Flanked by one of psychedelics’ biggest celebrity cheerleaders, Joe Rogan, and a troupe of MAHA loyalists, President Trump recently signed an executive order aimed at accelerating psychedelic access for clinical research and treatment.
Use of naturally occurring and synthetic hallucinogens traces back to the Neanderthals. Yet these substances have long been a pariah in mainstream medicine, written off as “club drugs” with little to no clinical value (or worse, downright negative effects).
But they no longer sit on the fringes of medicine. In August, for instance, pharmaceutical giant AbbVie inked a billion-dollar deal, the first of its kind, to acquire Bretisilocin, a psychedelic compound used to treat major depressive disorder. Now Trump is directing federal agencies to streamline regulatory pathways, expand clinical trials, and explore mechanisms for broader therapeutic use. With the federal government formally throwing its hat in the ring, this is likely just the start of a much broader trend of Big Pharma investing heavily in the drugs.
As researchers who focus on mental illness and addiction, we see psychedelics’ potential as a form of treatment as virtually unmatched. But their promise faces both scientific uncertainty and thorny political questions — especially when it comes to their benefits outside of white populations.
Today, psychedelics’ applications are more expansive than ever, having evolved well beyond their role as a treatment for mental illness to a clinical Swiss Army knife that appears to help conditions ranging from opioid addiction and chronic pain to eating disorders. The global psychedelics market is expected to reach roughly $11.7 billion by 2029.
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Currently, the most clinically — and politically — promising psychedelic is ibogaine. Ibogaine has shown efficacy in addressing depression, trauma, and substance use disorders and has gained praise from veterans with PTSD. Evidence of ibogaine’s increasing clout can be seen in its broad embrace outside of the white liberal enclaves typically at the forefront of drug legalization efforts, like Oregon and Washington state. For example, in June, Rick Perry, former Republican governor of Texas and secretary of energy during Trump’s first term, published an op-ed in The Washington Post calling for a legal embrace of ibogaine. (He’s also discussed his personal experience with the hallucinogen.) Former Republican House Speaker Newt Gingrich offered a similar co-sign on his podcast last summer.
In a YouGov poll, 28% of Americans indicated they had tried at least one of seven different psychedelics. The number of adults who have ever used psilocybin (magic mushrooms), America’s most popular psychedelic, increased from 25 million in 2019 to 31.3 million in 2023.
Retired boxer Mike Tyson, whose rage in and outside of the ring became the stuff of legend in the ’90s, has frequently sung psychedelics’ praises. “Everyone thought I was crazy,” the heavyweight boxer said in an interview with Reuters, going on to mention his ignominious bout with Evander Holyfield in 1997. “I bit this guy’s ear off.” Tyson’s introduction to psilocybin proved life-altering. “I did all this stuff, and once I got introduced to the shrooms … my whole life changed.”
Without a doubt, white people are psychedelics’ biggest audience. According to one study, 12% of non-Hispanic white Americans have used psilocybin at some point in their lives, compared with 3.4% of non-Hispanic racial and ethnic minorities (3.4%). Similar racial gaps have been observed for MDMA (ecstasy), LSD, and mescaline. White people are even consuming psychedelics deeply associated with Indigenous culture, like peyote and ayahuasca.
It’s racial minorities, though, who could gain the most from the use of psychedelics. The two of us been studying why they haven’t so far.
Black people experience higher levels of early-life post-traumatic stress than white people and are more likely to suffer from chronic depression later in life. Moreover, while suicide has been on the decline in white populations in recent years, rates have steadily increased among Black people, and attempts remain highest among Indigenous Americans.
On the substance use end, a study from our research team found that Black, Latino, and Indigenous people generally have higher rates of opioid overdose deaths relative to white people. Psychedelics — medically dynamic and relatively easy to procure and process for clinical use — look heaven-sent in their potential to address persistent health disparities like these.
Yet racial minorities haven’t benefited from the psychedelic renaissance. In fact, studies from our team and others consistently show that racial minority groups tend to experience substantially fewer clinical benefits from psychedelic use relative to non-Hispanic white people. One study published last June found that psychedelic use for Black and Hispanic users didn’t reduce their distress levels; however, among white psychedelic users, usage was associated with lower distress levels. Another study found that non-Hispanic white participants who had used psilocybin had reduced odds of hypertension. However, no such associations were observed for Black, Hispanic, Asian, Indigenous, or multiracial study participants.
There’s a key reason for findings like these: the persistent exclusion of racial minorities from psychedelics research.
Compared with white people, Black people and other racial minorities have historically participated far less in clinical trials — the primary staging ground for exploring the efficacy and safety of drugs. Minorities’ limited participation is due primarily to researchers’ lackluster outreach efforts and minorities’ deeply rooted mistrust of research and the medical establishment.
Compounding the problem, psychedelics are frequently best when taken in safe, comforting spaces that encourage openness. People with chronically negative experiences, for example with racism, may struggle to embrace the “trip” and absorb the full range of fruits it can potentially offer.
Researchers haven’t yet figured out how to tailor psychedelic regimens to the unique social, somatic, and psychological profiles of racial minorities. The Trump administration’s ongoing antagonism toward race-focused research adds an obvious wrinkle to addressing this issue.
Despite this, there’s a clear appetite for psychedelics among racial minorities. A study showed that when Black and white people were educated on psychedelic-assisted therapy, Black people had more positive views on it. And, unsurprisingly, this interest was related to unmet need: individuals with greater depression and PTSD symptoms, particularly Black participants, expressed higher levels of interest in psychedelic-assisted therapy.
Lastly, there’s the issue of criminalization, which impacts not just access but patterns of societal stigma toward drugs. In recent years, a number of American cities, including several with large Black populations — like Oakland, Calif.; Detroit; and Washington, D.C. — have crafted laws to eliminate criminal penalties for recreational usage and in some cases to make psychedelics more accessible. Whatever President Trump’s endgame, most psychedelics will likely remain illegal at the federal level, even as some companies operate in a legal gray area (for example retreats, ketamine clinics). These spaces exist alongside, not outside of, America’s hugely ineffective — and highly racialized — War on Drugs. And the War on Drugs indeed looms large in consideration of how race may impact the enforcement of future federal and state-level psychedelics policies. The real implications come into focus at the point of use.
The majority of psychedelic use is without incident, but there are exceptions. When they occur, they can be especially detrimental to the safety of racial minorities, whose usage is frequently framed as problematic rather than spiritual or part of a soul-searching process. Black and Latino men, for example, are more likely than white men to be arrested for severe mental illness-related behavior, such as psychosis, which has a modest connection to psychedelics.
Given how entrenched and complex our public health challenges are, we can’t afford to not capture the lightning-in-a-bottle that psychedelics offer. Fortunately, psychedelics as a field is still in its infancy, and there’s time to calibrate the science and racial sensitivity in a way that makes the drug safe, effective, and inclusive. We don’t have to sacrifice one benefit to secure the others.
Jerel Ezell, Ph.D., M.P.H., is a social epidemiologist and assistant professor at the University of Chicago Medical Center. He studies the social and racial aspects of health. Sugy Choi, Ph.D., M.P.H., is a health services researcher and assistant professor at New York University Grossman School of Medicine. She studies health policy and equitable access to care.