Research abuses against people of colour and other vulnerable groups in early psychedelic research

The authors conducted a historical literature review of human psychedelic administration studies performed in the USA between 1 January 1950 and 31 December 1980. Initial searches and secondary historical sources (including declassified CIA documents, historical reviews and books) were used to identify research institutions, groups and individual investigators that conducted trials involving vulnerable populations. The team identified twelve research groups or facilities active in this period and then performed author-level searches to capture associated publications. The screening process removed duplicate records (n=46), unavailable full texts (n=1), non-clinical or non-administration studies (n=42), studies conducted outside the USA (n=16) and studies that did not involve vulnerable populations (n=55), leaving 48 original research articles for qualitative analysis. Because many publications omitted participant ethnoracial details, the investigators attempted to recover demographic information from institutional records and region-level census data when possible; the extracted text notes that 73% of included studies (n=35) did not report race or ethnicity. Data from the selected studies were compiled into spreadsheets capturing study-level variables: source site demographics, recruitment strategy (for example recruitment from state institutions such as prisons or hospitals), drug dose/regimen, frequency and duration of administration, and any evidence regarding consent or undue influence. Study safety was assessed case-by-case with reference to dosing patterns, participant capacity and evidence of coercion. For qualitative synthesis, an inductive latent constructionist thematic analysis was applied to identify recurring themes related to ethics and safety. The authors list key thematic categories used in analysis: incarcerated populations, undue influence, problematic dosing, questionable scientific merit, and considerations of set and setting. The term set and setting is defined in the review as the participant's internal mindset (set) and the external physical and social environment (setting), factors known to shape psychedelic experiences.

From the screening process the authors included 48 original clinical administration studies in their qualitative analysis. Many studies involved vulnerable populations: 65% (n=31) of the selected studies reported using vulnerable participants, with 50% (n=24) recruiting from prisons and 15% (n=7) involving people with psychotic disorders. Participants were typically male prisoners aged about 18–50 where described. The Lexington, Kentucky Addiction Research Center (ARC) was used as a recruitment or study site for over 40% of the included studies and is highlighted as especially implicated; although Black Americans represented about 7% of Kentucky’s general population at the time, the ARC population was reported as 66% Black and of Mexican origin in the extracted text. Reporting of race or ethnicity in publications was poor: only 28% (n=13) of the 47 studies included in a particular reporting table explicitly reported using POC, and 73% (n=35) of studies across the sample omitted ethnoracial information. To address missing demographic reporting the investigators relied on institutional or regional census data; they note that, where prison demographics were known, POC—predominantly Black Americans—were overrepresented in recruitment sites. The authors also report that some studies (a minority) made differential provision of set and setting by race, and that a figure of 4% of studies reporting differential treatment by race is reported in the text; the extracted text does not clearly reconcile this percentage with the absolute counts. Safety and ethical concerns were widespread. The analysis found repeated use of what the authors call high-risk dosing schedules in 77% (n=36) of studies: administration more than once per week, more than five total administrations without clear rationale, repeated high doses in rapid succession, or multiple different psychedelics given to the same participants in close temporal proximity. Examples cited include studies that administered seven different drugs across a month and others that mixed routes of administration inconsistently between participants. Several reports described dehumanising observation and recording practices, including detailed reporting of patients' toilet habits and sexual behaviour, and the use of restraints. Thematic analysis identified routine use of undue influence for prisoner participants: volunteers were reportedly offered reductions in sentence or access to illicit drugs (for example heroin) held in a so-called 'bank account', and participants frequently opted for the drugs. The paper presents testimonial evidence, including a quoted recollection from Edward M. Flowers, an African American former prisoner who later understood his ARC participation as exploitative. Set and setting were often neglected or applied unevenly. The authors describe experiments in which White, non-incarcerated participants received LSD in comfortable, socially supportive environments while incarcerated POC were dosed in clinical or filmed conditions. For example, one study contrasted 'Negro' men dosed in a research ward with White professionals dosed in a private home with efforts to reduce anxiety. Several studies filmed prisoner participants during drug administration. The authors also document trials that included people with schizophrenia receiving repeated or high doses; they note contemporary practice generally excludes psychotic patients because psychedelics can precipitate destabilisation. Overall, the investigators judged that many studies exhibited questionable scientific merit combined with ethically unacceptable recruitment and consent practices.

Schultes and colleagues interpret their findings as evidence that many first-wave psychedelic studies would fail modern ethical review. They emphasise that a large proportion of the examined trials used dosing and administration schedules now considered high risk, and that participants drawn from prisons and psychiatric institutions were often subjected to coercive recruitment practices and poor attention to set and setting. The discussion stresses that POC, and in particular Black Americans recruited from southern state prisons during an era of segregation and intense racial oppression, were disproportionately affected; ARC and CIA-funded mind control studies are singled out for their particular harms. The authors situate these abuses within the historical context of the civil rights era, noting that ethical norms and public awareness about research protections were different at the time. They argue that understanding this history helps explain present-day underrepresentation of POC in contemporary psychedelic research and contributes to ongoing mistrust among communities of colour. To address current inequities the paper advocates for culturally competent research practices: diversifying research teams, ethnoracial matching of therapists and participants where appropriate, cultural competency training for clinicians, and participatory research with affected communities to inform design and implementation. The investigators also raise the question of how to treat the scientific record derived from unethical research. They draw an analogy to the handling of Nazi experiment data and outline two possible responses that have been discussed in the literature: either formally condemning and retracting or otherwise distancing from unethical work, or engaging with affected communities and descendants to decide appropriate handling. They recommend community consultation as a step toward redress and suggest further investigation into local impacts—for example, studying ARC's effects on Lexington's communities. The authors acknowledge limitations of their review: primary studies often lacked methodological detail (for instance on consent procedures and dosing duration), and poor reporting of race forced reliance on site-level demographics, which constrains specificity. They state these limitations restrict the precision of conclusions but do not negate the overall pattern of exploitation identified.

The authors conclude that during the first wave of Western psychedelic research, vulnerable groups—particularly people of colour, incarcerated individuals and psychiatric inpatients—were exploited and often subjected to harmful procedures. They call for contemporary research to acknowledge and rectify these historical injustices by enforcing current ethical standards, ensuring inclusion of POC at all research levels, and developing culturally informed practices so that emerging psychedelic treatments are safe, effective and accessible for diverse populations.