Article Text

Research abuses against people of colour and other vulnerable groups in early psychedelic research
  1. Dana Strauss1,
  2. Sara de la Salle1,
  3. Jordan Sloshower2,3,
  4. Monnica T Williams1
  1. 1Psychology, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Psychiatry, Yale University, New Haven, Connecticut, USA
  3. 3Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
  1. Correspondence to Ms Dana Strauss, Psychology, University of Ottawa, Ottawa, Canada; dana.strauss{at}uottawa.ca

Abstract

There is a growing resurgence in the study of psychedelic medicines for the treatment of mental health and substance use disorders. However, certain early investigations are marred by questionable research methods, abuses against research participants, and covert Central Intelligence Agency financial involvement. The purpose of this study was to understand how and to what extent people of colour and other vulnerable populations, specifically, individuals who were incarcerated or incapacitated due to mental health issues (inpatients with psychotic disorders), were exploited during the first wave of psychedelic research in the USA (1950–1980). To do so, we reviewed available empirical publications according to current ethical standards. Variables of interest included race and ethnicity of participants, population vulnerability, drug administration conditions, informed consent and undue influence. Our findings draw attention to the history of research abuses against people of colour in Western psychedelic research. In light of these findings, we urge a call-to-action to current psychedelic researchers to prioritise culturally inclusive and socially responsible research methods in current and future studies.

  • research ethics
  • minorities
  • psychology
  • research on special populations

Data availability statement

All data relevant to the study are included in the article.

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Introduction

A brief history of psychedelic medicine in the USA

Psychedelic substances have been used worldwide for thousands of years in rituals, ceremonies and other healing practices.1 Western investigations into the therapeutic potential of these substances began in the early part of the 20th century following the synthesis of lysergic acid diethylamide (LSD) in 1938 and the discovery of its psychoactive properties in 1943.2 After initial studies were performed by Sandoz Pharmaceuticals and a clinical human trial was conducted,3 LSD (under the name Delysid) was approved by the Federal Food, Drug, and Cosmetic Act (FD&C Act) and was brought to the USA for further testing.4 Over the next 15 years, LSD was examined in the treatment of many mental disorders such as anxiety, depression, schizophrenia, and substance use disorders, and as an adjunct to psychotherapy. It was also examined for both psychological and physical symptoms of terminal cancer5 and for its potential to change behaviours and even an individual’s personality.6

The excitement surrounding the potential therapeutic uses of psychedelic substances occurred during a time of revolutionary advancements within the fields of psychiatry and psychopharmacology, due to the concurrent development of antipsychotic and antidepressant medications.7 8 Aside from therapeutic examinations, LSD, psilocybin and the other ‘classic’ psychedelics (N-dimethyltryptamine (DMT) and mescaline) were also being investigated in the study of schizophrenia and other psychotic disorders, as they induced symptoms which mimicked acute psychosis.9

As psychedelics began to cross over into popular culture, a growing public sentiment against their widespread recreational use and their association with the ‘counterculture movement’ created a difficult environment for psychedelic researchers, particularly when Sandoz withdrew their sponsorship of LSD research in 196610 and transferred the rest of their supply to the National Institutes of Mental Health (NIMH).11 Additionally, the implementation of the Kefauver-Harris Drug Amendments of 1962 to the Federal FD&C Act required researchers to formally prove the efficacy of pharmacological substances prior to use, which has been suggested to have particularly disrupted the progress of LSD psychotherapy as it did not account for the therapeutic method employed in these studies.8 10 By the time the Controlled Substances Act of 1970 was passed, over one thousand scientific articles, which included over 40 000 individuals, had been published on psychedelic medicine, and several international conferences had been held.12 13 However, this Act effectively halted the majority of human psychedelic research trials until a resurgence in the early 1990s.

This most recent wave of psychedelic research has emerged despite restrictions in access to most psychedelic substances due to their classification as Schedule 1 substances (ie, no currently accepted medical use and a high potential for abuse) in the USA.13 This resurgence of interest has led to reanalyses of data from earlier trials14 as well as the development of new studies employing modern approaches, rigorous methods, and advanced procedures.4 Recent work has shown that psychedelic substances show promise as novel treatments for mood and anxiety disorders, trauma and stress-related disorders, obsessive compulsive disorder, end-of-life psychological distress, and substance use disorders, among others.2 15 Importantly, these substances may be useful for mental health conditions which are chronic, refractory, and for which effective treatments are lacking.4

CIA, MKUltra, and LSD experimentation

Five years after the end of this first era of psychedelic psychiatric research, news of the use of LSD in Central Intelligence Agency (CIA)-sponsored research emerged. Stemming from fears that LSD could be used as a form of biochemical warfare during the cold war16 and that the Soviets had already developed their own ‘mind-control’ techniques,17 details of a programme (code name MKUltra) consisting of multiple subprojects focused on mind-control, ‘brainwashing’, and the use of LSD as a ‘truth serum’ for interrogating spies, were revealed.

