If a single line endures from the psychedelic carnival of the 1960s, it’s probably Harvard psychologist and psychedelic cheerleader Timothy Leary’s catchphrase “Turn on, tune in, drop out.” A call to wake up, reject the norms, defy authority, protest the war.
Today, there is a new psychedelic fervor, best captured in a very different sort of pithy quip: “I finally understood Bitcoin.”
That was German billionaire Christian Angermayer, expounding last year on the ability of magic mushrooms to not only light up his world with colorful hallucinations but also facilitate a deeper understanding of cryptocurrencies, which are ideally suited to tax avoidance and money laundering.
Welcome to the strange new world of “psychedelic capitalism,” where dozens of start-ups have already raised millions (and in some cases billions) of dollars to commercialize psilocybin (the psychedelic ingredient in magic mushrooms), DMT (found in the Amazonian brew ayahuasca), mescaline (peyote’s active component), and LSD—despite the fact that all of these “classic psychedelics” are still ranked as Schedule I drugs under the federal Controlled Substances Act. Manufacturing any of these drugs without a license can still land you a long prison sentence. But marketing one, even though they all remain illegal and none have passed all the clinical trials required for approval? That can make you a millionaire.
Fifty years ago, how was Leary rewarded for his proselytizing? Richard Nixon labeled him “the most dangerous man in America,” Harvard stripped him of his academic position, and he was arrested more than 35 times.
Angermayer’s comeuppance? He is currently listed as one of the 200 richest people living in the UK, his incubator ATAI Life Sciences is valued at more than $2 billion, and he was given the honor of ringing the Nasdaq bell on Wall Street last June.
The days when mind-bending psychedelics were seen as appealing only to drug dealers, nut jobs, and hippies are over. Today, serious-minded people interested in randomized controlled trials and stock valuations are leading the charge.
The “psychedelic renaissance” we’ve awaited for half a century—the promised era when acid, shrooms, and peyote would be brought back into legitimate research and legal access—is finally here. But will it turn out to be worth the wait? Or the hype?
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Because it’s not like we ever stopped enjoying them: In the West, hippies, scientists, “healers,” and others have used psychedelics continuously for seven decades. And before we got our hands on them, Indigenous cultures used psychedelics for thousands of years as ritual sacraments. Now dozens of start-ups want to standardize, commercialize, alter, patent, and market these ancient compounds—and they stand to make a fortune doing so.
Will old-school profit-centered tactics bring down decades of dogged work by activists, scientists, and reformers to have these drugs reassessed for their virtues? Will we experience another nasty, research-smothering backlash?
Or could psychedelics become merely… boring?
Half a century ago, chemists, psychologists, artists, and good old-fashioned do-nothing hippies preached the virtues of psychedelics. Most gave the drugs away free—as did Sandoz Chemicals, the Swiss firm where the psychedelic properties of LSD were discovered in 1943, which later distributed it to American psychiatrists for research purposes at no cost.
Some wanted to explore the drug’s effects on consciousness. Others wished to discover medical therapies. Many thought they could change society. But almost nobody thought they could monetize the molecules.
Now a different breed is seeking to commercialize these once-taboo drugs: entrepreneurs, venture capitalists, Big Pharma—and, of course, tech giants.
More than 50 publicly traded companies working to develop or administer psychedelic compounds are now operating in America—three of them already valued at over $1 billion each: Angermayer’s ATAI Life Sciences, Compass Pathways, and GH Research. By some estimates, the industry is projected to soar from $2 billion in 2020 to $10.75 billion by 2027—which would be an even faster rate of growth than that of the cannabis market. Hence the trading floor shorthand for psilocybin: “the next marijuana.”
For 50 years, scientists have quietly, sometimes illicitly, toiled to bring these molecules into mainstream medicine. Now they have the backing of Big Pharma—the most profitable sector of industry on the planet. But with Big Pharma’s money comes Big Pharma’s tactics: restrictive contracts, exaggerated claims, costly lawyers, misleading advertising, and endless patent wars.
“It’s normal for these companies to try to block competitors from creating cheaper generic drugs through aggressive patents—that’s how they’ve always operated,” says Dr. Eduardo Schenberg, a Brazilian neuroscientist. So we shouldn’t be surprised to see such strategies become commonplace with psychedelic start-ups, no matter how edgy their origins.
