This is Part 2 in a two-part series about the lack of representation in psychedelic research. Part 1 explores the history of medical bias that continues to systematically exclude women, minorities, and gender diverse people from clinical trials. This second part explores the structural issues within the medical model and imagines community-based alternatives.
The evidence gap in psychedelic research is more than a methodological problem. At this year’s International Conference of Psychedelic Research (ICPR 2026), a panel on gender, precarity, and power made the case that these exclusions are not simply oversights waiting to be corrected with better data collection. They are structural features of a Western biomedical model that presupposes conditions many people do not have: safety, institutional trust, stable identity recognitions, and the freedom to exist without those conditions being questioned.
Consider what a clinical trial actually asks of its participants. It asks them to enter a medical or research institution with which their community may have a long and painful history with. It asks them to sign consent forms built around legal frameworks that may not account for the particular vulnerabilities they carry. It asks them, in many cases, to undergo one of the most psychologically intense experiences of their lives in a setting that cannot acknowledge who they truly are.
For people whose lives have been shaped by ongoing discrimination – those in contact with the carceral system, experiencing structural homelessness, or navigating gender-based violence – the clinical baseline is not a neutral starting point. The therapeutic promise of psychological flexibility, one of the key mechanisms thought to underpin psychedelic treatment, is only meaningful if there is something worth being flexible toward.
As Rafaelle Lancelotta, Licensed Professional Clinical Counselor and Doctor in Social Work Research from The Ohio State University specializing in psychedelic-assisted therapy, trauma, and LGBTQ+ mental health, said: “We are not succeeding if people are becoming more flexible to something that is oppressive”.
This is where the critique deepens into something the field has yet to fully reckon with. Lancelotta raised the question of how clinicians are supposed to meaningfully assess wellbeing outcomes for people who “have lost all reference to what wellbeing feels like”, and where standard outcome measures, developed on populations for whom safety is a given, simply do not hold.
Where the gaps become impossible to ignore
Perhaps the most stark example of the gap between psychedelic research’s promise and its present reality is in addiction treatment. Here, ibogaine in particular has drawn significant clinical interest and is now moving through clinical trials as a treatment for addiction, The research may be compelling, but the people most likely to benefit (those experiencing homelessness, polysubstance use, disconnection from healthcare and welfare systems, and in contact with the carceral system) are precisely those absent from trials and least likely to access clinical care. Set and setting, the most basic principles of safe psychedelic practice, are not technical requirements but social ones. They cannot be manufactured in a clinical setting for people for whom safety is not a feature of their daily lives.
To complicate matters further, the colonial dimension of this problem is equally unresolved. Iboga, the plant that produces ibogaine, has been used in cultural and ceremonial contexts in central and west Africa for generations. The idea that a Western clinical framework built in the last century can adequately evaluate a substance embedded in that depth of cultural knowledge has drawn criticism.
Panelist Ronica Mukerjee was quite direct in addressing this: “How do you use a drug from the last 100 years to understand something that is over 5,000 years old?”. She described this as the “arrogance of western medical practitioners”, and an extractive appropriation of Indigenous knowledge without meaningful engagement with the context or communities it belongs to.
Mukerjee was direct about where this trajectory leads: “It’s a billion dollar industry that we know won’t be helping those that need it the most”.
What care actually looks like
Against the limitations of the medicalised model, ICPR 2026 offered a different frame grounded in community and the kinds of trust that institutions rarely generate on their own.
“I don’t think of it as wound healing,” said Lancelotta, “I think of it as resourcing”. The distinction is significant: healing implies a return to a prior state, but for many people whose lives have been shaped by structural harm, there is no prior state to return to.
What psychedelics can offer, at their best, is not repair but resource in the form of a glimpse of what might be possible. But that opening requires somewhere to go. “Psychedelics are a tool that creates an opening”, Lancelotta continued, “but only community and relationships can make that opening concrete and real”.
This is not simply a theoretical position. It has practical dimensions that practitioners working outside of the formal clinical model are already navigating. Speaking to TalkingDrugs, Lancelotta described the reality of working with clients who cannot pay for formal psychedelic therapy in legal states or in legal contexts such as ketamine clinics, and instead rely on harm reduction preparation, integration support, and education around safe use in the absence of institutional pathways. Mukerjee’s work is grounded in the same understanding, captured in a simple formulation: “We take care of us”.
The clinical model has its own examples of attempts to bridge this gap. Professor Celia Morgan from Exeter University and lived-experience lead Alice Chapman have been developing community and lived experience trial models in the UK, advocating for peer knowledge and community participation to become compulsory elements of psychedelic research. Their core argument supports the work of Lancelotta, where the conditions under which psychedelics work best are not primarily pharmaceutical, but relational.
Towards a more inclusive psychedelic model
The medicalised model has something the community model does not: infrastructure, funding, regulatory legitimacy, and the ability to generate the kind of evidence that moves policy. The community model has something the clinical model consistently fails to produce: trust, relational depth, cultural knowledge, and the capacity to reach people who need care most. ICPR 2026 did not resolve the tension between these two approaches. What it did was refuse to let the urgency of that tension be treated as a footnote.
For women and gender diverse people, the urgency is not abstract. These are the populations carrying the heaviest burden of the conditions psychedelic medicine claims to be transforming, and yet current research is least equipped to speak for. A woman entering a clinical trial today is receiving treatment calibrated to a body that is not hers, at doses that have not been tested against her hormonal profile, within a framework that has never asked whether her specific experience of the world matters to her outcome of psychedelic treatment. A gender diverse person seeking care enters a system that may not be able to accurately record who they are, let alone account for the specific shape of their trauma. The science that is supposed to serve them was built without them.
This is not a peripheral concern that can be addressed once the science is settled, but a question about what the real work to be done actually is. If psychedelic therapy is to fulfil its promise of transformation – for those who need it most – then the field must do more than include women and gender diverse people in the existing frameworks. It must ask whether those frameworks are adequate to them at all, and be willing to redesign them when the answer is no.
The conversation about equity – about who is in the research, who is leading it, who can access treatment and under what conditions – is also not secondary to science. This was the theme of the conference’s final panel on gender, precarity, and power. The irony was hard to miss though: one of the most substantively challenging conversations of the entire conference was one of the most sparsely attended. The majority of those present were already part of the communities doing the advocacy work the panel was discussing. The questions raised, evidence shared, and alternatives proposed already largely circulated among themselves.
If the promise of psychedelic medicine is as transformative as evidence suggests, then the field has an obligation to ask honestly who that transformation is for. As it stands, the answer is too often a person who looks a lot like the researchers who designed the trial or the practitioners who run the clinics. There is still time to change that, but not, as Mukerjee and others made clear, without a reckoning that the field has so far been reluctant to have.
