on decriminalization or legalization in order to profit from it would probably be an unwise financial decision. It's definitely not clear yet that there is a hug profit to be made, and so far, most of people that are willing to take risks with their careers or their reputations or their own lives in order to participate in this movement for legal access to psychedelics have done so because of something beyond the profit motive. That, of course, doesn't remove the possibility of that coming in at some point, as we've seen with the cannabis industry, and I'm not so naive as to think that psychedelics are exempt from all of these market forces. However I do believe that with a lot of transparency and communication, and integrity and clarity, and community accountability, the system that gets created to allow for legal access to psychedelics, whether it's in a medicalized or decriminalized context, does so in a way that really pays attention to the harms that traditional forms of capitalism have created, especially within the medical industry. So, my hope is that although I, of course, want therapists to be able to build livelihoods off of this practice, I want to be able to make the living, doing good work, working with psychedelics in legal, safe, intentional contexts, I also know that we have to be very wary of, and thoughtful about, what we do to ensure that doesn't... that that pursuit does not mean that we're leaving people behind who could benefit greatly from the use, whether again it's in a medical, or spiritual, or any other context. 

Laura Northrup: Ok. So, I wanna switch gears a little bit here because, something that I notice a lot in the psychedelics community, psychedelics movement, is that there is a lot of conversation about legalizing or decriminalizing specific, single drugs — and/or medicines, however you wanna call them — like, for example, an initiative that will decriminalize psilocybin, or... obviously, cannabis, is a great example of going for one single drug. And, I'm wondering specifically why the psychedelics community pushes legalization just for psychedelics only — do you agree with that strategy? And I'll add, you know, and this is kind of a loaded statement, but I'll add: do you think that that is inherently classist and racist? 

Ismail Ali: So... I think that they're absolutely classist and racist elements of what I would call "drug exceptionalism", which is kind of what — the phenomenon that you're describing. Which is the idea that some drugs are okay and that should be commercialised and can be used safely by people, and some drugs aren't. The reality is that the perception of those drugs is extremely driven by racist and classist considerations. The best examples being the perception of drugs like crack, cocaine and heroin and meth, and just, like, the images of what is coming up in people's minds when we’re thinking of those drugs. So, the idea that leaving out some drugs and, thus, some users of drugs, some people, from the conversation about legalization and decriminalization, does imply that there is a justifiable difference between the use or framing of those drugs. I tend to not agree with that. I believe that the larger system and the larger conversation about liberation and freedom and justice has to look beyond single drugs at a time. And there are multiple reasons for this. One is tactical. If we spend 12 millions dollars on an initiative in every state for every drug, we're using a lot of money and many, many, many, many, many, many years getting this done. So, from a tactical perspective it may not make sense to go forward with legalizing one drug at a time — on top of the considerations that I mentioned earlier, that really have us believing that there's this dichotomy between people who are using some drugs and not using others, as if there is a population that only uses mushrooms and that doesn't use other drugs, or there's a population that's only using one “dangerous” drug and that isn’t using others. So, there's definitely a major component... There's a major, kind of, oversight, I think there, with single-drug decriminalization and single-drug legalization actions. On the other hand, I want to acknowledge that, with cannabis and mushrooms in particular, there are reasons why the people who are pursuing legalization or decriminalization felt like there would be a more likelihood for progress as a result. And, with cannabis in particular, where the route was specifically in response of the needs of particular communities, especially HIV-positive communities, who knew that this medicine could be good for their specific issues, and were kind of occurring in a time — in the late 80s and early 90s — where the federal government and medical system was just completely unable to support the needs of people who had HIV. So, I'm aware that the reason the medical marijuana conversation moved forward when it did is in response to a very real need that really took into account the needs of people who were extremely vulnerable. Unfortunately, that's involved into the belief that that's how we should do drug decriminalization or legalization, and I think that we've now progressed enough to the point where having "adult conversation" about decriminalization of all drugs and what would it mean to actually completely shift the relationship between criminal justice, healthcare and drugs, is on the table. It's no longer so radical and it's actually increasingly bipartisan to call for high-level mass criminal justice reform which includes drug policy reform. And, I want to hold space for both of those perspectives. The fact that, on one hand, there is a clear imperative, from the perspective of a just society, where all people who use drugs, who are criminalized for their identities and for their actions, are able to participate in this kind of legal, post-prohibition world that we’re all hoping to create. At the same time, not only are there sometimes reasons to put certain kinds of effort in certain buckets, you might say, in different times, but, the other benefit to having conversations about single drugs at a time is that it allows there to be a huge opportunity for education and community-building around things that wouldn't otherwise be possible. I'm having this wonderful experience in my, kind of... in my work where a lot of people are reaching out about how they can participate in legalization of access to psychedelics. And... One of the ways, for sure, might be to participate in, like, a local initiative or a legal change around psilocybin. And I strongly believe that for people who are interested in drug policy and drug policy reform, that there is a tremendous benefit also to people in the psychedelic community to engaging with people who do drug services, harm reduction for IV drug users. I think that we want really to be looking at this movement for safety, safe consumption sites, access to syringes, access to all of the things that would be needed for someone to have a safe experience — really, harm reduction at its core. Then, we would not only achieve more but we would do it in a way that's more inclusive, more just and more in consideration of the realities of the world that we're living in. So, from MAPS's perspective, we support the progress of laws and initiatives that are trying to create legal access to psychedelics on principle, because anything that moves away from criminalization is a good step. At the same time, it is incremental, and whether or not incremental changes is worth it or valuable is really something that people decide based on their own values and their own perspectives. 

