Op-ed: Harvard professor of psychobiology weighs in on ballot Question 4

By Dr. Bertha K. Madras
professor of psychobiology at Harvard Medical School | Special to The CFP

Massachusetts residents are once again being asked to weigh in on the legalization of hallucinogenic substances known as psychedelics. The outcome of Massachusetts Ballot Question 4, set for Nov. 5, is being closely monitored by billionaire investors, medical professionals and activists. Supporters, including those with financial stakes, are pouring more than $6 million into campaigns promoting the measure. In contrast, the opposition – an unorganized group of medical professionals, scientists, or individuals who have experienced drug-related harm – has raised concerns about the potential risks but lacks the financial resources for a comparable campaign.

If the measure passes, it would allow Massachusetts residents over 21 to grow, possess, and use “natural” psychedelics. While personal use would be decriminalized, the sale of these substances would be limited to “clinics,” which would offer psychedelic experiences at high prices. A state commission would be established to develop the rules and regulations governing this new industry, though specifics remain unclear.

Psychedelics are hallucinogens, a powerful class of drugs that have unpredictable effects on individuals. The mind-altering effects can also decrease the boundary between self/world. In some vulnerable people, use can result in psychosis or suicidality, especially if taken outside the context of a secure environment. Most disturbing is Hallucinogen Persisting Perception Disorder (HPPD) which is defined as reoccurrences of hallucinations, other visual disturbances without warning, a few days or even one year after drug use. Their use in medical experiments and by the public during the 1950s and 1960s led to so many chaotic consequences that California banned LSD in the mid-sixties. Eventually, interest in their medical use vanished and access by the public became highly restricted.

I urge voters to vote “no” on question 4 in the state election this November. Here are some of my reasons:

1. The public has been flooded with hype on the potential therapeutic effects hallucinogens and psychedelic drugs. They have been promoted as cures for depression, addiction, trauma and many other psychiatric problems along with their power to enhance creativity and expand consciousness. Yet, the use of psychedelics for medical purposes is not “settled science.” The Food and Drug Administration has not approved any psychedelic for any medical purpose. In fact, in 2024, it denied approval of MDMA (ecstasy) for post-traumatic stress disorder (PTSD) even though it had undergone evaluation in clinical trials for years, and its prime advocate had been asserting that FDA approval was imminent for a decade.

2. No profiteers should be able to open a “medical clinic” using drugs not approved by the FDA. FDA standards for approval are high, their professional staff are experts at ferreting out bias and wishful thinking.

3. Ballot initiatives are corroding the high standards imposed by the FDA and oversight of the safety and effectiveness of drugs in our nation. Anyone with deep pockets will be able to mount a campaign via ballot initiatives to make available non-FDA approved or fraudulent concoctions. This will take us back to the notorious 19th and early 20th century when people died of dangerous potions designated as “medicine.” When will approval of “medicines by ballot” end?

4. Out of many hundreds of people who volunteer for experiments with psychedelics, very few are chosen for clinical trials. They are mostly white, college-educated, with relatively high income and many have experimented with hallucinogens. Current clinical trials exclude people who are suicidal, have a personal or family history of psychosis, any type of heart disease or other vulnerabilities. Even with these exclusion clauses, no one can predict how an individual will react to a psychedelic, or long term adverse consequences.

5. Even the clinical trials that have breathlessly reported positive outcomes in carefully selected subjects have significant problems: studies that have examined this question have shown therapists to be biased towards the drugs, no one has carefully measured long term outcomes, and one study showed a disconcerting rise in suicidality among subjects after a single dose of psilocybin. Several clinical trials have reported positive benefits of psilocybin in alleviating treatment-resistant depression; yet in one of these studies, increased suicidality was documented in some subjects

6. We now pivot to the concerns of home grows. I have been challenged by some who believe that because “magic mushrooms” are a natural plant they must be harmless and safe to grow at home; actually they are a fungus. But not all plants are benign and healthy. Plants use chemical toxins as one strategy to protect themselves from threats. Plants that produce compounds that interfere with our brain communication include the coca bush and marijuana. Cocaine and THC within these plants are insecticides that interfere with nervous system communication.  

7. Enabling people to grow “magic mushrooms” in their homes or backyards eliminates even the flimsy guardrails against use by “at-risk” people. Who will screen for “at-risk” people at home, for access to the drug by children, adolescents, pregnant women, by people with a predisposition for psychosis? Who will provide what is currently deemed essential in psychedelic clinical trials, the presence of a stable trained therapist or partner who will carefully monitor and guide the individual during hallucinosis?

8. We now have an unprecedented rise in psychedelic use in our nation among youth and young adults. The public is not informed that we’ve also had an unprecedented rise in calls to poison control centers, to emergency departments and hospitalizations due to hallucinogens. The public is not informed of increased reporting of extended difficulties after the use of psychedelic drugs, or the association of psychedelic use among youth with higher prevalence of depression, suicidality, use of other substances, substance use disorders, and days unable to work because of mental health condition following use.

The harmful effects of these drugs are well documented by those familiar with the history of this class of dangerous substances. At least six books detail the sordid medical experiments with psychedelics in the 1950s and 1960s, some of which were sponsored by the CIA. Psychedelics have a long, controversial history in both American medicine and recreational use. By the early 1970s, their medical application was largely abandoned because outcomes were highly unpredictable.

The recent resurgence of public interest in psychedelics is a reminder that American society remains vulnerable to generational forgetting. Two centuries ago, we learned opioids could cause fatal overdoses, and for 150 years we understood that they were highly addictive. Opioid prescribing became restricted, mainly reserved for cancer pain, acute injuries, and post-surgical use. However, in the 1980s and 1990s, weak science combined with clever marketing misled the medical community and the public into believing opioids were safe and non-addictive for chronic pain management. The result? Nearly one million lives lost to opioid overdoses.

We should indeed support rigorous, high-quality research into the therapeutic potential of psychedelics. But we must also avoid repeating the mistakes of history by allowing misinformation and premature optimism to cloud our judgment. For the sake of our most vulnerable, our children, and the integrity of mental health treatment and the FDA, voters should reject Question 4 by voting “no.”

– Bertha K. Madras is a professor of psychobiology at Harvard Medical School based at McLean Hospital in Belmont. She has spent decades as a researcher, educator, inventor and public official in the field of drug biology and prevention. Under George W. Bush, she served as Deputy Director for Demand Reduction in the White House Office of National Drug Control Policy and in 2017 was a member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. She has also been invited to the World Health Organization, the United Nations Office on Drugs and Crime and the Pontifical Academy of Sciences.