After the Second World War, the CIA recruited 1600 German physicians and scientists to help develop technologies for use against the Soviets in the cold war. These included fifteen dedicated Nazis, and six had stood trial at Nuremberg for human rights violations. Their expertise arose from the manufacture of chemical weapons for the Third Reich, including the toxic nerve agent sarin. One of the German chemists, Richard Kuhn, brought LSD to the attention of the CIA in 1948, and it was soon tested as a tool for enhanced interrogation against Soviet spies who had been captured by Nazis. When MKUltra was formally established in 1953, some of the German physicians and scientists continued to consult in the operation.18

Over 80 public and private research institutions, including many universities, hospitals and prisons, were provided with MKUltra CIA funds, knowingly or unknowingly, to conduct human experimental research with LSD on civilians, prisoners and patients.8

Unfortunately, many records of this project were destroyed by CIA director Richard Helms, though some remained and were brought to light during multiple hearings before the United States Senate.8 19 Other insights have come from scientific publications authored by research groups at specific institutions that received funding through organisations that have since been tied to MKUltra.

Ethical conduct of human experimentation

The revelation of blatant ethical violations within research conducted or funded through the MKUltra programme was in stark contrast to the recent development of the Nuremberg Code in 1947 following the horrors of human experimentation conducted during the Holocaust.20 The fact that this code was enacted and agreed on by the USA at the time of the LSD experiments signifies a clear disregard for ethical practices by the researchers and their institutions.

In 1964, notably during the same time period as some of these experiments, the Declaration of Helsinki was adopted by the World Medical Association.21 22 Similar to the Nuremberg Code, it set out ethical principles for physician researchers to follow when conducting human medical trials, and specified that the goal of producing novel medical findings should never take precedence over the well-being of individual research participants. Importantly, it held physician–researchers (and any other person engaged in medical trials) responsible for the protection of participants enrolled in both therapeutic and non-therapeutic research trials.22 In the most recently revised version, there is an additional component pertaining to special protection for those who are ‘vulnerable and may have an increased likelihood of being wronged or of incurring additional harm’, and that the given group should benefit from the resulting knowledge, practices or interventions.23

Ten years after the Declaration of Helsinki was enacted, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was established by the National Research Act of 1974, and the resulting Belmont Report was released.24 This report set out basic ethical principles and guidelines for conducting research with human subjects and detailed three foundational principles: beneficence, justice and respect for persons.25 The Belmont Report was the first to introduce the concept of ‘vulnerability’ in research ethics.26

Undue harmful exploitation of vulnerable populations in early psychedelic research

The early psychedelic research studies, particularly those which were carried out or funded through the MKUltra programme, were found to have disregarded ethical guidelines agreed on by the US government. Two of the most prolific research institutions conducting this research were the U.S. NIMH’s Addiction Research Center (ARC) in Lexington, Kentucky and the NIH Clinical Center (NIHCC) in Bethesda, Maryland. A recent examination of archival documents, public testimony, interviews and oral histories from participants of the early LSD studies at these institutions details the conditions under which the experiments took place.27 At the ARC in particular, Black prisoners with substance abuse issues were routinely harmfully exploited in these LSD studies.27 28 However, there has been no systematic examination of the original publications resulting from these experiments.

There are several important reasons to document the ways that people of colour (POC) may have been unduly exploited in the ‘first wave’ of psychedelic research within the USA (1950–1980). First, it is important to acknowledge the major contributions of POC to the advancement of psychedelic medicines.29 Second, POC are presently being left out of this current wave (1990-present) of Western psychedelic research.30 Understanding how psychedelic research was part of a broader legacy of medical research abuses against POC, may help contextualise the current lack of diversity in psychedelic research participants, and shed light on modes of rectifying this inequality.

While there is no universally agreed on definition of vulnerability in clinical research, and its determination is often context-dependent,31 findings from the ARC and NIHCC suggest that not only POC, but individuals who were incarcerated or who were currently being treated for mental health issues were also being routinely administered psychedelic substances as part of the first wave of psychedelic research (participants at the ARC referred to as ‘post-addicts’, ‘patient-inmates’ or ‘patients’27 28).

