This article is based on research conducted as a part of the CA POST Command College. It is a futures study of a particular emerging issue of relevance to law enforcement. Its purpose is not to predict the future; rather, to project a variety of possible scenarios useful for planning and action in anticipation of the emerging landscape facing policing organizations.
The article was created using the futures forecasting process of Command College and its outcomes. Managing the future means influencing it — creating, constraining and adapting to emerging trends and events in a way that optimizes the opportunities and minimizes the threats of relevance to the profession.
By Lieutenant Paul Van Meel
Police officers are exposed to hazardous environments and dangerous people, and injuries happen. Of all forms of injuries, physical ones are the easiest to observe, diagnose and treat. From a social and cultural perspective, particularly within law enforcement, they are an informal rite of passage. In this context, x-rays, MRIs, braces and casts are akin to physical evidence at a trial. They indicate the injuries are real, “earned” and, most important, need professional medical treatment to heal.
This contrasts with injuries to the mind. Mental injuries are perceived and evaluated by subjective, often differing standards. Historically, police culture has also been much more accepting and forgiving of physical ailments than mental ones. To a degree, this is a byproduct of the survival-related component of the job. An officer cannot allow themselves to “break down” and let their emotions impede their reasoning, especially during high-risk situations. They must remain stoic, controlled and decisive. Clearly, these traits are important. This dichotomy, though, has unintentionally played a role in perpetuating a culture that is largely unhealthy for the expression, social acceptance and treatment of mental health injuries.
The job takes its toll
Officers train hard and often on what do to before and during critical incidents, but very little on what to do afterward. As with a physical ailment, the more trauma added to an initial injury, the more the damage is compounded, the harder it is to heal, and the more it impacts other areas of the officer’s personal and professional life. As a result of stressors and the rinse-and-repeat professional life of a police officer, the number of officers with post-traumatic stress disorder (PTSD) is estimated to be as high as 35%. [1] This does not include those struggling with clinical depression, anxiety, addiction or unknowingly working their way toward PTSD, nor does it capture PTSD’s impact on the organization and profession. Without intervention and healing, there is a spiraling relationship between the officer, his or her chronic difficulties and the repeated exposure to further critical incidents, which then perpetuates the cycle at an increasing tempo and pace.
Stigma persists, and officers may feel shame in seeking out mental health treatment. [2] A 2021 study identified that law enforcement officers have a 54% greater suicide risk compared to civilians. [3] Another study showed that officers suffering from PTSD have disruptions in rapid decision-making due to heightened arousal to threats, inability to screen out interfering information and inability to keep attention. [4] Symptoms of PTSD, depression and alcoholism are often observable, including absenteeism, medical retirements, leaving the profession before retirement age, low morale, disgruntled and disenfranchised officers, impaired decision making, familial problems, divorce, anger management issues, alcohol abuse, drug abuse and suicide.
Today there is a groundswell of social, political and financial support for alternative approaches to mental health treatment to combat illnesses like PTSD, depression, anxiety and addiction. One approach has been repeatedly proven to be effective, yet it comes with a significant social stigma, especially from the law enforcement perspective. Given the severity of the consequences of untreated and unmitigated mental health issues, the alternatives warrant consideration and further study. One with the greatest promise is using psychedelics to treat trauma. [5]
What psychedelics may help?
There are many contemporary clinical trials of psychedelics such as methylenedioxymethamphetamine (MDMA), psilocybin (hallucinogenic mushrooms) and lysergic acid diethylamide (LSD) aimed at qualifying and quantifying the benefits of psychedelics for treatment of illnesses, and the results appear promising. [6] As of 2023, there were more than 200 clinical trials in progress. [7] This trend is likely to continue.
