Psychedelic Medicine Has a Capitalism Problem, and We Need to Talk About It

The recent Psychedelic Science 2023 conference in Denver, Colorado was the largest gathering of its kind; the event hosted nearly 12,000 scientists, enthusiasts, artists, investors, and diverse members of the psychedelic community. Myself and hundreds of other reporters found ourselves packed into room after room filled to capacity with people enthused about the future of psychedelic medicine.

Many of these stages featured production values rivaling major music performances. The only thing that surpassed the sheer size of the gathering was the palpable passion of the guests and speakers alike, with Multidisciplinary Association for Psychedelic Studies (MAPS) founder and Executive Director, Rick Doblin going so far as to call this the start of the “psychedelic 20s,” during his opening address.

The conference also served as a microcosm of one of the larger issues in psychedelic medicine: The price of entry.

With three-day tickets starting at $805, the conference mirrored the current financial barriers within the psychedelic healthcare sector.

We should note that there was a scholarship program available, which is commendable, and feels aligned with the values of the psychedelic culture. However, we do want to open a door to a discussion about how high costs may impact accessibility within the psychedelic movement.

Psychedelic Science 2023 Opening Ceremony, Denver, CO, Wednesday, Jun. 21, 2023. (Photo/David Connell)

If you’ve been paying attention to news from states like Oregon, where psychedelic medicine could cost as much as $3,500 for a single session, then you’re probably not surprised. Psychedelic experiences may be affordable if you get them from the underground (though not always), but there are real concerns about high costs associated with (what may be) emerging clinics, retreats, and centers devoted to therapeutic psychedelic medicine.

For a moment, proponents of low-cost and community-access-style programs saw a glimmer of hope when Colorado voters passed CO. Proposition 122, which created the Natural Medicine Health Act. Initially Prop. 122 made room for unlicensed guides and facilitators who often offered significantly lower prices than those seen in places like Oregon, or the lusciously indulgent psychedelic retreats common in places like Costa Rica.

However, this recently changed when the state senate passed Senate Bill 23-90. The bill makes it much harder for unlicensed guides to offer psychedelic services. Even if it’s something as simple as a trip sitting. Instead, the senate version of the bill—which was signed by Governor Jared Polis, and goes into effect July 1st—shifts the focus back to licensed healing centers that require accredited professionals to run “healing sessions.” These professionals must be licensed counselors and therapists who will need additional training.

This brings us back to the conference, where Josh Hardman’s State of the Psychedelic Sector certainly didn’t pull any punches regarding costs. Hardman highlighted that the price for a single session of psychedelic-assisted therapy could run as high as $10,000, and said that psychedelics face a “problem of cost-effectiveness,” before moving on to showcase that treating 100,000 patients could rack up an insanely high price tag of $1,000,000,000. Yes, you read that right.

This astronomical number has more than a few people asking some important questions: Does psychedelic medicine have a capitalism problem? And if it does, why are so few (other than Hardman) willing to talk about it in detail? If we don’t face this issue directly, then how are we to find viable solutions?

I spoke with one attendee who had some very pointed issues with how much businesses in the psychedelic space are being driven by profit motives.

According to Branden Buck, a psychedelic enthusiast, and junior researcher, there’s a real concern that, “psychedelic medicine is going to become something that you can’t access unless you have thousands of dollars to throw at your mental health. If you think about it, this could drive people away from getting it [psychedelic medicine] in a professional setting, and push them towards the underground.” Mr. Buck certainly has a valid point; we’ve seen this happen before.

For a good example of what happens when you overregulate, and over-tax an industry, we can look to California. In a state where legal cannabis should thrive, it’s often still forced to compete against cheaper, black-market alternatives. This is due primarily to high taxes, and burdensome regulations that raise operating costs for businesses which are then forced to pass those costs on to their retail customers. For consumers, this can sometimes look like price gouging, but the reality is that high taxes and operating costs most often get passed on to consumers. We should also bear in mind that cannabis businesses across the 37 states, where it is legal in some form, cannot write off business expenses on their federal taxes. Again, passing burdensome regulatory costs to retail consumers.

This also illustrates that it’s not always business aiming to ensure maximum profits that is of concern. Regulations and tax systems can create a challenging baseline. If those tax dollars were to go back into funding for research and/or support for citizens utilizing these substances, that may make some sense. Though, businesses would still face profit barriers.

