The Drug Isn't the Medicine. Here's What Actually Is.
- Sascha Kuhlmann
- 1 minute ago
- 4 min read
A Johns Hopkins trial participant just said what the psychedelic field doesn't want to hear.
Erica Rex participated in the first Johns Hopkins psilocybin trial in 2012. She saw what the medicine could do under the right conditions: trained guides, days of debriefing, community support. It changed her relationship with cancer.
Thirteen years later, she's watching the field she helped build get stripped for parts.
In a piece published in STAT News this week, Rex writes:
The most transformative, curative, and life-affirming parts of the psychedelic experience include both ritual process and community involvement. But these elements cannot be monetized, so the companies seeking to profit from psychedelics are discarding them.
This lands while Compass Pathways moves toward an FDA application for synthetic psilocybin, potentially the first classic psychedelic approved in the U.S. The molecule is about to go mainstream. The question is w
hether the things that make it work will survive the trip.
What the Research Actually Says
Rex isn't anti-psychedelic. She's pro-context. The distinction matters.
Her argument rests on three pillars that decades of research and thousands of years of indigenous practice agree on:
1. Community Is the Container
Psychedelics are non-specific amplifiers. They magnify what's already there: humility, creativity, and compassion, and also narcissism, grandiosity, and delusion. Rex is blunt about this. Without other people around to moderate what comes up, the insights that feel like universal truth in the moment can become distorted self-perception that hardens into identity.
This isn't theoretical. Anyone who's sat with the medicine knows the feeling. You come out of a session convinced you've seen the fabric of reality, that you understand something no one else does. That feeling is real. It's also incomplete.
Fellow participants, people who've been in the same fire, are the ones who can say, "I hear you, and also, let's slow down." They challenge without dismissing. They hold space without enabling. A single therapist in a clinical room cannot replicate this.
2. The Guide Matters More Than the Molecule
Rex had two trained guides present for every session at Hopkins. Days of preparation. Days of debriefing. A psychiatrist on call afterward.
Compare that to the emerging commercial model: a single facilitator, one or two follow-up calls, and a credit card charge. Some retreats are essentially psychedelic tourism. Beautiful settings, minimal preparation, and almost no follow-through.
The guide's job isn't to administer a substance. It's to hold a space where someone can fall apart safely, and then help them put the pieces back together in a way that's more honest than what they walked in with. That requires training, experience, and genuine relationship. That last part doesn't scale.
Rex also raises the harder point: psychedelic states create vulnerability. The oxytocin flood from MDMA, the ego dissolution from psilocybin or 5-MeO-DMT. These states make people suggestible, open, and trusting in ways they wouldn't normally be. Without proper boundaries and oversight, that vulnerability gets exploited. The Lykos MDMA scandal, where sexual abuse occurred at a Phase 2 clinical trial site, is the evidence that this isn't hypothetical.
3. Integration Is Where the Medicine Actually Works
Here's what most people get wrong about psychedelics: the ceremony isn't the treatment. It's the disruption. It cracks the patterns open. Integration is where you decide what to build in the space that's been created.
Rex describes this as the phase where participants "right-size" their insights. Taking what was genuinely meaningful and separating it from the grandiosity, the pattern-matching, the conviction that you've been chosen for something special.
This is unglamorous work. It's not a mountain-top experience. It's sitting with what came up, week after week, asking hard questions:
What did I actually see about myself?
What patterns showed up that I've been running from?
What am I going to do differently, not in theory, but tomorrow morning?
Without integration, the psychedelic experience becomes a memory that fades. An interesting thing that happened once. Or worse: a story you tell at parties that replaces the actual inner work the experience was trying to initiate.
The Split That's Coming
The psychedelic field is heading in two directions at once.
Track one is pharmaceutical: Compass Pathways filing with the FDA, standardized dosing, clinical protocols, insurance billing codes. This will make psilocybin available to millions of people who need it. That's genuinely good.
Track two is what Rex is calling for, and what indigenous traditions have always known: that the medicine works inside a container of community, guidance, and sustained inner work. This doesn't fit into a billing code. It can't be delivered in a single 8-hour session with two follow-up calls.
Both tracks have value. If track one succeeds without track two, though, we'll have a new FDA-approved molecule and a generation of people who took it without the support to make it mean anything.
What This Means for Men Doing This Work
Men get a particularly raw deal in the current setup. Most psychedelic retreats and therapy models aren't designed for how men process. The expectation is often to open up immediately, emote on command, and have a breakthrough on schedule. That's not how most men work, especially men who've spent decades building walls that kept them functional.
The container needs to be different. The conversation after the experience needs to be different. And the community needs to be made of men who've done the work themselves. Not because women can't hold space, but because men need to see other men being honest about what they're carrying before they'll risk doing it themselves.
That's not a therapeutic insight. That's what I've seen, over and over, in the years since my own first experience in 2018.
The Bottom Line
Erica Rex isn't saying psychedelics don't work. She's saying they work because of everything around them: the preparation, the community, the guide, the weeks and months of integration that follow. Strip those away and you're left with a molecule that amplifies whatever's already there, for better or worse.
If you've had a psychedelic experience and feel like you didn't get what you were supposed to from it, or if you got something powerful and don't know what to do with it, the answer isn't another ceremony. It's the work that comes after.
That's integration. That's where it actually happens.
Ready to Start the Real Work?
Working with 5-MeO-DMT or other psychedelics and wondering what comes next? Integration is where the real work begins.