Advocate, doctor debate merits of psychedelics legalization

BOSTON (SHNS) – A ballot initiative that would legalize the use and growth of certain psychedelics could be the missing link in a broken mental health care system — or it could turn into a danger that packs hospital emergency rooms, opposing sides of Question 4 contended at a radio debate Tuesday.

Meanwhile, Treasurer Deborah Goldberg — who would have some authority over the proposed psychedelics regulators, if Question 4 passes — said Tuesday that she would be voting against the measure.

Polling on the question has been neck-and-neck among likely voters, with the difference between the “yes” and “no” sides falling within the margin of error in all three of the most recent surveys.

If approved at the ballot box, the measure would allow for at-home growing and sharing of five substances: psilocybin and psilocyn, found in mushrooms; and dimethyltryptamine, mescaline, and ibogaine, which are found in plants. The question would not allow for retail sales of the drugs.

There is a narrow swath of undecided voters for the sides to target: 14 percent of those surveyed in a UMass/WCVB poll said they weren’t sure about the legalization effort, 14 percent were undecided or nonresponsive in a WBUR/CommonWealth poll, and just around 7 percent were unsure or did not answer in a Suffolk/Globe survey released this month.

Proponents say psychedelics can be key in treating illnesses like depression or post-traumatic stress disorder. But on GBH’s “Boston Public Radio” Tuesday morning, Dr. Nassir Ghaemi of the Massachusetts Psychiatric Society warned of health risks and the potential for catastrophic injuries as a result of legalized psychedelic usage.

A doctor at Tufts Medical Center, Ghaemi described a patient who consumed ayahuasca in an attempt to treat mild depression, but her depression then became severe and she was eventually hospitalized for six months in a catatonic state.

“It’s going to be harmful to the public health by causing traffic accidents, emergency room visits overwhelming our hospitals. It’s going to be harmful to patients with mental illnesses who actually get worse and more psychotic with these drugs,” said Ghaemi, who is also a Tufts University professor.

Emily Oneschuk, with the Yes on 4 campaign, said during the debate that psychedelics could plug a gap in the mental health care system.

“If we could have addressed the mental health crisis with traditional medications through tools we already have, we would have addressed it already,” she said. “But 17 veterans die by suicide every day. … I had a friend text me last week that one of his veteran buddies at the college he’s attending killed himself. And I’m really tired of sitting by the sidelines waiting for someone else to come up with an option that, frankly, I haven’t heard of. So this is an option that we can act on right now.”

Oneschuk said that taking too much of a drug like Tylenol also poses a risk to one’s health, but that both risks can be mitigated by proper education about substance use.

“I’m sorry, Emily. Mescaline is not Tylenol,” said Ghaemi, who said Question 4 had drawn opposition from the American Psychiatric Association, Massachusetts Psychiatric Society, and Massachusetts Medical Society.

Ghaemi said he would support decriminalization, and would be on board with “medical use of these drugs by medical professionals in a supervised medical setting.” Uses, he said, could include treatment for veterans with PTSD, cancer patients, and people who are dying. But he said the ballot question “excludes medical professionals” and could potentially allow people without college or advanced degrees to dispense the drugs.

Talk show host Jim Braude asked about why the question was structured to include simultaneous legalization of multiple psychedelics, rather than limiting legalization to one substance like psilocybin, or requiring use in a licensed setting.

Oneschuk said the drugs are already being used by “hundreds of thousands” of people, mushroom growing kits are available for sale online, and the substances have already been decriminalized in some local communities Somerville, Cambridge, and Salem.

“And they’re using them without being able to talk to their health care provider about it. They’re not able to get vetted information anywhere but the internet. So keeping them criminalized is just keeping the stigma up where people aren’t getting information on what responsible, safe use looks like,” she said.

The proposal going before voters would create a structure similar to how the state currently regulates cannabis: a five-member commission with members appointed by the governor, attorney general, and treasurer.

Goldberg would get to appoint a member of the new Natural Psychedelic Substances Commission who would have “experience in corporate management, finance and securities.” She would also have a tripartite say in picking two other psychedelics commissioners.

Asked during a press availability in Boston about whether she supported the psychedelics question, Goldberg laughed for a few seconds Tuesday before telling reporters, “I’m voting no.”

“No. But I didn’t say why,” the Brookline Democrat continued.

When another reporter asked if she would like to elaborate on the reason for her opposition, Goldberg laughed again and said, “No.”

Many topics that make it onto the ballot are controversial issues that have gone unaddressed by the Legislature. But lawmakers sometimes pick up successful initiatives, once they clear the ballot, and alter the voter-approved statutes. That was the case with the similar 2016 cannabis legalization question, which the Legislature restructured in 2017.

A report on Question 4 by the Center for State Policy Analysis at Tufts University outlines potential paths forward for the psychedelics law on Beacon Hill if it passes in November.

Lawmakers could opt to limit the new law to only psilocybin, take a phased approach by legalizing one drug at a time, make a clearer division between psychedelic centers and medical facilities, or mandate a public education campaign about risks and necessary precautions around psychedelic usage.

“Voters should not assume that these adjustments will necessarily be made,” the report cautions.

On the radio, co-host Margery Eagan said after the debate that she gets frustrated when the Legislature rewrites ballot laws after they have won voter approval.

Braude disagreed.

“No piece of legislation is perfect in its first draft,” he said. “If they can improve within the spirit — assuming this passes, I have no idea if it will — improve it, make it better … then I think that’s their obligation to do. Not to mess with it, but to fix it.”

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