Where Did 2022 Take the Psychedelic Medicine Field?

Psychedelic Alpha, founded by Josh Hardman, is an independent website, newsletter and community that is devoted to empowering a diverse constellation of individuals and organizations with the knowledge, network and nuance to make an impact within the field of psychedelic medicine and beyond.

For the past couple of years at Psychedelic Alpha, we have stewed over the key events from the preceding year ‘in psychedelics’ for our Year in Review. It was, essentially, a glorified timeline of events, with a little analysis sprinkled throughout.

This year, we largely turned that format on its head and went for a more thematic bent. Despite writing tens of thousands of words ourselves (most of which went into the metaphorical shredder come editing time), we prioritized inviting the voices and ideas of subject matter experts in this year’s review. As such, I am very proud that we have managed to feature dozens of folks from across the space, from neuroscientists and historians through to execs and investors.

The Review is split into a handful of sections, but our state of the industry and research and drug development collections are by far the heftiest. Here, I attempt to condense the thirty thousand or so words that collectively represent these sections into short takeaways…

The State of the Psychedelics Industry

You don’t need a Patagonia vest, three vertically-oriented monitors or a Bloomberg Terminal to grasp the fact that 2022 was a bad trip for psychedelics companies. 

Indeed, the biotech sector more broadly saw its lofty valuations take a haircut (a buzz cut, in many cases), as the stock market itself began to cool off after a significant and sustained tear throughout the first seven quarters of COVID. 

Despite these broader downward pressures on stock prices and company valuations, psychedelic stocks outdid themselves in underperforming the market from September 2022 onwards, when they disconnected from a downward trend that was broadly correlated with market and biotech indices to plumb new depths.

It’s not just public companies feeling the pain, either. Psychedelic VCs (who invest in private companies) Clara Burtenshaw and Tim Schlidt told us that 2022 was, “a harsh economic reality check” and “an overdue market correction,” respectively. 

In response to cratering stock prices and a tricky fundraising environment, psychedelics companies have had to adapt their operations. In our analysis, this included a range of strategies: from reigning-in non-critical spend and shelving pipeline assets to taking on increasingly unsavory financings. In the most dire cases, psychedelics companies folded. We should expect to see many more companies fold in 2023.

This challenging financial backdrop is pulled into focus when we consider the vast sums of money needed to bring a psychedelic drug to market. In an opinion piece, MAPS’ Rick Doblin told us that the commercialisation of MDMA-assisted therapy might cost as much over the next two years as MAPS has raised in the last 37 years. It will be interesting to see how, and from where, this financing emerges.

As organizations like MAPS have shown, it is possible to break loose from the pharma playbook, at least to some extent. In this spirit, we rounded out our State of the Industry section by looking at a few individuals and organizations that are challenging the status quo and encouraging us to look beyond Business as Usual. While we might have to budge to some extent to meet the incumbent healthcare system—with all its woes and inequities—where it’s at, perhaps we can also try to make the mainstream a little more “psychedelic.” More on this later.

Psychedelic Research and Drug Development in 2022

Penning a thorough review of psychedelic research and trials in 2022 would have taken us the better part of another year. As such, we highlighted some key milestones and themes.

As psychedelics move into (and complete) late-stage trials, we’re increasingly turning our focus to what’s needed to take psychedelic-assisted therapies (PATs) from a topic of research to a scalable, accessible treatment option. To make sense of the challenges in this domain, we were fortunate to hear from Heidi Allenm, who urged us all to make “access” a meaningful part of every conversation about psychedelic therapy; BrainFutures’ Jazz Glastra, who suggested ways in which we might scale PATs in a time of dire therapist shortages; and, a trio of health economists who present an agenda for research into economic considerations surrounding PATs.

Our own analysis looked at the diverse stakeholders that must be engaged in any roll-out of PATs: from patients to payors. Finding a balance between the cost-effectiveness of psychedelic interventions on the one hand, and safety and efficacy on the other, will be a central and sensitive challenge for the field in the coming years. In this regard we also presented, for the first time, a spectrum of psychedelic therapy protocols, arranged by their broad labor intensity.

Aside from these late-stage clinical trials, which are taking up the most significant portion of funding, we were keen to delve deeper into a topic of great interest in 2022: psychedelic research methods.

