Smoke & Vapor
What Vaping Can Teach Us About Psychedelic Ethics
By Shirelle Noble & Dave McGaughey
Watching their 2005 master’s thesis presentation, it’s easy to see that Adam Bowen and James Monsees, are onto something. The presentation sets perceived upsides of smoking (social connection, habit and routine, pleasure) against its costs (health risks, social stigma, unpleasant stains and smells). Then it presents the idea: ploom. An elegant pod of tobacco vaporized with a heating element. All the good stuff, none of the bad. Watching the presentation, set against the backdrop of the 15 billion cigarettes they say are smoked each day, it is easy to root for them to succeed. And succeed they did, albeit with one small change. In the end, ploom didn’t have the right ring to it. They came up with a better name. They called their brand Juul. By 2018 the company’s valuation reached $38 billion.
Within twelve months of that time the valuation would be cut in half. The company would become quagmired in legal battles, and local, state, and federal legislators would be creating new laws against their products. How did this happen? What lessons does it offer for investors and entrepreneurs in psychedelic business?
The relatively recent perception of eCigarettes as innovations toward a healthier world contrasts with that of psychedelics. Despite the hype, psychedelics still carry societal stigma, and are viewed by some with skepticism and concern, often in language of drug war propaganda. The story of eCigarette legislation offers a cautionary tale to psychedelics of the way high profile public incidents can drive rapid regulatory action. Sometimes, as in the case of police reforms resulting from George Floyd’s murder, this can be for the better. Often, as is the case with most drug policy, it can be for the worse.
When eCigarettes were initially introduced, they were considered to be a life-saving innovation. Suddenly it was possible to imagine a smoke-free future. Yes it would still be a future of nicotine addiction, but that was already the status-quo. An estimated one billion people smoke, with nearly 500,000 Americans dying from smoking every year. Given the magnitude of the problem, many — including Juul Labs founders Bowen and Monsees — thought a nicotine-free world would be much harder to achieve than one where cigarette smoke, with its tar, toxins, and carcinogens, was exchanged for vapor.
On July 25th, the Wisconsin Department of Health Services issued a memo titled, “Severe Pulmonary Disease Among Adolescents Who Reported Vaping.” Within months of that initial outbreak, President Trump initiated an FDA ban the sale of flavored eCigarettes, and officially raised the age for buying tobacco products from 18 to 21. In the same period of time, dozens of states and municipalities crafted their own prohibitive legislation. China removed Juul from stores and India banned vaping all together.
Even before the 68 deaths and 2,807 hospitalizations for vaping-related infection, Juul was engaged in intense legal battles around its role in creating an “epidemic” of youth vaping, with some estimates as high as one third of high school age youth in the United States having tried eCigarettes, a market which Juul claimed over 70% of. Juul has denied targeting young people.
How does a company with the noble purpose of helping the one billion worldwide cigarette users go smoke-free find itself spending millions of dollars to create addicts out of kids? What lessons does this have to offer psychedelic businesses, setting out with the noble purpose of helping treat trauma and alleviate human suffering?
For some reason in their 2005 thesis talk, Bowne and Monsee forgot to mention the huge economic opportunity of convincing young people to start vaping. It’s even possible such action was never the founders’ plan. In highly capitalized businesses like Juul investor pressure, in the form of mandates for scale, competition to secure subsequent rounds of funding, and legal fiduciary responsibility, can fundamentally warp the values a company sets out with. These forces might have played a role in Juul’s focus on the youth market. Among other investors in Juul is Altria, who acquired a 35% stake in Juul Labs in 2018. Altria is the parent company of Marlboro, a brand that controls more share of the cigarette market than the next seven brands combined (and knows a thing or two about getting kids to smoke).
Scale, concentrated power, and investor mandates put serious pressure on companies to make ethical tradeoffs for the sake of growth. This begs the question for psychedelic businesses: how are the company’s foundational commitments to integrity and ethics preserved as the business grows and changes? No founder or investor wants to build something that ends up doing harm, regardless of the profits to be made along the way. In this field specifically, “harm” could not only be to patients but to the field at large.