Laura Northrup: What is the role of culture change in making psychedelics accessible and how is that different than policy change? 

Ismail Ali: So, that's really interesting and ties into the question around, like, legalization/decriminalization and the extent to which those are just or have, kind of racial or class-based elements. In part because the reality is that, in many cases, criminalization is not necessarily about the behavior, it's about the person. Law enforcement criminalizes sex workers independently of whether or not the laws in that particular state are safe or good or, well, created for sex workers. The identity, because of its existence of being targeted by law enforcement, incremental legal change that in theory protects people who are working as sex workers does not necessarily protect them as individuals because the thing that's been criminalized is them and their identity, not necessarily a practice. With drug use, it's very similar. We... The law enforcement utilizes the drug laws as a framework for enforcement, but the enforcement is racialized. Which means that the people who are being enforced on are not... it's not equally distributed between all people. 

Laura Northrup: Just to clarify, so that's like, for example, like... White people who are using cocaine are not necessarily being subjected to as much actual law enforcement around it.

Ismail Ali: Precisely. So the reason cultural changes is relevant is because we can change the laws, but until there is a deeper, more fundamental ideological reason for law enforcement to stop criminalizing a population of people — poor people, Black people, sex workers, trans people, whatever that population is — until they have a reason to not criminalize those people, then, beyond just the laws themselves, then they will continue to do so. Arrest rates for youth of color in Colorado are the same, or higher in many counties, for marijuana offenses than they were before legalization today — last year, at the end of last year. That tells me that until we really have a reason, until we really can pull the fangs out law enforcement's ability to criminalize certain populations, they will continue to do so whether or not the laws are actually there to "protect people" because the laws are not there to protect all people. They protect some people. 

Laura Northrup: Little bit of a shift, and this maybe doesn't relate so much to MDMA, but definitely relates to mushrooms and other medicines like Ayahuasca, Iboga, Peyote… What will happen, and is already happening, to the cultural stewards of these medicines, especially considering that those cultural stewards are typically people who have been subject to colonization and are not in possession to protect themselves through the legal system?

