Letter to Authors of CA State Bill 519
by Kristin Nash, MPH
Thanks for the time on the phone today. As I shared in our conversation, I’m new to this space, having lost my son Will at age 21 in an accident that occurred due to a psychedelic-induced psychosis. My son had no personal or family history of mental illness, took moderate amounts, had previous experience with the substances, and was in his own home with his best friends. Yet things went sideways and now he is gone. Unfortunately, I now know other parents who have lost children to psychedelic hallucinations and delusions, from jumps or falls and other trauma.
--I support the movement away from criminalization of drug use. I’m a progressive-minded public health professional and believe that drug use is a public health issue, and that we must end the war on drugs.
--I support the healing potential of psychedelics and am heartened by reports of desperately needed improvements in mental health. Though it’s important not to get ahead of ourselves,[i] as underscored by an editorial in last month’s New England Journal of Medicine.[ii]
From same editorial: “The momentum to also legalize hallucinogens shares strategies in common with movements that were calculated to increase legal access to prescription opioids and marijuana in the United States. One such strategy is to minimize potential adverse consequences and dismiss evidence-based safety concerns for general use.”
Let’s not do that. Let’s have transparent discussions about risk and safety – and needed guardrails -- as we think about how to bring these powerful substances into society:
Psychedelics can produce hallucinations, delusions, and detachment from reality. These experiences can lead to unpredictable and, sometimes, tragic results. Emotional responses can range from euphoria to paranoia, terror, and fight-or-flight panic, which can result in adverse events such as psychological trauma, erratic behavior, accidental injuries, violence toward oneself or others,[iii], [iv] even death. Furthermore, while under the influence of psychedelics, individuals are incapacitated, and become extremely vulnerable and suggestible in many unique ways.[v], [vi] This means that psychedelic therapists, guides, facilitators, ceremony leaders, etc., inhabit roles of great power and responsibility when working with clients, and that psychedelic dosing sessions create opportunities for clients to be manipulated or even sexually assaulted.[vii], [viii] Finally, available research indicates that psychedelic use can produce longer-term adverse effects such as persistent psychosis[ix] and hallucinogen persisting perception disorder (HPPD).[x]
Currently, we do not know nearly enough about patterns of use or the individual or public health impacts of use, particularly for different populations (e.g., individuals with different health conditions, those taking other medications).[xi] There is no data tracking the incidence of adverse reactions, preventing us, at this stage, from determining how often such events actually occur when psychedelics are used outside clinical research settings. This lack of data tracking makes it easy for adverse events to fly below the radar, and for the public to underestimate the risks involved in psychedelic use.
My particular concern is young people, who are especially vulnerable to the psychedelic hype, and I have started the William G. Nash Foundation in honor of my son to support projects including psychedelic safety and harm reduction. Young people are primed for risk-taking,[xii] and have the highest rates of drug experimentation,[xiii] not to mention a mental health crisis along with the increasing popularity of self medication, particularly with psychedelic mushrooms.[xiv] Perhaps unsurprisingly, this year’s Monitoring The Future (MTF) data showed hallucinogen use by young adults has increased significantly, reaching historic highs in this age group since 1988.[xv] This is concerning, because a systematic review of the literature on adverse reactions to psychedelics found that young people appear to experience these adverse reactions much more frequently than other age cohorts.[iii]
It's also important to understand how legalization shifts the perceptions of young people. An important study last year among young sexual and gender minorities showed that an increase in perceived decriminalization predicted a significant increase in odds of general marijuana use.[xvi] While not linking the findings to legalization per se, the same MTF data cited above showed marijuana use among young people reached the highest levels ever recorded.[X] I say this not to suggest prohibition, but to suggest a responsibility that efforts to legalize MUST include guardrails in the form of harm reduction, information, education and training.
I respectfully recommend you review the City of Berkeley’s “Responsible Psychedelic Drug Policy Reform Resolution” drafted by Berkeley Community Health Commissioner Joseph Holcomb Adams and his Commission colleague Karma Smart. Commissioner Adams will reach out to you directly, but the Berkeley approach prioritizes safety and harm reduction measures like public information, school-based drug education, peer support, and first responder training, and it incorporates the collection of public health data on psychedelic use and outcome patterns in the city to guide policy and services going forward. I believe the inclusion of such “safety scaffolding” is vital to a responsible psychedelics policy proposal. I'm wondering if Senator Wiener might be open to a conversation about including these provisions in his bill?
