Quick Summary: Despite presumed benefits, legalization would likely not increase psychedelic use in low/middle income countries, while legalization in high income countries is way too expensive to be worth funging against conventional global poverty interventions, even with extreme optimism about the necessary budget to cause legalizing and the resulting increase in usage.
Long Summary: For the purposes of this, I’m going to boldly just assume that psychedelics are a very good thing, and treat “giving people who want psychedelics access to psychedelics” as an endpoint. I don’t have any strong opinions about whether they actually are good or not, but I see that plenty of other people are trying to answer that question.
Hypothesis 1 (high confidence): For most of the world, the bottlenecks to accessing psychedelics have nothing to do with the law, so fighting to “decriminalize” them is premature. Populations whose bottlenecks are primarily legal live in high income countries, so everything to do with helping them is rather more expensive than other interventions. It’s therefore highly unlikely that legalizing psychedelics would effectively impact global health. Considering the scale of lack of access to mental health resources, I don’t even think that it’s a particularly effective way to improve mental health specifically.
Hypothesis 2: If you do work on this, consider focusing on lobbying, which may be surprisingly cheap compared to research and clinical trials (low confidence, worth further research). Even if lobbying for legalization succeeds, for this to work there are possibly additional, possibly more expensive barriers that you have to sort of hope the market sorts out on its own for it to become like an ordinary drug.
...all of which hinges on psychedelics themselves being at all good or effective medically, which seems to be something which isn’t particularly certain. So, as far as being an “EA cause area”...well, I don’t think this is something we should be diverting fungible funds to, at least. If you had activities in mind that don’t divert significant funds, or don’t boil down to changing laws, this analysis may not apply.
Evidence
Part 1: Exactly how illegal are psychedelics, really?
Please review these maps summarizing the legality of shrooms, mdma, and ibogaine
Note that most of the world is GREY (no data) in all these maps. What does that mean?
To quote Wikipedia’s page on India, which I picked because it is a country with high population: “Psilocybin mushrooms are officially illegal but the police is largely unaware of their prohibition and are poorly enforced in India.”
Okay, so… based on all this, I’m going to tentatively conclude that psychedelics are basically an unenforced non-issue for the major population centers of the world, to the point where it takes a lot of work to even figure out their obscure legal status. Maybe if you actually started distributing psychedelics it would become an issue, but as of now it’s not even on the map.
Part 2: But what if it was available by prescription?
You know what else is available by prescription and probably helps mental health? Antidepressants! This are two articles about the global picture for antidepressant use. 1) Business Insider 2) The Guardian
Eyeballing these charts, it seems pretty clear that prescription antidepressant use would drop off pretty sharply outside high income countries. It ranges from 1.1% to 0.1% for the relatively well off countries on this chart and looking at the trend of this chart, i think it would be even lower than 0.1% in low income countries. I doubt that this is because the population of countries just don’t need anti-depressants—it’s probably an issue of access to medicine. So I’m pretty sure legalizing psychedelics is not actually going to help most people acquire psychedelics.
Part 3: Okay, but what about people for whom laws ARE a limiting factor? They matter equally!
Okay, lets just consider the United States as the case study, since it’s easy to get data about the USA.
Americans may be the best case scenario in terms of post-legalization uptake, because, as per the previous articles, they use the most drugs. 1 in 6 Americans use prescriptive psychoactives of any kind.
This is promising! Maybe Americans would benefit from using more psychedelics, and they would do so if it was legal. Marijuana legalization did increase marijuana use...although ehhhh I suggest clicking on that link and eyeballing that chart, or going into the original paper and looking at the stats if you want to quantify this. Colorado is the most dramatic increase at ~11% to ~16% (eyeballing the chart) but e.g. Washington didn’t really see huge increases. The grayed-out lines are states that didn’t get legalized, and some of them saw increases to. Still, there are probably important differences between marijuana and various psychedelics in terms of ease of producing them and acquiring them.
Anyway, how much would it cost to do make it legal and available?
For the USA, full R&D to “marketing approval” of a random compound is estimated to cost 1.4b and increasing to 2.9b USD (2013 dollars) post-R&D cost. “Marketing approval” is a high standard. This means that you can openly advertise for it. For the USA, FDA approval for things (that have not been made illegal) costs 19m USD (2013 dollars.
But maybe the market would take care of that itself. What would be the lobbying costs?
Here’s a linkdump preliminary research on the landscape of current lobbying spending to legalize marijuana and end the War on Drugs in general. The numbers I’m seeing in these articles are inconsistent with each other (e.g some of Opensecret’s figures are lower than 1 million/year nationwide, yet this random article which is just about New Jersey is higher than 1 million?) but I admit I have not read this super carefully. I’m not going to summarize these further because I’ve set aside 1.5 hours to write this post, and that time is now up, but I will leave these sources for anyone who wishes to carry this forward. It’s possible that lobbying might actually be sort of affordable?
