Ética en el uso de psicodélicos: la definición de las drogas ilícitas bajo la óptica de la bioética crítica

https://doi.org/10.18294/sc.2024.4630

Publicado 14 febrero 2024 Open Access


Sergio Alexandre Liblik Magíster en Bioética. Profesor, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil. image/svg+xml , Thiago Rocha da Cunha Doctor en Bioética. Profesor, Programa de Pós-grado em Bioética, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil. image/svg+xml , Carmem Silvia da Fonseca Kummer Liblik Doctora en Históra. Investigadora, Grupo de Pesquisa CNPq/PUCPR Bioética, Saúde Global e Direitos Humanos, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil. image/svg+xml , Diego Nicolás Biscioni Magíster en Salud Pública. Profesor, Departarmento de Salud y Actividad Física, Universidad Nacional de Avellaneda, Avellaneda, Argentina. image/svg+xml , Dennys Robson Girardi Magíster en Tecnología en Salud. Doctorando em Direito Empresarial e Cidadania, Centro Universitário Curitiba, Curitiba, Brasil. image/svg+xml



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Palabras clave:

Psicodélicos, Interdicción Legal, Salud Colectiva, Bioética, Derechos Humanos

Resumen


Este ensayo, ubicado en el campo de la bioética, analiza la prohibición del uso de psicodélicos, explorando argumentos sobre las crecientes evidencias de potenciales terapéuticos y su historia milenaria de usos culturales y espirituales. Discute inicialmente el contexto histórico de los psicodélicos y diferentes términos utilizados para nombrarlos. Problematiza la definición de “drogas”, indicando falta de criterios objetivos para distinción entre lícitas e ilícitas. Bajo conceptos y referenciales teóricos de la bioética crítica, se analiza cómo el discurso moral prohibicionista se sostiene más por intereses políticos y económicos que por justificativas científicas, generando estigmatización y vulnerabilidad. Defiende el fin de la prohibición de los psicodélicos con base en argumentos éticos, resaltando su importancia para la reducción de sufrimientos individuales y colectivos. El trabajo contribuye a una reflexión profundizada sobre este tema socialmente controversial, articulando conocimientos interdisciplinarios.


Referencias bibliográficas


1. Samorini G. The oldest archeological data evidencing the relationship of Homo sapiens with psychoactive plants: A worldwide overview. Journal of Psychedelic Studies. 2019;3(2):63-80. DOI: https://doi.org/10.1556/2054.2019.008

2. Winkelman MJ. Entheogens in Buddhism. Journal of Psychedelic Studies. 2021;5(1):1-4. DOI: https://doi.org/10.1556/2054.2020.00161

3. Muraresku B. The immortality key: The secret history of the religion with no name. New York: St. Martin’s Press; 2020.

4. Tupper KW. Entheogens and existential intelligence: The use of plant teachers as cognitive tools. Canadian Journal of Education. 2002;27(4):499-516. DOI: https://doi.org/10.2307/1602247

5. Brouwer A, Carhart-Harris RL. Pivotal mental states. Journal of Psychopharmacology. 2021;35(4):319-352. DOI: https://doi.org/10.1177/0269881120959637

6. Rodríguez Arce JM, Winkelman MJ. Psychedelics, sociality, and human evolution. Frontiers in Psychology. 2021;12:1-26. DOI: https://doi.org/10.3389/fpsyg.2021.729425

7. Fadiman J. The psychedelic explorer`s guide - Safe, therapeutic, and sacred journeys. Rochester: Park Street Press; 2011.

8. Oficina de las Naciones Unidas contra la Droga y el Delito. Terminología e información sobre drogas. 3ra ed. New York: UNODC; 2018.

9. Escohotado A. Historia general de las drogas II: De la prohibición a nuestros días. Madrid: Editorial La Emboscadura; 2018.

10. Sessa B. The psychedelic renaissance: Reassessing the role of psychedelic dugs in 21st century psychiatry and society. London: Muswell Press; 2017.