The process of bringing psychedelics back from the cultural periphery has been decades in the making. The eCigarette example illuminates how small the margin for error really is. In a media environment where major outlets from 60 Minutes to Fortune Magazine are scrambling to cover psychedelics, it is a small jump to imagine the kind of coverage high profile mistakes in the psychedelic field could lead to. Such a story would simply be too juicy for the media to pass up.
The history of psychedelics in the west is one of media sensationalism. Even now it is not uncommon to hear questions about LSD changing chromosomes, or storing for years in spinal fluids only to come back for a full-fledged trip. Even major media outlets from the sixties and seventies published psychedelic headlines with claims so extravagant they could make up a gag reel. Read in the context of their time, those stories were devastating to the burgeoning field of psychedelic research, ultimately contributing to the prohibition that took from mental healthcare some of the most promising treatments in generations.
At times it is striking that a psychedelic field so full of hope and possibility can be perched on such unstable ground. With breakthrough designations, compelling clinical results, and new ventures seemingly forming every day, it is easy to start thinking of a mainstream psychedelic future as an inevitability. This is far from the case.
At any time the field of psychedelics could be one disaster away from legal setbacks. After the backlash to the FDA around opioids, it is not difficult to imagine that regulators may be reluctant to take what appear to be “risks” around rescheduling psychedelics, despite the compelling outcomes of the trials.
Capitalism has never intersected with something like psychedelics. It presents unique considerations around integrity and ethics. The team at North Star illuminates some in our story, We Will Call It Pala. Examples include:
- Pressure to maximize profits in psychedelic businesses could lead to a model that is oriented around as many successive treatments as possible (securing the most lifetime value of a patient)
- Companies could leverage the suggestibility of patients in psychedelic treatment to sell products and services, as well as affiliate marketing
- Companies facing a mandate for revenue growth could begin to cut corners around patient treatment, including the caliber of training required for practitioners, a given practitioner’s caseload, how patients are supported during treatment, how quickly beds are turned, and the emphasis placed on integration.
All of these actions build risks of psychedelic business somehow doing harm, and the field facing vape-like legal consequences.
Every investor should lose sleep over the slim margin for error in psychedelics. This is true whether or not they came to the field centering integrity and ethics in their approach. A regulatory reset could mean a total loss of their investment. In this way, it is “good business” to care about integrity and ethics in psychedelics, especially the closer to the actual patient care the business is.
When we “move fast and break things” in the business of treating consciousness, what is being broken?
This fact provides a strong incentive for investors to mandate that integrity and ethics are built into the foundations of any business they invest in. This process begins with investors and entrepreneurs taking honest assessments of risks, as well as taking proactive steps to deepen their understanding of psychedelic medicines, and build relationships with elders and wisdom-keepers across the field.
The backdrop to the psychedelic field is the level of trauma in the world. Mental health has rarely found tools so powerful in treating it. The need is truly great. COVID-19, the resulting mass unemployment, and the racial inequities spotlighted by George Floyd’s murder all add urgency to the need for quality psychedelic treatment to be accessible at scale. Each person in the field delicately balances the healing potential of psychedelics with their precarious legal standing. Each person working in the field could help bring about a transformation in mental health. Each person could also be one of the reasons all the progress could be stopped. Such a future would be beyond devastating. There is so much suffering in the world today. Psychedelics are too important to treating it.
The fragility of this movement unifies everyone who imagines a new regulatory paradigm for psychedelics. Integrity and ethics matter here. The businesses that are forming today may scale psychedelic treatment to millions of people. Along with this opportunity comes many ethical considerations and many possible risks. We have a window to build integrity into the DNA of these businesses, to ensure safe, accessible psychedelic medicine is available to those who need it. Doing less means risking seeing this work, and this opportunity for healing, go up in smoke.
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Stay tuned for deeper dives into risk considerations for different types of businesses around integrity and ethics in future articles.
North Star is a nonprofit committed to centering integrity and ethics in the psychedelic field, starting with the North Star Ethics Pledge. Over the coming months, North Star will continue to raise considerations around integrity and ethics, as well as offer practical solutions, resources and tools as part of this series, Wayfinding: A Path Integrity & Ethics in the Emerging Psychedelic Field.
