Bay Staters for Natural Medicine Co-Founder, James Davis, on Grassroots Psychedelic Policy Reform, a Community-based Facilitator Network, and the Corporatisation of Psychedelics

Hardman: I want to pick up on something that you started talking about: the corporatisation of psychedelics, which is obviously a big topic. I don’t see that we can’t, at least theoretically and directionally, get to a point where we have various models of access to psychedelic ‘therapy’ or non-criminalised use: we could have decrim. as a kind of baseline, then regulated models that fall outside of the medical system, and then the more classic medical model. Do you not believe these models could coexist?Daviss: It’s quite literally a billion-dollar question. It’s not just a billion-dollar question because of the profits it could generate for these companies, but also the foregone value we could generate for society in treating opioid addiction, depression, trauma and so on. These conditions have robbed our society of trillions of dollars in wealth and innovation and in healing, potentially.I’ll answer in three parts. The first part is that these companies say nice things, but they act in a very different way. They’re putting forward legislation in Connecticut and Massachusetts that would undercut access in pretty severe ways while essentially leaving working and middle class people with fines and an unregulated grey area where a lot of people who are nervous about trying psychedelics will forego that experience because it’s either too expensive or the legal status is a little too muddled.The second point I’ll make is that it’s very hard to change a house once the scaffolding has been laid. We’ve seen that with cannabis policy across the U.S. Massachusetts, for example, where we legalised cannabis and allowed for small amounts to be grown at home, we have the mouldiest weed in the country and the least diverse cannabis system, despite having the most robust social equity programme. If we allow for systems like those in Oregon or an FDA-approved version of MDMA, there is going to be so much capital and auxiliary businesses that attach themselves to that model that it will be very difficult for reformers to change those policies. My last point is that I think medicalisation is going to fail: it’s going to fall on its face and waste a lot of federal and state resources that we could be using to actually end the war on drugs in an equitable way.In Australia, its equivalent of the FDA approved MDMA and psilocybin in a highly regimented model. We’ve interviewed advocates on the ground who tell us that the average cost is almost $25,000 to $30,000 for an MDMA experience, whereas we know people can have a comfortable and life-affirming MDMA experience for pennies on the dollar, if they know the right person; or even hundreds of dollars if they know the right guide who is willing to hold space for them.And it is a fantasy to believe that private insurance is going to cover these treatments. So even when these corporations say that, even at that high price point, in theory, it would still save our healthcare system money compared to just therapy and just psychopharmacological medicines, they’re not realising the reality of the U.S. healthcare system.For example, the psychedelic ketamine is still not covered by most private health insurers because insurance companies know we switch plans throughout our lives. So they actually save money by just paying for conventional therapy and medications while they are still the company insuring us rather than fronting the tens of thousands of dollars for care that has long-term benefits. And even when insurance companies cover expensive treatments, middle class Americans struggle to pay their deductibles and copays too. Our model is one in which we are willing to wait to implement reform until enough people are educated, including those people who are still reeling from decades of propaganda. We start at the community and local level and focus on affordability. We need to get this right from the get-go and we’re willing to wait and educate, instead of this idea that somehow a pharmaceutical model is going to be politically convenient in the interim.Hardman: I agree with you that reimbursement is a key question, and I know that a lot of psychedelic drug developers and advocates agree that is a key challenge… demonstrating the cost-effectiveness of these protocols.Davis: MDMA therapy should not have to compete with talk therapy… that means that model is antiquated. MDMA therapy should free up wait-lists of therapists so they can see more talk therapy patients. These systems should be complementary, so if we’re creating a model where they’re having to compete for scarce resources, that means that the model of MDMA and psilocybin therapy that’s being put forward is too expensive.Hardman: But another way of looking at the situation is that it’s a supply issue: our healthcare systems and their payors are not spending the right portion healthcare budgets on behavioural and mental healthcare (for whatever reason), or are not making decisions about coverage on a long-enough time horizon or from a suitably societal perspective.Davis: I don’t agree. Bay Staters’ facilitator network has provided more guided psilocybin sessions as a nonprofit with about $100,000 in fundraising (and we haven’t spent any of that money) than the entire state of Oregon.And so what we’re desperately in need of is a more community-based model where you connect people with similar energies as we do with our facilitator network to have this experience as adults, as friends, as trusted mentors. We’re getting covered in mainstream media, we’re trip-sitting for people who work for the federal government, who hold positions of power in their community. We’re not going to be able to put that cat back in the bag.I do think that for people who have more severe psychiatric conditions, there will be a role for the formal healthcare system to play. Ibogaine, for example, has a unique safety profile that is in want of FDA regulation and a more strict container to ensure people’s safety. But when it comes to psilocybin and MDMA, these substances are relatively safe and highly effective. So that’s our paradigm, and it’s definitely a paradigm that is not going to make a lot of investors happy. We’ll make a lot of philanthropists happy.Hardman: I agree that there’s good evidence to support the physiological safety of many classic psychedelics. But I do think that, especially with severe