Purpose of present investigation

The purpose of this investigation was to determine how and to what extent POC and other vulnerable populations were unduly exploited in early psychedelic research in the USA. Through our work organising a 3,4-methylenedioxy-methamphetamine (MDMA) training in Louisville, Kentucky in 2019, we had heard reports that POC and people with mental illnesses had been exploited during the first wave of psychedelic research (Williams & Labate, 2020),32 which prompted initial interest in these groups. We were particularly interested in studying those that were vulnerable based on marginalised ethnic/racial identities, incapacity due to mental health issues (inpatients with psychotic disorders), and those who were incarcerated. To do so, we conducted a literature review of first wave psychedelic research involving vulnerable populations within the USA (1950–1980) and assessed recruitment strategies, study methodologies and experiment safety.

Methods

Definition of psychedelics

The term ‘psychedelics’ was coined in 1957 by Humphrey Osmond, a British psychiatrist working in Canada, to attempt to capture the substances’ mind-manifesting capability.33 One way is to classify psychedelics based on their chemical structure and primary mode of action. Following this definition, psychedelics can be classified into two main categories: indolamines (which act primarily on serotonin 5-hydroxytryptamine [5-HT] receptors) such as LSD, DMT, and psilocybin, and phenylalkylamines (calcium channel blockers) such as MDMA and mescaline.34 Another way to define psychedelics is through their subjective behavioural and cognitive effects, such as their ability to induce altered state of consciousness, and their profound effects on perception, emotions and sense of self.35–37 For the purposes of this investigation, we will define psychedelics more broadly, classifying substances that meet any of the above definitions as psychedelics.

Selection of studies for inclusion

An initial search was performed in order to assess how many human clinical studies (in addition to the known ARC and NIHCC studies) were conducted in the USA during this time period. Our initial literature search (PsychINFO, Medline/PubMed, EBSCO) examined clinical studies/clinical trials (ie, no case reports, reviews) involving human subjects, which were conducted between 01/01/1950-12/31/1970 (1970 was when the Controlled Substances Act was passed), using the keywords ‘LSD [OR] lysergic acid diethylamide [OR] psychedelic [OR] hallucinogen)’, and that were available in English. This led to an initial result of 129 records. These articles were further screened for location (conducted in the USA) and participant group (POC, incarcerated, inpatients with psychotic disorders). The clinical decision to administer high doses of hallucinogenic substances to individuals with psychotic disorders without considering decisional capacity or the physical and psychological risks of precipitating acute psychotic states are the primary reasons for including individuals with psychotic disorders as vulnerable populations. Concurrently, we examined secondary historical sources and review/compilation articles17 27 38–44 in order to identify research institutions, groups, and affiliated members who were actively conducting human research trials with vulnerable populations using psychedelic substances. These sources were identified through literature reviews, historical books, and CIA declassified documentation pertaining to: human medical experimentation and human rights violations in the USA, early psychedelic/LSD experimentation, and MKUltra/CIA experiments and funding. Twelve research groups and facilities that conducted human psychedelic research in the USA during the specified time period were identified. An additional literature search for associated research group members was carried out using the following search criteria: (1) human studies, (2) research occurring between 01/01/1950-12/31/1980 and (3) the author(s) first and last names, as we reasoned that if a researcher is participating in unethical research studies, then other studies that they were involved with should also be scrutinised accordingly. An annotated bibliography of studies conducted at the ARC research facility,28 as well as a ‘Neurotree’ (a website designed to track ‘academic genealogy’45; profile of one of the most prolific researchers, Dr. Harris Isbell,46) were also used in conjunction with the author search to ensure that no publications were omitted.

While there were many more scientific publications resulting from the first wave of psychedelic research,47 we screened out those that were performed outside of the USA and those that did not involve the direct administration of a psychedelic substance to a human participant group deemed to be vulnerable.

After the removal of duplicate articles (n=46), non-availability of full texts (n=1), and those that were not a clinical/psychedelic administration study (n=42), were not conducted in the USA (n=16) and did not involve vulnerable population groups (n=55), 48 original research articles were included for further qualitative analysis (figure 1).

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram of studies included for qualitative analysis. ARC, Addiction Research Center.

Missing data

Missing data from this investigation includes any unavailable publications as well as studies that were mentioned but for which we could not find a resulting publication, as was the case with many of the military studies. Most of the studies included in this investigation did not report on race or ethnicity of participants. For studies that otherwise met the inclusion criteria but did not disclose ethnoracial information in the publication (n=35, 73%), we tracked down the source of participants and searched for demographics information at the corresponding institutions or local geographical region.

Compilation of research

Studies where we were able to ascertain that vulnerable populations were included were compiled into a spreadsheet, where information relevant to our research questions could be organised. Descriptive information about the sites from where research participants were sourced was compiled into a second spreadsheet.