Suppose Hardman is right and costs for the average person run between $3,500-$10,000 for a single psilocybin-assisted therapy session. How will anyone other than the Jaden Smiths and Aaron Rodgers of the world afford it? And if the average person can’t afford it, will they even be interested in, or motivated to participate in the growing psychedelic renaissance? (Maybe that’s a bit of an exaggeration. There are certainly segments of the population who have disposable income who are not also hyper-wealthy celebrities.)

However, the point stands that the majority of Americans don’t have the kind of financial flexibility needed for psychedelic therapy (as it is now). This is an issue for many reasons, but one the most pressing is the fact that, according to a survey published by Bankrate, 57% of Americans can’t cover a $1000 emergency. While 76% of the U.S. population lives paycheck to paycheck.

So how do we make psychedelics more accessible or get people excited if they could easily go down the street and pick up an ounce of psilocybin (magic mushrooms) for as little as $90? Then ask their favorite trip sitter or experienced friend to keep an eye on them for a few hours, likely for free, or a few handfuls of shrooms. Of course, there is real value in having a professional, trained person guide you through a psychedelic event. But we already know this. The issue here isn’t value, but accessibility.

Another possible concern lies with just how new and unfamiliar psychedelic therapy is with some therapists. This contrasts with some indigenous practitioners who have been using psychedelics to heal for years, often at no cost to the individual. In this scenario we are effectively looking at a system where therapists with less experience (with these substances) charge much more.

Jaden Smith speaks about his experiences with psychedelic medicine during Psychedelic Science 2023, Denver, CO., Thursday, Jun. 22, 2023. (Photo/KCSA)

We do, of course, have to pause for a moment and admit that every business must make money.

Even our humble publication has to have money. Otherwise, we won’t have the funds to pay the writers that create the articles you (hopefully) enjoy and find valuable. That said, we aren’t talking about an ordinary industry. We’re talking about a new field of medicine that could completely change how medical professionals and patients deal with crippling mental health issues.

Unfortunately, this is something that few of the 400 experts at the convention wanted to address head-on. During a session with Dr. David Bronner of Dr. Bronner’s Magic Soaps, one attendee asked, “What advice can you give to people navigating the profit motive and dynamic in psychedelic business?” Unfortunately, the response she received only danced around the topic, with Bronner making promises to “share wealth with workers” and “create equity and representation for all communities.”

That is, of course, all well and good. And to his credit, Bronner does run a very equitable company. He was one of the first business leaders to offer his employees psychedelic-assisted therapy when he partnered with Flow Integrative to provide all of his employees with ketamine-assisted therapy. Bronner’s company has been lauded for its efforts to improve their employees’ lives. In an article published by RollingStone, Bronner himself talks about how he thinks psychedelics may be a cure for capitalism.

However, his answer, which makes sense for a consumer products company, does not address the larger problem, leaving several issues that the industry still needs to face. Particularly those in the business of making, and distributing, and/or administering these medicines.

Ultimately, Dr. Bronner may not be the best person to address this issue. Rick Doblin, however, is, and had this to say: “With the MAPS public benefit corporation, there’s always this balance between public benefits and profits. I think we have to be very vigilant about that.” Adding, “On the one hand, there’s the danger of becoming over-focused on profits, but on the other hand, there’s the access to capital [needed for research and advocacy].”

Doblin also raised concerns about how pricing and training may be affected by the current, profit-focused system, saying, “Pharmaceutical drug pricing is a challenge, and a lot of people don’t even have insurance. So is there willingness over time for psychedelic pharmaceutical companies to try to minimize the amount of therapy or minimize the training of the therapists so that the total cost is lower so that it can be more easily covered by insurance? I worry about that. I worry about all the people who don’t have insurance.”

Doblin lays out some clear issues. Capitalism is what’s funding the psychedelic renaissance. It’s how the researchers and leaders in space have managed to do the amazing work that has brought the psychedelic movement to where it is today. But it can, and maybe is, at risk of getting out of control.

There is an inherent conflict that arises when a largely capitalistic approach is taken toward psychedelic medicine. Nick Hilden had a chance to speak with Michael Pollan at PS2023, and Pollan offered some concerns about capitalism in the industry. Saying, “I think it’s a legitimate concern. The efforts to lock up the IP and the patent gold rush are really questionable, considering how old these substances are. In general, so far though, the commercialization of psychedelics has been a failure. Companies are going out of business before they get to market. It’s kind of remarkable that with all this capital and with all this talent, I don’t think anyone has figured out a viable business model yet.”

The aforementioned conflict raises two significant questions. The first is that the prevalent, medical-only model may continue to contribute to restricting access to, and prolonging the prohibition of, the adult use of psychedelic medicines, while also increasing problems with affordability.

