I am a believer in the power of certain psychedelic medications to help depression, awaken spiritual experiences, and break damaging compulsive behaviors such as smoking or alcohol use. I have used ketamine in my clinical practice in several forms, and under a variety of circumstances, to help my patients. In some cases, I have seen dramatic transformations. I fully support decriminalization of psychedelics, but for a variety of reasons, I cannot support the proposal currently in front of voters.
Early on, I prescribed ketamine without accompanying therapy, simply as a pharmacologic intervention. Repeatedly, I saw it give temporary relief from anxiety and depression, but I did not see lasting transformation. Then, after being trained in ketamine-assisted psychotherapy, I started to prescribe it in combination with psychotherapy. In that setting, I did see lasting changes. Psychedelic medication precipitates a period during which there is increased connectivity between parts of the brain that don’t regularly communicate. There is a period of about 72 hours after the experience during which there is a marked increase in the brain’s ability to change and adapt its structure, and function in response to stimuli. In other words, there is an opportunity for the brain to learn new skills and change its perspective. Theoretically, that is why psychedelics help some alcoholics to completely lose their interest in drinking, or smokers to lose their interest in smoking. At best, if psychedelics are used recreationally, without well-trained professionals assisting with psychotherapy tools, an opportunity for mind expansion may be lost. At worst, these powerful substances can do damage.
Here is a relatively mild example. A curious colleague of mine went to a psychotherapist who specializes in psychedelic psychotherapy. Her experience with psilocybin was profound. Afterward she said, “I just don’t sweat the small stuff anymore. Now, instead of experiencing road rage, I experience road incredulity: ‘Gee, cutting me off that way strikes me as not a safe way to drive.’” After a couple of years, hoping for another transformative experience, she used mushrooms recreationally with two friends. The experience was characterized by severe anxiety, and led to weeks of unease. Years later, memories of her experience still trouble her.
Question 4 will increase the availability of five drugs: psilocybin, psilocin, mescaline, DMT (found in ayahuasca) and ibogaine for recreational and — purportedly — for psychiatric use. In the right setting, and with proper dosing, these substances can induce profoundly meaningful experiences. Some indigenous cultures have used “plant medicine” for generations for life-altering spiritual awakenings. Those who administer these medicines are part of a lineage and study under an elder for decades before being qualified to work with participants on their own.
But none of the substances in Question 4 have been well-studied or proven effective as psychiatric treatments. If Question 4 passes, these powerful substances would be available for people to grow, share, and use at home, where, presumably, they would receive little or no professional guidance or support. The psychedelics would also be available for use at “therapy centers” under the guidance of nonprofessional assistants who are required to have no more than a high school degree and minimal training, which would make for an experience that, at best, would almost certainly be less helpful than one guided by a practiced and well-trained professional. At worst, it could be dangerous and damaging.
The Massachusetts College of Emergency Physicians, which opposes Question 4, is concerned that it will “increase the likelihood of overdose, especially in minors and individuals with pre-existing or susceptibility to psychotic disorders and bipolar disorders. Moreover, the ballot question includes ibogaine, which has known risks for inducing arrhythmia, which can lead to cardiac arrest. Until the science is more conclusive, MACEP would support decriminalization over legalization.”
According to the Massachusetts Psychiatric Society (MPS), “These hallucinogens have been shown to lead to a 50 percent increase in emergency room visits and hospitalizations. A third of regular hallucinogen users admit to driving under the influence in the past year. Fatal car accidents have doubled in Massachusetts in the past few years, along with a 65 percent increase in drugged driving.” Furthermore, some people with bipolar disorder, anxiety, and depressive disorders, and schizophrenia have severe worsening of symptoms under the influence of hallucinogens like these five substances. This bill requires no medical or psychiatric screening of would-be users by professionals.