Many in the old vanguard—including some of those responsible for the very studies that newcomer start-ups are now monetizing—worry that traditional business strategies, driven by shareholder profits instead of patient needs, could jeopardize the future of the entire field. As an editorial published last month in the Journal of the American Medical Association bluntly put it, “The first wave of psychedelic research was disrupted by conflict between cultural and political forces. The current wave of psychedelic research could be susceptible to an emerging conflict between entrepreneurial enthusiasm and scientific deliberation.”
The roots of the psychedelic start-up boom can be found in the square 1950s, when LSD was legal and psychiatrists were free to explore its potential to treat alcoholism, depression, anxiety, and other afflictions. Long before it leaked from the lab and became a notorious party drug, psychiatrists were using acid not just to probe the mind but to attempt to heal it. Albert Hofmann, the Swiss chemist who first synthesized LSD while working at Sandoz Chemicals in 1943, believed it could revolutionize psychiatry and inspire a generation of artists and intellectuals.
Some of the early trials were promising. Consider, for instance, the studies carried out at the Weyburn Mental Hospital in Saskatchewan by Dr. Humphry Osmond—the British psychiatrist who gave mescaline to Aldous Huxley, inspiring the book The Doors of Perception (1954).
Osmond and other psychiatrists believed they could cure alcoholism by using LSD to induce the symptoms of delirium tremens, the shakes, seizures, and hallucinations that accompany alcohol withdrawal. Patients would be scared straight by the experience, they hoped. In fact, the opposite happened, though with the same intended outcome: Patients found their acid trips invigorating and rejuvenating, reducing their desire to drink and restoring their desire to live.
This echoed the way Hofmann himself described his first LSD experience: “A sensation of well-being and renewed life flowed through me,” he said.
Between 1954 and 1960, Osmond treated more than 2,000 problem drinkers with LSD at Weyburn. Over 40 percent of them were still sober a year later. Compare that with the 12-step program Alcoholics Anonymous, which (despite the myths) has a success rate of less than 8 percent.
Cary Grant—who took LSD more than 100 times to process his childhood trauma—may have put it best: The drug, he said, provided “an immeasurably beneficial cleansing.”
But the dream that LSD could revolutionize psychiatry fell apart in the 1960s with the counterculture explosion and its attendant backlash. Scientists, therapists, politicians, and parents were all alarmed. Hofmann—who was a great fan of LSD, enjoying it himself until the age of 96—despaired, calling the drug “my problem child.”
In 1971, as part of the Nixon administration’s War on Drugs—and on Black America and the counterculture—lawmakers in the US deemed LSD to have “no medical value” and shunted it into Schedule I of the Controlled Substances Act, the most restrictive category of drugs. Clinical studies evaporated. Therapists retreated into the shadows.
For decades, underground therapists, drug reform activists, and optimistic scientists quietly kept the flame alive, hoping one day to bring these drugs back into respectable research. Therapists treated clients in secret. Reformers slogged through bureaucratic paperwork. Scientists toiled over tiresome grant applications.
Now their efforts are finally bearing fruit. The reemergence of psychedelics into mainstream medicine is one of the biggest medical news stories of the past two years. Those who diligently worked for 50 years toward this goal are finally seeing their dreams realized.
Last April, a long- awaited trial from Imperial College London demonstrated that psilocybin is just as effective as escitalopram (better known as Lexapro) a common SSRI, at combating depression, with the results published in the world-renowned New England Journal of Medicine. Less than a month later, another long-anticipated study, examining how MDMA could aid in the treatment of post-traumatic stress disorder, was published by Nature Medicine. And in the past three years, Ann Arbor, Denver, Oakland, Washington D.C., and the entire state of Oregon have all voted to decriminalize psilocybin to lay the groundwork for legal therapeutic use.
Regulatory agencies have taken note. The Food and Drug Administration granted “breakthrough status” to psilocybin-assisted psychotherapy for “treatment resistant depression” in 2018, thus recognizing the treatment as a “substantial improvement” over conventional therapies. By treating depression with a completely new mechanism of action, psilocybin-assisted therapy has changed the playing field—and thus will be sped through regulatory hurdles for further study and eventual approval. MDMA-assisted therapy for PTSD has received the same status.
Naturally, headlines in the mainstream media have amplified the excitement. From The New York Times: “The Psychedelic Revolution Is Coming. Psychiatry May Never Be the Same.” From CNN: “Psychedelics: Can Getting High Improve Your Mental Health?”
