‘If We Turn a Blind Eye to Harm Reduction Efforts, We May Have Another Moral Panic on Psychedelics’

Josh Hardman is the founder and editor of Psychedelic Alpha, a newsletter, web resource and boutique consultancy, where he explores the curious intersection of psychedelics and business, sharing regular updates and working with a group of subject-matter experts to maintain numerous free resources and datasets to help individuals and organizations make sense of this burgeoning field. 

Hardman recently discussed the evolution of Psychedelic Alpha’s mission, the contrasting attitudes toward healthcare in the U.S. and the U.K., and the critical importance harm-reduction programs will have on the future of psychedelic medicine.




Over the last year or so, Psychedelic Alpha has seemed to expand from a pure industry news and analysis site to include more viewpoints and op-eds about broader issues in psychedelics. Is this part of a bigger shift in your strategy?

When I started the website back in early 2020, the first task was just to put all the information in one place. Mostly I was just trying to make sense of what things like patents meant in psychedelics, taking the time personally to learn about IP and its relevance to this space and how it might shape the industry, for example. I certainly wasn’t in a position then to have any opinions. The idea was just to bring all the data into one place and let the smarter people — the real investors and entrepreneurs and journalists, like Shayla Love —take the information and actually explain it and editorialize it.

But over time I’ve become more confident in having my own opinions. And given the correction in the market in the last year or two, now is a really good time to get back to first principles. What does sustainability look like in this field? What does equity look like? How much can we realistically push back on broader issues, whether it’s in the patent system or the reimbursement system? It’s really a fertile time for having all these discussions as we move into the next phase of psychedelics coming to market.


Does this make Psychedelic Alpha more mission-based than before?

Yeah, I think so. In the beginning I didn’t care about who used the data we were bringing together. And a lot of organizations used our patent trackers and decriminalization trackers to either gloat about their IP (which were often just patent applications at the time) or to help pump up expectations that a huge market was coming.

But now I’m much more excited when our decrim and legalization trackers are used to help steer harm-reduction efforts in the U.S. I’m also excited to see the data used in grey literature like the U.N. World Drug Report. It helps further narratives around things I’m passionate about: harm reduction, increasing access, winding down the war on drugs, seeing drugs as a healthcare topic rather than a criminal one. So, we’ve just been putting more weight behind those uses of our data analysis.


What are your biggest interests right now in psychedelics field?

Well, access is probably the biggest issue for me. You can look at it through many lenses, but growing up in the U.K. with the NHS (National Health Service) and a single-payer healthcare system, obviously healthcare accessibility is a huge part of our national identity. So I try to bring that perspective, especially because attitudes about it are so different in the U.S.

I studied political economy and sociology, so I’m always trying to use my sociological imagination to understand how and why things become exclusive or inaccessible. Sometimes this makes me come across as pessimistic. But the fact is I wouldn’t have been doing this for three years if I wasn’t excited about the idea that psychedelics could lead to a potential sea change in how we conceptualize and treat mental health.

And then there are the personal motives. I was very socially anxious as a teenager and at university. I studied abroad for a while in Berkeley, and that actually did more to help me than any psychedelic ever could. People in California just talk about how they feel, which is the perfect opposite to how it is in Britain, where you’re often encouraged not to talk about your feelings at all.

So I think I saw a lot about how culture can influence you, not only in how you express yourself, but also your whole attitude toward drugs and drug culture. People where I grew up, even my family, when we think of psychedelics, we don’t think of the fried-egg-in-the-pan image like what you had in the U.S. We have our own kind of war-on-drugs culture, but it’s definitely a different flavor to the U.S. version. So I’ve always been drawn to exploring these differences.


In the early days of your site, many online investor forums picked up your analysis and used it to help pick stocks. What was your reaction to your work being used that way?

I like to think that we never put fuel on the fire of hype, but the hype was certainly there all along. I remember doing some analysis on the marketing budgets of some of the publicly traded companies and how much they outstripped the R&D budgets by an order of magnitude. I think I’ve always had a good radar for sensing a grift. Which is why I was never really interested in retail investing or stock picking or setting price targets. The valuations were just so disconnected from fundamentals.


You also pointed out some of the questionable elements of certain patent applications — such as the use of “soft furniture” and “mood lighting” in therapeutic settings. So you seemed to be well aware not only of the hype cycle, but also the games being played in intellectual property.

