By Vincent Joralemon
There is little consensus in defining “psychedelic.” Yet, research on and access to these substances hinges on what gets included in the “psychedelic” umbrella. It is time to talk about why we include (and exclude) particular drugs from this category.
Grants, Research, and Medical Codes
This matters because funding will flow from this categorization. Besides grants for “psychedelic” research, the FDA just released draft guidance on considerations for psychedelic clinical investigations with an ambiguous definition of what is considered to be a “psychedelic.” When we discuss FDA clinical trials, we’re talking big money, so clarity matters here.
Insurance coverage codes will also be a big issue here. At least some insurance plans have indicated they will cover “psychedelic therapy,” and the AMA created an insurance code reimbursement class called “psychedelic therapy” earlier this year. Psychedelic therapy isn’t cheap — so coverage is key to expanding access. To be reimbursed through these codes, a drug needs to be recognized as a “psychedelic.” Who controls that distinction?
Psychedelic Etymology
First, a bit of etymology. Dr. Humphry Osmond offered the word “psychedelic” at the New York Academy of Sciences in 1957 (“to fathom Hell or soar angelic, just take a pinch of psychedelic”). Osmond said the word meant “mind manifesting” (from the Greek “psyche” for mind or soul; “deloun” for show). Yet, much of the medical industry, including Osmond, shifted to using “hallucinogen” in the 1970s (the DEA still uses “hallucinogen” instead of “psychedelic”).
When I was in the D.A.R.E. program in the 1990s, they were still teaching us about “hallucinogens,” not “psychedelics.” And we were taught they were bad. Yet, organizations such as the Multidisciplinary Association for Psychedelic Studies (MAPS) have continuously used the word “psychedelic” when advocating that these drugs had a lot that was good about them.
Somewhere along the line, the category of “classical psychedelics” emerged; LSD, mescaline, and psilocybin are pretty much always included in that group. These drugs all cause similar subjective “tripping” effects, including alterations in perception and cognition that bring about mystical experiences that are both indelible and ineffable. And, all modulate the 5-HT2A receptor, which is linked to a reduction in the default mode network and increased functional connectivity between regions in the brain.
Here’s a catch: many people (myself included) also include ketamine and MDMA as “psychedelics.” Both drugs cause a lot of the effects that LSD and psilocybin do (altered perception, euphoria, etc.). But neither fits the “classical” formula:
- Ketamine’s psychedelic effects likely come from glutamate/NMDA receptor modulation.
- MDMA primarily works through rapid serotonin and dopamine release (and maybe also 5-HT2A receptor modulation).
So, should we somehow include these substances by broadening our “psychedelic” demarcation?
Psychedelics and Drug Normativity
Expanding the definition of “psychedelic” too far, however, presents some issues. PCP (“angel dust”), methamphetamine (“meth”), and DPH (the potentially psychoactive ingredient in Benadryl) are useful to illustrate this next point:
- I seldom hear PCP mentioned as a psychedelic. Yet, PCP modulates the same receptor complex as ketamine (in fact, ketamine is a PCP derivative), and brings about subjective distortions similar to that of ketamine (dissociation, euphoria, etc.).
- Likewise, I’ve never heard meth called a “psychedelic.” Yet, here’s a study that says meth causes a release of oxytocin that increases feelings of social connectedness — just like MDMA!
- Finally, you would be a pariah if you advocated for the psychedelic benefits of “deliriant” drugs like DPH. Yet, the internet is ripe with stories of people taking large doses of the drug and hallucinating a “hat man.”
Why don’t we ever see PCP, meth, or DPH discussed in “psychedelic” circles? The answer is that these drugs have terrible reputations as dangerous substances that make people do awful and criminal things. This reveals a significant point: the term “psychedelic” attaches normative weight.
What counts as a “psychedelic” transcends mere neurochemical methods of action, legal status, or subjective experience. Instead, “psychedelic” is now used to differentiate: to signal that these drugs are “good” or “healthy” enough to endorse, and differ from other drugs that are too “bad” or “dangerous” to make the cut.
This definitely makes me uneasy, but I also acknowledge a lot of people put in a lot of work to make “psychedelics” more palatable to the public. With that comes some gatekeeping — “psychedelics” have a brand to maintain!
The public holds a highly unfavorable view of drugs like PCP and meth. If you think drugs like LSD and MDMA carry immense therapeutic potential, you want to improve and maintain their public perception! That means avoiding connections with such unpopular substances. So, we include LSD and MDMA and exclude PCP and meth from the label of “psychedelics.”
Stop Assuming, Start Enumerating
I understand we need to draw lines somewhere here — there’s good reason to differentiate “psychedelics” from “hallucinogens” or “deliriants.” Maybe soon, a court case over a contract will start with: “The issue is, what is psychedelic?” (For the non-lawyers, I’m referring to this classic case). Until then, we need open discourse, or at the very least, a commonly recognized heuristic to classify these substances. What bothers me is when these distinctions are not specified — and we just rely on influential figures in the psychedelics field to discuss whichever drugs they deem suitable.
When we leave our assumptions silent, there is little opportunity to critique them. This risks perpetuating insidious forms of drug elitism informed by problematic notions of classism or racism (remember the disproportionate punishment of crack v. cocaine?). Instead, I wish that academics, government officials, and businesspeople would, at the very minimum, pre-establish what metrics determine if something is “psychedelic.” At least then, such a definition would be subject to analysis and discussion.
The best way to identify problematic assumptions is through meaningful dialog; if we say what we think is (and is not) a “psychedelic,” we invite others to critique those classifications. This field is too important not to develop a more thoughtful definition for “psychedelics.”