I agree that we should decriminalize these substances. There is no reason the users should be sent to jail. But let’s remember that this bill is supported by money from venture capitalists like Peter Thiel, who have a financial interest in promoting use and access. If there were not billions to be made if this bill and similar initiatives pass, there would be no bill. Is it ever a good idea to let medical decisions be made by people whose primary interest is maximizing financial profit? I think not. There are good reasons why the Massachusetts Medical Society, the American Psychiatric Association, and the State Police Association of Massachusetts oppose this measure.
My opposition to this bill is informed by experience with the commercialization of cannabis. For most people, recreational use of cannabis is harmless, and can bring joy and relaxation. However, as the New York Times has reported, its harms are increasingly evident. About 18 million people — nearly a third of regular users — have developed cannabis use disorder, which is often characterized by physical dependence, decreased IQ in minors, psychotic disorders like schizophrenia, sleep and anxiety disorders, and multiple medical problems. And even if psychedelic substances are not legal for minors, minors and people with mental illnesses whose brains are vulnerable will have increased access — just as they do with cannabis. Cannabis is a far better-known substance than the substances that Question 4 promotes. Do we really want to repeat this gigantic, inadequately studied, and dangerous experiment on the American public with these substances?
Let’s continue to make use of psychedelic medications in safe and well-controlled situations while we intensively study their effects and side effects. In the meantime, Question 4 simply goes too far, too fast, and the damage that it will do to many people is certain. As the Massachusetts Psychiatric Society sums up, “The ballot question is not about public health, but private wealth and recreational use and abuse.”
Dr. Charles Silberstein is a psychiatrist affiliated with Martha’s Vineyard Hospital and Island Counseling Center, where he is the medical director. He is board-certified in general, addiction, and geriatric psychiatry. He writes regularly about issues Islanders have with mental health.
Laura Roosevelt added to this essay. She is a poet, journalist, and editor who writes regularly for Bluedot Living magazine.
Thank you very much for taking the time to write this essay. It was extremely helpful. Many of the concerns shared are concerns I have, but I have no medical training. Hearing from a medical professional makes all the difference.
Charlie-I wish you had written this before early voting.
There can be serious problems with certain avoidance drugs like suboxone that is not revealed to a family or patient. Mr Silverstein has been an enthusiastic supporter of suboxone but one serious effect is rapid tooth decay. There are numerous class actions suits against suboxone drug companies right now . If you were harmed just go online and join for free a class action case. So be careful
hmm ok on this… but Suboxone is typically prescribed to persons with substance abuse and addiction challenges. Many have been willingly purchasing illegal drugs from anonymous sources cut with unnamed chemicals and laced with potentially lethal substances. Seems ironic that you’re now advocating for a class-actin suit due to side-effects from a prescription medication that likely included detailed potential adverse events and side effects – a medication that has likely save 10’s of thousands of lives.
Whataboutism.
I voted yes on this issue for a number of reasons.
First, this is America and we should have the freedom to
put whatever we want into our bodies. I disagree with mr. Silberstein’s
assertions of all the nasty things he claims about marijuana.
I also wonder where Mr. Silberstein came up with the idea
that ” Fatal car accidents have doubled in Massachusetts in the past few years…”
Since he chose not to post any verifiable information about this, I looked it up,
and found this : According to MassDOT in 2022 there were 409 fatal accidents in Massachusetts and in 328 fatalities in 2023″
https://www.jasonranallolaw.com/massachusetts-motor-vehicle-accidents-stats#:~:text=Statistics%20on%20Massachusetts%20motor%20vehicle,in%20328%20fatalities%20in%202023.
It seems 2021 had the highest death rate “in over a decade”.
Let’s also keep in mind that many of these accidents had nothing to do with
drug use of any type.