Ismail Ali: Yeah, that's a big, big question, and it's really crucial that we talk about it. So, I’ll kind of work backwards from what you said, the first one being around protection from, or within, the legal system. And that is the kind of higher level conversation that's happening around, how to determine who and what has rights. And there is an increasing interest, at the international level, to protect biocultural rights, which include not just the rights of indigenous people and their relationship to the land, but also elements of the land itself and practices. So there's this interesting phenomenon that occurs at the international level where the UN can protect, or at least acknowledge, a certain practice as cultural patrimony, and there is a process happening, kind of, at the level now, to acknowledge practices like the Mexican mushroom traditions, the pre-Mexican mushroom traditions, and then also Ayahuasca in the Amazon as cultural patrimony, which is really exciting. But that's all coming after many, many, many years, as you said, of genocide and colonialism, and enforced servitude and all kinds of really horrific oppressions that have occurred over the course of five hundred years in the "New World". So, the question around what happens... what's happened, and what continues to happen and what will happen with respect to the peoples who have carried any of these traditions for a long time, I think, is an evolving one. On one hand, I think that there needs to be an open, ongoing dialogue between the people who are interested in engaging with these esoteric or indigenous plant medicine practices, whether they're in religions context or otherwise, and the people from whom these practices came. That's really hard when most of the people that used to work with these practices are gone, because they have been genocided or because they have lost their culture — their access to their, kind of, cultural context, which has happened to many, many generations of indigenous people all over the world. So, what's happening now is this interesting, kind of, what feels somewhat like a re-indigenizing process, a global re-indigenizing process, where there are a number of Native communities who have been resilient and who continue to exist around the world, some of which have preserved their entheogenic medicine practices. And because there's so much interest coming in from the global North, from the West, from places like the United States and Canada and Europe, there's this a) increased interest from youth in indigenous context, and this is definitively happening in places like Brazil and Columbia, to reconnect to their cultural roots in a way that wasn't accessible through their parents, maybe even their grandparents, because those generations tended to be really heavily subjected to colonization and assimilation. So, you have this phenomenon of young indigenous or mixed people who are engaging with this huge wave of interest from the global North that's creating this really interesting, like, neo-shamanic indigenous movement that's really flourishing all over Central and South America now. At the same time, I don't wanna skip over the fact that there also isn't really any effective mechanism that... that the, kind of, Western world, you might say, like the American government and these different kind of entities, have regarding the rights of Native people and practices, because we just have never really respected the treaties or any of the agreements that were made throughout history. So, any efforts that are occurring now, whether or not they're in good faith, are still limited by a deep, unacknowledged, unwitnessed history that, until, I think, it's properly accounted for within entities, like, the US government and the Native American tribes of North America, or the Mexican government and indigenous tribes there, or the Columbian government and indigenous tribes in Columbia, or the Brazilian government... I mean, you could go on because the harms are so grave that it feels — I feel like it seems... it feels easier for many people, including people who engage with these psychedelic medicine practices to... it feels too big to, kind of, fit within the relationship to the medicine and to those practices. Unfortunately, without seeing that whole story, then people participating in that really are just perpetuating the same, kind of, rejection, repression and denial of history that we've been living with, which is the legacy of all of these colonial settler governments. So, from the perspective of how to protect and what to do, I really feel like people in the psychedelic community or people interested in these esoteric healing practices, in addition to doing their personal, emotional healing work — I mean, every indigenous practitioner and mestizo practitioner that I was spoken with over many years now has said very clearly "Ayahuasca is for everyone, these medicines are really meant to be for the healing of humanity”, but that doesn't mean that serving the medicine is for everyone, or that you can just do it however you want. You know, like, part of the trade-of is that these practices are done in right relation with the people who are... who have held them, with such resilience, for such a long time. 

So, I guess just, kind of close that thought the... The core ask I would have for the psychedelic community and people who are involved in these practices is not to just learn about the healing capacity of these medicines and tradition, because those are huge and significant and powerful and are to be honored, but also the current, present-day realities of what Native people, all over the world, are facing. And, you know, even just focusing on a place like the Amazon in Mexico, or the Amazon in Central America, the influence of mining, cattle and timber, soy, all these massive multinational corporations that have really done a tremendous amount of damage — Nestle, I'll call Nestle out by name — you know, have done a tremendous amount of damage to indigenous people all over the world, that really need to be reckoned with. And I think that, like, you know, for the people in the psychedelic community, if you wanna show up, then you look at those issues, like what's going on with oil, and timber, and silver... What's going on with all of these particular industries and government practices that have caused so much harm, and how can we show up in solidarity there. Because if we can show up in solidarity to that larger cosmology that acknowledges the entirety of the world-viewing experience, then the medicine itself, kind of, becomes more than just something you're consuming because you want to heal or feel better, it'd be really becomes part of a larger human cosmology that... it's, it's... that is significantly impacted by that solidarity in a very fundamental way. 