Rick Doblin, founder of the nonprofit Multidisciplinary Association for Psychedelic Studies (MAPS), has worked for decades to achieve such a breakthrough. And he’s not worried that we’ll see a backlash like we did in 1971.
“Society is in a fundamentally different place compared to 50 years ago,” he says. “Back then, taking psychedelics meant you were against the war in Vietnam. Now we have bipartisan support from Republicans and Democrats for the treatment of veterans with MDMA for PTSD.” Doblin points to Rick Perry, the former governor of Texas, and Jeff Shipley, an Iowa state representative, as two Republicans who have endorsed psychedelic therapy for traumatized soldiers.
Psychedelics have long had the ability to be all things to all people: therapeutic tools, creative lubricants, weapons of warfare. As psychedelic therapy pioneer Stan Grof put it, they are “non-specific amplifiers.”
As such, they have always attracted a wide range of fans, including the conservative and the powerful. In 1955, the straitlaced British politician Christopher Mayhew took mescaline as part of an experiment and had his experience filmed by the BBC. (Sadly, the episode never aired.)
And before the hippies got their hands on it, the US military and intelligence agencies had their own love affair with LSD, documented in delightful detail in Martin A. Lee and Bruce Shlain’s 1985 book Acid Dreams. At one point the CIA ordered 100 million doses of LSD directly from Sandoz Chemicals—enough for every adult in the United States. The agency’s intention? Nobody knows.
However, we do know that thousands of CIA employees consented to being dosed with LSD in the 1950s to explore how the drug could be used as an interrogation tool, a torture aid, and an enemy “destabilizer.” As one employee put it, “surprise acid trips became an occupational hazard.” Yet despite dropping acid dozens or hundreds of times, these CIA employees remained committed to the military-industrial complex. So much for Leary’s claim that kids turned on to LSD “won’t fight your wars.”
If Leary had known his history, he would have been well aware that psychedelic use is by no means an impediment to violence. In the Middle Ages, when gearing up for raids, Scandinavian explorers would routinely gorge on Amanita muscaria, or fly agaric mushrooms.
In Central America, Mayan priests were high on a teonanacatl mushroom brew during the ritual sacrifice of hundreds of live victims, including infants. And throughout the Amazon, ayahuasca was used to aid in witchcraft, curses, and raids on neighboring villages. The modern era, too, has seen its fair share of psychedelic-dropping murderers and maniacs, the most famous being Charles Manson—but in recent years, plenty of others have come to light.
Now, with so much money on the table and breathless headlines celebrating psychedelics as miracle cures, the newcomers jumping into the industry are stranger and more diverse than ever before.
Silicon Valley has long been enamored with psychedelics and their counterculture origins. Tech CEOs love to cite Steve Jobs’s (dubious) quote that LSD was “one of the most important things” he’d ever done—and have long been fascinated by ayahuasca, summed up nicely in an Onion headline from 2016: “Ayahuasca Shaman Dreading Another Week of Guiding Tech CEOs to Spiritual Oneness.” For years, executives have come back from the jungle bearing tales of enlightenment—and plans to make a killing. A group called Entrepreneurs Awakening has provided psychedelic-assisted executive coaching since 2012—including a 10-week Amazon Ayahuasca Mastermind Retreat Program.
But you might be surprised to learn that mining companies are also getting in on the action. A four-part series published by the nonprofit organization Psymposia in 2020 documented the new wave of Canadian mining companies investing in psychedelics. Why these firms in particular? As Russell Hausfeld of Psymposia summarizes, “Canada has lots of failed mining companies littering its stock exchanges that are ripe for takeover.” For psychedelic enthusiast investors, acquiring a bankrupt or nonoperational mining company—which still exists as a legal entity—allows for instant access to the stock market and the ability to raise abundant funds without the scrutiny that an IPO would bring.
In this way, publicly traded psychedelic entities can appear instantly on the Toronto or Vancouver stock exchanges—even when the executives lack any experience with pharmaceuticals, psychedelics, or any other kind of drug.
Take Toronto’s Field Trip Psychedelics, created in a 2020 reverse takeover of the Canadian oil and gas company Newton Energy Corporation—and now worth close to $253 million.