Data analysis

The selected studies were analysed using descriptive and summary statistics in order to summarise the ethnoracial composition of the participants for each study, recruitment strategy, study methodology and safety across the studies.30 Recruitment strategy refers to whether or not participants were recruited from state institutions such as prisons and hospitals. Study methodology includes factors such as dose, frequency, duration of drug administration, and number of different drugs administered. Safety of the studies was evaluated on a case-by-case basis based on risk–benefit analyses of the aforementioned factors, as well as whether the research participants gave informed consent and whether the researchers used undue influence to attract participants. In addition, an inductive, latent, constructionist thematic analysis was used to examine recurring themes regarding safety and ethics throughout the studies.48 The themes included incarcerated populations, undue influence, problematic dosing, questionable scientific merit and set and setting.

Results

Participants

Inclusion of POC?

As seen in table 1, many of the selected studies (65%, N=31) reported using vulnerable populations as participants, consisting of either prisoners (50% of studies, N=24) or people with psychotic disorders (15% of studies, N=7). Research participants were usually male prisoners between the ages of 18–50. Unless, the purpose of the study was to examine the effects of drugs in schizophrenia patients, participants were reported to be in good physical health and without ‘any of the major psychoses’ (eg, Isbell, 1959; Isbell, Miner, & Logan, 1959a).1,1 The prisoners, particularly if they were characterised as having substance use disorders, were often described as having ‘character disorders’ or ‘inadequate personalities’ (eg, Isbell, Bellville, Fraser, Wikler, & Logan, 1956). Of the studies that reported the race of participants, all of the participants of colour were Black, with the exception of one study which reported seven Black participants and three Puerto Rican participants (Rosenberg, Wolbach, Miner, & Isbell, 1963), and one was described to be of an ‘impoverished socio-economic background’ (Monroe, Heath, Mickle, & Llewellyn, 1957)1.

Table 1

Selected studies with ethical violations

Recruitment

What was the source of participants in the study?

Participants were mainly recruited from either prisons or hospitals. The main prisoner recruitment sites were the ARC in Lexington, Kentucky, Atlanta State Penitentiary, Louisiana State Penitentiary (a.k.a. Angola Prison), New Jersey Reformatory, and Maryland correctional facilities. As seen in table 2, compared with the state population, POC were overrepresented in all of these institutions for which demographic information was available.49 50 Though POC constituted 7% of the Kentucky population, Black Americans and Americans of Mexican origin represented 66% of the population at ARC,51 the site used for over 40% of the selected studies.

Table 2

Ethnoracial makeup of recruitment sites averaged over 1950–1970

The ARC in Lexington, Kentucky was built by the CIA to research the effectiveness of LSD for ‘mind control’.17 27 The site consisted of a prison specifically for people who were charged with violation of the narcotics laws, what the researchers called ‘drug addicts,’ and it also housed a separate ‘special ward’ for drug research. Researchers preferred their participants to be drug addicts because they were deemed ‘experienced’ and, therefore, better able to give informed consent.52

Thematic analysis

Incarcerated populations

A common theme among the studies under investigation was mistreatment of incarcerated people. Many studies used incarcerated populations to experiment with different psychedelic drugs (Isbell, Logan, & Miner, 1959; Isbell, Miner, & Logan, 1959a; Isbell, Miner, & Logan, 1959b; Katz, Waskow, & Olsson, 1968). These studies often used high, frequent, and prolonged dosing; and techniques of undue influence without any informed consent. When race was reported, which it often was not, the incarcerated participants were usually Black.

In some cases, participants were subject to differential and torturous treatment and dosing dependent on race. In a study by Isbell et al (1956), Black participants were given more than double the dose of LSD (180 μg) compared with White participants (75 μg). White participants endured only 8 days of LSD administration, while Black participants endured chronic administration for up to 85 days. One of the Black participants had a ‘very severe’ reaction to the 180 μg dose. The researchers wrote, ‘after recovery from this severe reaction, the patient wished to drop out of the experiment but, after considerable persuasion, agreed to continue’ (p475). They then began chronic intoxication of this patient with a dose of 50 μg of LSD daily, which was gradually increased until he again received 180 μg of LSD on the 22nd day of intoxication.

Undue influence

Another common theme throughout the studies was the use of undue influence. Prisoners at the ARC were told that in return for volunteering in a research study, they would be paid in either time off of their sentence or drugs (ie, heroin). They could either take these drugs on completion of the study or save them in their ‘bank account’ for later ‘withdrawals’.52 Participants almost always chose to receive drugs rather than a reduced sentence. Though at the time, participants might have felt that they were benefitting, the life-long damage these studies caused to prisoners and participants of colour is aptly illustrated in testimony from Edward M. Flowers, the only surviving prisoner participant of the CIA-funded mind control experiments to have been located. Flowers was an African American man who had taken part in psychedelic experiments at ARC in the early 1950s while incarcerated, who later testified in US Senate hearings.27 It was only after the congressional hearings that he was able to piece together what had been done to him and understand the ARC experiments as exploitative.