Laura Northrup: All right. You've been listening to an interview Ismail Ali, Policy and Advocacy Counsel for MAPS. Thank you so much to Ismail for coming on the show. My next guest is Jag Davies, Director of Communications Strategy for the Drug Policy Alliance. To start, I asked Jag the same question about the differences between medicalization, decriminalization and legalization, as I did Ismail. And while both of them said fairly similar things, this interview starts with Jag explaining a bit more about decriminalization and some interesting aspects of medicalization.

Jag Davies: What decriminalization doesn't do, is it doesn't address the role of drug sellers, and production and distribution, where distribution is still considered illegal and can face very harsh penalties sometimes. Now decriminalization has a long track record of success. A number of countries in Europe have decriminalized all drugs, the most well-known example is Portugal, where they’ve had incredible success. Overdoses, deaths, HIV/AIDS and even drug use itself have gone down in Portugal since they decriminalized drugs in 2001. The Czech Republic, Netherlands, Switzerland, Spain also have similar systems. There's a number of countries around the world that are currently considering moving towards decriminalization, including some parts of the US. And decriminalization is widely supported by the US public. Around 50 to 55% of the US public supports this concept. Legalization... With marijuana, we have some good examples in the US, but there’s not a lot of examples from around the world of formerly illegal drugs that have been fully legalized, at least among the drugs that are illegal now. Unlike decriminalization, legalization has pretty low public support, even for drug — you know, unless we're talking about marijuana — even with, you know, psychedelics, drugs like psilocybin, MDMA, LSD… support for legalization is under 20% generally, some more being around 10%, whereas support for decriminalization is more like around 50%, or even higher in some places. Part of the problem with medicalization — or the limitation of it, at least — is that the FDA's definition of what makes a drug medically safe and efficacious is very narrow. And it takes a very large amount of resources and time to put a drug through the FDA clinical trials necessary in order for it to get approved as a prescription medicine. Prior to MDMA and psilocybin — which are currently being put through FDA drug development trials under a non-profit model — there haven't been other examples of psychoactive drugs that have been able to be put through the FDA’s clinical trial process. Part of the reason for this is that there is... is the profit incentive. Pharmaceutical companies only have a profit incentive to develop novel, single-compound pharmaceuticals, where when we have, for example, medicinal plants that have been used for hundreds or thousands of years, they would not be able to be patented. And so there is, unless you're working under a non-profit model, there's no way to develop it until a prescription medicine. And even if you are doing that into a non-profit model, there's no guarantee of success, it takes tens of millions of dollars and decades of time (laugh). 

Laura Northrup: What is the war on drugs, if you could explain that briefly. 