Or consider Numinus Wellness Inc., a Vancouver psychedelic company with a market cap of $126 million created in a reverse takeover of the mineral exploration outfit Rojo Resources Ltd. Google Numinus and you’ll see it was ostensibly “founded” in 1964, long before serious corporations would go anywhere near psychedelics. Numinus is the first start-up to ink a deal with psychedelic institution MAPS, which was founded in 1986—decades before these new companies existed (and, indeed, years before many of their CEOs were born). But it probably won’t be the last.
The list goes on. The psychedelic start-up Mind Medicine—MindMed for short—grew out of a reverse takeover of Broadway Gold Mining Corp. NovaMind Ventures Inc. went public in a reverse takeover of Hinterland Metals Inc. And throughout the industry, executives who used to steer the direction of mineral extraction and other mining companies are now in high positions with some of the leading names in psychedelics.
Professional athletes, too, have been hopping on the psychedelic bandwagon. Some, including Mike Tyson, have vouched for the efficacy of psychedelics in treating traumatic brain injury. Predictably, the headlines tend to focus on celebrities like the tattooed boxer (who, let’s not forget, is also a convicted rapist). But the science behind his claim is solid. Many studies, such as one that appeared last year in the journal Frontiers in Neuroscience, have confirmed that psychedelics, which bind to the serotonin receptor—including psilocybin and DMT—can repair nerve endings.
Then there are the religious freedom advocates, who argue they deserve access to psychedelics as a First Amendment right—just as the União do Vegetal and Santo Daime churches in Brazil successfully argued for their right to use ayahuasca in the US.
Thankfully, some of the eccentric characters from the last psychedelic wave are still around. One of the most noteworthy is Amanda Feilding, Countess of Wemyss and March. Nearly 80 years old, Feilding lives in a Tudor manor in Oxforshire featuring three moats. Years before most VCs, tech bros, and financiers expressed any interest in psychedelics, Feilding supported research into the compounds with her charity the Beckley Foundation.
“But nobody wants to give me any credit, because I’m a woman, I’m old, I’m an aristocrat, and I’ve got a hole in my head,” she complained to me in 2015.
You read that correctly: Feilding has a hole in her head.
In 1966, Feilding was introduced to the ancient art of trepanation—the strange practice of boring holes into the skull that has cropped up in cultures across the globe, from China to Africa and Central America.
Feilding believed increasing blood flow to the brain by relieving the pressure of the skull would allow her to achieve a permanently enhanced state of consciousness. Unable to find a surgeon in London willing to perform the procedure, she did what any sensible person would: She did it to herself. With a dentist’s drill. On acid.
Unfazed, she then wrapped her head in a colorful scarf and headed to a party.
Effusive young millionaires hoping to cash in on the psychedelic boom might get more airtime with noisy press conferences about patent portfolios or stock market valuations, but none of those joiners can come close to matching Feilding’s contributions. She may have a hole in her head, but she deserves enormous credit for pouring large volumes of energy, blind faith, and—above all—raw cash into psychedelic research in an age when few others would fund or pursue it.
Feilding’s not the only one to see their contributions overshadowed now.
“You’ve got all these new companies that have been set up by people I’ve never heard of…people who have never done any research in this space until they saw psychedelics as vehicles for investment. And it does concern me,” complains David Nutt, the director of the Neuropsychopharmacology Unit in the Division of Brain Sciences at Imperial College London, who has partnered with Feilding and the Beckley Foundation for many years.
“Most of these companies are driven simply by commercial gain, rather than the need to treat patients,” Nutt says.
When I began researching the history of psychedelic therapy 10 years ago, it was hard to imagine that there had been a time, before the War on Drugs, when these molecules were seen as miracle cures and investigating them wasn’t considered career suicide.
Now every day a psychedelic start-up announces plans to “revolutionize health care”—backed by a war chest of millions (or billions) of dollars.
It’s widely acknowledged that many of these newcomers are in this only for the short term and will prove to be nothing more than old-fashioned pump-and-dump schemes. Given that the start-ups who bark the loudest on social media are also the youngest, this is easy to believe.
“They only exist to ride out the current boom without having any substantial concerns about the science,” Nutt says.
Still, the net worth of some of these companies is staggering, especially considering that they are marketing drugs that are still in the research stages and have not even passed clinical trials.
