Patients Before Patents

“Psychedelics, like pharmaceutical products, are just going to be inaccessible to many, many people,” says Professor Susi Geiger, a patent expert from University College Dublin. Step one to ensuring equitable access, and giving hospitals some respite from the straightjacket that often forces them to pay well over the odds for drugs, is reforming a patent system that enables Big Pharma to hike prices on existing drugs cartel-style thanks to the monopolies they enjoy over their products. To prevent the far-out possibility of Google founder Sergey Brin controlling the price of certain psychedelic therapy protocols, Geiger suggests a complete moratorium on private patents over psychedelics. “That’s the equivalent of nationalizing it at the source and keeping it as a public good.”

The idea may sound utopian and raise more questions than it immediately solves, even if the US patent office got on board and Congress created a European-style semi-socialized health care system, free at the point of use. “How can we trust exclusive access through a national health service when the state has only previously handled access [to psychedelics] through prohibition and religious censorship?” asks Chris Byrnes, a patent attorney at CalyxLaw. Matt Brockmeier, counsel at Antithesis Law, says less charitably: “I don’t trust the federal government — this or any other administration — to oversee something as monumental as our collective consciousness. Their track record is abysmal; they ruin everything they so much as look at because of the influence of special interests, fraud, waste, abuse, outright corruption, and general incompetence.”

Byrnes argues that any such plan would require a “built in, hard-coded tax” to serve as a reparations or reciprocity fund. This would, he contends, be owed to indigenous communities who stewarded the knowledge of psychedelic medicine in Mexico, Gabon, and elsewhere for centuries, despite serious persecution aimed at stifling their preestablished spiritual practices. He cites proposals by the Chacruna Institute, an anthropology-focused psychedelic research organization, which has promoted the idea of reciprocity between the nascent psychedelic industry and the psychedelic-using communities that suffered during colonialism. “What models do we have where the US government has rightly been trusted to honor any treaty with indigenous peoples?” (More recently, social-equity initiatives in states that have legalized cannabis have also often fallen flat, bogged down by bureaucracy, lack of political will, and lawsuits from companies that claim the equity companies would be unfairly advantaged competitors).

Still, Byrnes suggests, psychedelic medicine could be uniquely placed to “cure the rampant mental health illness” of the society that resulted from colonialism, even if a trip does not always crush the ego and make humble men of megalomaniacs. In August, a hopeful AI-generated video featuring Donald Trump discovering ayahuasca went viral. In the clip, the former US president undergoes a moral metamorphosis, subsequently growing a beard and devoting his life to genuine public service. “I left politics to heal myself,” the fictional rendering of Trump says. “I gave away most of my possessions and I went to India and meditated with the gurus. . . . I purged everything that I thought made me great.”

Not everyone, however, emerges from the psychedelic experience with more humility.  Some gain “a heightened sense of righteous purpose,” according to drugs writer Rich Haridy in Salon, with no reckoning for any wayward beliefs. Citing research, he adds that “psychedelics just amplified a sense that they were the only ones that could save the world.” Photographer James Oroc, meanwhile, wrote in an influential book on psychedelic culture, “We are the 5 percent who have to help humanity move into its next phase, the recognition of our own divine origins.” This “more-evolved-than-you” discourse is only increasing in certain circles.

Still, it does seem that for many people, psychedelic medicine could provide relief from mental health conditions like depression, anxiety, and PTSD, for which the current treatment options often tend to mask symptoms, rather than get to their root. “In a very good way, [nationalization] would theoretically make us at Thank You Life obsolete,” says Kevin Cannella, the CEO of the nonprofit, which helps people access psychedelic therapy through grants from high-net-worth individuals. “We exist because there’s inequitable access. And so, if access isn’t an issue, how great of a win would that be?”

Public Control

As it stands, Oregon is the only place in the United States where Americans can legally take a classical psychedelic — namely psilocybin — under supervision. There are a few lower-cost options, which do not include subsequent talk therapy, but for an entire package the fees are in excess of $3,000 up front. The costs of undergoing ketamine-assisted therapy under supervision are not dissimilar. Better-off Americans also spend more than $10,000 to go on luxury psychedelic retreats in Jamaica, Costa Rica, and Mexico.

“For the majority of potential patients, the lack of insurance coverage is a serious challenge: It’s one of the prime reasons they can’t pay the sky-high prices, and it’s the difference for all too many between getting treatment and forgoing it, or between getting treatment and going into debt for it,” wrote Alissa Quart, the executive editor of the Economic Hardship Reporting Project, in the Nation in May. Psychedelics, not long out of the criminal underground, have swiftly been swept up in an “investor bonanza,” she writes, and the industry could be worth $8 billion by 2028. “Eager to turn therapeutic promise into corporate profits, billionaires like Peter Thiel have gotten in on the action, infusing money into biotech start-ups racing to patent new psychedelic compounds, while pharmaceutical companies scramble to concoct their own psychedelic treatments.”

Big Pharma (the big beasts of the industry) has been slow to get involved with psychedelics. The drugs do remain federally illegal, after all, and the research proving their efficacy is far from beyond doubt. Still, public funding bodies are already giving cash to universities to undertake research, the findings of which will then be patented by private companies working with them. As in wider health care, this arrangement raises the question of why the taxpayer should fund research that ends up underpinning private profits. Perhaps more alarmingly for psychonauts, it seems like certain organizations are more interested in taking the trip out of psychedelics than letting everyone turn on, tune in, and drop out.

Companies like AbbVie are investigating the potential of “pseudodelics”: trip-free, psychedelic-like drugs that have been modified to remove the possibility of hallucinations. “The thought of having a full-blown spiritual awakening in a doctor’s office has always felt a little awkward, hasn’t it? Maybe the solution is a hard fork after all,” psychedelic industry newsletter Tricycle Day joked recently. For believers, the efforts are yet more indication that the system will inevitably squeeze the magic out of the medicine.

There is an even more fractious debate within the psychedelic community between advocates of psychedelic use in medicalized settings and those who favor psychedelic use in community settings, like group ceremonies. Medicalization advocates say that harm, abuse, and dreaded bad trips are more likely outside of controlled settings. But following one of the MDMA trials, a therapist established a sexual relationship with a vulnerable former participant. The much-discussed episode, which later led to studies being entirely retracted, shows that medical settings for psychedelics are not impervious to the issues that manifest in hospitals and clinics across the world.

The original plan for psychedelic medicine, as devised by its campaigning trailblazer Rick Doblin, who founded the Multidisciplinary Association for Psychedelic Studies (MAPS), which masterminded MDMA therapy’s ultimately doomed passage toward FDA rejection, was for “human wellness over profit,” but he was unable to secure enough philanthropic funding to take it all the way. It was “my dream for the whole time to try to have nonprofit ownership,” Doblin said in a company newsletter. “I wanted the returns to go back to the nonprofit.” Eventually, the MAPS breakaway corporate outfit Lykos even disavowed Doblin’s fiercely antipatent stance when it filed for intellectual property rights related to MDMA.

Whatever happens next, support for psychedelics in Congress is growing, and we are beyond a cultural point of no return from the evidence-lite decades of demonization and stigma. However, while this increased support and buy-in from celebrities who have enjoyed drinking ayahuasca signals something like progress, it also highlights a seeming paradox. Psychedelic medicine, despite its indigenous history, often presents itself as innovative and postmodern. But the real novelty would be to return to a quite basic idea: a public good ought to be in public hands.