MDMA has been around since the early 1900s but was largely introduced to the medical community in the 1970s as a potential tool for psychotherapy. In 1985 the Drug Enforcement Agency banned it, declaring it as having no medical value and a high abuse potential. [8] This eventually changed, and in the 1990s it was studied again to discover whether it could aid terminally ill patients with pain management. Since then, there has been a resurgence in interest in MDMA. Trials have continually shown it significantly aids people when combined with psychotherapy, particularly those with PTSD. According to one group of researchers that studied the pharmacological mechanism of psychedelics, “Not only were the effects of MDMA on PTSD symptomology robust, but they also appeared to be extremely durable, lasting for at least one year after treatment.” [9]
Psilocybin and LSD are currently being studied for treatment for depression and addiction. A 2021 study noted psilocybin-assisted therapy produced “large, rapid and sustained antidepressant effects in patients with major depressive disorder.” [6] Ketamine, another psychedelic, is already legalized as a medication for treatment-resistant depression. Although ketamine is the only legal hallucinogen being used in a clinical setting, this is likely to change, as this field is gaining significant attention and momentum. Other hallucinogens in clinical trials include ibogaine, ayahuasca and dimethyltryptamine (DMT), all of which appear to show promise in the treatment of addiction, anxiety and depression.
Perhaps the greatest difference between psychedelic medications and traditional psychiatric medications is that psychedelic use is not intended to be extended, as is the case with traditional medications. Instead, psychedelics are confined to a few uses, all while under the care of a psychotherapist, during a psychotherapy session.
Before these treatments can become an alternative doctors can consider, though, there are legal, economic and cultural hurdles to overcome.
A flawed bill is vetoed
In 2023, California Senate Bill 58 (SB 58), authored by Senator Scott Wiener, aimed to legalize personal possession of psychedelics by January 2025. On the California Senate website for SB 58, Wiener said, “California’s veterans, first responders and others struggling with PTSD, depression and addiction deserve access to these promising plant medicines... SB 58 has prudent safeguards in place after we incorporated feedback from three years of deep engagement with a broad array of stakeholders.” [10]
While the bill said there would be established guidelines for how to best use psychedelics, it lacked any defining rules and advocated for the legalization of personal possession and use of psychedelics. It was not signed into law by the governor.
The California Narcotics Officers Association (CNOA) posted a statement on their website when SB 58 was vetoed by Governor Gavin Newsom: “We are excited to announce that SB 58, which would have legalized the psychedelics, was vetoed by Governor Newsom. This is a calamitous bill of this legislative year putting Californians at risk.” [11] The two studies cited by Wiener in pushing for SB 58, the CNOA said, concluded that psychedelics may produce positive results only under carefully controlled conditions and are not ready for widespread use.
The ongoing debate over legalization is expected to continue, with stakeholders extending beyond politicians, advocates and law enforcement into the corporate boardrooms of pharmaceutical companies whose financial benefits could be in the billions.
FDA approval is expected
The potential financial benefit of psychedelic medications is not lost on pharmaceutical companies. The global market for psychedelic pharmaceuticals is anticipated to more than double to $8 billion by 2029. In addition, 25 states are considering legislation to make certain psychedelics available for therapeutic use, and the FDA is expected to approve substances like MDMA and psilocybin for mental health treatment within the next few years. [12]
A randomized clinical trial found psilocybin administered to patients with major depressive disorder resulted in “large, rapid, and sustained antidepressant effects.” [13] Another review of psychedelic clinical trials that included MDMA and LSD noted MDMA was successful in treating people with anxiety and PTSD (particularly severe, treatment-resistant PTSD), while LSD was beneficial to patients with depression and anxiety. The study noted, “Early trial data suggest that MDMA, in conjunction with psychotherapy, may be a fruitful therapeutic for several complex treatment populations, which lends further credence to the theory that psychedelic medicines could prove to be rapid, long-lasting, novel therapeutics for mental health disorders.” [9]
If psychedelics can be used to treat a wide variety of mental health conditions, it is reasonable to consider their application to law enforcement. Given the reality and severity of what officers face, the benefits to the officers, agencies and the profession could be considerable. If they are found to be safe and effective, they may help improve officer retention, reduce time spent on medical leave, prevent medical and early retirements, improve individual and organizational morale and reduce officer suicides. These benefits, however, do not come without challenges and risks. There are legal, medical and social hurdles and complications unique to law enforcement when considering psychedelic therapy.