This is partly due to the costs, regulations, and restrictions inherent to the “healing center” model. The result could be that a handful of companies end up as gatekeepers of the emerging psychedelics industry, potentially inhibiting research, stifling innovation, and limiting access to necessary therapies​. These companies must also engage in typical business practices. They must raise capital, recruit, train, and retain staff, defend potential patents (in some cases), and spend resources acquiring additional patients. All of which drive up costs.

Here’s an example of what just startup costs could look like in a state like Oregon, which focuses solely on a “healing center” model:

A second key concern is that the dominant narrative around psychedelics often focuses almost exclusively on individual medical uses, neglecting their potential for collective benefit. Some examples of those benefits to society as a whole might be: improved mental health outcomes, decreased instances of substance abuse disorders, and increased personal satisfaction with life in general. For society as a whole that could potentially mean less time out of work, increased wellness in family units, and decreased need for drug related rehabilitation services and less money spent on hospitalization, prevention and incarceration of individuals with substance abuse problems.

Those profound impacts of psychedelics are shaped by the intention and context of their use, and it’s possible that their revolutionary potential may be overlooked if we focus solely on their medical uses​.

Focusing solely on the medical and clinical side of psychedelics also removes other important aspects from consideration. Do individuals and community groups not have a right to use psychedelics for personal, religious, or spiritual growth? If not, are psychedelics another tool to continue making Americans more productive? To get them out of depressed, traumatized, or anxious states and back into the workforce? Then, consuming goods and services with the money they earn in the workforce? Hopefully not.

The truth is that pure capitalism isn’t the right fit for psychedelic medicine. To truly harness the potential of psychedelic therapy, we need to consider a more nuanced approach. One that balances the capitalistic drive for development and distribution with the need for accessibility, affordability, and collective benefit.

As the psychedelic sector continues to evolve, the conversation must expand beyond just the cost-effectiveness of these therapies to include their potential to facilitate personal growth, improved mental health, and greater social equity.

So what, if any, solutions are there?

One of the easiest fixes to the current capitalistic model has been the attempted inclusion of community-based models for psychedelic healing. John Dennis, Executive Director of Vital Oregon, made several attempts to introduce both community-based models and religious use exemptions to the state’s psychedelic services bill during the 2022/23 rule-making process. Unfortunately, his attempts were voted down by the Oregon Psilocybin Advisory Board, who said that this was beyond the scope of the committee’s authority. But the idea itself is sound.

Community-based models (meaning getting mental healthcare in your community, such as your church, community center, school, etc., instead of in a clinical or institutional setting) can be effective for a variety of reasons. Often they are operated by non-profit organizations that do not have the same profit motive as businesses. They may also improve accessibility by lowering costs and providing access to underserved, geographically isolated communities. Furthermore, they are more likely to be better attuned to the local cultural nuances of their area, and could also offer better peer support networks to their fellow community members.

Another option could be found in group therapy models. Dr. Alex Belser, MPhil, Ph.D., and a senior psychedelic researcher at Yale School of Medicine, voiced his support for group-based models, saying, “I think the field is looking to the wisdom of indigenous people and to the wisdom of underground practitioners who have been well practiced with group therapy work where you could have a group of 12 or eight people with a handful of clinicians. Safely. Feasibly. Providing a good setting for people to do good, really good work to relieve depression, anxiety, or addiction.”

There is also a third option, at least for Americans. Adopting a single-payer system, such as medicare for all, that makes access to healthcare a right (this also makes assumptions about the future FDA approval and subsequent rescheduling of drugs like MDMA, psilocybin, DMT, and more). This is something that’s supported by some leaders in the space, with Rick Doblin saying, “The whole American healthcare system is so screwed up, and it’s screwed up because of the profit motive and because we have profits over people.”

Of course, these are just a few ideas. There are bound to be more, and other, minds ready to bring people together to find solutions that work for all. Maybe part of the problem is that psychedelics are supposed to make us think in new ways. Yet some of the people leading the psychedelic movement are just going through the same motions, in the same ways, with the same processes.

However, the more we talk about it, the more we ensure it remains a meaningful part of the conversation, the more we can expect bright minds and passionate people to create positive change so that there can be a complete spectrum of accessibility possibilities within the psychedelic medicine ecosystem.

Until then, the question remains: Is the psychedelic community ready to have this conversation? The clock is ticking, and the time to address the capitalism question in psychedelic medicine is now.