Opinion | Endorsement: Vote no on Question 4

For some people, the use of psychedelic substances can be life-changing. Former army infantry officer CJ LoConte said during and after his deployment, several soldiers he commanded attempted suicide. LoConte was on multiple psychiatric drugs when he was hospitalized for suicidal ideation. Then he tried a psychedelic drug with help from a counselor.

“My psychedelic experience changed my life. I was finally able to release the blame, guilt, shame, everything I’ve been bottling up from my time in the military,” LoConte told the editorial board.

He is not alone. Studies suggest the drugs can be useful for people with “existential distress” stemming from serious physical illness or those with severe depression, anxiety, substance use disorder, or post-traumatic stress disorder.

If Question 4 on November’s ballot just allowed patients like LoConte to receive the drugs in safe settings, it might be easier to support. But the proposal goes further than that, also allowing home growing and unregulated consumption of five psychedelic drugs, some of which carry real health risks. For that reason, this board encourages voters to vote no on Question 4.

But that shouldn’t be the end of the story. Given the passion surrounding this issue, the Legislature should create a committee of experts to recommend a framework for allowing access to some psychedelic drugs in a thoughtful, limited way based on science and the experience of other states.

As importantly, scientists, doctors, and pharmaceutical companies should continue conducting the serious research that is already ongoing into the medical benefits of these plants, with the goal of getting medicines approved by the US Food and Drug Administration. While that will take time, FDA approval would ensure that a neutral agency has weighed the risks and benefits of drugs. It would also let drugs be prescribed by doctors and covered by insurance.

The point of FDA review is to do what Question 4 asks voters to do instead: vet the evidence and make sure data back up anecdotal stories of the drugs’ benefits.

That’s a demanding process. The FDA recently rejected an application to use the psychedelic drug MDMA to treat post-traumatic stress disorder, citing study flaws and the potential for serious health risks after taking the drug — and it is that kind of rigorous review that ensures drugs given to patients are safe and effective and potential risks are known.

Psychedelics are not addictive and are relatively safe, but they are not risk-free. Ibogaine can cause cardiac irregularities and has been associated with sudden death. DMT, a chemical in ayahuasca, can cause serious psychological effects like hallucinations, even days after its use. Psychedelic drugs carry the risk of “bad trips.” As a report on the ballot question by the Center for State Policy Analysis at Tufts University notes, the risks of serious negative psychological effects, like psychosis, can be particularly pronounced for people with mental illness. As with any mind-altering drug, there is danger in driving while impaired. There could be harmful effects if drugs are ingested accidentally by children or pets. As we’ve seen with marijuana legalization, even drugs generally considered low-risk can cause serious side effects.

Question 4 would legalize — at a state level — the use of five drugs found in mushrooms or plants: psilocybin, psilocin, DMT, ibogaine, and mescaline. (As with marijuana, these drugs would remain illegal federally.) The ballot initiative would create therapeutic centers where someone could pay to obtain psychedelic drugs and receive therapy by a trained facilitator before, during, and after their use.

In a meeting with the editorial board, initiative proponents stressed the importance of having trained facilitators guiding psychedelic sessions. Dana-Farber Cancer Institute psychiatrist Roxanne Sholevar said people can experience intense feelings including agitation or confusion while using psychedelics and “having robust support structures in place is critical to be safe and effective.” A trained facilitator can screen out patients who have conditions or are taking medications that make psychedelic therapy risky and can ensure someone takes an appropriate dose.

Of course, this method is not foolproof. These facilitators would likely not be doctors or nurses due to federal prohibition. That’s why the ballot question would require the creation of a specialized training course along with oversight to ensure facilitators provide appropriate care. Given the state’s dysfunctional Cannabis Control Commission, it’s questionable whether Massachusetts has the ability to set up the guidelines and oversight needed to safely oversee another controlled substance.

Additionally, while the opportunity for enhanced supervision is a strong argument for bringing these drugs aboveground, it begs the question of why the proposal would also let people grow significant amounts of the drugs themselves. It goes beyond decriminalization, which is the de facto policy now since virtually nobody is prosecuted in Massachusetts for growing a small amount of mushrooms. If the ballot question passes, adults 21 and older could possess limited amounts for personal use and could grow these substances in a 12-foot by 12-foot area in their home and gift them to other adults.

That’s the basic contradiction of Question 4 — which on one hand stresses the importance of rigorous oversight and on the other proposes a free-for-all.

While retail sales of those homegrown psychedelics would be prohibited, the Legislature’s Special Joint Committee on Initiative Petitions points out that although the ballot initiative forbids “commercial activity” related to psychedelics and would not license guides outside of the official centers, growers could try to circumvent the prohibitions by giving the drug away free but requiring the customer to pay the grower to be their guide while using — or pay the seller to give the user advice about using, as has occurred in Denver.

The therapeutic centers, which wouldn’t open before 2026, would be expensive due to the number of a hours a therapist would spend with clients. In Oregon, the only state where centers are already operating, a psychedelic experience can cost more than $1,000. Allowing home grows (which Oregon does not) would likely, as the legislative committee pointed out, create one system for those who can afford a licensed center and another system that would be cheaper but unregulated and unlicensed.

So far, the only state to legalize personal use and growth of psychedelics is Colorado, which voted to do so in 2022. While a report by the libertarian-leaning Reason Foundation found few major impacts in areas like hospitalization and drug crimes, it’s too early for conclusive data about the impact.

If the initiative does pass, we hope the Legislature and any new regulatory agency would impose guardrails that protect public safety. This could involve limiting the size of home grows, requiring all guides be trained and licensed regardless of whether they work in a center, increasing monetary penalties for violating the law, and ensuring there are evidence-based guidelines and strict oversight of center operations so patients are treated in a safe, healthy way.

But if it doesn’t, regulators and lawmakers shouldn’t interpret the result as a verdict on the medical potential of psychedelics. Clearly, the potential is there — the drug industry and the FDA just need to follow the evidence to exploit it.

Read the Editorial Board’s positions on the 2024 Massachusetts ballot questions:

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.

Psychedelic drugs have great therapeutic promise. But Question 4 goes too far.

The Editorial Board encourages voters to vote ‘no’ on Question 4.

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