Indigenous Knowledge Systems & Psychedelic Science: Towards Ethical and Reciprocal Collaboration

Abstract

Indigenous Peoples have cultivated and protected natural psychoactive medicines through ceremony, kinship, and spiritual responsibility across generations, yet their long-standing contributions have often been marginalized through extractive research, commercialization, and policy exclusion. It is Indigenous communities that have stewarded and gained expertise working with psychoactive medicines for centuries, yet they remain underrepresented within the scientific discourse. This commentary advances the case for reciprocal and equitable collaboration in psychedelic science, grounded in Indigenous sovereignty, cultural and intellectual property rights, and governance. Drawing on traditions involving ayahuasca, psilocybin, peyote, and iboga, we illustrate how Indigenous methodologies, including ritual, community-based practices, and ecological approaches, offer insights critical to both safety and efficacy. We argue that research and policy must embed free, prior, and informed consent, equitable benefit-sharing, and Indigenous leadership. Such efforts require moving past tokenistic inclusion toward meaningful collaboration and systemic change in psychedelic research that is both scientifically rigorous and culturally just. We conclude by calling for more formal, transparent, and globally legitimate convening processes, such as those modeled on WHO global consultations, that can bring Indigenous leaders, researchers, and policymakers together in dialogue. These steps represent profound acts of inclusion essential for these medicines to realize their full potential to heal and transform.

Stewardship Recognition We recognize that many of the practices, medicines, and frameworks shaping today’s psychedelic movement come from the long-standing stewardship of Indigenous Peoples who have cultivated and protected these medicines through ceremony, kinship, and spiritual responsibility across generations. These knowledge systems and healing traditions continue to thrive in Indigenous communities today. As we engage in psychedelic research, policy, and practice, we acknowledge our responsibility to respect Indigenous sovereignty, support cultural and intellectual property rights, and center Indigenous leadership. This recognition is a call to uphold relationships grounded in respect, responsibility, and ongoing commitment to the Indigenous Peoples and worldviews that have made this work possible.

Introduction

The resurgence of psychedelic research and its potential therapeutic applications present an opportunity to integrate knowledge from Indigenous medicine systems into contemporary mental health practice and psychopharmacology (Schultes and Hofmann, 1992). Psychedelics have entered mainstream neuropharmacological research, with increasing investment in clinical trials, biotechnology startups, and intellectual property claims (Garcia-Romeu et al., 2022). The growing commodification and commercialization of these substances raise ethical concerns regarding cultural erasure, extractive research practices, and biopiracy that fail to compensate or credit Indigenous knowledge holders appropriately (Jacobs et al., 2024; Williams and Labate, 2020). It is Indigenous communities that have stewarded and gained expertise working with psychoactive medicines for centuries, yet they remain marginalized within the scientific discourse (Ninnemann and Williams, 2022; Dobkin de Rios, 1984; Grob, 1998). Indeed, natural substances at the heart of this field—ayahuasca, psilocybin, peyote, iboga, and others—have been applied within Indigenous medicine traditions for centuries.

In this commentary, we use Indigenous Peoples as defined by the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP; United Nations, 2008): distinct cultural groups with ancestral ties to lands predating colonization, who maintain unique governance systems, languages, and knowledge traditions. While global in scope, our discussion focuses on specific Indigenous communities in the Americas whose ceremonial and medicinal practices have historically involved psychedelic medicines, including but not limited to the Huichol/Wixárika (peyote), Shipibo-Konibo (ayahuasca), Mazatec (psilocybin mushrooms), and Comcaac (Sonoran Desert toad). We acknowledge that not all Indigenous nations have such traditions, and that cultural practices are diverse, dynamic, and context-specific. The emphasis here is on living, evolving ceremonial and medicinal practices identified by communities themselves as culturally appropriate for contemporary collaboration in psychedelic science.

Researchers generally approach these substances through a biomedical lens, while a growing body of evidence suggests that Indigenous ritual, community-based methodologies, and ecological approaches could significantly enrich contemporary psychedelic frameworks. Recognition of these practices, with their intricate ritual and healing structures, has informed key concepts such as the importance of “set” and “setting” (e.g., Yaden et al., 2022), which are known to modulate therapeutic outcomes (Celidwen et al., 2023; McCleave et al., 2024). From this perspective, a non-extractive process of exchange, often referred to as reciprocity, with Indigenous cultures is both a moral and methodological imperative.

In the spirit of Roland Griffiths’ legacy, this commentary underscores the ethical and epistemic necessity of elevating and respecting the intrinsic value of Indigenous perspectives and knowledge, emphasizing respect, equity, and community- and relational-based healing grounded in culture. Specifically, this commentary calls for an ethically robust and interdisciplinary approach that prioritizes Indigenous sovereignty, the right to access their traditions, culturally appropriate permission and consent process, and fair compensation for economic or scientific benefits resulting from psychedelic research. We highlight the importance of moving past tokenistic inclusion toward meaningful collaboration and systemic change in psychedelic research that is both scientifically rigorous and culturally just.