I am not going to bother checking his other assertions…
As a society, we would be much better off to ban unhealthy fast food
and “Big gulp” sugar drinks disguised as “soda”
But my second reason for voting yes is that I have experienced
the effects of most of these drugs–multiple times
And the effects are astounding and life changing– for the better,
in my opinion–
Of course, that’s my opinion, and I am sure a few people here who
have never experienced the effects of these substances will tell me that my opinion is
wrong–and some who have will disagree with me also –Ok–
To them I can only say Peace,Love and Pasta.
And please vote !
Thank you for this essay, which confirms my own observations concerning cannabis use.
Don is free to enjoy himself, but I certainly don’t want to be in an insurance pool with users of these substances. The whole US society pays for the sky-high medical costs boosted by individuals’ poor life-style choices and the schemes of entrepreneurs such as Peter Thiel to profit from our health-care “industry”—which should not be an industry in the first place.
The idea that everyone should be free to do exactly as they please even though their actions affect others is puerile.
Katherine– Just for the record, I no longer
indulge in cannabis or psychedelics.I haven’t for at least 30 years
and have never had any medical intervention or rehab related to and drug or
alcohol use.
I pointed out some of the things people are free to ingest.
Some people will have 2 big macs . supersized fries
and a 42 ounce soda or a milkshake to wash it all down.
Twice a day,
With bags of seriously addictive chips and snacks in between
and “energy drinks” to keep thep them moving — cost– $412.9 billion
dollars of insurance money just to treat diabetes annually.
https://diabetes.org/newsroom/press-releases/new-american-diabetes-association-report-finds-annual-costs-diabetes-be
Not even factoring in all the other health problems–
How about tobacco ?
Legal over 21 , but I have to say I have actually seen younger
people engaging in this “poor lifestyle choice”
$ 170 billion per year in medical cost.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4603661/
Alcohol ? — “excessive drinking” alone cost $249 billion
— 2010 costs– apparently the alcohol lobby is pretty
good as I cannot find any data past 2010 on this specific
cost projection.
https://providernews.anthem.com/california/articles/alcohol-use-disorder-has-a-big-cost-5-10564
Those kind of “poor lifestyle choices ” are just fine, I suppose
Not much info on psychedelics costs to society , since they are not widely
used, but I’m sure they are extremely low comparatively.
All other substance abuse combined direct medical cost
over $13 billion– 2017 numbers–
https://pmc.ncbi.nlm.nih.gov/articles/PMC7936257/
Now, I’m not saying we should ban people from freely
engaging in the poor lifestyles choices we all indulge in
occasionally, but really, put psychedelics in perspective, please.
Unfortunately, Katherine– you ARE in an insurance pool with all these
people making poor choices.
Re “I pointed out some of the things people are free to ingest.
Some people will have 2 big macs . supersized fries
and a 42 ounce soda or a milkshake to wash it all down.
Twice a day,”
Er, those items are not on the ballot, Don.
Katherine– if you do not want to be in an insurance
pool with these people who make poor lifestyle choices,
I suggest you start a petition to get this societal
blight on the ballot, or just be “self insured”.
Sadly, republicans are funded in a major way by the health-care industry and big pharma.
This psychiatrist from McLean Hospital in Massachusetts, one of the best psychiatric hospitals in the country, and an instructor at Harvard Medical School, urges voters to vote YES on Question 4: https://psychedelicalpha.com/news/op-ed-from-a-massachusetts-psychiatrist-why-doctors-support-yes-on-question-4
Graham, I read your link. Thank you. There doesn’t seem to be any disagreement between Dr Silberstein and the psychiatrist from McLeans, as far as the therapeutic value of these substances when used in a safe, supervised setting. The problem is with how Question 4 is worded. A Yes Vote means anyone (who can pay) can be licensed to sell this stuff, and individual idiots over 21 can produce their own. Most of us have observed what recreational overuse does to a person, so it seems wise to not have blanket availability at pot shops to those whose daily actions, including driving and personal interactions, are clearly pathological and impaired by their substance abuse. Dr Silberstein makes clear that these substances can have enormous value to some patients needing help, but can also be detrimental to others. As is made obvious in another comment, recreational availability is not a problem for those seeking out their fun and don’t mind putting others at risk to do so. Should these people still be arrested for illegal possession of psychedelics? Yes, because recreational use is irresponsible and dangerous to others, the way lighting prohibited fires in a state forest is dangerous. Many medications, including psychiatric medications, given in the hospital or as prescriptions are illegal as street drugs and are not sold OTC at pharmacies. There’s a good reason why. Widely available, not well- regulated psychedelics are the last thing MV needs.
