Psychedelic-assisted therapy might just be the next breakthrough in mental health care. But much of its success hinges on laying the groundwork for equitable access. Mental health issues, like depression and PTSD, stem from systemic socio-economic problems that disproportionately affect communities of colour. But in the push for medical legality, clinical trials are for the most part a homogenous group. At this critical time in the push for prescribed psychedelics, the research to support its integration into medical practice lacks diverse perspectives.
People of colour (POC) made up just 11% of participants in psychedelic studies conducted between 2006 – 2016. What’s more, is that there were just 2.5% of Black participants globally. Even that is slightly more than the number of Black participants in the United States. It’s now the year 2020 and MAPS is nearing completion of a trial with MDMA for PTSD. Yet again, research participants were mostly White. That discrepancy is problematic. Clinical trials form the framework or protocol therapists will use in practice. We’re supposed to be examining the “safety and efficacy” of psychedelic-assisted therapy, but right now, we’re not exactly giving people of colour the right amount of weight into the equation.
MAPS did have at least one clinical trial site dedicated to recruiting diverse participants. The University of Connecticut Health Center had a number of protocols in place to attract diverse participants. They focused on culturally sensitive treatment, including how racial trauma could require adaptations to treatment, and the research team was diversified. In terms of outreach, advertisements were altered with inclusive language that addressed culturally specific traumas. Since POC tend to be disadvantaged economically, other obligations such as work and family care, interfered with their ability to participate in trials. So MAPS compensated at least $400 among participants for their time. Such efforts continue into the final phase of MAPS clinical trial with MDMA. Yet POC are still underrepresented in clinicians on site, and that makes it difficult to recruit and retain POC in clinical trials.
Biomedical research hasn’t exactly been kind to marginalized groups. Take the Tuskegee Experiment (1932 – 1972), the trial was portrayed to treat syphilis. Most of the participants were Black, all of whom were given placebos. They didn’t receive any treatment and died. In the 60s/70s Black, Puerto Rican, and Mexican-American women were violently abused through medical sterilization. Then there was the infamous Harvard psychologist Timothy Leary who toted LSD as a cure for homosexuality. It’s no wonder that minorities have reluctance or distrust in clinical trials. When MAPS made efforts to diversify its research staff, “several potential participants expressed gratitude, safety, and comfort when interacting with our therapists of colour.” But it’s a rather high barrier of entry to become a psychedelic therapist. The legal routes cost somewhere to the tune of $9,000 – $15,000. A pretty steep price-tag considering the legality of the job still hangs in the balance.
Let us not repeat the past in our quest to integrate the traditions of indigenous medicine into the medicalization of psychedelics. We can start by continuing active efforts to diversify leadership in research teams. Moving forward, it will broaden the framework as we re-evaluate study designs and therapy models.