Yeah, but I actually think some of us probably went too far and were too critical of some companies. Obviously, Compass Pathways was an easy bogeyman. That was the big one. We used them as a study of how patents interface with psychedelic drug development, and perhaps we weren’t clear enough at the time that this wasn’t necessarily a Compass Pathways-specific strategy. There’s some element of, ‘don’t hate the player, hate the game’. In time we realized that we should be paying more attention to the bigger structural issues in bringing these drugs to market.

That’s actually one of my big interests at the moment: How can we move the goal posts for how patent offices determine something to be ‘innovative’, or how payors think about cost-effectiveness? I think things like that are really intellectually stimulating. Can we actually change the entire way we think about mental health treatment and payment in the U.S. healthcare system? Maybe, maybe not. But we’re going to have some good conversations about it.


As far as the issue of equitable access, do you believe the non-medical regulated state models will allow far more people to access psychedelic drugs than the FDA medical model?

Yes, absolutely. Of course, in Oregon it’s been difficult out of the gate because of the way the program and its license fees are structured, which has driven up prices quite a bit. But hopefully as these programs will be iterated on, including in new states like Colorado and perhaps Massachusetts next, we’ll work out ways of bringing the prices down and having a more sustainable system.

But yes, if I had to make a bet I would say far more people in the next decade are going to access psychedelics outside the healthcare system than within it. Even if you do the basic numbers in terms of how many people will meet the appropriate PTSD diagnosis to be eligible for MAPS’ MDMA therapy, and then discount those who don’t have appropriate insurance, and then discount it again by the number of appropriate facilities and facilitators available. The medical model will certainly help this important patient population, but the numbers won’t compare to those who access through state models.


Is that why you started the “Colorado Natural Medicine Advisory Bulletins” on your site? Because it reflects your interest in regulatory models that increase access?

Yeah, for sure. That bulletin is a partnership with Vicente LLP, and Josh Kappel and Jeff Fitzgerald write them. The big impetus for it was: How do we shed some transparency on the discussions that are happening in Colorado about the rules? In Oregon, there was quite a lot of discussion around what was happening during the development period. But there hasn’t been so much of that in the case of Colorado.

There are some big elements of Prop 122 that will be really important. For example, the ability to co-locate a natural medicine healing center with an existing healthcare facility — or with a palliative care facility, for example. Imagine a situation where you can have a hospice that can now offer natural medicine services starting with psilocybin. That could significantly bring down the costs, and it could also allow people who have medical licenses to practice some elements of that license while also delivering the natural medicine. This would be very different to Oregon. Things like this are clearly important to voters who endorsed the proposition, so I thought it was important to shed some light on how they’re being discussed in these Advisory Board meetings.


If the Advisory Board keeps the gifting component outlined in Prop 122, it could expand access immensely. Do you have any concerns that greater use may lead to greater numbers of bad outcomes and a possible backlash in public opinion about psychedelics?

Yes, I think the states where these reforms take place need to allocate real money to harm-reduction services and meet people where they are. We’re currently seeing a whole cultural backlash against decriminalization in places like Portugal and Oregon, where people feel it’s a failure because of all the bad experiences they hear about or encounter. So psychedelic drug reformer advocates are right to focus on how we support those people who will inevitably have bad or difficult experiences and pressure governments to provide adequate support services.

This is something I’ve been passionate about and talking with government agencies in the U.S. and the U.K. about. Governments and professional bodies need to do continuing education with folks like pharmacists and emergency room doctors and mental health nurses to try and help them understand how to help someone who presents with a challenging psychedelic experience. If we don’t, if we turn a blind eye to harm-reduction efforts, then we might have another moral panic and harm.

Historically, think about indigenous use, 1960s hippie culture and rave culture: In these scenarios, you see some form of a cultural or community container of harm reduction. Obviously in indigenous settings you often have the spiritual wisdom of the elders. With hippies and ravers, you often have explicit harm-reduction resources as well as community tenets, like dedicated tents and ‘PLUR’ at electronic music festivals, for example.

But, now we’re seeing a whole new demographic of people trying psychedelics for the first time. They’ve read about the PTSD studies, they’ve read about the depression studies, and some of them have complex, entrenched mental health issues. While psychedelics might help some of them, others are going to have a really hard time. And they may have no cultural or community container available to them for harm reduction.

I think we have to acknowledge that the type of person using psychedelics is changing, and we’re going to see different types of issues coming up. So I strongly feel we need to have the appropriate safety nets in place.