In an excellent article (and, fortunately for our time-bounded review, of the 2022 vintage), Jacob Aday and colleagues write that, “[a]lthough some challenges are shared with psychotherapy and pharmacology trials more broadly, psychedelic clinical trials have to contend with several unique sources of potential bias.” Indeed, these methodological challenges abound: (how) can we mask participants to their treatment arm, or to the broader and intensifying hype surrounding psychedelic therapies in popular media, for example? Some are soluble (at least, theoretically), while others are intractable and/or inherent.

Fortunately, we’re walked through these various concerns, and potential paths forward, by a truly interdisciplinary group of academics. Erika Dyck kicks us off by providing the historical perspective of psychedelic trials, explaining that the very nature of psychedelic therapy is incongruent with the methodology of randomized controlled trials, which became the gold standard around the time of the downfall of 20th century psychedelic research. Then, Tehseen Noorani, writing on behalf of the Reimagining Psychedelic Trials working group, introduces and contextualizes the bevy of questions around psychedelic research methods that their group surfaced last year.

Finally, a panel of experts identify the most significant methodological challenges in psychedelic trials and how we might overcome—or embrace—them. The ideas here are invigorating. While many are working to control for expectancy, for example, Stanford’s Boris Heifets told us that he, “can’t give up on the idea that we will one day understand how hope and expectation work, not so we can obliterate them in search of a miracle pill but rather to embrace the processes of preparation, immersion, and integration, and fold them into a mature biomedical mental health model.”

Elsewhere in our R&D review, we interviewed two neuroimaging researchers; presented our Bullseye Chart depicting the psychedelic drug development pipeline; and, delved into a dozen-or-so key psychedelic research themes that proved salient in 2022 in a lengthy piece that couldn’t possibly be reproduced here.

Closing Thoughts

In the late ‘60s, a subset of anti-war students shaved their beards, cut their hair, and occasionally donned suits to go door-to-door campaigning for Eugene McCarthy, an anti-war candidate running against Lyndon B. Johnson. Such was the strategy of the loosely-organized “Get Clean for Gene” campaign.

Today, we’re arguably seeing a “Get Clean for FDA” in the psychedelics space, where some folks and organizations are eschewing the “cultural baggage” of psychedelia past and present in their engagements with regulators, investors and other key stakeholders in the path to psychedelics as medicines in the West. Some of these folks are simply being pragmatic. Others are worried of psychedelics once again entering the zeitgeist outside of a regulated, medical model.

In practice, this might look like an increasing bent toward strategic politics, as seen in a focus on mustering bipartisan support achieved through the foregrounding of groups like Veterans; or, a Paltrow-like “conscious uncoupling” and separation of formerly integrated harm reduction/advocacy and drug development efforts.

Much of this is natural and somewhat necessary. It’s also grounds for great debate and upset. This challenge of delicately balancing prefigurative and strategic politics; principles and pragmatism; and, in-group cohesion and ostracisation, is not new. Indeed, these tensions tore many of the social movements of the late 20th century apart.

As we enter a new year, I hope we—as a loosely defined psychedelic field—can be more collaborative with, and forgiving to, one another. I also hope that we will appreciate and engage with contributions from those beyond our own field, and grapple with challenges posed by systems and structures that are far larger than our own. As we zoom ahead towards potential regulatory approvals and policy reforms, might we also benefit from zooming out? I think so.

In this vein of balancing the nurturing of a diverse, inclusive and collaborative psychedelics space with a clear need to look beyond our bubble, I end with two of my favorite quotes proffered in contributions to our 2022 Year in Review:

“Imagine a psychedelic future where we took seriously the evidence from pharmacologists, Indigenous knowledge keepers, underground chemists, and users themselves. We might more sustainably integrate psychedelics into our modern lives if we are willing to heed the lessons of a more diverse set of perspectives on how to know them.” – Erika Dyck

“Psychedelics are not contained within an insular bubble anymore. If you have a vested interest in psychedelics improving the world, I call on you to look at the larger systems that psychedelics are going to be operating within and tackle those systems rather than just expect psychedelics to do all the work.” – Shayla Love