Against Psychedelics

I can already hear your gears turning, dear reader: “Wait, you’re pro-booze, pro-cannabis but anti-psychedelics? At least be consistent, you human paraquat!” And look, I get it. But hear me out.

I’m not anti-psychedelics; I’m anti-hype. And right now, the psychedelic hype train makes me want to gouge out my eyes. I’m a libertine when it comes to recreational drugs—they’re fun, they open up new ways of seeing the world, they remind us that other realities exist, and they can even bring us closer to our friends. Sign me up!

But please don’t insult my intelligence by telling me this stuff will solve all my problems. Don’t promise me oceanic boundlessness—yes, an actual scientific term—when what you mean is that it will deliver moments where you think you’ve unlocked some deep mysteries that have been holding you back, only to realize later it was just some half-baked epiphany that makes little sense when you’re not tripping balls.

Maybe I should back up a minute and describe what, exactly, is being hyped.

Over the past decade, psychedelics—the lay term for a class of drugs that, apart from MDMA[1], make you hallucinate—have shifted from hippie relics to the forefront of mental health innovation. Proponents cite studies showing that substances like psilocybin, MDMA, and ketamine can alleviate PTSD and treatment-resistant depression, purportedly achieving results traditional therapies struggle to match. Researchers suggest these drugs, especially when paired with guided therapy, can trigger profound insights and lasting psychological change in just one or two sessions. Backed by high-profile authors, clinicians, and investors, these findings have spurred the FDA to fast-track their approval, framing psychedelics as a potential revolution in mental health care.

So, what’s my beef?

My first issue is that the promises being made border on the fantastical, and the otherwise sober bureaucrats of our society have swallowed them whole. As psychedelic critics Michiel van Elk and Eiko Fried point out, the research doesn’t just claim psychedelics can help with depression or PTSD—it promises that psychedelics make everything better. Psychedelic trips are billed as life-changing events, right up there with your wedding day or the birth of your first child. They’ll unlock your creativity, help you solve problems, make you care deeply about the planet, and transform you into a mindful, connected soul. Surely, they’ll also fold your laundry, file your taxes, and make you “fitter, happier, more productive.” All this… from a mushroom trip?

While I would expect this sort of sales pitch from the high priests of this stuff, surely the guardians of public health would hold psychedelics to the same rigorous standards as any other therapy, right? Nope. Instead, regulators granted psychedelics so-called breakthrough therapy status, fast-tracking their review with lower evidential requirements. In the U.S., the FDA has given this designation to MDMA for PTSD and psilocybin for depression (though they recently backtracked on MDMA-assisted therapy due to insufficient data). Australia has gone even further, becoming the first country to approve psilocybin and MDMA for clinical use earlier this year, despite similar concerns about the strength of the evidence.

But maybe I’m just being grumpy again. Maybe I just need to open my mind to all the rock-solid evidence of psychedelics’ transformative magic. After all, if a blot of acid was fun and helpful, I’d give it breakthrough status too.

So, what does the science reveal?

When Keith Humphreys—a Stanford Professor and research scientist at the Veterans Health Administration—and colleagues looked at the data, they discovered a striking gap between the extraordinary claims made and the actual evidence to support them. For a field so popular, there is a remarkable lack of solid research. Humphreys and his team pointed to the shockingly low number of studies meeting even basic scientific standards, despite hundreds of publications. And by basic standards, they meant randomized controlled trials with at least 15 participants per treatment arm, a number far below what is required for reliable conclusions. This is why meta-analyses in this space are worse than useless: garbage in, garbage out. Limiting analyses to only high-quality studies would leave too few to even review.

This situation is reminiscent of social psychology in the 1990s and 2000s, before the replication crisis forced the field to take a hard look at itself. That crisis taught us a crucial lesson: rigor is never optional. This is especially true when dealing with powerful and potentially dangerous drugs. Strong claims demand strong evidence, yet that standard is sorely lacking in psychedelic research.

Nonetheless, when examining only studies that meet minimal scientific standards, Humphreys and colleagues found positive signals that ketamine might hold promise in the treatment of substance use disorders, as might MDMA for PTSD, and psilocybin for depression and end-of life-anxiety. Before getting too excited, when they say, “positive signals,” they mean these studies warrant replication with larger samples and better controls. And, they note, while some studies show small effects here and there, many of the effects are transient, present for a day or a week after treatment, but absent weeks or months later. That’s the extent of the good news, folks: small, transient effects that have not yet been effectively replicated.

The bad news is more concerning: the biggest obstacle to good science in this field is the difficulty of keeping participants blind to their condition: psychedelic drug versus the placebo control condition. When participants know what condition they’re in, their expectations can run wild, and it’s possible that it is these expectations—not the drug itself—that shape any downstream effects.

