I am a practicing psychiatrist, medical director, and assistant professor in psychiatry in Massachusetts. I also hold a PhD in the history of psychiatry, making me keenly aware of the achievements and setbacks in the development of the field. This November, Massachusetts voters have the opportunity to accomplish a historic milestone. By approving Question 4, voters will reverse the unjust criminalization of five naturally-occurring psychedelics, all with unique therapeutic potential widely recognized decades ago, and generate a regulated framework for supervised use that protects vulnerable individuals.
Many experts and organizations indicate that we are facing a mental health crisis, putting our current conventional therapies under pressure to effectively address it. Each year in Massachusetts, over 600 individuals, including dozens of veterans, disproportionately suffering severe mental illness, die by suicide.
Considering this reality, it should be no surprise that patients are increasingly turning to the substances in Question 4 for relief. In observational and clinical research, just one or two doses of certain psychedelics have consistently been associated with long-lasting reductions in debilitating or life-threatening behavioral health conditions, with few side effects. Combined with the growing flood of patient testimonials crediting psychedelics with helping their lives, it is naive to expect long-suffering individuals to wait three, five, or ten years for FDA-approval before they seek to access these treatments.
Question 4 is a compassionate and commonsense response to this reality, which is why the approval of Question 4 is supported by many healthcare professionals. The measure ends the threat of arrest for people already accessing natural psychedelics for themselves, making that use more transparent and safer, and it creates an aboveground model of responsible, supervised use that is optimized for healing, not for profit or for recreation. There are no retail sales permitted by Question 4, and those who access the regulated care will be required to attend consultation appointments before and after being administered a psychedelic, which is not conducive to cramming in customers to turn a buck.
Still, this initiative has been the target of misinformation from opponents, complicating what is, on the merits, a simple proposition. To help voters make an informed decision, I am writing to dispel a few common misconceptions.
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Misconception 1: The policies in Question 4 are not supported by healthcare professionals and experts.
Truth: The policies in Question 4 are supported by many healthcare professionals and experts, as reflected in survey data, official positions of medical professional organizations, and endorsements. In fact, the overwhelming majority of the most relevant experts, psychedelic researchers, are either publicly neutral or in support of the measure.
A recent survey of American psychiatrists found majorities in support of both the decriminalization, and the legalization for medical use, of psychedelics like psilocybin in Question 4. Furthermore, the American Medical Association and the Massachusetts Medical Society both officially support the decriminalization of personal substance use. I am one of over fifty MDs, and hundreds of healthcare professionals and experts overall, who individually endorsed Question 4. These endorsers include over twenty current and former psychedelic researchers, including Dr. Matthew Johnson and Dr. Bessel van der Kolk, giants in their fields.
Misconception 2: There is insufficient evidence to support Question 4.
Truth: There is more than sufficient evidence to support Question 4. First, the evidence that Question 4 does not pose a risk to public health or safety is strong. There is not a single locality opponents can point to where the decriminalization or legalization of the substances in Question 4, which are all non addictive, appeared to increase DUIs or hospitalizations. In fact, after Colorado passed a measure like Question 4 in 2022, hospitalizations related to hallucinogens, including but not limited to psychedelics, remained lower than they were in 2020 and fatal DUIs went down by 23.8%.
Furthermore, in Massachusetts, the deprioritization of arrests related to natural psychedelics by eight localities, encompassing over 390,000 residents, did not produce increases in hospitalizations or DUIs or an explosion of black market activity.
Second, all the substances in Question 4 have long histories of therapeutic use, dating back centuries or thousands of years in certain populations, and the relevant clinical and observational research, while very preliminary in some cases, suggests they are uniquely effective. Moreover, all the substances are already legally employed as therapeutics abroad relatively safely. Considering the many individuals currently seeking these treatments, it is prudent to provide regulated access for harm reduction purposes at the very least.
Criminalization makes the natural psychedelics use that is happening, and will continue to happen, less safe. If someone has an adverse reaction to psychedelics, they should not hesitate to seek medical assistance because of fear of arrest for drug possession. Individuals need to feel safe to discuss their healthcare decisions with loved ones and healthcare providers.
Misconception 3: Proponents of Question 4 rely on anecdotes while opponents rely on facts.
Truth: The stories of individuals, particularly veterans, whose lives appear to have been saved or positively transformed by natural psychedelics, are central to overcoming the non-evidence-based fears of many voters, but they do not reflect the absence of supporting evidence.
Rather, some of the circulating opposing arguments have made misleading claims in the absence of solid data and non-anecdotal evidence to support their concerns. Below are a few representative examples.
One of the most repeated misleading claims is that “1 in 3 frequent psychedelic users [report] driving under the influence of psychedelics in the past year.” The study opponents cite does not contain the word “psychedelic.” Instead, the study refers to users of “hallucinogens,” a broad category of drugs that includes addictive substances, like PCP, that the National Institute on Drug Abuse (NIDA) does not consider to be psychedelics and that are not in Question 4.
Another claim is that the psychedelic substances in Question 4 “have been shown to lead to [a] 50% increase in emergency room visits and hospitalizations,” for which there is no citation or supporting study. Another claim, that “MDMA causes persistent long-term psychosis in 25% of persons,” is attributed to a study on methamphetamine, a different drug, which does not support even the 25% figure. It is worth noting that MDMA, while widely considered a psychedelic, is not included in Question 4.
Lastly, the ostensibly pro-psychedelics group Bay Staters for Natural Medicine has attacked Question 4 for being too restrictive by making a series of false claims not supported by textual evidence, including that the measure would criminalize indigenous and traditional use of natural psychedelics and would limit personal possession to 1 gram of psilocybin mushrooms rather than to 1 gram of the chemical psilocybin, as is actually specified in the measure.
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In conclusion: I invite voters to not take at face value claims made by opponents and to seek out information on natural psychedelics, and Question 4, for themselves. I ask them to consider whether arresting people for possessing non addictive substances with potentially groundbreaking therapeutic potential is a compassionate or effective way to protect public safety or promote lifesaving public education. I ask voters to consider whether they would be willing to wait—whether it’s three, five, or even ten more years—to access a therapy that could enable them to live a full and happy life, especially if they are dealing with incapacitating anxiety or depression and other treatments have failed.
I ask voters to consider whether they would prefer that vulnerable patients seeking psychedelic therapy have no regulated option, pushing many into the clutches of drug dealers and underground facilitators.
As a psychiatrist, I know what I prefer: an end to the climate of fear around natural psychedelics, a regulated, safe option for patients seeking psychedelic therapy, and a historic opportunity for Massachusetts, and the field of psychiatry, to build something better.
Dr. Fernando Espi Forcen is a psychiatrist with a background in clinical practice and the history of psychiatry. He has more than 40 peer-reviewed publications in a variety of aspects of psychiatry, such as akathisia due to drugs, metabolic syndrome, inflammation, dissociative symptoms, history of psychiatry, and cinema.