Jackie– thank you for your reasonable, articulate comment
on this subject. I totally agree with almost all of your points.
Agreeing with even one of my points about why a NO vote mattered, means you regret your YES vote.
Jackie– Your opinion does not make something true.
I do not regret my YES vote in any way, even for a second.
Nor do I regret donating to the ADL. I never said it, I never
thought it, and I never will.
Quit lying please.
But it’s nice to see how dedicated you are to coming together
and healing the divides that the “radical leftist fascist”
have created. Great start —
Jackie– Recently I posted this:
“Feel free to quote me later–
The F*****ng ruthless radical terrorist pigs that are hiding among
the civilian population and hiding like rats in tunnels
and hospitals while raping innocent people
deserve to be killed in the most painful way”– Keller
Oct 28 7:42 PM
Any questions ?”
I also posted this :
“the Jewish people are proud of their culture and their heritage–
with good reason in my opinion.”– Keller oct 31 10:14 am
I have also clearly stated many times here that the state
of Israel has the right to exist and to defend itself.
Do you agree with any of those statements ?
A simple yes or no will be sufficient.
If so , what does that say about you ?
Keep in mind, that i agreed with some of your points
about psychedelics, and you immediately retorted
with a wildly inaccurate lie about my opinions.
Or do you disagree with my statements about
Israelis and the ruthless terrorist they are fighting ?
Again, a simple yes or no will be sufficient.
Again– If so , what does that say about you ?
I know you will twist yourself and my words
every way you can to deflect from these simple
questions.
I urge you to be brave, and admit that you agree
with me about something.
Or not–
I promise I won’t make any untrue radical pronouncements
about what you are thinking or why.
Just give me a straight answer please.
Thanks–
Dr Silberstein’s medical degree, research, and experience with practical applications through years of his work dedicated to helping people are important to consider. His work gives the credence to professional conclusions, certainly not to recreational anecdotes. The island’s substance abuse issues are no secret. Chronic recreational over use of mind altering substances, including recreational cannabis, is often a dependency… it’s drug abuse. Neither is it a secret to any but the over-users that mind altering drugs can and do negatively impact individuals and also have a negative effect on those forced to be around the user. It’s like an alcoholic denying he has a problem when everyone around him sees it. Medical settings with controlled use to help folks are what’s best for how these powerful drugs are used in the community. Thank you, Dr Silverstein. This essay, and comments, should really help achieve a majority NO vote on Question 4.
We need more regulations on what we may put in, and remove, from our bodies.
These decisions must not be left to the individual.
No one has the right to remove their God given body parts.
I am too weak minded to decide what I want to put in, and remove, from body.
I want a New York City real estate tycoon to make those decisions for me.
Or at least someone with a deep understanding of the bear body, like RFK Jr..
Albert, some NYC real estate professionals have been laundering money for the Russian mob.
What have we done? The republicans have said they will end the money to Ukraine, which may lead to the downfall of the free Europe. If Europe topples what comes next?
We are going to be living in a “reality” tv show where the president is an actor.
😢
But what about cannabis, alcohol, nicotine, and caffeine?
W need more rules and regulations, not less . . .
What happened to Katherine Lane. The best writer on this site?
Great question sir. Maybe she just got tired of spitting in the wind within this liberal echo chamber. Trying to get your thoughts approved here is a daunting task and honestly exhausting at times.
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