The gold standard of scientific quality is a randomized control trial with a double-blind design. In these sorts of studies, participants are randomly assigned to one treatment group, and they (and the researchers) are left unaware of their group assignment. To evaluate a new antidepressant drug, say, study volunteers could be randomly assigned to either the active drug condition or the placebo/sugar-pill control condition, and both the study volunteers and researchers are unaware of which pills they are ingesting. The reason blinding is so critical is because expectancy effects alone might lead people to report a remission in symptoms if they are in the active drug condition or an exaggeration of symptoms because they were disappointed to be in the control condition. Effective blinding is thus essential.

Unfortunately, unlike an antidepressant drug that might quietly adjust your serotonin levels behind the scenes, psychedelics announce their presence with vivid, unmistakable effects: if the walls are melting, you can be pretty sure you’re in the active drug condition. Unless participants are rendered unconscious—something that was recently tried and incidentally failed to produce measurable benefits—it is impossible to mask who gets the drug and who doesn’t. The problem is that when participants know they’ve taken the real drug, their expectations about life-changing benefits can kick in, potentially amplifying the perceived effects—effects that may owe more to their beliefs than to the drug itself.

And this is where hype becomes more than just an annoyance: It can heighten participants’ expectations, making it harder to disentangle the drug’s actual effects from those driven by belief alone. When media coverage and cultural narratives frame psychedelics as transformative life experiences that can act as an “antidote to evil” (I kid you not, that’s a quote from one of the pioneering scholars of psychedelics), participants enter clinical trials primed with expectations so high they could make even a sugar pill feel transcendent. This issue is compounded by the fact that many of these participants are self-selected enthusiasts further muddying the waters. By convincing millions of people that psychedelics can be a salve to what ails their spirits, psychedelic enthusiasts like Michael Pollan have inadvertently undermined the science.

Perhaps the most serious problem with psychedelics, though, is with serious side effects. Psychedelics can give you an upset stomach and leave you sitting on the toilet for a bit, but the real issue is with suicidal ideation. A bad trip is scary and deeply disorienting and just might leave you thinking that jumping out of a window is a good idea. In one study, a non-trivial number of patients with treatment-resistant depression taking psilocybin reported not only suicidal ideation and intentional self-harm but actual suicidal behaviours. In another study of patients with treatment-resistant depression, one quarter of participants needed to be hospitalized for one week after their experiences with ayahuasca, a powerful hallucinogen “due to presenting a more delicate condition”, whatever that means [2]. To clarify: the drugs that we are touting as medicine to treat depression (among other things) leave some of its users more suicidal than before treatment.

Another serious concern is the addictive potential of some of these drugs. Ketamine, and possibly MDMA, carry a risk of addiction, compounded by unknown long-term safety records. The tragic case of Friends actor Matthew Perry underscores this danger. In the month before his death, Perry was reportedly injecting ketamine six to eight times a day, racking up a $55,000 monthly habit. He tragically died after taking a large dose of the drug and deciding to go for a swim. Cases like this make it clear: these substances can be abused, and their therapeutic use should be approached with extreme caution.

Adding to the mess, pharmaceutical companies have jumped on the psychedelics rush, further muddying the waters with financial incentives. Critics Van Elk and Fried highlight an alarming example: in a recent paper on ketamine, 19 of the 25 authors had conflicts of interest, including financial ties to ketamine treatments. You know me, I can’t complain—but maybe we should all start. When so much of the research is conducted by people with financial or ideological stakes, it’s a reminder of how vital independent replication and scrutiny are to ensure the findings hold up under unbiased conditions.

So, am I really against psychedelics? Yes and no. I’m against all the hype that has promised so much more than it can ever deliver. No, psychedelics will not fill your god-shaped hole; no, they won’t fix all your problems. But I’m certainly not against more and better research. There is a positive signal, as Humphreys and colleagues say, meaning there might be something here that we should continue exploring. I’m also not against psychedelics for recreation. They do produce glorious moments of euphoria that seem revelatory. Even if these experiences are not as meaningful as the birth of a child, they are fun and can spark moments of profound beauty.

So, should you do psychedelics? Sure, if you want to. Take a trip, marvel at the fractals, commune with your inner child. But let’s stop pretending they’re the answer to our collective mental health crisis. The real answer is far more complex, likely requiring systemic changes in how we approach mental health care—better access, better therapies, and yes, more rigorous science.

Psychedelics might help…or they might just leave you convinced that your landlord’s dance cycle was a secret conduit to the divine.

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[1] Technically, MDMA is not a psychedelic but falls within the amphetamine class of drugs. However, due to its similar therapeutic potential, it is often grouped with psychedelics in discussions about mental health therapies.

[2] A previous version of this post, failed to mention that these two studies were of patients with treatment-resistant depression. This is important context given that suicidal ideation and other complications might be more common with people suffering from treatment-resistant depression.