Take Toronto’s Cybin, worth an estimated $278 million. New York’s MindMed comes in at $924 million. GH Research in Dublin and Compass Pathways in London are valued at $1.3 billion each. And, of course, there’s Angermayer’s ATAI Life Sciences, at an eye-watering $1.9 billion.
Moreover, the provenance of that money has raised eyebrows. It comes not only from the predictable tech industry figures who have long touted the performance-enhancing virtues of “microdosing” (for which there is little evidence), but also, curiously, from figures on the far right.
Take Rebekah Mercer (whose family has financed Donald Trump, Steve Bannon, and Breitbart News), who donated $1 million to MAPS.
Or consider the billionaire Peter Thiel, who owns a 7.5 percent stake in the psilocybin giant Compass Pathways. Last November he casually plowed another $12 million into ATAI Life Sciences, keeping the German firm at the forefront of psychedelic start-ups. Thiel, to refresh your memory, cofounded not only PayPal but also Palantir, the data analytics firm responsible for facilitating the National Security Agency’s surveillance of the whole world and the separation of migrant children from their families at the Mexican border. Not exactly the guy you’d imagine selling shrooms.
Hippie paeans to “mystical experiences,” “ecological empathy,” and “embracing oneness” have been supplanted by talk of “vertical integration,” “technology additions,” “target populations,” “evergreening,” “product hopping,” and “precision psychiatry.”
For those of us who have followed this field for many years, the whiplash can be severe. Ten years ago, scientists and activists who understood the power of these molecules struggled to have their voices heard. Now they’re being drowned out by the venture capitalists, the financiers, and all the other newcomers who see psychedelics as the next big market opportunity.
Many in the psychedelic scene find the injection of cash anathema to the ethos of psychedelic culture and worry about the new start-ups’ adopting the tactics of Big Pharma. Yet you’d struggle to find a scientist focused on psychedelics who hasn’t partnered with one of the them. This includes Nutt, who has made his discomfort with “companies driven by commercial gain” clear. Widely seen as an elder statesman in the field, Nutt sits on the board of the controversial Compass Pathways, his research heavily sponsored by Angermayer and Thiel.
Nutt defended his position to me three years ago for a short piece in Medium. “My view is straightforward,” he told me then. “Most of the people who will benefit from our research will never even have heard of Peter Thiel—they want a medicine that will help them when other medicines won’t. If, at present, the only way to get that medicine is through a for-profit company, then that is how it has to be. Maybe it’s not ideal, but we spent 50 years doing nothing, and it’s time we did something.”
Which is a fair point. It’s easy to understand why scientists opt to take the money—even if it comes from a character as ludicrous as the Bitcoin-loving Angermayer: These people have spent decades toiling with little funding, getting nowhere. Now they are being offered the kind of cash that can pay for expensive clinical trials and for the medical-grade psilocybin needed to conduct them.
“I don’t see this as a gravy train for neophytes involved in pharma,” Nutt says. “To be honest, I’d quite like to have Big Pharma involved, because then at least we would have good quality control on the compounds.”
But does the cash spoil the broth? Are profits being put above patient needs? Just about every financier in the rainbow of psychedelic start-ups will say the same thing: They want to provide essential life-changing remedies to those who need them while making a fair profit, and they have no desire to stifle healthy competition. But take a closer look, and the holes in that narrative soon start to appear.
Consider Universal Ibogaine, a Vancouver start-up looking to commercialize extracts from Tabernanthe iboga, a central African psychedelic shrub, to treat opioid addiction. Last year the company hired biochemist Rami Batal as its new CEO. Batal had previously worked for Purdue Pharma—the firm that created OxyContin, the drug that helped precipitate the opioid epidemic. Purdue pleaded guilty to criminal charges and will end up paying billions in fines. Yet in an interview with Proactive, Universal Ibogaine’s founder, Shayne Nyquvest, called Batal “the right person for the right job” because of his “pharmaceutical experience.” One could say that appointing an executive from Purdue to a top position with a start-up seeking to treat opioid addiction isn’t just giving the fox the keys to the henhouse; it’s handing the fox a fork and knife. Batal has since been replaced—but the fact that he was appointed in the first place reveals much about Nyquvest’s business strategy.
And through casual slips of the tongue, many of the new breed of psychedelic capitalists seem to have shown their true colors. When MindMed went public on Nasdaq last April, its founder, J.R. Rahn, proudly proclaimed, “Forty percent of the country is suffering—that’s a big, big market.”
