Brain Police: How the Rise of Psychoactive Substances Will Change the Ethics of the Future

Deliberately concealing facts is ethically undesirable, as it often indirectly harms others. Humanity will continue to face a series of problems with similar origins: first, known facts are intentionally suppressed in various places. Then, they suddenly resurface in new, broader forms. Today, information can no longer be controlled by national laws or the political measures of individual countries. It seems as if all the knowledge that was repressed has burst out of the human subconscious in the form of new demons, gradually taking over our living space. Typical examples include organized crime, the now-unleashed global financial industry, and climate change. Our attitude toward new psychoactive substances belongs to the same category.

Currently, the field of neurotechnology most likely to lead to the commercial exploitation of consciousness technologies and rapidly change society is the area of psychoactive substances. Overall, these substances promise many benefits: we may be able to treat mental and neurological disorders using new combinations of imaging, surgery, deep brain stimulation, and psychopharmacology. In most countries, one to five percent of the population suffers from serious mental illnesses. Severe mental disorders often lead to a loss of self-worth, and these are the very illnesses in which we have made the least progress over centuries (which clearly indicates that our theory of consciousness was flawed). Now, there is real hope that a new generation of antidepressants and antipsychotics will ease the suffering of those afflicted by these age-old maladies.

But we won’t stop there. In the important new discipline of neuroethics, the new buzzword is “cognitive enhancement.” This refers to new medications designed to improve mental performance—essentially, drugs that make you “smarter” and “more alert.” Soon, we will learn to enhance the thinking and mood of healthy people. In fact, “cosmetic psychopharmacology” has already entered Western culture. If we can tackle dementia and memory loss, if we develop drugs that sharpen attention and eliminate shyness or even everyday sadness, why not use them? And why should doctors decide what role such medications play in our personal life stories? Just as today you can choose breast augmentation, plastic surgery, piercings, and other ways to alter your body, soon we’ll be able to finely and precisely tune our brain chemistry. But who should decide which changes will enrich our lives and which we might regret?

Should We Make the Smart Even Smarter?

If we learn to make normal people smarter, should we make the already smart even smarter? The prestigious scientific journal Nature recently conducted an informal online survey among its readers—scientists in the natural sciences—about the use of cognitive enhancers. Fourteen hundred people from sixty countries responded. One in five reported using such drugs for non-medical purposes, to boost attention, focus, or memory. The most popular was methylphenidate (Ritalin), used by 62% of respondents, while 44% took modafinil, and 15% used beta-blockers like propranolol. A third bought these drugs online. The survey revealed not only the widespread use of such substances among scientists but also that four out of five respondents believe healthy adults should be allowed to use them at will. Nearly seventy percent said they were willing to risk mild side effects. One participant said, “As a professional, I feel it’s my duty to use all my abilities for the good of humanity. If drugs can enhance them, it’s my duty to take them.”

It’s safe to assume that pharmacological neurotechnologies for enhancing the mental performance of healthy people will continue to improve, and that we won’t be able to simply look away from the ethical issues, as we did in the past with classic hallucinogens. The most important difference is that far more people will want to enhance their minds than ever sought spiritual experiences. As cognitive neuroscientist Martha Farah and colleagues wrote some time ago: “The question is no longer whether we need guidelines for neurocognitive enhancement, but what kind of guidelines we need.”

What States of Mind Should Be Outlawed?

Will the arrival of a new generation of cognitive stimulants mean pre-exam urine tests in schools and universities? With the widespread availability of reliable mood optimizers, will grumpiness and PMS in the workplace be seen as sloppiness and neglect, much like strong body odor is today? As a philosopher, I’m especially interested in this question: what will we do when “moral enhancement drugs” allow people to behave more prosocially and altruistically? Should we then force everyone to optimize their ethics? Some will argue that a dynamic system like the human brain, refined over millions of years, can’t be further improved without sacrificing some stability. Others will counter that we can launch optimization in a new direction, different from what evolution has step-by-step crafted in our conscious self-model. Should we become neurophenomenological Luddites?

