Certifying Psychedelic Practitioner Safety and Ethics

How can we certify people and venues in psychedelic as ethical and safe? This is a hard question. But maybe not for the reasons that people might think.

I’ve seen multiple people promoting their ideas & systems for certifying psychedelic practitioners and/or retreats as meeting safety and ethics standards. As one of the founding members of EPIC, I’ve thought about it myself, and had numerous long discussions with my colleagues, most notably my friend, Dr Sandra Dreisbach. Between these discussions and my background in academia, I know the ethics well. And I’ve been involved with running both businesses and charities in the psychedelic space. So, I think I know what I’m talking about when I say that the difficulty here is not just philosophical, it’s practical and systemic.

Are you ethical? Please check all boxes that apply.

This is not about asking the right questions. There is huge scope in what you could ask of an individual or venue to assess their level of safety and ethics. Funnily enough, this isn’t where the biggest problems are, though most attempts in this area are lacking philosophical depth (largely because they refuse to hire Dr Dreisbach or myself.).

The reality is that it’s not enough to just ask good questions about safety and ethics. Corporate and medical history are littered with examples of malfeasance and suffering caused by people and organizations that said they were playing by the rules. A code of ethics is only as good as the culture of the organization and people it’s governing. Likewise, the rules & guidelines someone has to adhere to in order to hold an ‘ethical’ certification are only as good as the ethical culture & commitment of the person or organization it applies to.

So, we can’t take answers at face value. Certifiers need to check what applicants actually do, then enact ongoing monitoring to ensure continuing compliance. This means viewing and keeping official certified copies of things like first-aid PAT and therapist qualifications. It also means viewing, assessing and keeping copies of lineage statements, emergency plans, complaints procedures, ceremony or treatment protocols, and local licensing requirements.

This all must be stored in ways that are compliant with local laws, are private, secure and confidential, and easily accessible in case of complaints or subpoenas etc.

Photo by Jakub Żerdzicki on Unsplash

Meanwhile, back in the real world…

But certification and plans are, in the end, just pieces of paper. In other caring roles in health & medicine, people with fancy pieces of paper still make unethical or unsafe decisions. (Just ask a certain high-profile psychiatrist who has recently returned to practice.)

Certifiers need to know what practitioners and retreats are actually doing in real life. What are some ways they could do this? Solutions include but are not limited to:

• Onsite inspections: send people to physically view locations and example sessions  

• Mystery shoppers: as above, but incognito, so they get the ‘real’ treatment

• Feedback pathways that are controlled by the certifier: every client gets a link that allows them to report any problems directly to the certifier

Of these three, possibly the most important is the last one. Ideally, the feedback channels must be something that the practitioner never touches. E.g., an email or text message that goes directly to the client from the certifier after their experience, so the practitioner can’t track the link clicks and compromise privacy. It’s not impossible. The NSW health authority here, in sort-of universal healthcare Australia, does something along these lines for everyone admitted to a public hospital. But it would require the certifier to have client/patient contact details, which means an even higher level of data security.

Now we’re getting close to something that’s a more worthwhile certification. Except we’ve not closed the feedback loop. The only way this works is if there are proportionally appropriate negative consequences for practitioners and retreats if they are found to have broken whatever reasonably robust code they’re supposed to honor. These negative consequences need to be enough that even practitioners who don’t really care about ethics will at least want to avoid them. (I will come back to specifics of these in a moment.)

Serious consequences add another layer of complexity. Consequences mean that breaches, either uncovered by the certifier directly or (especially) reported by clients, need to be investigated thoroughly and with respect to natural justice & procedural fairness.

What are these consequences? At a bare minimum, they’d have to include temporary or permanent delisting & revocation of the certification.

This brings me to the first of two elephants in the room. Why will potential clients, or ‘seekers’ as it’s become popular to call them, care about whether a facilitator or retreat has the logo of some third-party certifier on their website? Not “why should they care” but where is the real actual pathway to a certifier’s approval being so socially and commercially powerful that lacking it is a viable threat to a business, in and of itself?

I humbly put it to readers that there are no organizations in the psychedelic space that could meet this requirement. There was a time when MAPS could have. But between splitting into Lykos and MAPS PBC, and MAPS’ association with the egregious ethical failures in the MDMA trials, it simply doesn’t have the moral standing or confidence of enough of the people on the ground in communities.

When people care if a qualification or service meets certain standards, trust in those standards does not come out of nowhere. It takes years, even decades, of work to build up public faith in an institution, all of which comes at considerable financial cost.

Show me the money!

This leads me to the other elephant - the factor I’ve notably omitted thus far. All of this is expensive. Like, amazingly expensive. The systems and staffing required to do this well cost enough that a certifier could charge $1000 a year for registration and still not remotely break even. Don’t believe me? Look at the operating budget for something like the Australian Health Practitioner Regulation Agency (Ahpra.) How about the Medical Board of California, which, despite collecting tens of millions per year in renewal fees, still limps along by taking out multimillion dollar loans?

Sure, there are probably fewer psychedelic professionals & retreats to certify worldwide than there are doctors in California. But there is a higher level of ethical and legal complexity, no economy of scale, and no government-backed cheap loans. There’s a reason why medical boards and professional bodies are run as nonprofits or government-funded statutory authorities:

The work these organizations do is necessary, but you can’t make a profit from it. My extremely rough calculation is that a certifier would need to charge at least $5000 USD a year to do what I’ve described, and even then, that’s only if you can get at least 100 practitioners and/or retreats on board. I know that sounds like a lot, but staffing, legally compliant record-keeping, site visits, insurance, legal fees, PR and comms etc. easily adds up to hundreds of thousands of dollars per year.

No facilitator or retreat is going to throw $5000-$10,000 a year at a safety/ethics certification that has no guarantee of serious commercial advantage or where lacking it doesn’t seriously impede their ability to operate.

Photo by Gabriel Meinert on Unsplash

And as soon as you take that money from them, unless the fee is unavoidable, as it is for renewing a medical license, the certifier faces a conflict of interest as they lose money by delisting people, giving them incentive to cultivate the appearance of ethical compliance, but enforce as little as possible to minimise costs and maximise revenue.

Thus, as a commercial exercise, it’s both ethically and financially self-defeating.  

And even as a non-profit, in order to both be thorough and break even, the cost will be considerable and likely unattainable unless you can compel practitioners to buy your certification. Which you can’t. Because you’re not a real medical board and consumers don’t know you from a bar of soap.

So, there it is. If a safety/ethics certification can break even, there is a high likelihood that it’s relatively less diligent than your average medical board. If they do everything they should do, there’s probably no way they can financially survive, maybe not even as a nonprofit. These are real-world problems, and there will be no efficiencies to find through things like AI or blockchain technologies. Even people who are happy to volunteer have bills to pay, and they can’t do that with feelings of gratitude.

Helping psychedelic seekers/clients stay safer is a public good. Until ethics and safety are important enough to enough people, especially those with money, it will not be viable to fund this work through private contributions.

Is anything viable in the overlap between ethics, safety and psychedelics? Maybe, but that’s a story for another day.  

Are you looking to build a certification business or non-profit for psychedelic practitioners and retreats, and want to give your project the best shot at success?

I offer ethical consulting, credible content, and plain-language guidance for people doing serious work in this space.