And I really got a first-hand insight about some things when we had the hearings, because then the bigger picture kinda showed. Then I got in touch with the fact that the CIA was behind all this,. … They used my ass and took advantage of me, you know, being a young kid and all the rest of that kind of stuff. Back then at that time for a while there I was angry, bitter and … a little further, further down the line, um, I kind of um, probably kinda like chalked it up as a bad experience, okay? I went back up on The Hill a second time. I sat down with a couple of people and they talked about some things that had to do with compensation and … and that was the last I heard of it (,27 pp. 841–842).

Problematic dosing

Another notable theme throughout the studies was problematic dosing of psychedelics. Many of the studies documented high dose administration of psychedelics to incarcerated people and/or people with psychotic disorders, namely schizophrenia (Sokoloff, Perlin, Kornetsky, & Kety, 1957). The researchers seemed to be interested in tolerance and cross-tolerance between different psychedelics, meaning that the psychedelics were often administered chronically and at very high doses (Chessick, Haertzen, & Wikler, 1964; Cholden, Kurland, & Savage, 1955)1.

Cholden et al (1955) reported that four schizophrenic patients received 100 μg of LSD daily for 2 weeks, and

later in an attempt to overcome the tolerance…the dosage was increased by 100 mcg daily. Thus, each patient would receive 100 mcg the 1st day, 200 mcg the 2nd day, 300 mcg the 3rd day, 400 mcg the 4th day, and 500 mcg the 5th day (Cholden et al., 1955, p. 218).

In recent research with LSD, the maximum dose is generally 200 μg, given the high intensity of subjective effects at this dose range and an increased likelihood of adverse events if exceeded.47 Moreover, giving people high dose psychedelics on consecutive days could be mentally destabilising, especially for patients with schizophrenia.5 53

Questionable scientific merit

Many of the studies examined used high risk experimental designs without clearly articulating the potential benefits to participants or to science that would justify the risk. For instance, numerous studies administered multiple different psychedelics to the same participants with weak rationales, if any. The Jarvik, Abramson, and Hirsch (1955) report was one of these studies. They gave participants seven different drugs and two tap water placebos, each on a different day over the course of a month. Without safety data or a rationale, it seems as though the risks to participants are significant without any clear benefits. Additionally, administering so many different drugs increases the statistical ‘power’ needed to draw any meaningful conclusions about the observations being made.

Silva, Heath, Rafferty, Johnson, & Robinson (1960)1 reported using three prisoners and one psychiatrist. The number of drugs administered and the method of administration varied between participants, and the researchers did not report which procedures were used with the prisoners or the psychiatrist. There are ethical concerns around administering prisoners high doses of mescaline, as was done in this study (eg, undue influence; physical, psychological and environmental safety concerns). Further, giving some patients intravenous drugs and others oral (as was also done in this study) demonstrates inconsistency and poor experimental design.

The study by Cholden et al (1955) exploited, disrespected and dehumanised four female, schizophrenic patients. The researchers observed ‘toilet habits’ and ‘eroticism’. They reported how often patients ‘soiled themselves’ and whether or not they ‘smeared faeces’. They also reported how often the patients ‘masturbated or talked about sex’. The experimenters even recorded one of the patients calling out their mistreatment: ‘Dr. X, this is serious business –, we are pathetic people – don’t play with us’ (p217). The language used in the report was dehumanising and objectifying.

Monroe et al (1957)1 document a study in which vulnerable people were exploited and tortured, particularly one African American participant, patient A-22. He was described as ‘a 48-year-old colored man of low intelligence with only 2 years’ education and an extremely impoverished socioeconomic background’ (p633). The researchers described this participant as if he were an animal and treated him like one, using restraints during an LSD dosing session. They reported that he was frightened and had asked for ‘medicines to relieve his fear’ (p. 633). Despite this, they tested the highest doses and combinations of drugs on him compared with any of the other participants (whose race was not reported).

There was no regard shown for participant safety or well-being. Despite clearly describing the participants as having negative reactions to the drugs, researchers continued administering them, even against their will in the case of this African American participant. Additionally, at least four of the six patients were schizophrenic. This study demonstrates clear ethical violations in addition to fraught scientific methodology.

Set and setting

The importance of set and setting in psychedelic experiences has been well known for centuries in Indigenous cultures practicing psychedelic healing.54 Set, or mindset, refers to internal conditions (eg, mood, personality, intentions, preparedness, etc), and setting refers to external conditions, including the physical and social environment.55 In the West, the understanding that extra-pharmacological factors are essential in shaping the psychedelic experience evolved concurrently with a growing interest in psychedelics in the early to mid-20th century.56

Despite this, there is no indication that studies prior to the 1970s made any effort to create a comfortable environment for vulnerable participants. Prisoners (often POC) and psychotic inpatients were subject to physical and emotional discomfort during their psychedelic experiences. They were administered high doses of psychedelic drugs, often in combination with multiple other drugs, in prison or hospital wards. Participants were given physiological and psychological evaluations at many different time intervals both prior to and after drug administration (eg, Isbell, Miner, & Logan, 1959a). Participants, especially participants of colour, usually did not trust the researchers, and often did not feel comfortable enough to confide in them.

