Rethinking Psychedelic Risk

As a Brazilian who immigrated to the US, I have been intrigued following the conversation on psychedelic safety, harm and risk in the recent years in the media here.

Risk is everywhere. We encounter it daily when we drive a car, drink alcohol, eat processed food, travel, etc. According to the World Health Organization, alcohol alone causes over three million deaths each year worldwide – more than all illicit drugs combined. Tobacco remains one of the leading causes of death. Yet we don’t treat these behaviors as inherently pathological. We manage their risks. We contextualize them. We live with them.

When it comes to psychedelics, however, we see a different story. They are often singled out as exceptionally dangerous, framed through narratives of harm, danger, and criminality. But this framing reveals more about our cultural assumptions than about the substances themselves. It’s time we rethink the “psychedelic risk” approach; not to ignore or minimize potential harms, but to reframe the conversation around history, culture, and power.

The Colonial and Prohibitionist Legacy

The modern notion that psychoactive substances are a “problem” requiring control is historically recent. For most of human history, psychoactive plants and compounds have been part of religious, medicinal, and social life. The shift toward prohibition emerged alongside colonialism and efforts to control the behaviors of racialized and marginalized communities.

Drug policy was never just about pharmacology. It was also about social control. The demonization of cannabis, peyote, ayahuasca, coca, and other substances often went hand-in-hand with the criminalization and surveillance of Indigenous, Black, Hispanic, and working-class populations. Sacred plants were portrayed as threats to public order. Rituals were persecuted and outlawed. Entire knowledge systems were erased.

Our views on “drugs” are not just about safety and health – they’re about morality. The framing of drug use as inherently dangerous, criminal, or pathological is rooted in colonial ideologies, inquisitorial campaigns, and centuries of demonizing sacred plants. Today’s drug discourse remains steeped in moral and religious worldviews, even when dressed in the language of science and public health. These narratives often ignore the longstanding networks of cultural norms, informal care, and community-based safety that have accompanied psychedelic use across generations.

We often overlook how contemporary policy and media discussions still echo this legacy. When drugs are discussed in mainstream arenas, it’s typically through a Western, medicalized, and moralizing lens, where non-clinical or traditional uses are portrayed as risky, unregulated, or irresponsible. This framing conceals its own assumptions while dismissing other ways of knowing and relating to these substances. Calls for urgent “guardrails” in psychedelic policy are a clear example. While framed as health-conscious and pragmatic, they often reproduce the logic of Prohibition. But more control does not automatically mean more safety, and there is no clear evidence that regulating psychedelics increases problematic use, or causes naïve people to experiment with novel psychoactive substances and have substantial negative effects.

Risk Is Not Harm

One of the most important distinctions we can make is between risk and harm. Risk is the possibility that something might go wrong. Harm is when it actually does. When we treat risk as harm, we collapse possibility with outcome. We accept risks in nearly every part of life. We don’t outlaw driving, flying, or scuba diving because it’s risky, even though accidents happen all the time. We manage risk based on context, values, and informed consent.

Yet dominant narratives in media and policy often fail to make this distinction. Risk becomes synonymous with harm. A single “bad trip” can be enough to discredit entire traditions and communities of use. Meanwhile, thousands of people who report healing, insight, and spiritual growth through non-clinical psychedelic use are largely ignored. Why do narratives of risk, stories of trauma, and calls for increased oversight dominate the public debate? Why don’t we call for a nationwide alcohol ban every time someone dies from drinking?

The answer lies in which stories we choose to legitimize. Narratives of harm are often amplified under the banner of “caution,” and individuals who have suffered negative experiences are elevated to the status of “risk experts.” Meanwhile, stories of healing, creativity, community, and transformation are dismissed as merely anecdotal or not serious enough. This selective storytelling reinforces stigma and upholds systems of control over bodies, minds, populations, and cultures.

Medicalization and the Politics of “Safe Use”

The mainstream embrace of psychedelics in recent years has largely come through the lens of medicalization. Clinical trials, FDA approvals, and pharmaceutical investments are transforming psychedelics into tools for treating mental health disorders. While this has clear benefits—including wider access and legal protections—it also reinforces a narrow idea of what “safe” or “legitimate” use looks like.