Hurdles to overcome
The first hurdle is the legal status of psychedelics. In 1970, the U.S. Congress passed the Controlled Substances Act, classifying LSD and other hallucinogens as having a high potential for abuse and no accepted medical use. Ultimately, LSD was banned in the United States in 1986. [14] These drugs are still illegal outside of clinical trials and could not reasonably be considered for use by law enforcement unless their classification changes. The FDA has granted breakthrough therapy designations to psilocybin and MDMA for PTSD, which makes their ultimate approval more likely. [14]
Presuming these drugs become legal for medicinal purposes, the second hurdle is their medical effects. There must be a risk-versus-gain assessment that weighs the potential risks, with focus within the law enforcement context of decision-making and using force. While many studies show benefits, there are also reports of lasting negative consequences, such as flashbacks. [7] Flashbacks impede perception of the real world and may include imagining things that aren’t there, false perceptions of movement and other forms of hallucinations. They can be unpredictable, or they can be triggered by stress, anxiety and fatigue. [15] This is one of the most concerning problems, as they seem to affect a greater number of people who ingest hallucinogens and can remain dormant until months or years after ingestion. From a law enforcement perspective, this is obviously problematic for officers and the public. These side effects warrant serious examination, and medical professionals should exercise caution when considering their application to active-duty law enforcement officers.
Another concern identified in several studies is the potential for psychosis to be triggered. “The science seems to support the idea that psychedelics increase the risk of schizophrenia in people who were already at higher risk of developing it, rather than causing it in people who have no risk factors,” wrote one expert. [16] According to research, people already predisposed to these disorders are at an increased risk of negative reactions. Even a single use of a hallucinogen has the potential to trigger schizophrenia in susceptible people, [7] although not everyone who uses psychedelics has flashbacks, and psychosis as a resultant condition is rare. [16] One method of mitigating this risk is a screening process to identify who is at an increased risk for developing schizophrenia or bipolar disorder and remove them from candidacy for this type of therapy.
The most widely discussed approach to minimize these risks is microdosing. This entails giving a dose of the hallucinogen that is so minimal, it does not result in hallucinations, yet can still provide some benefits. According to psychosocial educator Kendra Cherry, “Proponents of microdosing suggest that even these very low doses can have beneficial health effects such as enhancing performance, increasing energy and decreasing depression.” [17] Another potential option is producing “psychedelic” drugs that are modified to not cause hallucinations, while still positively influencing the brain during therapy. This has already been done with a drug called Br-LSD (2-bromo-lysergic acid diethylamide), an LSD-based drug that has been modified to prevent hallucinations. Studies of Br-LSD have shown an improvement when treating people with depression. [18]
The third hurdle is perhaps the least definable: There are social implications, internally and externally, if police officers engage in this form of therapy. What will society say about this, and how will it affect how police are perceived in the public eye? The answer depends on the segment of populace in question. There are many advocates for this therapy, yet there are those who are opposed to it as well. A law enforcement officer experiencing hallucinations or psychosis poses a substantial risk to themselves, fellow officers and the public. Perception and reaction are the cornerstones of use of force and decision-making, and the profession cannot afford to compromise them due to drug-induced psychological impairment.
That said, while concerns about the dangers of hallucinogens are valid, there is a level of irony here as well. Opioids are famously addictive; yet they are commonly prescribed and consumed. Arguably, most law enforcement officers know others who have become addicted to pain medication and may have had severe consequences as a result. Another example is law enforcement officers’ tendency to self-medicate with alcohol. Many officers know coworkers whose lives were impacted and damaged because of alcohol abuse. The greatest contrast here is that psychedelics would have to be administered by a medical professional during a psychotherapy session, whereas opiates and alcohol are self-administered.