The problem of “phenotechnology” is both ethical and political. Ultimately, we must decide which states of consciousness should be outlawed in a free society. Is it legal, for example, for children to see their parents intoxicated? Would you object if elderly citizens or your coworkers used new drugs to boost their thinking? What about libido enhancement in old age? Is it acceptable for soldiers, possibly fighting for ethically questionable causes, to fight and kill under the influence of psychostimulants and antidepressants that shield them from PTSD? What if a new company offers everyone religious experiences via brain electrostimulation? When it comes to psychoactive substances, we urgently need a rational and nuanced drug policy—one that meets the challenge posed by 21st-century neuropharmacology. Today, there is a legal and an illegal market, which means there are legal and illegal states of consciousness. If we succeed in creating a rational drug policy, its goal will be to minimize harm to users and society while maximizing potential benefits. Ideally, the distinction between legal and illegal states of consciousness will gradually fade, as desired consumer behavior is controlled by cultural consensus and citizens themselves—from the bottom up, not top down by the state.

Nevertheless, the better we understand neurochemical mechanisms, the more illegal drugs will appear on the black market, both in variety and quantity. I predict that by 2050, the “good old days” when we dealt with just a dozen or so molecules on the black market will seem like a holiday. Make no mistake: bans haven’t worked in the past, and experience shows that for every illegal human desire, there’s a product on the black market. If there’s demand, there will be an industry to serve it. In the future, we may see a proliferation of new psychoactive substances, with ER doctors encountering kids on drugs they don’t even recognize by name.

The Challenge of New Psychoactive Substances

Illegal party drugs show how quickly this development can happen. In the first German edition of this book (published in 2009), I cautiously predicted that the number of banned substances on the market would soon rise sharply. In the three years after that prediction, Europe saw the discovery of 41, then 49, and by 2012, 73 types of synthetic drugs previously unknown. The trend hasn’t stopped: the following year, 81 new psychoactive substances were identified for the first time, and by 2014, there were 101. Reviewing annual reports from Europol and the European Monitoring Centre for Drugs and Drug Addiction, it’s clear the situation is out of control. The same applies to “brain boosting” prescription drugs. As soon as a truly effective brain-enhancing drug appears, even the strictest controls won’t work. There are already hundreds of illegal labs ready to copy any new molecule and flood the black market.

Globalization, the Internet, and modern neuropharmacology together pose a challenge to drug policy. For example, the legal pharmaceutical industry knows full well that with the rise of online pharmacies, state authorities can no longer control non-medical use of stimulants like Ritalin and modafinil. The day will come when we can’t escape this challenge through denial, disinformation, PR campaigns, or even legislative measures and draconian sanctions. We already pay a high price for the status quo in prescription drug and alcohol abuse. Meanwhile, new challenges arise, and we haven’t done our homework.

We have yet to convincingly assess the intrinsic value of artificially induced states of consciousness, or the risks and benefits they bring not only to individuals but to society as a whole. We simply haven’t looked in that direction. Failing to integrate such substances into our culture and declaring them illegal also causes harm: spiritual practitioners and serious students of theology and psychiatry lose access; young people come into contact with the criminal world; people experiment with unknown doses in unsafe conditions; especially vulnerable individuals may behave dangerously or suffer serious harm during panic or anxiety episodes, or develop long-term psychotic reactions. Everything we do has consequences. This applies to both past problems and the challenges we’ll face in the future.

Risk and Reward: The Ethics of Altered States

Let’s consider the risk of psychotic reactions. A UK review of LSD in clinical work covered about 4,300 people and 49,500 LSD sessions. The suicide rate was 0.7 per thousand patients; accidents, 2.3 per thousand; psychoses lasting more than 48 hours, 9 per thousand (with two-thirds making a full recovery). Another study, surveying scientists who conducted controlled LSD experiments, found that 0.08% of 5,000 volunteers experienced psychiatric symptoms lasting more than two days. Recently, researchers have improved control over such adverse reactions through careful monitoring and preparation. Still, it’s best to stick to conservative estimates and expect nine long-lasting psychotic reactions per thousand patients.