Vulnerable participants in these studies felt at the most in danger and at the least uncomfortable during these experiments (Silva et al., 1960). Silva and colleagues (1960) reported that following an injection of Taraxein (3–10 mL), Volunteer lll, B.S., (an inmate at Louisiana State Penitentiary) ‘stated that he felt the examiner was going to attack him with a blackjack’ (p373). The experimenters then continued to administer mescaline (750 mg) and psilocybin (10 mg) to this person. The time in between drug administrations was not reported. The researchers reported that another participant in this study, Volunteer lV, O.D.W. (another inmate at Louisiana State Penitentiary)

showed an unusual amount of aggressive behavior. He entered the office of the prison physician, put his feet on a table, and asked for his chart. He recalled that he had been suspicious of the examiners and had felt the need to hold back some information (Silva et al., 1960, p374).

Some of the studies reported that participants felt frightened, angry, and/or suspicious (Monroe, et al., 1957; Silva et al., 1960), however, most of the time they were reported simply as being ‘uncooperative’ (Monroe et al., 1957; Chessick et al., 1964).

As was previously mentioned, some studies employed differential treatment based on race. One such study describes two groups that received LSD, one was ‘Negro’ men convicted on drug charges who were recruited from prison and given LSD in a research ward, and the comparison group was professional White people at Cold Spring Harbor, living freely, who were not coerced but given LSD in the principal investigator’s home ‘under social conditions designed to reduce anxiety’ (Abramson, 1960, p. 1121).

Many of the studies, however, used incarcerated populations and did not report race. In these cases, there was often differential treatment based on incarceration. In a study by Silva and colleagues (1960), only the prisoners were filmed during drug administration. The authors reported that

moving picture films (16 mm sound) were obtained of each of the prisoner volunteer participants when they received taraxein. One of the prisoner participants, W. L., was filmed before and after the administration of each of the four compounds (371).

Being filmed during a psychedelic experience could make a person feel uncomfortable, especially if done without proper consent. Moreover, it could change the participants’ behaviour thereby affecting study results. Given the importance of set and setting in the psychedelic experience, the use of different settings with varying levels of comfort within a single study is ethically and methodologically problematic. Studies, such as Abramson (1960) and Silva et al (1960) demonstrate that the importance of set and setting was understood at the time and was carefully considered for White participants but not for Black, incarcerated, or other vulnerable participants.

Discussion

Ethical conduct of research

Many of the first wave psychedelic studies under investigation in this report would not have passed ethical review today. Over three quarters (77%, N=36) of the selected studies used dosing schedules that would be considered high risk and generally unacceptable today (see table 1). These consisted of administering psychedelics either more than once per week, more than five times in total, in rapid succession without a rationale or hypothesis, or administering multiple different psychedelics to the same participants in close temporal proximity. As discussed above, doses administered were also in many cases above the dose range considered safe and ethical today. Additionally, studies involving people with psychoses would not be considered safe today, but it is possible that they could have been considered ethical at the time. The current rationale is that psychedelics could destabilise patients with psychoses5 53; thus, this population is currently excluded from all psychedelic research.

Additionally, the researchers did not put any effort into ensuring a comfortable set and setting for participants. In some cases, the experimenters treated the participants quite badly, observing them as if they were animals, acting without compassion, and disrespecting and dehumanising them, and this language was reflected in their reports (Chessick et al., 1964; Cholden et al., 1955).

The lack of attention paid to set and setting may have been particularly harmful for the participants of colour as race has been identified as an important contributing factor in set and setting.55 In his experiment comparing the reports of Native Americans’ use of peyote to those of White Americans, Wallace (1959) demonstrated that psychedelic experiences are understood through cultural systems of knowledge that vary based on race.57 Neitzke-Spruill (2020) describes the ways in which identity, motivation and experiences with discrimination may influence set, while the sociocultural environment, including race relations and the War on Drugs are aspects of social setting; therefore it follows that psychedelic experiences, interpretation and therapeutic outcomes are affected by race.55 Disregard for and neglect of set and setting in the studies examined herein might have been particularly harmful for the participants of colour.