11. Oliveira AF, Gómez Mateus DP. Plantas (i)legais: proibição, regularização e estados de transformação na América Latina contemporânea. Cadernos de Campo (São Paulo, 1991). 2022;31(1):e201147. DOI: https://doi.org/10.11606/issn.2316-9133.v31i1pe201147

12. Xi D, Berger A, Shurtleff D, Zia FZ, Belouin S. National Institutes of Health psilocybin research speaker series: State of the science, regulatory and policy landscape, research gaps, and opportunities. Neuropharmacology. 2023;230:109467. DOI: https://doi.org/10.1016/j.neuropharm.2023.109467

13. Martínez Oró DP, Apud I, Scuro J, Romaní O. La funcionalidad política de la “ciencia” prohibicionista: El caso del cannabis y los psicodélicos. Salud Colectiva. 2020;16:e2493. DOI: https://doi.org/10.18294/sc.2020.2493

14. Suárez AL, Clua-García R. Políticas públicas dirigidas a personas consumidoras de drogas: Estrategias para la desestigmatización y la promoción de los derechos humanos. Salud Colectiva. 2021;17:e3041. DOI: https://doi.org/10.18294/sc.2021.3041

15. Lorenzo C. Teoria crítica e bioética: um exercício de fundamentação. In: Porto D, Garrafa V, Martins GZ, Barbosa S do N, editors. Bioéticas, poderes e injustiças: 10 anos depois. Brasília: Conselho Federal de Medicina; 2012. p. 173-189.

16. Rocha da Cunha T, Lorenzo C. Bioética global en la perspectiva de la bioética crítica. Revista Bioética. 2014;22(1). DOI: https://doi.org/10.1590/S1983-80422014000100013

17. Rocha da Cunha T. Bioética crítica: bases teóricas y metodológicas para luchas biopolíticas. En: Sariego JRA, editor. Bioética y biopolítica. La Habana: Acuario; 2023. p. 129-143.

18. Rocha da Cunha T, Biscioni D. Bases teóricas e metodológicas da Bioética Crítica frente os desafios do Antropoceno. O Mundo da Saúde. 2023;47:e15072023. DOI: https://doi.org/10.15343/0104-7809.202347e15072023P

19. Sanches MA, Mannes M, Cunha T. Vulnerabilidade moral: leitura das exclusões no contexto da bioética. Revista Bioética. 2018;26(1):39-46. DOI: https://doi.org/10.1590/1983-80422018261224

20. Oliveira YS, Santos MFS, Apostolidis T, Aléssio RLS. Drogas, normas e representações sociais: Uma análise de conteúdos evocados em diferentes contextos. Revista de Psicologia da IMED. 2021;13(1):55-71. DOI: https://doi.org/10.18256/2175-5027.2021.v13i1.3641

21. Reiff CM, Richman EE, Nemeroff CB, Carpenter LL, Widge AS, Rodriguez CI, et al. Psychedelics and psychedelic-assisted psychotherapy. American Journal of Psychiatry. 2020;177(5):391-410. DOI: https://doi.org/10.1176/appi.ajp.2019.19010035

22. Rucker JJH, Iliff J, Nutt DJ. Psychiatry & the psychedelic drugs: Past, present & future. Neuropharmacology. 2018;142:200-218. DOI: https://doi.org/10.1016/j.neuropharm.2017.12.040

23. Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry. 2017;16(1):90-99. DOI: https://doi.org/10.1002/wps.20388

24. Hyman SE. Psychiatric drug development: diagnosing a crisis. Cerebrum. 2013;5:PMC3662213.

25. Rose N. Our psychiatric future: The politics of mental health. London: Polity; 2019.

26. Hengartner MP, Plöder M. Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that the drugs work: Effect size and method bias matter! Front Psychiatry. 2018;9:5-7. DOI: https://doi.org/10.3389/fpsyt.2018.00517

27. Gøtzsche PC. Why I think antidepressants cause more harm than good. The Lancet Psychiatry. 2014;1(2):104-106. DOI: https://doi.org/10.1016/S2215-0366(14)70280-9

28. Schenberg EE. Psychedelic-assisted psychotherapy: A paradigm shift in psychiatric research and development. Frontiers in Pharmacology. 2018;9:1-11. DOI: https://doi.org/10.3389/fphar.2018.00733

29. Krebs TS, Johansen PØ. Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. Journal of Psychopharmacology. 2012;26(7):994-1002. DOI: https://doi.org/10.1177/0269881112439253