Now, suppose a group of a thousand carefully selected citizens is legally offered access to the phenomenal states opened by psilocybin, as in two recent studies by Roland Griffiths and colleagues. Since psilocybin is very similar to LSD in this respect, empirical data suggest that nine will experience serious, prolonged psychotic reactions, with three of them lasting more than 48 hours, possibly with lifelong consequences. Three hundred thirty people will rate the experience as the most spiritually significant of their lives; 670 will say it was the most meaningful or among the top five most meaningful experiences. Who outweighs whom—9 or 670?

Suppose further that some citizens decide to take the risk and demand legal, maximally safe access to these phenomenal states. Should the state intervene on ethical grounds, perhaps deciding that citizens have no right to risk their mental health and the potential to become a burden on society? In that case, we’d have to ban alcohol immediately. What if legal experts say that, as with the death penalty, one wrong decision—one lasting psychotic reaction—is already too much, and it’s unethical to take such risks? What if social workers and psychiatrists argue that making such experiments illegal will increase the overall number of serious psychiatric complications and make them invisible to statistics? What if the church officially declares (in line with reductive materialism) that these experiences are “not-zen”—not real, just phenomena with no epistemic value? Does a citizen of a free society have the right to seek their own answer to this question?

Would we consider it significant if the risk-to-benefit ratio were much higher, say 80 to 20? What if citizens uninterested in spiritual matters decide to indulge in pure “empty” hedonism, enjoying Meister Eckhart’s “istigkeit” just for fun? What if, later, ultraconservative believers and aging hippies who still believe in “psychedelic communion” feel deeply offended by the purely recreational, hedonistic use of such substances and protest against blasphemy and desecration? These are all concrete examples of ethical questions for which we have yet to find normative, generally accepted answers. We have not yet developed a reasonable way to handle these substances—a risk-minimization strategy that allows people to enjoy potential benefits. All we’ve managed to do is wall off this part of the phenomenal state space, making academic research and rational risk assessment nearly impossible in most countries. This demonstrates not only the weakness of legal culture but perhaps also a lower standard of living regarding our own consciousness. We haven’t done our homework, and as a result, lives are being ruined.

The price of denial may rise. New hallucinogenic-type psychoactive substances are being developed—they hit the black market without clinical testing, and their numbers keep growing.

Changing Demands, New Technologies

These are still old (and “simple,” because they’re easy to solve) problems—the unfinished business of the 1960s. Today, demand is changing, technology is becoming more precise, and the market is expanding. In our ultra-fast, increasingly competitive and ruthless modern society, very few seek deep spiritual experiences. People want sharp minds, focus, emotional stability, and charisma—everything that leads to professional success and eases the stress of life in the fast lane. There are few Aldous Huxleys left, but a new demographic factor has emerged: in wealthy societies, people live longer than ever—and want not just longevity, but quality of life. Big pharmaceutical companies know this. Everyone’s heard of modafinil, and some know it’s already used in Iraq, with at least forty more molecules on the way. Yes, there’s a lot of hype, and panic is certainly unwarranted. But the technology isn’t going away, and it’s improving.

Major pharmaceutical companies, trying to elegantly bypass the boundaries between legal and illegal substances, are quietly developing many new drugs: they’re confident that cognitive enhancers will bring big profits from “non-medical use” in the future. For example, Cephalon, the maker of modafinil, reported that about 90% of prescriptions are for off-label use. The recent spread of online pharmacies has created a new global market for these products and new tools for unofficial long-term studies with many participants.