Jag Davies: Yeah. The war on drugs is the dominant paradigm through which the government treats certain drugs. Basically, it involves, for drugs that are considered illegal, a high level of criminalization — the idea that, through punitive measures, we can reduce drug use and, thereby, reduce the harms of drugs. The drug war officially dates back to Richard Nixon in the early 1970s, and through transcripts, you know, historical records, we've seen that the motivation for starting the war on drugs was political: to go after... to associate… drugs with certain groups that were politically problematic for Nixon. You know, for example, you know, he tried to associate marijuana with Vietnam protesters and with the hippies. And, with Black people and civil rights protesters, he associated them with heroin. He knew that they couldn't criminalize people simply for being Vietnam protesters or being black, particularly after the civil rights movement, but that by criminalizing substances that they used, he could disrupt their communities. And the war on drugs actually goes back much further, in many ways. Looking to the late 1800s, early 1900s, we see that, whether or not a drug ends up getting classified as illegal or legal has nothing to do with the science behind the drug or its harms but everything to do to who is associated with using the drug. The first marijuana prohibition laws were implemented in the early 1900s as a method of criminalizing and deporting Mexican-Americans immigrants. The first cocaine laws were used as a way to vilify Black people in the South in the early 1800s. The first opium prohibition laws, which were actually passed in San Francisco in the late 1800s, were a means of vilifying, and stigmatizing, and criminalizing Chinese immigrants, since it was their traditional practice to use opium. And so, we see over time that there’s been a racially bifurcated model of access to legal drugs. The war of drugs really hit... expanded a lot in the 80s and 90s — that was when there was the largest increase in the prison population and in the criminalization of drugs. In 1980, there were about 40,000 people in jail for drugs in the US, and by the beginning of the 21st century, we had half a million people in prison or jails simply for a drug law violation. And... Over the past 10 years, that number has kind of plateaued, but it's still basically going at the same levels — the highest level ever, in a lot of ways. A lot of the media stories recently have kind of framed what where the current federal administration is doing as restarting the war on drugs. And while the Obama administration did make some modest reforms to scale back the scope of the drug war, they didn't end it, by any means. They simply kind of limited its growth (laugh) in some ways. 

Laura Northrup: So, how does the war on drugs impact psychedelic use, and who is it impacting? 

Jag Davies: When we're looking at the war on drugs writ large, arrests and incarceration for psychedelics are a relatively small part of it. Unfortunately, there's not the data on this, but likely under 10% of people in jail or prisons are there for MDMA, LSD, psilocybin, those kind of drugs... But, considering the scope of how large the drug war is — where we have 1.6 million drug arrests every year, half a million people behind bars for drugs, as a mentioned, even 1 or 2% of that is still a lot of people. And I think what often get discounted is the phenomenological aspect of criminalization. Even if someone isn’t arrested for using a psychedelic, the fact that people know that they're doing something that is criminal makes it harder to benefit from the experience and increases the risk of potential harms, where if someone has problems, they may be less likely to get help. And it also has a really disproportionate effect on people of color and people who come from heavily policed communities. If you’re using a psychedelic drug in a context where you don't feel safe, where you're under constant threat of police violence or other forms of violence, you're much more likely to have a negative psychedelic experience. We all know the concept of set and setting, and criminalization has a big impact on that. The vast majority of drug arrests, also, are of people under thirty, people in their late teens or early twenties, oftentimes at large events like music festivals and places like that. So, criminalization also disproportionally affects young people because they are the most heavily policed community. 

Laura Northrup: What is DPA’s [Drug Police Alliance] strategy or stance on the most viable route towards psychedelic access, while decreasing the harm on the communities most impacted by anti-drug policy?

Jag Davies: That's a great question. Unfortunately, even if psychedelic drugs are made available through the FDA, that won't do anything to end arrests, or change the criminal penalties for people who use or possess psychedelics outside of... you know, highly supervised, expensive (laugh) medical contexts. So, we believe that it's essential to also work to reduce the criminal penalties for people who use them outside of medical contexts. When it comes to psychedelics and public opinion, there's not a huge benefit to separating out psychedelics. When we do polling on questions around decriminalization of psychedelic drugs and compare that to decriminalizing all drugs, the results are quite similar. And DPA's priority, going forward over the next few years, is to really mainstream the concept of drug decriminalization in the US. As I mentioned earlier, Portugal and a number of other countries have had surprising success with this. And a number of municipalities and localities in the US have taken steps towards decriminalization, for example by changing drug possession from a felony to a misdemeanor. And, we think it's not strategic necessarily to single out psychedelic drugs when talking about decriminalization. If we're just decriminalizing, say, one drug, like psilocybin, you know, most people who use psilocybin also use other illegal drugs and the number of arrests are a small portion of overall drug arrests. So, I think both the most strategic thing to do and the most ethical thing, for people who care about... Reducing the harms of psychedelic prohibition is to work towards decriminalizing all drugs. Drugs like heroin and cocaine also have been vilified and mythologized by the war on drugs. One thing that is surprising to a lot of people is that data consistently shows over time that something like 80 to 90% of people who use even the drugs that some people think of as the most dangerous drugs, methamphetamine, crack cocaine, heroin... Only a very small percentage, around 