30. Johnson M. Classic Psychedelics in Addiction Treatment: The Case for Psilocybin in Tobacco Smoking Cessation. En: Barrett F, Preller K, (eds.). Disruptive Psychopharmacology: Current Topics in Behavioral Neurosciences #56. Berlin: Springer; 2022. DOI: https://doi.org/10.1007/7854_2022_327

31. Jones G, Ricard JA, Lipson J, Nock MK. Associations between classic psychedelics and opioid use disorder in a nationally-representative US adult sample. Scientific Reports. 2022;12(1):1-8. DOI: https://doi.org/10.1038/s41598-022-08085-4

32. Holze F, Gasser P, Müller F, Dolder PC, Liechti ME. Lysergic acid diethylamide–assisted therapy in patients With Anxiety with and without a life-threatening illness: A randomized, double-blind, placebo-controlled phase II study. Biological Psychiatry. 2023;93(3):215-223. DOI: https://doi.org/10.1016/j.biopsych.2022.08.025

33. Ramaekers JG, Hutten N, Mason NL, Dolder P, Theunissen EL, Holze F, et al. A low dose of lysergic acid diethylamide decreases pain perception in healthy volunteers. Journal of Psychopharmacology. 2021;35(4):398-405. DOI: https://doi.org/10.1177/0269881120940937

34. Griffiths RR, Johnson MW, Carducci MA, Umbricht A, Richards WA, Richards BD, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology. 2016;30(12):1181-1197. DOI: https://doi.org/10.1177/0269881116675513

35. van Amsterdam J, van den Brink W. The therapeutic potential of psilocybin: a systematic review. Expert Opinion on Drug Safety. 2022;21(6):833-840. DOI: https://doi.org/10.1080/14740338.2022.2047929

36. Palhano-Fontes F, Barreto D, Onias H, Andrade KC, Novaes MM, Pessoa JA, et al. Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: A randomized placebo-controlled trial. Psychological Medicine. 2019;49(4):655-663. DOI: https://doi.org/10.1017/S0033291718001356

37. Ribeiro S. Whole Organisms or Pure Compounds? Entourage Effect Versus Drug Specificity. En: Labte B, Cavnar C, (eds). Plant Medicines, Healing and Psychedelic Science. Berlin: Springer; 2018. DOI: https://doi.org/10.1007/978-3-319-76720-8_8

38. Ly C, Greb A, Cameron L, Wong J, Barragan EV, Wilson PC, et al. Psychedelics promote structural and functional neural plasticity. Cell Reports. 2018;23(11):3170-3182. DOI: https://doi.org/10.1016/j.celrep.2018.05.022

39. Shalit N, Rehm J, Lev-Ran S. Epidemiology of hallucinogen use in the US results from the National epidemiologic survey on alcohol and related conditions III. Addictive Behaviors. 2019;89:35-43. DOI: https://doi.org/10.1016/j.addbeh.2018.09.020

40. Iserson K. “Go Ask Alice”: The Case for Researching Schedule I Drugs. Cambridge Quarterly of Healthcare Ethics. 2018;28(1):168-177. DOI: https://doi.org/10.1017/S0963180118000518

41. Smith WR, Sisti D. Ethics and ego dissolution: The case of psilocybin. Journal of Medical Ethics. 2021;47(12):807-814. DOI: https://doi.org/10.1136/medethics-2020-106070

42. Dworkin RH, Anderson BT, Andrews N, Edwards RR, Grob CS, Ross S, et al. If the Doors of Perception Were Cleansed, Would Chronic Pain be Relieved? Evaluating the Benefits and Risks of Psychedelics. The Journal of Pain. 2022;23(10):1666-1679. DOI: https://doi.org/10.1016/j.jpain.2022.05.003

43. Miceli McMillan R. Global bioethical challenges of medicalising psychedelics. Journal of Psychedelic Studies. 2021;5(2):57-64. DOI: https://doi.org/10.1556/2054.2021.00188

44. Wallace AF. Cultural Determinants of Response to Hallucinatory Experience. AMA Archives of General Psychiatry. 1959;1(1):58-69. DOI: https://doi.org/10.1001/archpsyc.1959.03590010074009

45. Nichols DE. Phychedelics. Pharmacological Reviews. 2016;68 (2):264-355. DOI: https://doi.org/10.1124/pr.115.011478

46. Angell T. Denver voters approve measure to decriminalize psychedelic mushrooms. Forbes Maganize [Internet]. 2019 [citado 10 may 2023]. Disponible en: http://tinyurl.com/mryrcrre.

