The Future of Psychedelics Isn’t Clinical

Most psychedelic use already happens outside clinics. It’s time to build for that reality.

Image courtesy of the Chacruna Institute

Colin Pugh, founder of the Brooklyn Psychedelic Society, has spent years working at the intersection of psychedelic culture and community care.

In this essay, he turns our attention away from the clinical spotlight and toward something more elusive, yet arguably more essential: the social infrastructure that actually makes psychedelic experiences meaningful, safe, and sustainable.

He highlights a core tension in the modern psychedelic movement: we are investing heavily in clinical systems, while most psychedelic experiences continue to happen outside of them.

That tension sits at the heart of Psychedelic Archives.

Our aim is not just to document the history of psychedelics, but to help cultivate a modern culture where their benefits can fully unfold.

Colin makes a compelling case that community is not peripheral to this process. It is central.

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Community Is the Medicine We’re Failing to Fund

Science has made psychedelics respectable, but not yet accessible. The real work now is building the communities where their benefits can safely take root.

By Colin Pugh

Imagine if we lived in a world where basketball was illegal. Then, after 50 years of tireless research and advocacy, the scientific community accepted the benefits of basketball, acknowledging that it is replete with physical, mental, and social benefits. But there’s a major problem: All of the funding and momentum that went into making basketball legitimate in the eyes of the scientific and medical communities is now being funneled into the creation of the NBA rather than local basketball courts in playgrounds and gyms.

While the NBA is great and will make a lot of people appreciate basketball (and also make some people a lot of money), it’s still not where the vast majority of people are going to play the sport. And, because there’s relatively little to no support for local community courts, people try to start playing basketball in their living room, on busy streets, or on the roof of their homes or apartment buildings.

Meanwhile, local courts are either not popping up or languishing because they rely on volunteers who can’t dedicate the time needed to run a functional, safe, and consistent basketball court. Nothing changes until there’s a shift in the field that realizes we need to fund local courts alongside the NBA — otherwise it’s just going to be a spectator sport at best, or a cruel system where people who want to play are barred from doing so altogether, or getting unnecessarily hurt.

This metaphor largely reflects the current state of the psychedelic field. The local basketball court equivalents are psychedelic societies and adjacent communities. These communities are often where people seeking the therapeutic use of psychedelics in non-clinical environments go first to get acquainted with them. And these communities, if properly funded, are where the norms of healthy, safe, and supportive psychedelic culture are going to be incubated. This is how safety and norms have evolved throughout most of human history: in and through community.

What’s happening currently is not based on evolution but instead based on modern clinical practice: we are funding a state-of-the-art version of psychedelic healing through clinical settings, while the places where people can realistically access and experience psychedelics — like psychedelics societies and adjacent communities — remain severely underfunded. In fact, it’s estimated that almost 95% of psychedelic use in the U.S. has taken place outside of clinical settings. Much like the NBA, clinical settings are where only a small percentage of people (most likely from the upper-middle-class and upper-class) are going to enjoy the benefits and transformational potential of psychedelic medicines. But as these compounds become more widely known and subsequently less taboo, thanks to research from organizations like MAPS and leading universities, people will increasingly use them, regardless of FDA approval or whether local clinics offer them.

How Should We Incorporate Psychedelics Into Society?

I like to think about integrating psychedelics into society using the If? versus How? distinction. The “if” question asks if psychedelics should be a part of our society. Thanks to the pioneering work of MAPS and other institutions, that question has been mostly answered. I don’t think we need another paper showing that psychedelics have beneficial effects on depression, addiction, or PTSD. Not that we shouldn’t be researching those things, but we’ve largely already succeeded on the “If” question.

So, then, how are psychedelics going to be integrated into our culture? We need to approach this question with as much creativity, boldness, and tenacity as Rick Doblin displayed 40 years ago when he founded MAPS. Right now, while I’m of course hopeful of the clinical approach to psychedelics passing FDA muster, I can’t help but sense that so much of the field’s momentum has gone toward proving that psychedelics work and how to study them. It’s to the extent that we’ve lost some imagination when it comes to pioneering visions for how the psychedelic field could be built. Maybe the real task now is to integrate that success before we discern how to move forward.

The answer to the “how” question is community. By that, I mean community-based approaches involving structured, non-clinical settings that provide preparation, peer support, harm reduction, and integration outside the formal medical model to create access for all people who want to explore these medicines and reduce harm. This includes psychedelic societies, peer-support networks, harm reduction services, and other organized community care environments.

Let’s Look at History

How do we know this will work? One place to look is history. Anthropological evidence shows that humans have been consuming psychedelics for thousands of years and almost always in communal settings.

Of course, that doesn’t necessarily mean this container is superior. But it does suggest that these experiences have traditionally been held, processed, and integrated in relationship to others, not in isolation.

That matters because psychedelic experiences are not just pharmacological events; they are deeply contextual experiences, shaped by the environment and the people around us. And if research continues to show this is true, it makes little sense to design modern systems for psychedelic use in isolated settings. If anything, the historical record points to an exact opposite format. If humans have consistently engaged with these substances in communal settings, we should take that knowledge seriously by designing institutions that reflect it from the outset.

“But It Could Ruin the Movement”

A common reason I hear for why the community-based side of the psychedelic ecosystem remains underfunded and largely unsupported is the fear that one mishap with psychedelics — a death, an abuse scandal, or something just as serious — could “set the psychedelic field back” or “ruin the movement.” But that way of thinking feels like a relic from the “if” era, when public opinion towards psychedelics was far more fragile.