10 to 20% of people who use them, develop an addiction and are going to use them problematically. So, we think it's important to remove the threat of criminal coercion, that allows people — that small percentage who does have problems with them — to get help more easily when they need it, without coercion. In the US, one concept that has caught on in a number of states, is the concept of treatment instead of incarceration, and the public overwhelmingly supports that. But, in practice, the way that works oftentimes is that the only way people can access drug treatment is through the criminal justice system. You get arrested, and then you've given a choice of "ok, you either do treatment or you go to jail", and so, of course people are gonna choose treatment oftentimes in those situation. But the vast majority of drug treatment in this country is very problematic — it's not science-based — and while we believe that evidence-based treatment should be available on demand, for everyone in the country, like it is in many European countries, the evidence also shows that coerced treatment, involuntary mandated treatment, is much less effective for people than when they go on their own volition and it's voluntary. So, it's important for people who care about psychedelics to work towards ending criminalization of all of drugs, and that is most likely the quickest and most strategic route to reducing the harms of psychedelic prohibition. 

Laura Northrup: So, one of the reasons I asked this question is because there is a lot of push, in the psychedelics community, to decriminalize or legalize a single drug. And it sound like DPA's strategy is more focused on decriminalizing all drugs, and part of the reason for that is because it's more ethical and compassionate towards people who are most affected by drug criminalization, but also because, in the long run, it's not very effective to go through and decriminalize single drugs. Like, it's gonna happen a lot faster and with a lot less resource to just go for all decriminalization. It this what it sounds like you're saying?

Jag Davies: Yeah... Yeah, that's right. And, I mean, one important thing to note is, looking at the history of marijuana... Marijuana became available for medical use before it was legalized more broadly, but there is a lot of things that are very different about marijuana from psychedelics. One of them is that just way more people have used it. About half the adult population in the US has used marijuana, whereas with the psychedelics, it's more like a fifth of the population. So, I think it's much easier for people to be misled about the risks and benefits of psychedelics, compared to something, like, marijuana. And, part of the other reasons — it wasn’t just because of medical marijuana that marijuana was legalized, it was also a civil rights issue for a long time. A number of states, back in the 1970s, decriminalized marijuana, and a big part of the push to legalize marijuana has not just been because of its medical benefits, but also because it's such a civil rights issue: about half of the drug arrests are for marijuana, even to this day. And, so, at this point, you know, our focus with marijuana is not whether we get it done, but how it's legalized — that it includes reparative justice measures, that it includes retroactive criminal justice reforms so that people who are most harmed by the drug war are the first in line to benefit from its legalization, and I think that's important that we take a similar approach when it comes to psychedelics. The people who have been harmed the most by psychedelic prohibition should be the ones driving the agenda, and the ones who stand to benefit the most from it. The way things are playing out now, where the focus is overwhelmingly on medicalization, the people who stand to benefit from medicalization are the people who already have the most privilege. To access psychedelic therapy, it requires a lot of time from highly paid and experienced professionals — and that's part of what's remarkable about psychedelic therapy and what makes it so effective, and it's certainly a good thing that psychedelic therapy is becoming available to more people, but when it's only available through the medical system, people who are socio-economically disadvantaged are, of course, less likely to benefit from them. And, also, while it's important that, you know, people who are using psychedelics in therapy are supervised appropriately and given professional and thoughtful care, inevitably, lots of people are going to continue to use psychedelics outside of medical contexts, and those uses are oftentimes just as valid. There can be more potential for harms in those situation and people need to be educated about what the potential risks of psychedelic use are. 

Laura Northrup: Yeah. So, why do you think the psychedelics community is so focused on legalizing, medicalizing or decriminalizing single drugs? 