Neuroethics and the Future of Drug Policy

Modern neuroethics will have to create a new approach to drug policy. The key question is: which brain states should be considered legal? Which areas of the phenomenal state space should (if any) be outlawed? It’s important to remember that all cultures have used psychoactive substances for thousands of years to induce special states of consciousness—not just religious ecstasy, relaxed cheerfulness, and heightened attention, but also simple, dull intoxication. The new factor is that the tools are getting better. So we must decide which of these altered states to integrate into our culture, and which to avoid at all costs.

In a free society, we should strive for maximum individual independence. The liberal Western understanding of democracy requires a right to mental self-determination regarding psychoactive substances, which is also enshrined in the constitution. However, the essence of the problem is to limit this basic liberal principle with reasonable and ethically convincing arguments.

Weighing Risks and Benefits

I am against the legalization of classic hallucinogens like psilocybin, LSD, and mescaline. It’s true that they are not addictive and have very low toxicity. Nevertheless, there remains a risk of use in unsafe conditions, without necessary knowledge and competent supervision, and that risk is too high. The simple demand for legalization is, first, too broad and, second, too cheap—often coming from people who won’t have to pay the price for its consequences. Here lies the real problem: on the one hand, it’s clear that in a free country, every citizen should in principle have access to the states of consciousness described above, if only to form their own independent opinion. But on mature reflection, we must admit that most people making political and legislative decisions, for this very reason (lack of such experience), have no idea what’s at stake. On the other hand, we must be ready to pay for access to these very unusual subjective experiences and the corresponding increase in individual freedom. A new cultural context doesn’t arise by itself. Therefore, we’ll have to invest creativity, reason, money, and a lot of work into developing new, sensible ways of handling psychoactive substances. For example, we could develop something like a “driver’s license” requiring a special psychiatric risk assessment, a theoretical exam, and perhaps five “driving lessons” under professional supervision in safe conditions. Those who pass could be allowed to legally purchase two single doses of a classic hallucinogen per year for personal use. This model could be gradually refined, very selectively and, most importantly, based on experience, and later perhaps adapted for cognitive stimulants and other classes of substances. This would only be the starting point of a long process, and of course, there are many other reasonable strategies. The main thing is that after decades of stagnation and ongoing harm, society is beginning to move forward.

Given all this, we must take a sober look at the problem. We should minimize the price we pay in deaths, addictions, and possible harm to our economy, such as a noticeable drop in productivity. But the question isn’t just how to protect ourselves; we should also assess the hidden benefits psychoactive substances might bring to our culture. In some professions—think of a finance minister, long-haul pilot, sniper, or emergency surgeon—temporarily boosting concentration and mental performance serves the public interest. Should we, in principle, ban spiritual experiences induced by some classic hallucinogens? Is it acceptable to deny serious theology and psychiatry students access to such altered states of consciousness? Is it right to force anyone seeking valuable spiritual or religious experiences—or just wanting to try for themselves—to break the law and risk taking unknown doses of impure substances in dangerous settings? Many aspects of current drug policy are arbitrary and ethically unconsidered. Is it ethical, for example, to advertise dangerous, addictive substances like alcohol and nicotine? Should the government profit from suicidal behavior by taxing such substances? Should the pharmaceutical industry be allowed to sell drugs like Ritalin and modafinil directly to consumers without a doctor (as in New Zealand and the US)? We’ll need precise laws covering every molecule and its neurophenomenological properties. Neuroethics must consider not only the physiological effects of a substance on the brain but also weigh psychological and social risks against the intrinsic value of the experiences produced by each brain state—a complex task. It will become easier if we can establish a fundamental moral consensus supported by most citizens—the very people for whom the rules are made. Authorities should not lie to their audience; instead, they should work to restore trust, especially among the younger generation. Regulating the black market is harder than the legal one, and political decisions usually affect consumers much less than cultural context. Laws alone won’t help. To meet the challenges posed by new psychoactive substances, we’ll need a new cultural context.