https://www.opensecrets.org/lobby/indusclient.php?id=N09 https://www.opensecrets.org/news/issues/marijuana/
We’ve taken USA as a case study, but it is probably cheaper to lobby other countries. (But, most of the countries for which legalization is a likely barrier are also high income countries...with smaller populations...and less prescription drug use)
But even if you succeeded at all of this in the United States...how many people would you really help? The US population is 327.2 million, and even if we really optimistically assume that the number of psychedelic users will grow to match the number of antidepressant users, that’s only 1.1% of them, so… around 3.6 million people, and let’s forget about those who would use psychedelics anyway. How much are you really willing to spend on accomplishing that? I mean, pick a realistic budget, and put it into here to compare it to some other stuff https://www.thelifeyoucansave.org/impact-calculator
Let’s suppose you happen to spend a probably unrealistically low 5 million dollars on this problem, and you have an unrealistic high 100% chance of success, and as a result an unrealistically high 3.6 million people who weren’t motivated enough to buy illegal psychedelics are now free to use psychedelics a decade earlier than it otherwise would have been legalized without your intervention...you could have given 3.9 million people access to a year of clean water. Sort of—i don’t think this impact calculator takes room for more funding and scaling into account. But, just to be in the ballpark—Does that really seem at all equivalent? To me, it feels extremely not equivalent, by orders of magnitude. (Not to put too sharp a point on it, but I bet having access to clean running water also boosts creativity, problem solving, reduces stress, aids in healing from trauma, and all the other benefits listed.)
Epistemic status: all my knowledge on this topic was acquired during the 1.5 hours it took to research and write this post, and I admit that the research is extremely haphazard—aimed at establishing very rough “order of magnitude” type estimates. I have no prior stake or knowledge about this, I just quickly wrote it up because I felt like taking a shot at the prize. Nevertheless, I do feel fairly confident in the opinions expressed here.
>My current view is that psychedelics are an extremely promising altruistic cause area (on par with global health & x-risk reduction) – I’d like to learn more about how this might be mistaken.
A point of clarification: Your “on par with” phrasing perhaps inadvertently suggests that psychedelics are not a global health intervention. My analysis views psychedelics legalizations AS a global health intervention, and therefore subject to the same metrics. E.g. the way Givewell considers laws restricting and taxing tobacco a global health intervention).
I’m a researcher at SoGive conducting an independent evaluation of StrongMinds which will be published soon. I think the factual contents of your post here are correct. However, I suspect that after completing the research, I would be willing to defend the inclusion of StrongMinds on the GGWC list, and that the SoGive write-up will probably have a more optimistic tone than your post. Most of our credence comes from the wider academic literature on psychotherapy, rather than direct evidence from StrongMinds (which we agree suffers from problems, as you have outlined).
Regarding HLI’s analysis, I think it’s a bit confusing to talk about this without going into the details because there are both “estimating the impact” and “reframing how we think about moral-weights” aspects to the research. Ascertaining what the cost and magnitude of therapy’s effects are must be considered separately from the “therapy will score well when you use subjective-well-being as the standard by which therapy and cash transfers and malaria nets are graded” issue. As of now I do roughly think that HLI’s numbers regarding what the costs and effect sizes of therapy are on patients are in the right ballpark. We are borrowing the same basic methodology for our own analysis. You mentioned being confused by the methodology - there are a few points that still confuse me as well, but we’ll soon be publishing a spreadsheet model with a step by step explainer on the aspects of the model that we are borrowing, which may help.
If you ( @Simon_M or anyone else wishing to work at a similar level of analysis) is planning on diving into these topics in depth, I’d love to get in touch on the Forum and exchange notes.
Regarding the level of evidence: SoGive’s analysis framework outlines a “gold standard” for high impact, with “silver” and “bronze” ratings assigned to charities with lower-but-still-impressive cost-effectiveness ratings. However, we also distinguish between “tentative” ratings and “firm” ratings, to acknowledge that some high impact opportunities are based on more speculative estimates which may be revised as more evidence comes in. I don’t want to pre-empt our final conclusions on StrongMinds, but I wouldn’t be surprised if “Silver (rather than Gold)” and/or “Tentative (rather than Firm)” ended up featuring in our final rating. Such a conclusion still would be a positive one, on the basis of which donation and grant recommendations could be made.
There is precedent for effective altruists recommending donations to charities for which the evidence is still more tentative. Consider that Givewell recommends “top charities”, but also recommends less proven potentially cost-effective and scalable programs (formerly incubation grants). Identifying these opportunities allows the community to explore new interventions, and can unlock donations that counterfactually would not have been made, as different donors may make different subjective judgment calls about some interventions, or may be under constraints as to what they can donate to.
Having established that there are different criteria that one might look at in order to determine when an organization should be included in a list, and that more than one set of standards which may be applied, the question arises: What sort of standards does the GWWC top charities list follow, and is StrongMinds really out of place with the others? Speaking the following now personally, informally and not on behalf of any current or former employer: I would actually say that StrongMinds has much more evidence backing than many of the other charities on this list (such as THL, Faunalytics, GFI, WAI, which by their nature don’t easily lend themselves to RCT data). Even if we restrict our scope to the arena of direct (excluding e.g. excluding pandemic research orgs) global health interventions, I wouldn’t be surprised if bright and promising potential stars such as Suvita and LEEP are actually at a somewhat similar stage as StrongMinds—they are generally evidence-based enough to deserve their endorsement on this list, but I’m not sure they’ve been as thoroughly vetted by external evaluators the way more established organizations such as Malaria Consortium might be. Because of all this, I don’t think StrongMinds seems particularly out of place next to the other GWWC recommendations. (Bearing in mind again that I want to speak casually as an individual for this last paragraph, and I am not claiming special knowledge of all the orgs mentioned for the purposes of this statement).
Finally, it’s great to see posts like this on the EA forum, thanks for writing it!