47. O’Hare R. Imperial launches world’s first Centre for Psychedelics Research. A New Vision for Mental Health [Internet]. 2019 [citado 10 may 2023]. Disponible en: http://tinyurl.com/fny3ac5p.

48. Lamkin M. Psychedelic medicine is coming: The law isn’t ready. Scientific American [Internet]. 2019 [citado 10 may 2023]. Disponible en: http://tinyurl.com/yj73skj8.

49. Rybka LN, Nascimento JL do, Guzzo RSL. Os mortos e feridos na “guerra às drogas”: Uma crítica ao paradigma proibicionista. Estudos de Psicología. 2018;35(1):99-109. DOI: https://doi.org/10.1590/1982-02752018000100010

50. Laurindo CR. Drugs, racism and violence. Sociedade em Debate. 2021;27(2):30-44. DOI: https://doi.org/10.47208/sd.v27i2.2770

51. World Health Organisation. Global status report on alcohol and health. Geneva: WHO; 2018.

52. Stone A, Storr C, Anthony J. Evidence for a hallucinogen dependence syndrome developing soon after onset of hallucinogen use during adolescence. International Journal of Methods in Psychiatryc Research. 2006;15(3):116-130. DOI: https://doi.org/10.1002/mpr.188

53. Adam L. Halberstadt. Recent advances in the neuropsychopharmacology of serotonergic hallucinogens. Behavioural Brain Research. 2015;277(15):99-120. DOI: https://doi.org/10.1016/j.bbr.2014.07.016

54. Schlag AK, Aday J, Salam I, Neill JC, Nutt DJ. Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. Journal of Psychopharmacology. 2022;36(3):258-272. DOI: https://doi.org/10.1177/02698811211069100

55. Stanislav Grof C. Spiritual emergency: The understanding and treatment of transpersonal crises. International Journal Transpersonal Studies. 2017;36(2):30-43. DOI: https://doi.org/10.24972/ijts.2017.36.2.30

56. Grof S, Grof C. Respiração holotrópica: Uma nova abordagem de autoexploração e terapia. Rio de Janeiro: Capivara; 2011.

57. Barrett F, Griffiths R. Classic hallucinogens and mystical experiences: Phenomenology and neural correlates. En: Halberstadt A, Vollenweider F, Nichols D, (eds). Behavioral neurobiology of psychedelic drugs current topics in behavioral neurosciences. Berlin: Springer; 2017. DOI: https://doi.org/10.1007/7854_2017_474

58. Venturi G. Consumo de drogas, opinião pública e moralidade: Motivações e argumentos baseados em uso. Tempo Social. 2017;29(2):159-86. DOI: https://doi.org/10.11606/0103-2070.ts.2017.126682

59. Barry C, Sherman S, Stone E, Kennedy-Hendricks A, Niederdeppe J, Linden S, et al. Arguments supporting and opposing legalization of safe consumption sites in the US. International Journal of Drug Policy. 2019;63:18-22. DOI: https://doi.org/10.1016/j.drugpo.2018.10.008

60. Potter VR. Bioethics: Bridge to the future. Englewood Cliffs: Prentice hall; 1971.

61. Rocha da Cunha T. Bioética crítica, saúde global e a agenda do desenvolvimento [Tesis]. Brasilia: Universidade de Brasilia; 2014.

62. Miron J, Partin E. Ending the war on drugs is an essential step toward racial justice. The American Journal of Bioethics. 2021;21(4):1-3. DOI: https://doi.org/10.1080/15265161.2021.1895590

63. Nascimento WF, Garrafa V. Por uma vida não colonizada: Diálogo entre bioética de intervenção e colonialidade. Saúde e Sociedade. 2011;20(2):287-99. DOI: https://doi.org/10.1590/S0104-12902011000200003

64. Cox R. Production, power, and world order: social forces in the making of history. New York: Columbia University Press; 1987.