In line with their embrace of Big Pharma’s exploitative ethos, psychedelic start-ups have eagerly adopted one of the industry’s most reliable tactics: aggressive patents. To lock out competitors and ensure exclusivity in the future, companies have been attempting to erect legal fences around new chemicals, new chemical formulations, and new applications (in layman’s terms: new drugs, new ways to make the drugs, and new ways to use the drugs).
In theory, patents provide an incentive to innovate. In reality, they often incentivize companies to concoct dubious excuses for laying exclusive claim to something they plainly didn’t invent. For instance, psilocybin, mescaline, and DMT are all found in nature—DMT is even found in the human body. None of them can be patented, and the patents on LSD’s chemical makeup expired in 1963. But a tiny modification—an extra hydrogen atom or carbonate group—to the molecular makeup of each is enough in the eyes of a patent office lawyer to stake a claim, even though new analogs rarely have new effects.
Every day, I receive a press release from some company announcing a patent for a new chemical tweak. To take just one example, MindMed recently saw its shares rise by 25 percent in a single day after patenting a “proprietary LSD analog.” It is also researching a combination of LSD and MDMA. Back in my day, we called this a “candy flip.” (If MindMed’s executives would like to pay royalties to my friends, I would be delighted to make an introduction.)
“Everyone is going for tiny changes in molecules, or tiny changes in formulation, because if they can get those approved through the FDA, then they have a regulatory shield around them which keeps anyone from doing anything,” says Graham Pechenik, a patent attorney who founded the psychedelics IP firm Calyx Law and runs the Psilocybin Patent Tracker.
However things pan out on the patent front, legal psychedelic therapy is coming. But the risks it poses are far more sinister than just proprietary patents on psilocybin. For a taste of what we’re facing, we need look no further than America’s love affair with ketamine infusion clinics.
I speak from experience, having seen ketamine’s effects firsthand: destroyed bladders, lost teeth, erased years. I have countless friends who will never be the same.
First, it is important to note: Though it is often called a psychedelic, ketamine is not one. In pharmacological terms, it is a “dissociative.” That means it is neither an “up” (like speed) nor a “down” (like alcohol)—but a “sideways.” The classic psychedelics—psilocybin, DMT, LSD and mescaline—all act on the serotonin 2A receptor. Ketamine acts on an entirely different system in the brain: the N-methyl-D-aspartate (NMDA) family of receptors, modulating releases of the neurotransmitter glutamate. It is a different animal.
Ketamine has profoundly different effects at high and low doses. In low doses, it can be pleasant and soothing. But in high doses—either as a “wreck-head” party drug or when administered in medical emergencies as an anesthetic, it induces a total separation from oneself in space and time. This high dose potency is what makes it so handy for vets to sedate large animals (hence the nickname “horse tranquilizer”). Recreational users affectionately term this “the k hole.”
It’s hard to describe the experience. All I can tell you is that the only time I ever k-holed—when I unwittingly consumed an enormous line a cheeky British friend gave me, delighting in pulling a fast one on a naive young Canadian—I forgot my own name. And then asked my friend if I’d taken drugs. “Yes,” he replied. “Ooooh,” I responded.
That power to yank your brain away from immediate reality is why ketamine is such an important anesthetic in the modern medicine cabinet. The World Health Organization has included it on its Essential Medicines List since 1985. Every ambulance carries it; requiring no oxygen supply and posing no risk of respiratory suppression, it is one of the safest drugs one can receive in a crisis. If paramedics found you on the street with a broken leg after a hit-and-run, the first thing they would give you is ketamine.
Recently, ketamine has attracted interest as a treatment for depression because it has antidepressant effects at low doses. It can spark “neurogenesis” (the formation of new neurons) and “synaptogenesis” (the formation of new neural connections). It also appears to induce the release of the neurotransmitter brain-derived neurotrophic factor (BDNF)—fertilizer for the brain.
Patients experience a “rapid antidepressant effect”—relief within hours—a striking contrast to SSRIs, which may take weeks to work (if they work at all). Clinicians have found ketamine to show great promise for treatment-resistant depression (TRD)—a devastating affliction in which sufferers do not respond to conventional antidepressants.
However, like most other sedatives, such as alcohol, morphine, and Valium, ketamine’s history of recreational abuse has demonstrated it is extremely addictive. Moreover it has an extremely high “tolerance profile”—meaning regular users require higher and higher doses to feel the same effect. Addicts have been known to snort five grams a day—or even 12.