Jag Davies: Yeah, I think it's a term I call "psychedelic exceptionalism", you certainly also see this with marijuana, where there's a lot of marijuana exceptionalists. I think a lot of people in the psychedelics community, feel that — and this is correct to some degree — that psychedelics are quite different from other kinds of illegal drugs, and have different kinds of benefits, and that's why they should become legal. You know, what I think is that, actually, with drugs, even if you think other drugs are inherently harmful and don't have beneficial uses, I would argue that legal regulation and decriminalization is the best way to address those potential harms. For example, as I mentioned earlier, perhaps, in Portugal, the number of people, after they decriminalized drugs there, who use drugs problematically went down. I think this is something that pervades history in a lot of ways, where people like to bifurcate drugs into good and bad categories. I mean, you oftentimes even hear people who use certain psychedelics say that they're not a drug, it's something else, you know. And that tendency for societies to split drugs into good drugs and bad drugs and to associate certain people with each of those groups runs very deep, and that's a lot of what we're running up against, and I think that's why it's been so easy for politicians, and for corrupt actors, to demonize people who use drugs. 

Laura Northrup: I mean, it sounds like what you're saying is that, when you're talking about psychedelic exceptionalism, is that there is this sort of idea that some drugs are superior to other drugs. And it sounds like when people push drug decriminalization only for things like psilocybin, or only things like marijuana, though they might not be overtly saying "this drug is superior to other drugs", that that's some of the kind of behind-the-scenes thinking about it, and it sounds like DPA is more focused on decriminalizing all drugs, and the decriminalization is not because a drug isn't a drug, or isn't bad, or isn't superior, or is superior... but that it's more focused on trying to actually help people either gain access to something that could be beneficial to them, or, for example, with decriminalizing something that people die from, then decriminalizing it, if somebody is potentially gonna die from a drug, they can have drug testing and gain access to resources to keep them alive. 

Jag Davies: Exactly, yeah. And there's no guarantee that if certain drugs are decriminalized in certain contexts or medicalized in certain contexts, that they won't continue to be criminalized in another contexts. I mean, many illegal drugs, I mean, opioids, even cocaine, are both highly criminalized and stigmatized illegal drugs, but then also have approved medical uses. Even crystal meth is basically the same drug as Aderall, so, yeah, it's essential that we teach people how to reduce the harms of using those drugs, as opposed to trying to coerce people through the criminal justice system into not using them. One of the projects at DPA that is most exciting to me is something called the “Safer Partying” campaign that's run by my colleague Stefanie Jones. She's been working for a number of years with night-life institutions and festivals to implement harm reduction programs and make harm reduction information available to the attendees. And to make that work, something that's expected of, if you're organizing a festival, you need to be provided these resources because it's inevitable that people are gonna using drugs in this context. In a number of countries pill-testing or drug-checking is widely available, it’s caught on a lot in the UK, in Australia and so, you know, we're working to trying to expand that in the US. Both Rhode Island and Maryland in the past year passed laws that we worked on to legalize drug checking. And that's one of the best ways, within a prohibition system, to reduce the harms of a unregulated drug supply, like we have with psychedelics. And the vast majority of people — even though there's been all this progress with the medicalization of psychedelics — the vast majority of people still see psychedelics as something that cannot be used safely and in moderation. 

One of the things — I work in communications — and I'm, really, into dorking out on, like, polling and messaging research to try and figure out what people’s underlying values and assumptions are about drugs. And something we tested a couple of years ago, was asking people about that question of, you know, "which drugs do you think could be used safely and in moderation?". And with MDMA, LSD, psilocybin — less than 20% of the population thinks that can be used safely and in moderation. So, a lot of the drug war myths that have demonized other drugs are still the case with psychedelics as well. 

Laura Northrup: So, it sound like with the “Safer Partying” campaign, you're basically saying that festivals or places that are gonna be having some kind of event where, it's like completely known that people use drugs at those events, that they would actually have some kind of area or system in place for people to test their drugs; and that would be something that, like, because they were throwing the event, these organizers would have at their events. 

