It is clear that the cultural zeitgeist has turned towards the therapeutic use of psychedelics. Recent articles in The New York Times and CNN are slowly informing the public of the exciting research that MAPS supporters have known about for some time—that some psychedelics, even with their historic baggage, their potential for misuse, and vilified reputation, have some of the most promising therapeutic potential that we have seen in psychopharmacology in a generation.

However, what are the attitudes of those clinicians who would be empowered to prescribe these substances, should the FDA approve them as safe and effective therapeutic agents and the DEA reschedule them to make them able to be prescribed legally?

Unfortunately, the discussion around drugs in the United States, for at least the last 50 years, has largely been polarized between drugs that are therapeutic and drugs that can be abused. Even though some of our most effective psychotherapeutic agents (e.g. stimulants and benzodiazepines) are also some of the most likely to be abused, there is a distinct discomfort that arises among clinicians when a substance, which historically has been abused, is suggested to be therapeutic.
Perhaps it is because, as clinicians, when it comes to substance abuse, we often only see the casualties, and this perspective has created a bias that a substance that can be abused can never have therapeutic utility (witness MDMA for the treatment of PTSD or the dramatic response to ketamine from sufferers of severe major depression). Rarely do we hear about how a drug changed someone’s life for the better. In some ways, the more esoteric the substance, the less reflexive resistance it elicits.

It was interesting to see attendees at last November’s U.S. Psychiatric and Mental Health Congress in San Diego stop by the understated MAPS booth in the convention hall, where it shared space with much glitzier displays for conventional psychiatric medications. Many people would ask, “What’s MDMA?” having not associated it with the cultural baggage associated with “Ecstasy.” Scientists who want to study compounds such as ibogaine or psilocybin will likely have an easier time getting past the negative biases that have accreted against more commonly used (and abused) substances such as cannabis and LSD.

I would propose that the attitudes that most people have regarding psychedelics fall into one of four broad categories:

(1) I have tried them and they have changed my life for the better.
(2) I have tried them and was unchanged or had a negative experience.
(3) I have never tried them but have an open mind about them.
(4) I have not tried them and can only imagine they are more dangerous than helpful.

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