[i] Yaden DB, Yaden ME, Griffiths RR. Psychedelics in Psychiatry—Keeping the Renaissance From Going Off the Rails. JAMA Psychiatry. Dec. 2, 2020. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2773734
[ii] Madras BK. Psilocybin in Treatment-Resistant Depression. New England Journal of Medicine. Nov. 3, 2022. https://www.nejm.org/doi/full/10.1056/NEJMe2210975
[iii] Strassman RJ. Adverse Reactions to Psychedelic Drugs. Journal of Nervous and Mental Disease. Oct. 1984. https://wiki.dmt-nexus.me/w/images/5/5c/psychedelic_adverse_effects.pdf
[iv] Carbonaro TM, Bradstreet MP, Barrett FS, MacLean KA, Jesse R, Johnson MW, Griffiths RR. Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology. Aug. 30, 2016. https://pubmed.ncbi.nlm.nih.gov/27578767/
[v] Anderson BT, Danforth AL, Grob CS. Psychedelic medicine: safety and ethical concerns. Lancet Psychiatry. Oct 2020. https://pubmed.ncbi.nlm.nih.gov/32949507/
[vi] Carhart-Harris R, Leech R, Hellyer P, Shanahan M, Feilding A, Tagliazucchi E, Chialvo D, Nutt D. The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Frontiers in Human Neuroscience. 2014. https://www.frontiersin.org/articles/10.3389/fnhum.2014.00020
[vii] Brennan W, Jackson MA, MacLean K, Ponterotto JG. A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing. Journal of Humanistic Psychology. Sept. 16, 2021. https://doi.org/10.1177/00221678211045265
[viii] Goldhill, O. MDMA on Trial: Psychedelic Therapy Has a Sexual Abuse Problem. Quartz. March 3, 2020. https://qz.com/1809184/psychedelic-therapy-has-a-sexual-abuse-problem-3
[ix] Patel A, Moreland T, Haq F, Siddiqui F, Mikul M, Qadir H, Raza S. Persistent Psychosis After a Single Ingestion of "Ecstasy" (MDMA). Primary Care Companion for CNS Disorders. 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304680/
[x] Perception Restoration Foundation. https://docs.google.com/document/d/1xIvb041-RhaAyrUiCfau9H7o_Eez4VhJl_I_e8RAzQA/edit
[xi] Johnstad PG. Who is the typical psychedelics user? Methodological challenges for research in psychedelics use and its consequences. Nordic Studies on Alcohol and Drugs. Oct. 20, 2020.https://journals.sagepub.com/doi/10.1177/1455072520963787
[xii] Shulman EP, Smith AR, Silva K, Icenogle G, Duell N, Chein J, Steinberg L. The dual systems model: Review, reappraisal, and reaffirmation. Developmental Cognitive Neuroscience. 2016. https://www.sciencedirect.com/science/article/pii/S1878929315001292
[xiii] United Nations. Drugs and Age. 2018. https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_4_YOUTH.pdf
[xiv] Matzopoulos R, Morlock R, Morlock A, Lerer B, Lerer L. Psychedelic Mushrooms in the USA: Knowledge, Patterns of Use, and Association With Health Outcomes. Frontiers in Psychiatry. Jan 2022. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.780696
[xv] National Institute on Drug Abuse (NIDA). Marijuana and hallucinogen use among young adults reached all time-high in 2021. Aug. 22, 2020. https://nida.nih.gov/news-events/news-releases/2022/08/marijuana-and-hallucinogen-use-among-young-adults-reached-all-time-high-in-2021
[xvi] Morgan E, Dyar C, Hayford CS, Whitton SW, Newcomb ME, Mustanski B. Perceptions of Marijuana Decriminalization Among Young Sexual and Gender Minorities in Chicago: An Initial Measure Validation and Test of Longitudinal Associations with Use. Cannabis and Cannabinoid Research. April 15, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064955/
by Kristin Nash, Will's Mother
There are no words to express how much we miss Will, every moment of every day. But we are finding ways to remember him and to smile in doing so. The last time we spent with Will was Christmas and New Year’s (2019-2020) when we went to Costa Rica. A favorite memory from that trip was a day we spent snorkeling and fishing. We all caught something and Will especially was tickled to have reeled one in. On the way home, we started talking
about what we would make for dinner, along with our fresh fish. Will wanted to stop at a roadside fruit and vegetable stand and he knew exactly what he wanted for patacones, creamy guacamole, and poki tuna. He was so confident and comfortable picking out the items and engaging the clerks with questions in Spanish. To see him blossom in his language, culture and cooking skills was so joyful. We went home and Will just hummed in the kitchen. He was so creative and so fun to cook with. We joked and laughed and then ate an incredible fresh feast!
There are some things we’ve learned this past year… about life, death, love, grief and gratitude. We’ve learned that we all grieve in our own
way, there’s no right or wrong way or prescribed amount of time needed. It’s not something one “gets over,” rather it’s something one learns to live with to incorporate into a new self and life. A loss like this breaks you open, and so we are figuring out how to put a life back together. There is a grief theory called “continuing bonds” and this has been our approach… Will will always be with us and part of our family. We will always be 5. We feel his presence and are creating rituals to foster that. We take comfort in sharing the memories, music and things he taught us. We have also learned that love and gratitude are all that matter. We are here to love each other in the best way we can and to have gratitude for our many blessings. Experiencing the sudden, shocking passing of a child/brother may be one of the greatest
tragedies one could endure. However, there are gifts. Feeling the depths of such sorrow enables one to feel emotions so incredibly deeply. And being this close to death makes one appreciate both the fragility of life and the gift that it is. So through gratitude and hope, we will heal and live and love, better than before. Another thing we’ve learned is that we could not do this alone. So a bottomless thank you to the friends and family who have supported us through this time. Thank you.