Under this framework, only regulated, clinical, institutional use is seen as valid. All other uses—Indigenous, religious, personal, collective, social—are marginalized as unsafe or irresponsible. A hierarchy is created: Regulated is seen as legitimate and responsible, while unregulated is portrayed as dangerous and deviant.

But this hierarchy doesn’t reflect reality. Traditional and underground communities have developed robust methods for minimizing risk. These are not lawless spaces – they are living systems of knowledge, habits, etiquettes, protocols, sensitivities, ethos, and hierarchies that have adapted and evolved over decades, even centuries.

In contrast, claims for regulation as a clear and unique pathway for dealing with and legitimizing psychedelics reasserts authority over substances that have always existed outside the bounds of formal institutions. Instead of honoring the knowledge that already exists, they treat non-clinical users as reckless or naïve. This attitude reproduces the very exclusionary logic that prohibition relied on. Drug regulation must depart from the knowledge and systems of control that already exist and not erase them in the name of “safety.”

Traditional Uses and Cultural Contexts

Around the world, Indigenous and traditional communities have long used psychoactive substances in sacred, social, and relational contexts. These uses are not framed as social problems and do not demand intervention. They are embedded in systems of ritual, meaning, and intergenerational knowledge. Take ayahuasca in the Amazon, peyote in North America, mushrooms in Mexico, or iboga in Central Africa. These psychoactive plants are used within frameworks that have managed risk, not eliminated it, but contextualized and contained it. They rely on guidance, community, and respect. Risk is acknowledged, not feared. 

Yet, these traditions are often invisible in the psychedelic mainstream. Their knowledge is appropriated, exoticized, or ignored. Instead of being consulted, Indigenous voices are sidelined in conversations about healing, safety, policy, and legitimacy. This is a form of epistemicide: the erasure of entire knowledge systems in the name of science or public health.

We need to shift this narrative. Safety in psychedelic use should not mean necessarily conforming to recent, external, and formal institutional models. It should mean honoring the diverse ways communities have already built systems of care and supporting those systems rather than replacing them. In the US, people often claim that “in other cultures, using these substances is part of life, and that is normal, but not here.” This is not true. It reflects a romanticized idealization of Indigenous practices in distant jungles or deserts, coupled with a lack of self-respect and cultural confidence in our own land and traditions. 

The United States is home to a wide array of psychedelic communities and traditions. From foraging circles and grassroots social movements to iconic gatherings like Burning Man, gay rave culture, and the growing number of mushroom and ayahuasca churches emerging across the country, psychedelics are deeply embedded in diverse social scenes. Millions of Americans use these substances, not in secret or isolation, but as part of vibrant cultural ecosystems; and yet, we are not witnessing a national crisis. 

Embracing Risk Without Fear

Risk is part of life. Psychedelics are not the exception. They are part of culture, part of history, and part of an ongoing human relationship with consciousness. We are not beings confined to a single, rational, vigilant state. We dream, fall ill, fall in love, become intoxicated; we move through multiple modes of experiencing the world. Our consciousness is shaped, not only by reason, but also by our relationships with the non-human, the invisible. 

If we truly care about safety, we need to decolonize our imagination about psychedelics. That means moving beyond stories of psychedelics as salvationist and messianic panaceas, stereotyped hero’s journey stories, diabolical and pathological entities, and moral-religious and prohibitionist assumptions. Psychedelics are a part of life. They can work, or not; they may be boring too. Most importantly, not all uses of psychedelics need to be clinical to be meaningful. This means acknowledging that people, communities, and cultures have long known how to engage with these substances responsibly, and even joyfully.
The obsession with risk reflects something deeper: a fear of losing control. But control is not the same as safety. And, sometimes, fear of risk is just another way of maintaining outdated systems of authority. Instead of asking how to protect people from psychedelics, maybe we should ask how to support their uses and maximize their benefits, not through top-down mandates, but through respect, curiosity, dialogue, and cultural humility.