There have already been highly publicized mishaps, deaths, and scandals. And guess what? The psychedelic field hasn’t been brought to a draconic, Nixon-era standstill. In fact, I would argue that having safe community spaces and healthy community networks would make these tragic situations less likely to occur because a community resourced enough to have a robust staff and volunteer team that can demonstrate a working ethical protocol massively mitigates the risks associated with the underground.

Imagine having a nonprofit-supported basketball court to play in rather than going to a court on a rooftop or in the middle of a busy street. Supporting psychedelic communities will allow the norms and protocols of non-clinical psychedelic use to evolve much more quickly, reflecting how the vast majority of people actually experience psychedelics, rather than relying on the slow drip of clinical progress.

The Community Model Is Far More Scalable

The cost of legalizing psychedelics — federally or state by state — and building out the necessary infrastructure is enormous. You have to create regulatory bodies, train therapists, and secure investment to open up clinics, all of which cost hundreds of millions of dollars.

That process will take years, if not decades, to complete. And all of this is happening without sufficiently validating whether there will be a sustained market for clinical use of psychedelics. Meanwhile, people can grow mushrooms at home with relative ease (despite it being illegal in most regions), and there are a growing number of resources, such as Zendo and Fireside Project, supporting people by sitting for them during psychedelic experiences.

None of this is to say that the clinical model isn’t worthwhile or important. But isn’t it more likely that clinical settings will serve acute cases rather than become the default? And even if most people do have their first experiences in a clinical environment, what happens after that? Once someone realizes they can grow mushrooms for a fraction of the cost — 1/100th of the price of a clinical journey — most people are probably not going to be repeat customers.

Imagine if you had to pay $3,000 to get the nutritional benefits of broccoli (I hope you aren’t tired of my metaphors yet). After your first clinically-guided broccoli feast, you’d probably be wondering if you could just grow them yourself or ask your friend who knows how to cook it well. Or, better yet, maybe that friend could cook for you and six other people at the same time. This is what the community-based model for psychedelics offers.

Of course, there will still be training. It will just look different because it will be designed for a community-based approach to psychedelic care rather than a clinical one. So, instead of one-on-one therapy, it might involve peer-led training and group support, where an experienced sitter works alongside trained facilitators to support multiple people at once.

Community-based approaches to psychedelics are inherently more scalable because they can support many people at once without the cost and constraints of clinical infrastructure, and, as I’ll argue in the next section, are more impactful.

Community Models Leave a Deeper Impact

I’m going to make a controversial claim: The real energy driving the psychedelic movement isn’t coming from institutions. It’s coming from people who have experienced profound healing and insight from these substances and want others to experience the same.

For those of us who have benefited from psychedelics, the change doesn’t come from some kind of chemical reset that magically erases depression or anxiety or addiction. It comes from the depth of the psychedelic experience. Sometimes it really is the experience itself, an encounter with something deeply authentic or something beyond ourselves. The ways we’ve been living out of alignment, or the ways our behaviors have been shaped by unresolved trauma, become visible.

Therapy can help guide that process. But it’s through community and relationships that those insights actually take root and become integrated. We need other people to be part of this healing process. Traditional therapeutic models center the individual as the primary unit of care. In community, the kaleidoscopic, multi-faceted nature of being a living, breathing person comes into view. Not just for oneself but also in relation to others: cooking together, sharing stories, making art, caring for someone during a crisis, or helping someone move into or out of a home. These activities are what actually facilitate people’s healing and growth.

So the question isn’t whether psychedelics work. It’s how do we ensure that most people can access these experiences safely and affordably? And while the clinical model has a role to play, we could certainly be more imaginative around the models we’re building around healing and access.

If we take seriously that community-based approaches aren’t just a nice-to-have accessory to the clinical approach, but are central to how most people will actually experience psychedelics, then the way we’re allocating resources is fundamentally misaligned. Much of the funding, company-building, and momentum currently directed toward clinical approaches fails to reflect how these substances are used in the real world, and will only reach a fraction of the people who could benefit.

Of course, the clinical model will help people. But it will likely always be the secondary approach for delivering psychedelics due to the inherent financial barriers to access.

Just as in our basketball analogy, the NBA may be the most visible expression of the sport, but it supports only a fraction of the people who actually play it. The real impact happens in high schools, colleges, churches, parks, YMCAs, or in backyards. If, after decades of research, nearly all resources were directed toward the NBA while local courts were neglected — or worse, suddenly made illegal — we would immediately recognize that as a massive, multi-pronged failure.

The same thing is happening with psychedelics right now.

We are modifying psychedelics to fit into our current, very broken, healthcare system, rather than building a new one around these plants and compounds, and the people who want to use them. We have an increasingly narrow window of opportunity here in this little psychedelic ecosystem of ours, one that could be a transformative step in the right direction for at least one sector of society. It’s time to get to work. We have to create the community pathways for integrating psychedelics into our culture. If we don’t, we will miss out on decades of building effective, cultural infrastructure, much like we lost 50 years of psychedelic research thanks to them becoming illegal.

I’m envisioning a world where psychedelic communities are legal, well-funded, and thriving. They would have rigorous screening, clear escalation protocols, trained staff and volunteers, and strong referral networks for cases beyond their scope. And as we continue to contemplate how to integrate psychedelics into our society accessibly, I hope everyone can begin to give a second look at what humans have known all along: community is the real medicine.

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This article was written by Colin Pugh and published by Psychedelic Archives. It originally appeared in the Drop In by Doubleblind.