Indigenous knowledge in psychedelic science

Indigenous Knowledge Systems offer invaluable insights into the use of psychoactive medicines, highlighting community-based and relational models, grounded in reciprocal engagement and spirituality (Fotiou, 2020; Magar et al., 2023; Urrutia et al., 2023). Traditional practices such as the use of ceremony and ritual, storytelling, and ecological stewardship provide models whose healing benefits extend beyond those of individualized biomedical approaches. These practices have been developed over generations, reinforcing the importance and value to society of integrating Indigenous epistemologies into psychedelic-assisted therapies (PATs) (McCleave et al., 2024).

Indigenous psychoactive medicines are considered sacred and are integrated into complex spiritual and communal frameworks that view the medicine as a relative or spiritual being, rather than as an inert chemical (Bravo and Grob, 1989; Fernandez, 1982). Indigenous Knowledge Systems are based on relational healing and ecological balance, contrasting with the dominant reductionist biomedical model. Indigenous traditions emphasize the essential role of set, setting, and ritual elements, dimensions that have been largely overlooked in contemporary clinical research (Ona et al., 2022).

Lobo Blanco, an Otomí ceremonial and spiritual leader, emphasizes the necessity of understanding Indigenous psychoactive medicines within their full cultural, societal, and spiritual contexts (see Figure 1). He describes the intricate relationship between the plants, the land, and the rituals that have maintained their efficacy for generations. He explains that Indigenous medicine does not primarily focus on the biochemical properties of plants but rather on the reciprocal relationships between humans, nature, and the spirit world. He states our medicines are part of a sacred dialogue with the Earth. They cannot be separated from the songs, the prayers, and the ceremonial spaces that have carried their wisdom for generations. When researchers seek to isolate the active compounds, they often miss the deeper healing mechanisms that are embedded in community and spiritual practice (Óscar Martín López Fernández (Lobo Blanco), co-author, personal communication March 2025).

Figure 1.

Image of a village-center in Cuncunul, Yucatán by Chichen Itza in 2012, reestablishing the council of elders. Photo by Óscar Martín López Fernández (Lobo Blanco), 2012.

Lobo Blanco’s perspective highlights the risk of reducing traditional psychoactive medicines to isolated compounds, overlooking the role of ceremony, ancestral knowledge, and the careful stewardship of these substances within Indigenous communities (Figures 2 and 3). His insights align with the growing discourse in psychedelic research that argues for the inclusion of Indigenous methodologies and ethical frameworks to ensure these medicines are studied in a way that respects their full cultural significance and potential.

Figure 2.

Image of meeting of traditional doctors in the state of Mexico, convened by the state council for the integral development of the indigenous populations in the state of Mexico, with the participation of herbalists and ceremonial prayer leaders. Photo by Óscar Martín López Fernández (Lobo Blanco), 2024.

Figure 3.

Image of ceremony honoring the rains and marking the beginning of a reforestation effort on the sacred mountain Xinatépetl (Nevado de Toluca, Mexico), with the participation of the State Secretary of Agriculture, Lic. María Eugenia. Photo by Óscar Martín López Fernández (Lobo Blanco), 2024.

Ethical considerations: Reciprocity, reparations, and equity

Although foundational to the psychedelic renaissance, Indigenous communities have largely been excluded from its economic and scientific benefits, highlighting the urgent need for meaningful reciprocity and reparations. Reciprocity emphasizes ethical relationship-building and mutual benefit, while reparations refer to justice-oriented efforts to address and repair historical and ongoing harms caused by extraction, marginalization, and violence. While conceptually distinct, the concrete practices associated with reciprocity and reparations often overlap, encompassing measures such as co-authorship, benefit-sharing, and Indigenous governance inclusion.

Concerns around biopiracy, cultural appropriation, and extractive research practices persist (Celidwen et al., 2023; Labate and Cavnar, 2021). These cases illustrate that Western biomedical research and commercial interests continue to benefit from Indigenous traditions and practitioners, who have developed extensive knowledge over centuries regarding the safe and beneficial use of psychedelic medicines. However, true reciprocity demands more than learning from Indigenous practices; it requires a mutual exchange of knowledge and benefits. Indigenous knowledge holders and their communities must receive tangible advantages, rather than simply providing insights that enrich biomedical science without reciprocal returns. All forms of reciprocity and reparations must occur with the explicit consent of Indigenous parties, following the UN standards of Free, Prior, and Informed Consent (World Health Organization, 2023; UNDRIP, 2007).

WHA Resolution 76.16 urges Member States and other relevant actors to take actions for the health of Indigenous Peoples in consultation with Indigenous Peoples, with their free, prior, and informed consent. By upholding the principle, Indigenous communities are empowered to shape their own health, well-being, and future.