When I arrived in the UK in 2003, ketamine was everywhere. Legal, cheap, weird, powerful, and quick (trips typically last less than 15 minutes), it was the drug of choice for people who wanted to get out of their heads without signing up for the nine hours you might need to devote to an acid trip.
Fans of the drug had to find out the hard way how addictive it was—and how caustic. Ketamine is profoundly corrosive, much more so than anything else you might shove up your nose, such as speed or cocaine. It has an unparalleled capacity to mangle septums, sinuses, and teeth.
Heavy and repeated use of ketamine can also lead to painful bladder inflammation. Dr. Celia Morgan, a psychologist at the University of Exeter, has worked with teenagers—teenagers—who required bladder transplants before they were old enough to vote. “This is now a huge problem in Taiwan, and we are still seeing bladder problems in the UK. I’ve seen 16-year-olds who are now infertile and wearing colostomy bags for the rest of their lives because of ketamine,” she says. “Yet I’ve spoken to people who run ketamine clinics in Canada who confidently tell me that ketamine addiction ‘isn’t a thing’ and they’ve ‘looked at it.’ It is definitely a thing, and people are minimizing the risks for corporate gain.”
Anyone who spent time in the UK’s festival or rave scene 15 years ago will recall the epidemic of ketamine addiction—in particular around 2007, when it could be found for £5 a gram. For me the ubiquity of ketamine’s wave of destruction is summed up in a remark by a friend: “It seems everyone in Bristol has to sit on a plastic doughnut these days” (because their nether regions were so inflamed.)
Now, in the US, an explosion of ketamine infusion clinics (complete with plush waiting rooms, fancy furniture—and soft cushions) are offering rapid relief from “depression, anxiety, bipolar, and post-traumatic stress disorder.” While none of these claims rest on evidence as convincing as that for TRD, effusive stories in The New York Times have contributed to the hype, with headlines like “The Ketamine Cure” and “I Was Paralyzed by Severe Depression. Then Came Ketamine.” America is now home to at least 600 ketamine infusion clinics, with more popping up every month, led by the stock market darling Field Trip Psychedelics, which charges $750 for a two-and-a-half-hour personalized session (including the dose of ketamine plus “integration therapy”).
Why should a drug that has caused teenagers to lose their bladders be so enthusiastically promoted as a therapeutic treatment?
First, ketamine does indeed produce a “fast-acting antidepressant effect,” according to studies: People suffering from depression feel immediate relief, in striking contrast to SSRIs, which can take weeks to produce any effect (if they work at all). Second, ketamine is already legal in medical settings—unlike psilocybin or LSD, which are still ranked as Schedule I drugs. Combine these factors, and it is easy to understand why investors see ketamine—despite not being a true psychedelic and despite its addictive and corrosive qualities—as a low-hanging fruit.
But perhaps most important, America never experienced an explosion in ketamine addiction like the UK. Therapists in Canada and California I respect who endorse ketamine therapy have admitted to me that if they’d seen what we saw in Britain, they would view the drug differently.
Hence the proliferation of clinics.
And advertising. Take, for instance, the helpful billboard from the Charleston Ketamine Center in South Carolina shown here. Who needs the messy data of peer-reviewed studies when handy diagrams like this can simplify the equation for us?
Not everyone charges $750, of course. In the free market of privatized American health care, competitors may reduce prices however they wish. The average clinic charges around $300 per treatment—but if you wish to pay less, you can.
Slashing prices, though, means cutting costs. And the easiest way to do that is to reduce therapy and counseling time—anything involving expensive, pesky humans. An abundance of ketamine clinics will welcome you through the doors, jack you full of horse tranquilizer for a couple hundred bucks, and send you on your merry way without any psychological support or even a cursory conversation. Assembly-line ketamine therapy, after all, produces the highest profits for the lowest operating costs.
The most appropriate descriptor I have heard for clinics that skimp on therapy while doling out the drug—“opium dens”—comes from Rafael Lancelotta, a PhD student and “somatic-focused, trauma-informed therapist” at Ohio State University, who previously worked at a private clinic in Colorado using ketamine and cannabis in combination with therapy.
