A letter I wrote to women in my field of Psychedelic Science and Therapy:


Hi all,

I am compelled to share with this group that I am noticing a very dangerous trend amongst the drug positive community I am part of in the Bay Area. On December 11, one of my best friends and a leader in our community died, after becoming addicted to ketamine over the last 1.5 years, habits clearly exacerbated by quarantine. Three weeks earlier, a well known CEO and close friend of mine died, after becoming addicted to ketamine and nitrous oxide aka whippets. I am aware of 4 additional deaths from ketamine in the past 6 weeks, 3 in the Nevada City area, and at least one more in my Oakland friend group. I currently know several close friends who are heavily addicted to ketamine, experiencing delusions a la John C Lily, and fiercely defending their use.

We took the ketamine from my friend's room and had it tested at a lab, and found fentanyl in it. Now, my community's entire dialogue around drug safety is centered on fentanyl testing, as it is super clear the fentanyl is in the ketamine supply in the Bay Area and elsewhere, and I have heard of it showing up in LSD and MDMA recently as well. The calls for safety include: drug checking, not using alone, awareness of dosage, Narcan training, and safety positions. While these are all critically important, there is something missing.

Why isn't frequency of use discussed in terms of harm reduction? It used to be the case that nobody could safely talk about the amount of use, because doing so would implicitly condone the use of scheduled substances. Now, with shifts in drug policy occurring around the country, there is more space to speak to this. I believe this is a necessary part of harm reduction that is not discussed, and potentially not well understood. Many of the decisions around frequency of use are extremely personal, and I won't judge someone who might need to use a substance daily, whether it be caffeine or cannabis or methamphetamines. People need to do what they do to get by.

I perfectly understand the extreme stigma attached to drug dependency. The dominance of the abstinence only approaches to sobriety are predicated on a false dichotomy: that you are either using substances and its bad, or you are sober and it is good. There is a massive grey area which is only beginning to be discussed, which is that there is a broad spectrum of use, and that spectrum moves from healing, supportive and sustainable, all the way to unhealthy, destructive, and not sustainable.

On Monday, my friends hosted a call to have an open, honest, and vulnerable conversation about our personal relationships to substances. It was extremely illuminating, and I left the call with a dark realization: many more people than I previously knew are daily users of ketamine. Daily. Many of them have not seen this activity has harmful, until this most recent loss. Many perceive themselves to be helping themselves, and are now coming up for air and realizing that perhaps, they might be experiencing challenges around dependency. There was a rich conversation about what is considered "safe" or "healthy" use, where to draw lines, how to check in with oneself honestly around intention (am I doing this because I am trying to disassociate from my problems, or am I doing this to turn towards my problems?),

All of the people I am close to have in common the narrative that they are healing themselves with psychedelics. They say that they are using ketamine to treat their anxiety/depression/trauma and other mental health issues, and frequently cite scientific information and the data driven results of the emergent psychedelic therapy movement. As this narrative becomes ever more popular, there is a massive risk to having people perceive psychedelics as a panacea, a silver bullet solution to all psychiatric and mental health problems. I think this can be damaging to our overall movement, as it is not just the psychedelics that are helpful, it is the container and context they are received through, and the integration work that happens to repattern a person's life.

(I also need to note that many of my friends are artists and cannot afford to do ketamine in a supervised setting or cannot afford therapists, and therefore are doing it on their own. I understand that many therapists might feel the only safe way to do ketamine is with supervision, yet I think it is unrealistic to think that is the ONLY way to do it.)

One of my friends who died shared with me a letter he had written titled "In Search of Addiction", where he enumerated all of the mental health benefits of using ketamine, and fiercely defended his frequency of use. He declared that he was all around healthier, happier, smarter, more efficient, and able to learn complex things much easier through the regular use of ketamine. He completely ignored the fact that he had abandoned every one of his close friends and replaced them with enablers, that his behavior had become totally erratic and unpredictable, he was unable to show up to work, and he had ceased sleeping for more than 3-4 hours per night (his assessment was that he had "hacked sleep" and could get more done being awake more), he lost so much weight he became frail, and he started making irrational and irresponsible decisions about his wealth. He flat out rejected the notion that his use was problematic.

What stunned me the most about him, and some of my other friends, is that he strongly believed that Ketamine is not addictive, that it is only healing, and that he had somehow unlocked a master key to the universe through regular use of this substance. Despite the articles I sent on long term kidney damage. Despite stories of the rash of deaths associated with ketamine in the late 70s and 80s such as the story of Marcia Moore, and explaining the generational amnesia about this that seems to be happening.

While the drug war has done a phenomenal job to paint substances in a super negative way, I believe that it is my responsibility as someone who extolls the healing potential of psychedelics to also clearly discuss the risks and harms that can be associated with this work. Especially with substances like ketamine.

Additionally, I have seen countless people over-use psychedelic journeys, including ayahuasca ceremonies and other classic psychedelics, continually going to drink from the well of creation, while not taking the time to integrate the lessons. I have witnessed people's lives get turned upside down, and people become even more destabilized and disoriented through frequent journeying. This correlates with the huge amount of people who have quit their lives to take up the mantle of the psychedelic renaissance after a few journeys. An elder once told me to wait 6 months before making any big decisions with a romantic partner after doing MDMA with them. This is sage advice. We need more road signs like this for novice users.

I do believe there is a future where people can safely use substances in unmediated and unregulated settings, and through direct experiences on their own. Yet, as of today, I do not believe that we have a strong enough culture around how to do this safely and effectively. I am not certain the drug positive communities I have been part of for 15 years emphasize best practices, despite thinking that we do.

We certainly have our work cut out for us to generate a mass culture of safe substance use. I am afraid we are so busy celebrating the positive aspects of psychedelics, that we are not paying enough attention to the ways things can go terribly wrong. Is this willful ignorance? For me, the highlight of the Esalen retreat we did a few years ago was when a case around a 65 year old man who died in a  mushroom therapy session that was facilitated by a well trained person was discussed. As terrifying as it was to hear this, it was real. And true. And humbling to recognize the extraordinary power of these experiences to potentially take life.

I sometimes wonder if the collective hubris of declaring to be experts in something that is so unknowable and so unpredictable might be our downfall.

To me, the drugs are NOT the point. The healing IS. And, there are many ways to heal, with and without psychedelics. I am committed to sharing this message at every chance I get.

This very long winded expression is to ask this: how would people on this list approach questions of harm reduction in relation to frequency of use? Do others perceive a similar trend of people using the narrative of healing to mask potentially problematic use? Do people feel they are adequately addressing the risks and potentials for abuse in their practices and public declarations? Is there other activity I and others should consider in response to these trends?

If you made it this far, thanks for reading.