The social impact of psychedelic therapeutics within the police community has many implications. What was once an illicit drug being used by officers, regardless of the setting, is likely to produce skepticism and strong reactions. Even for those open to this new practice, there will likely be concerns regarding potential side effects and how psychedelics might influence officers’ decision-making and performance. This has the potential to stigmatize those who seek this treatment, and objectively, concern is not unwarranted.
Recommendations for law enforcement involvement
To prepare for the potential legalization of psychedelics, this form of therapy needs to be studied, explored and assessed from within a law enforcement context. Law enforcement should take measures to investigate how it might impact the profession, and then robustly discuss how to handle this before it becomes a factor we are not prepared for. Police agencies and professional organizations should educate themselves on this topic and make recommendations based on data. An organized approach could result in further studies and trials tailored to the realities of active-duty law enforcement.
Given the quantity of current data on psychedelics, rhetoric and historical stances on the issue will likely not stand up to scrutiny and may nullify credibility with certain groups. There is simply too much in the way of viable, peer-reviewed studies and clinical trials to turn this into an ideological debate. Instead, an honest, objective assessment of risk versus gain needs to be conducted.
Current medical practices for people are privacy-protected, and employers are typically not granted access to information about what type of treatment people are receiving. Unless this changes, it can be reasoned that police agencies will not be aware of officers who are seeking and receiving psychedelic therapy. Law enforcement must develop an awareness of which practices are working, which are not and what needs to progress and change that is within their control.
References
1. Weaver C. Documenting the traumas of first responders. National Alliance on Mental Illness. March 2021.
2. Stanton C. Police, firefighters die by suicide more often than in line of duty. Why rates remain high. USA Today. June 2022.
3. McAward A. Law enforcement officer suicides: risk factors and limitations on data analysis. American College of Emergency Physicians. January 2022.
4. Violanti J. PTSD among police officers: impact on critical decision making. Department of Justice. Community Policing Dispatch. May 2018.
5. NYU Langone Health. Post-traumatic stress disorder treatment with psychedelic drugs. 2023.
6. Grinspoon P. Back to the future: psychedelic drugs in psychiatry. Harvard Health Publishing. June 2021.
7. Gotbaum R. The promise and perils of psychedelics – ITT episode 3. New England Journal of Medicine. February 2023.
8. National Institute on Drug Abuse. What is the history of MDMA? April 2021.
9. De Gregorio D, Aguilar-Valles A, Preller KH, et al. Hallucinogens in mental health: preclinical and clinical studies on LSD, psilocybin, MDMA, and ketamine. Journal of Neuroscience. February 2021.
10. Office of Scott Wiener. Senator Wiener’s psychedelics bill passes assembly. September 2023.
11. California Narcotic Officers’ Association. October 2023.
12. Cunningham M. Wall Street gets behind next wave of mental health treatment: psychedelics. Investopedia. February 2023.
13. Davis AK, Barrett FS, May DG. Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA Psychiatry. November 2020.
14. Marks JL. What are psychedelic drugs, and how can they help treat mental illness? Everyday Health. March 2024.
15. Hartney E. What is hallucinogen persisting perception disorder (flashbacks)? Very Well Mind. June 2024.
16. Douglas S. Psychedelics and schizophrenia. Mindleap.com. April 2021.
17. Cherry K. What is psychedelic therapy? Very Well Mind. June 2023.
18. Wenk G. A beneficial psychedelic that does not cause hallucinations. Psychology Today. March 2023.
About the author
Paul Van Meel is a lieutenant with the Santa Maria Police Department in Santa Barbara County, California. He has 26 years of experience, having worked a variety of investigative assignments as a detective in sex crimes and crimes against persons, gang suppression and narcotics. He has also worked administrative assignments in the training and administrative bureaus.