Jag Davies: Yeah, or at least allow for it. There’s a number of groups in the US — DanceSafe is the most well known — that have been doing, you know, oftentimes, doing pill testing in an underground, unregulated way. You know, we're hoping that, in the future, we'll be able to work more directly with people who organize these events, which are the kind of places where people are most likely to have difficult experiences with psychedelics — as well as beneficial one, oftentimes — being in a large, potentially chaotic, setting. And where people can test their drugs to ensure that they're taking what they think they're planning on taking. Due to the lack of regulation around MDMA and other drugs, it's very common for them to be adulterated with other substances. Sometimes even there's been a few instances in the US of opioids like fentanyl getting mixed in with the MDMA supply, and so it's important for people to know what they're taking, whether or not they chose to take it or not, and that can help reduce a lot of the harms of living in a prohibition society. 

Laura Northrup: Yeah, and just to clarify, fentanyl is a drug that is very easy to overdose on, so, if it's in the MDMA supply, and people don't know that they're taking it, it's... there's a high potential for somebody to overdose. 

Jag Davies: Yes. Fentanyl is one of the strongest opioids available. There's something that's being called the iron law of prohibition: when a drug is made illegal, it inevitably leads to more potent forms of the drug. For example, during alcohol prohibition in the US, in the early 20th century... Before that, Americans primarily drank low-alcohol cider and beer... It wasn't until prohibition that people started to drink harder liquor a lot more, because it's a lot easier to transport. If you're gonna smuggle a barrel of something in from Canada, you're not gonna smuggle a barrel of beer, you're gonna smuggle a barrel of whisky or something. And it's the same principle when it comes to other drugs, like heroin or cocaine, where there's a profit incentive to develop more and more potent forms of... The more it gets cracked down on, the more potent and dangerous the drugs become. 

Laura Northrup: All right. You've been listening to an interview with Jag Davies, Director of Communications Strategy for the Drug Policy Alliance. Thank you so much to Jag for coming on the show. If you're interested in learning more, or getting involved with drug policy reform, the DPA hosts a conference called the International Drug Policy Reform Conference. The next one is in November of 2019. 

And before the show ends, I wanna share a little about my opinion on this topic. It's widely understood among healers that there is a very clear relationship between addiction and coping with trauma. If you take away all the stigma associated with each of these substances, and think of them like medicines for a moment, they each really do something incredible. Crack cocaine makes you feel like you're in control and capable, and that feels pretty amazing to someone who feels out-of-control and is struggling with self-worth. Heroin makes pain go away, and for someone who is living with intolerable pain, whether that's physical or emotional, that's pretty miraculous. Alcohol subdues fear, and for anyone living with intense anxiety, it is such a relief.

Trauma leaves us with lasting, intense emotions, that we often cannot handle on our own, And, as a culture, we don't have a lot of accessible ways for people to heal. So, a lot of people self-medicate for trauma with substances. The strange part about criminalizing substances is: it doesn't actually stop use, and, generally speaking, it just makes those substances more dangerous to ourselves and people we love. Criminalizing drugs is sort of like criminalizing people for trying to cope with trauma. I really see addiction as a mental health issue and public health issue, not a criminal issue. So, I'm pro-decriminalization. 

And obviously, because I'm making this series, I also believe that while some drugs push the feelings away, others actually help you heal them, which is what the rest of these episodes are going to focus on. So, we will leave at there for today, but please, join me next week, when I interview a survivor of childhood sexual abuse about healing with Ayahuasca. 

And, if you enjoyed this episode, please, subscribe to the podcast. To stay connected, and find out about my other projects, you can follow me on Instagram at @lauramaenorthrup. And, finally, many, many thanks to Joey Seward at Left Field Studios for volunteering a lot of additional audio engineering to make this series possible. If you need an audio engineer, he's excellent. You can find his website in the show-notes. Until next time. 

Many thanks to CHC & Nell for volunteering time to make this show more accessible by creating transcripts.