And there’s the catch—which no clinic advertises: The antidepressant effects of ketamine do not last more than a few weeks—sometimes just a few days. A 2019 review of 14 independent studies found that “maximum efficacy [was] reached at 24 hrs. Its effect lasted for 1–2 weeks after infusion, but a longer-term effect is little reported.” More damning was a longitudinal follow-up study in the journal Molecular Psychiatry: “There is…little evidence of meaningful therapeutic benefit for most drug doses after day five.”
So you wind up right back where you started.
Do the math. What would happen if you had suffered from severe depression for decades, went to an upscale center for help, and after just one session experienced the kind of serenity and happiness you hadn’t felt for years—maybe ever? What would you do if that feeling evaporated a few weeks later? You’d want to feel it again. And if you wanted to dodge the scrutiny of the first clinic, you could easily find another. And then another.
If money were no object, you could visit a different clinic every week. And if money were an object, you might eventually figure out how to take the drug at home—by yourself.
In fact, you already can. Legally. Numerous start-ups currently provide ketamine therapy—mailed right to your door!
Mindbloom, for example, offers “breakthroughs that don’t cost the bank” at a starting price of “$99 per month” for six treatments. Key phrase: “per month.” Because the money isn’t in the cure; it’s in the treatment. Mindbloom is far from the only start-up that will deliver ketamine. My Ketamine Home and Nue Life will also mail you the drug. The two companies have much in common—including the same stock photo and design on their websites.
I wager these ketamine clinics will spawn the next wave of addiction in America. Today we’re calling it a wonder drug—in five years we’ll be calling it the next OxyContin.
As always, history is instructive. In 1895, Bayer marketed a “nonaddictive” opiate known as diamorphine, which it claimed did not have the potential for abuse and dependence that morphine did. Today we call it heroin. In the 1950s, “mother’s little helper” was marketed as a nonaddictive cure-all. Today, Valium and other benzos are renowned for their capacity to induce dependence. And, of course, OxyContin was aggressively marketed by Purdue Pharma as a “nonaddictive” painkiller—and we all know how that story played out.
This is not to deny that ketamine has a legitimate role: For people suffering from catastrophic depression, experiencing a relief from their psychic prison—even just for a week—offers a powerful reassurance that life can be different. But the potential for abuse needs to be monitored. And most important, clinics must focus primarily on the therapy, rather than adopt the pharmaceutical industry’s standard approach: viewing pills themselves as a cure.
Ketamine clinics exhibit many of the same problems we can expect to see with future clinics using legal psychedelics: risks insufficiently communicated, corners cut, therapy time reduced.
While skimping on therapy is the easiest way to cut costs (time with qualified professionals is expensive), the quality of the therapy is not just an important factor—it is the most important factor.
A curious thing happened after that groundbreaking psilocybin study was published in The New England Journal of Medicine last year. Even though the study showed psilocybin was as effective in treating depression as escitalopram, the results were profoundly disappointing to many in the psychedelic field. Some of the new start-ups even saw their stock values plummet.
This was because many had expected psilocybin to be phenomenally more effective than the boring old SSRI—not merely equally effective. Both groups of patients improved, whether they received psilocybin or escitalopram, but perhaps the most important factor was that both groups were given nearly 40 hours of psychotherapy—far more than a typical patient in a typical SSRI trial would receive. And certainly far more than the average person prescribed an SSRI would receive from their GP.
“The more I do this, the less I care about psychedelics, because I actually find their role to be rather small,” Lancelotta says. “Relationships—including the relationship you have with your therapist—are what heal you. Psychedelics are just tools that can help bridge connections.”
As for the start-ups, everyone in the old vanguard may take comfort from the fact that it’s quite likely many will go bust. And fast. Many of the new psychedelic capitalists will waste phenomenal amounts of money on pricey lawyers in drawn-out patent wars. But more crucially, they seem totally unprepared to deal with some of the challenges that psychedelics can present. Unlike with an SSRI or an antibiotic, the effects of psychedelics are unpredictable—a person can become angry, weepy, or, of course, psychotic. Without preparing adequately for bad trips and much worse, things could get very ugly for many of these inexperienced start-ups.
“Psychedelic therapy is not scalable by definition,” says Dr. Jack Allocca, a pharmacologist. “Injecting it into a scaled model, that of traditional capitalistic product development, in the long term is a death sentence…. Eventually, something truly catastrophic will happen—and somebody will have to pay the consequences.”
