Ethics in the use of psychedelics: The definition of illicit drugs from the perspective of critical bioethics

Sergio Alexandre Liblik Master in Bioethics. Professor, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. image/svg+xml , Thiago Rocha da Cunha Doctor in Bioethics. Professor, Postgraduate Program in Bioethics, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. image/svg+xml , Carmem Silvia da Fonseca Kummer Liblik PhD in History. Researcher, CNPq/PUCPR Bioethics, Global Health and Human Rights Research Group, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. image/svg+xml , Diego Nicolás Biscioni Master in Public Health. Professor, Department of Health and Physical Activity, Universidad Nacional de Avellaneda, Avellaneda, Argentina. image/svg+xml , Dennys Robson Girardi Master in Health Technology. Doctoral student in Business Law and Citizenship, Centro Universitário Curitiba, Curitiba, Brazil. image/svg+xml
Received: 19 August 2023, Accepted: 5 February 2024, Published: 14 February 2024 Open Access
https://doi.org/10.18294/sc.2024.4630 | PMID: 38381110
Abstract views
1359
Metrics Loading ...

Abstract


This essay, situated in the field of bioethics, examines the prohibition of psychedelic use, exploring arguments surrounding the growing evidence of their therapeutic potential and their millennia-long history of cultural and spiritual uses. It initially discusses the historical context of psychedelics and the various terms used to describe them. The essay problematizes the definition of “drugs,” highlighting the lack of objective criteria for distinguishing between legal and illicit substances. Drawing on concepts and theoretical frameworks of critical bioethics, it analyzes how the prohibitionist moral discourse is sustained more by political and economic interests than by scientific justifications, leading to stigmatization and vulnerability. The essay advocates for the end of the prohibition of psychedelics based on ethical arguments, emphasizing their importance in reducing individual and collective suffering. The work contributes to a deeper reflection on this socially controversial topic, integrating interdisciplinary knowledge.

Keywords: Psychedelics, Legal Interdiction, Public Health, Bioethics, Human Rights

Categories: Dissidences, Policies, Psychoactive substances, Bioethics

Full-text of the article is available for this language: Español.


References


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.
Crossref

2. Winkelman MJ. Entheogens in Buddhism. Journal of Psychedelic Studies. 2021;5(1):1-4.
Crossref

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.
Crossref

5. Brouwer A, Carhart-Harris RL. Pivotal mental states. Journal of Psychopharmacology. 2021;35(4):319-352.
Crossref | PubMed

6. Rodríguez Arce JM, Winkelman MJ. Psychedelics, sociality, and human evolution. Frontiers in Psychology. 2021;12:1-26.
Crossref | PubMed

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.
Crossref

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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).
Crossref

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.
Crossref

19. Sanches MA, Mannes M, Cunha T. Vulnerabilidade moral: leitura das exclusões no contexto da bioética. Revista Bioética. 2018;26(1):39-46.
Crossref

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.
Crossref

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.
Crossref | PubMed

22. Rucker JJH, Iliff J, Nutt DJ. Psychiatry & the psychedelic drugs: Past, present & future. Neuropharmacology. 2018;142:200-218.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

27. Gøtzsche PC. Why I think antidepressants cause more harm than good. The Lancet Psychiatry. 2014;1(2):104-106.
Crossref | PubMed

28. Schenberg EE. Psychedelic-assisted psychotherapy: A paradigm shift in psychiatric research and development. Frontiers in Pharmacology. 2018;9:1-11.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref

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.
Crossref | PubMed

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.
Crossref | PubMed

40. Iserson K. “Go Ask Alice”: The Case for Researching Schedule I Drugs. Cambridge Quarterly of Healthcare Ethics. 2018;28(1):168-177.
Crossref | PubMed

41. Smith WR, Sisti D. Ethics and ego dissolution: The case of psilocybin. Journal of Medical Ethics. 2021;47(12):807-814.
Crossref | PubMed

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.
Crossref | PubMed

43. Miceli McMillan R. Global bioethical challenges of medicalising psychedelics. Journal of Psychedelic Studies. 2021;5(2):57-64.
Crossref

44. Wallace AF. Cultural Determinants of Response to Hallucinatory Experience. AMA Archives of General Psychiatry. 1959;1(1):58-69.
Crossref | PubMed

45. Nichols DE. Phychedelics. Pharmacological Reviews. 2016;68 (2):264-355.
Crossref | PubMed

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.
Crossref

50. Laurindo CR. Drugs, racism and violence. Sociedade em Debate. 2021;27(2):30-44.
Crossref

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.
Crossref | PubMed

53. Adam L. Halberstadt. Recent advances in the neuropsychopharmacology of serotonergic hallucinogens. Behavioural Brain Research. 2015;277(15):99-120.
Crossref | PubMed

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.
Crossref | PubMed

55. Stanislav Grof C. Spiritual emergency: The understanding and treatment of transpersonal crises. International Journal Transpersonal Studies. 2017;36(2):30-43.
Crossref

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.
Crossref | PubMed

58. Venturi G. Consumo de drogas, opinião pública e moralidade: Motivações e argumentos baseados em uso. Tempo Social. 2017;29(2):159-86.
Crossref

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.
Crossref | PubMed

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.
Crossref | PubMed

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.
Crossref

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



Crossref
Scopus
Google Scholar
Europe PMC