and/or complex psychiatric diagnoses, there is a significant population that would rather have a psychedelic experience in the healthcare system container.Davis: A lot of people who have those severe psychiatric conditions, where I do believe a medical container actually makes sense, do not trust the mental healthcare system. In fact, for about half of Americans, their first interaction with the mental healthcare system is actually a call from the Department of Child Services. That was my first interaction with the mental healthcare system in the United States. So there are a lot of people who do not trust the FDA and do not trust these more formal medical paradigms, and I think they’re going to be extremely difficult for those companies to reach.And if they do, will those patients be able to afford this care? I don’t have all the answers to that question, but I think that for the cases where it would be more helpful to have a medical model, they have a tall task ahead of them to build trust with psychiatric patients. Many of them are turning to online forums, they’re growing mushrooms themselves, they’re discovering these treatments in their own container… which might not be the safest, but it’s what they’re going to do if it’s not affordable and accessible.I do not think it’s a zero-sum game. We support a regulated use model as well. In fact, we’ve put a lot of work into creating one through the Department of Public Health that will be affordable. I just think there are a lot of realistic problems with trying to turn this into a pharmaceutical.Hardman: I don’t disagree that it’s a tall ask. A lot of our coverage at the moment is concerned with those related questions of affordability and accessibility.Back to Massachusetts… your group has been working on state-level policy there for a while, long before the present ballot initiative was introduced. Can you give us a brief history of what you have tried to achieve?Davis: In three years, we worked with about eight cities across the Commonwealth to pass measures that allow people to grow and share plant medicine. Those cities did not do so spontaneously, they were persuaded by hundreds of volunteers that we mobilised and that required an unprecedented campaign of peer-to-peer education. It’s taken a tremendous amount of courage, to make those campaigns happen, with volunteers risking their jobs and family relationships to speak out about their experiences.We also passed an additional measure through a city Commission of Worcester, the second biggest city in New England, that essentially tells law enforcement to no longer enforce psilocybin-related laws against first responders and veterans. We were using this measure to demonstrate to state lawmakers that they didn’t need to have as much anxiety about filing psychedelics-related state legislation.So, we filed about eight bills in the state legislature dealing with psychedelic policy. There are two or three that it’s boiled down to and that we’re now using to replace the ballot question. These laws were not just about plant-based psychedelics, they were also about ending the drug war more broadly and sealing records. We also filed a bill through rep. Boldyga, a former police officer and Republican that’s the self-described most conservative in the state legislature, who agreed with our thesis that we need to make a statement about how expensive MDMA-assisted therapy will be if it gets FDA approval.And so we’re very proud of our new legislation, An Act Relative to Therapeutic Plant Medicine, that we’re proposing as a substitute for the ballot question, meaning this would go to voters either alongside New Approach’s… or, if New Approach decides to put its money where its mouth is, they could work with us to pass it together as a coalition. Our legislation would create a regulated use model through the Department of Public Health that requires 20 hours of in-person training, a background check, and a $155 fee every two years to become a facilitator.This is modelled after how our state already treats licenced counsellors. We don’t believe we need a new regulatory body that’s prone to capture, corruption, and conflicts of interest in order to create a category that functionally already exists within the Department of Public Health. By keeping licencing and training fees relatively low, we hope to keep these services vibrantly available in Massachusetts, unlike the system that has been created in Oregon and that is emerging in Colorado.Hardman: How likely do you think it is that you’ll get the ballot question substituted?Davis: We have an ‘Under the Dome’ coalition of both Republican and Democrat lawmakers that are putting forward the substitute, so I’d say there’s a very high likelihood that we get it done. New Approach PAC is freaking out about it, whereas they should be meeting with us and trying to come together around a policy that meets their goals and those of the people who, you know, live here in Massachusetts.The legislature has until May to substitute the ballot question.And I would bring it all back to a single quote by Tip O’Neill, who was the Speaker of the House for Massachusetts and the Speaker of the House under President Reagan: “All politics is local.” Politics happens at the dinner table, or outside your grocery store. It’s real people having real dialogue.Headlines that MDMA is FDA-approved or legalised will invite a lot of cultural animosity. It won’t actually get the quality MDMA experience in the hands of people for quite a while, assuming insurance will cover it. And if anything, a lot of people think psychedelics are already legal because they see exaggerated headlines, so it will create this unregulated grey market that I think will also draw people away from the more formal, regulated market too.Depending on how we implement a model in Massachusetts, it’s very likely that the federal government is going to look to our state for leadership on these types of things. We’re the global capital of biotech, and a lot of the most powerful politicians are from Massachusetts. A lot of people in Washington tend to think that the world doesn’t exist much beyond the East Coast! And so it’s a very influential state to get this right and that’s why we’re trying to keep these services innovative and affordable.I think that the challenge to donors and investors is to question a dominant narrative that medicalisation is going to be the most politically convenient or the most accessible route to getting people care.



Source link