In terms of vulnerable populations, it is evident that POC were unduly exploited in early psychedelic research. It is important to consider that POC were highly disenfranchised during this era, where segregation was the law in many US states. Although only 28% (N=13) of the 47 studies included in this report reported using POC, 49% (N=23) reported recruiting their participants from prisons (see table 1). As seen in table 2, POC were overrepresented in all but one of the prisons from which participants were recruited.49 50 Further, of the studies that reported using POC, 4% reported differential treatment of participants based on race. It is worth noting that some of the studies that reported race only used POC (38%, N=5); therefore, it is not possible to compare their treatment to that of White participants. However, the majority of studies used undue influence and did not obtain informed consent, and it is clear that the experiments involving POC and prisoners were particularly brutal.

Analysis of the region demographics for the time period during which these experiments occurred demonstrates that in each state from which prisoners were recruited, the population percentage of POC was almost entirely Black with other races constituting less than one percent.49 Therefore, although poor reporting through a Eurocentric lens prevented disaggregated data for prisoners of colour during this time, if the region demographics are any indication of the prison demographics, the prisoners of colour in all of the state prisons that served as recruitment sites and, thus, the prisoners recruited in the studies currently under investigation were almost entirely black. It is important to acknowledge the unique exploitation of Black Americans through CIA-funded mind control studies and to understand the toll this has taken on the Black community in particular.

Understanding research abuses in historical context

To understand how these research injustices could have occurred, the studies must be situated within their historical context. The first wave of psychedelic research reviewed for this investigation occurred at the same time as the civil rights movement in the USA. The white majority in the South (where most of these studies took place) opposed equal rights for POC and racial tension and terrorism was high. In addition, there was little public awareness about mental health and ethical standards of research were very different from today’s. Though The Nuremberg Code and The Declaration of Helsinki were created in 1947 and 1964, respectively, it was not until 1979 that The Belmont Report emerged to protect the rights of research participants and to bring forth the concept of ‘vulnerable’ populations, largely inspired by the US civil rights movement.26 Therefore, at the time that these studies were conducted, researchers generally were not prioritising informed consent or taking extra precautions when using vulnerable populations, and even if they reported doing so, exactly what was entailed in these procedures is unclear and questionable. For these reasons, one can imagine how unethical and exploitative human experimentation on POC and other vulnerable groups might have been accepted by the research community and by mainstream Western society at the time.

Toward cultural competency in psychedelic research

The majority of psychedelic researchers today put a great deal of thought and effort into creating a comfortable set and setting for research participants. This can include use of a couch or bed, eyeshades, relaxing music, male and female therapist dyad, and even an artefact of the participants’ choosing. While attempts to remove the ‘clinical’ from the clinical trial may help to encourage participation of POC, this cannot erase the strong cultural memory of research abuses perpetrated against them by white, Western researchers. This legacy has resulted in a deep cultural mistrust of Western research and stigmatisation of research participation within communities of colour.58 59 Given the lack of diversity of research participants in recent clinical trials with psychedelics,30 it is clear that additional considerations must be made for participants of colour.

First and foremost, research and clinical teams should be diverse. Diverse perspectives are not only important for generating innovative insights,60 but they are necessary if psychedelic research and the resulting treatments are to be accessible to historically disadvantaged groups.29 Further, since research abuses were facilitated by white researchers, POC often feel less safe and able to be open and transparent with White researchers and clinicians.58 Opportunities for ethnoracially matching therapists and participants and creating a culturally informed setting are some ways to help ensure participants of colour feel safer and more comfortable.29 In addition, all clinicians should undergo cultural competency training to prevent participants of colour from being further harmed.59

Finally, researchers should seek out diversity through participatory research with communities of colour.61. Community collaboration may help to reduce barriers to research participation for POC, reduce cultural bias in study design, and increase the effectiveness and generalisability of findings.29

Present efforts to address past injustices and current inequities

There have been many calls to action for researchers to conduct culturally inclusive and socially responsible research.29 62 Inclusion does not simply mean having a diverse sample of research participants, but more importantly, treating all participants, and particularly vulnerable participants, based on the principles outlined in the Belmont Report.24 The principle of beneficence means that treating a person ethically involves maximising benefits, preventing harm, and working to secure their well-being. In terms of justice, benefits and burdens of research should be fairly distributed, rather than people of colour being subjected to more hazardous conditions. Finally, the principle of respect for others states that individuals should be treated as if they are autonomous, unless they are found to be otherwise. This includes consideration of each autonomous individual’s opinions and choices in whether or not to participate in research, free of undue influence.

Inclusive research must also involve representation on research teams, as principal investigators, on journal editorial boards, and so on. Community collaboration on study design and implementation is also an important measure, particularly if research teams are not diverse.29 The exclusion of black, Indigenous and POC from legitimate and potentially beneficial psychedelic research is an ethical concern above all else. A further implication is that the novel treatments produced by this research might not generalise to or be safe or effective for a culturally and racially diverse population.30

Finally, we must consider the question of whether the ethically fraught research papers discussed in this investigation should still be used and cited, even though they were unethical. We can look at the handling of data resulting from unethical Nazi medical experiments as a guide. Due to the appallingly unethical nature of these experiments, most of the scientific world has agreed that their use is unethical, and that publications that have cited the original findings should be considered unethical and be retracted,63 even if the resulting data could lead to scientific breakthroughs that would save lives.64

If a major determinant of notability in academia is the number of citations for a research article, then we may be perpetuating injustice by continuing to cite these studies and also increasing the recognition of unethical researchers. One proposition, as outlined by Post64 with regard to the Nazi experiment data, could be for editors of journals which have published the original findings and any resulting citing publications to issue a statement of moral condemnation with reference to this work.64 The handling of Nazi research has already set a precedent for what is considered socially unacceptable within the academic community. As such, the experiments examined herein could be handled the same way, and doing so might signal respect for the victims. Additionally, the thoughts and feelings of the victims and their families should be sought and respected.

On the other hand, it is also conceivable that the participants themselves who sacrificed so much for these studies might not want the findings to be discarded and forgotten about. Unfortunately, most, if not all, of the vulnerable participants used in these studies would not be alive any more to ask. Perhaps in order to decide how to handle these unethical studies we should attempt to locate the original participants, and if this is not possible, we should consult their descendants and the local communities of colour that were affected. Perhaps consulting the descendants of the participants that were exploited and the communities that were affected would be a first step towards rectifying this injustice.

Another potential next step for addressing the research abuses against POC examined in this article might be to investigate the impact of facilities such as ARC on the local communities of colour, in this case in Lexington, Kentucky. For example, researchers could go to Lexington, connect with community leaders and organisers, and, with their guidance, interview descendants of the victims of these experiments. Though it might not be possible to quantify the intergenerational trauma caused by these unethical experiments, if we are attempting to rectify this injustice, we should make an effort to understand the toll this work has taken and continues to take on communities of colour.

In the following section of this article, we will address the limitations of our research. The limitations of the studies examined herein, predominantly, a failing to report detailed methodology (eg, informed consent procedures), do not translate to methodological limitations within our own research; however, we felt it was important to note that as our work is a review of these studies, the methodological limitations of these studies limited our ability to draw conclusions from our findings.

Limitations

There are several limitations which should be considered when evaluating the findings of this study. As was mentioned above, the studies examined herein did not always include detailed methodology. Procedures for informed consent were rarely reported. As well, on many occasions, the researchers did not report the total length of time over which participants were administered psychedelics. Further, many of the studies reviewed did not report the race or ethnicity of the participants. This forced us to rely on demographic information for the sites from which participants were sourced, or omit those studies when this could not be reliably determined. The state prisons from which participants were recruited only used the racial categories, ‘Black’, ‘White’ and ‘Other’ and included the prisoner count for ‘other races’ within the Black prisoner count.50 Due to the inadequate reporting of ethnic and racial demographic information for prisoners, our study focused on the exploitation of POC more broadly although it is clear from the region demographics as well as the limited information reported in the studies that black Americans were uniquely exploited during this first wave of psychedelic research.49

Conclusion

During the first wave of Western psychedelic research, vulnerable populations, particularly POC and individuals who were incarcerated and hospitalised (inpatients with psychotic disorders), were exploited and one might even say tortured in the name of science. They were administered drugs that caused them physical pain and psychic trauma. As the current wave of psychedelic research unfolds, it is imperative that we do not ignore the unjust research practices on which current studies build on. Rather, we must seek to rectify past injustices and root out current inequities plaguing psychedelic research. There are many ways to rectify current inequities in psychedelic research; a starting point would be to hold researchers accountable to current ethical standards. Further, POC must be included at every level of the research process, from participants to principal investigators, and culturally informed practices must be developed, implemented, and refined so that mental health treatments can generalise to and be safe, effective and accessible for a diverse society.

Data availability statement

All data relevant to the study are included in the article.

Ethics statements

Patient consent for publication

Acknowledgments

The authors would like to thank Joseph La Torre and Morgan Campbell for their contributions.

References

Footnotes

  • Twitter @drmonnica

  • Contributors MTW designed the study and oversaw its completion by providing mentorship and manuscript revisions. DS and SdlS reviewed the literature, analysed the data and prepared the manuscript. JS contributed to the data analysis and provided manuscript revisions.

  • Funding This research was undertaken, in part, thanks to funding from the Canada Research Chairs Program and the University of Ottawa.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

  • The unethical studies examined herein are not included in the References section due to ethical issues around citing unethical research. These issues are discussed in section 4.4 of this report. See online supplmental appendix table 3 for references for the unethical studies.

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