Sandor Iron Rope, a Lakota ceremonial leader from South Dakota, powerfully articulates the challenges Indigenous communities face in maintaining control over their traditional medicines amid increasing scientific and commercial interest. He reflects on the long history of knowledge extraction, where Indigenous wisdom has been taken without permission or adequate benefit-sharing. He underscores that genuine trust can only be rebuilt through concrete reparative actions. He advocates for Indigenous governance in psychedelic research and asserts that any study involving Indigenous medicines should, at a minimum, be co-led and/or co-authored by Indigenous peoples. Most Indigenous communities are walking with embedded traumas from the past, and engaging with non-Indigenous people and communities is a big step in which trust is established through reparations. For too long, researchers have come into our communities, taken what they needed, and left without giving back. That is not research; that is extraction. If we are to be part of this so-called psychedelic renaissance, then our knowledge must be valued, and our people must be part of the process—not as subjects, but as partners (Sandor Iron Rope, co-author, personal communication, June 2025).

Iron Rope emphasizes that, “reparations are not about blame but about acknowledging past harms and establishing trust through concrete commitments.” The harms and risks of disregarding Indigenous governance in psychedelic research are well documented. One frequently cited case is that of María Sabina, a Mazatec healer from Huautla de Jiménez, whose ceremonial use of psilocybin mushrooms became known internationally after R. Gordon Wasson attended her velada in 1955 and later published accounts without her consent (Dobkin de Rios, 1984; Estrada, 1981; Metzner, 2004). Wasson’s publications, which revealed her identity and location, brought a wave of outsiders to her community, disrupting local life and leading to her ostracization (Devenot et al., 2022). This episode has become emblematic of how extractive research and tourism can fracture communities and disrupt the delicate relationships of trust and reciprocity that sustain ceremonial practice.

A parallel example can be found in biomedical research on ibogaine, an indole alkaloid derived from Tabernanthe iboga and central to the Bwiti spiritual tradition of Gabon and Cameroon. Ethnographic and pharmacological literature documents the complex ceremonial, therapeutic, and cosmological dimensions of iboga use (Alper, 2001; Alper et al., 2008; Fernandez, 1982; Goutarel et al., 1993). Yet much of the contemporary clinical research on ibogaine, including studies on its potential for treating opioid dependence and traumatic brain injury, has been conducted without substantive acknowledgement of or reciprocity toward Bwiti knowledge holders (Alper et al., 2008). This omission exemplifies how biomedical science can benefit from Indigenous knowledge systems while sidelining the people and traditions that developed them.

Such cases illustrate that extractive practices do more than harm individual knowledge holders; they disrupt cultural systems, undermine sovereignty, and perpetuate the very asymmetries that ethical collaboration seeks to redress.

These ethical commitments must be operationalized in research collaborations and through formal institutional and policy mechanisms. Policies must move beyond nominal acknowledgments of Indigenous contributions toward concrete forms of reciprocity and reparations that are relational, respectful, and aimed at restoring equity. Doing so will assure full access to benefits, including but not limited to:

• The co-development of research questions and methodologies and the sharing of findings with Indigenous leaders and communities.

• Indigenous-led or co-led ethics boards or Spiritual Advisory Councils to verify that consent is fully free, prior, and informed, and that reciprocity is meaningful.

• Co-authorship, financial support, and policy influence that benefit Indigenous communities based on research evidence.

• Benefit-sharing models that reinvest profits from psychedelic commercialization into Indigenous health and education initiatives.

• Opportunities for Indigenous people to collaborate in studies as researchers and participants.

• Capacity-building efforts, such as training Indigenous stakeholders in scientific and participatory action research methodologies, grant writing, and organizational development, while also fostering intergenerational transmission of traditional knowledge.

• Collective efforts to protect sacred ceremonial sites, ancestral lands, and culturally significant resources while upholding Indigenous Peoples’ rights to access, steward, and govern these places in accordance with their traditions.

• Strengthening Indigenous governance over traditional medicines through legal frameworks such as the Nagoya Protocol (Ona et al., 2022).

Collectively, these measures represent essential steps toward both ethical reciprocity and reparative justice. They ensure that Indigenous communities are not merely sources of knowledge but full partners and beneficiaries in the evolving field of psychedelic research and practice.

Community-based and relational healing approaches

Indigenous approaches to healing prioritize interconnectedness and community, whereas clinical psychotherapeutic models often highlight individual treatment. An example of community-based frameworks is observed in the Yaqui Intercultural Medicine Clinic in Mexico, which demonstrates the effectiveness of integrating traditional healing methods with modern therapeutic interventions (Giovannetti et al., 2025; Loizaga-Velder and Loizaga-Pazzi, 2024). Building on these pilot initiatives, the program is expanding to five Indigenous groups in the state of Mexico through a new intercultural clinic established in collaboration with nongovernmental organization partnerships involving researchers (Nierika) and Indigenous knowledge holders (Momoposhtia). Such initiatives prioritize collective well-being and intergenerational healing, offering scalable and culturally sensitive PAT models (Rush et al., 2024).

Additionally, Indigenous perspectives highlight the ongoing process of healing, which is embedded within the relational nature of healing rather than isolated biomedical interventions (Gone, 2013). Several Western psychedelic-assisted group therapy models inspired by Indigenous frameworks provide promising alternatives, focusing on culture, community, and family support and reintegration into social structures (Anderson et al., 2019; McCleave et al., 2024; Ponomarenko et al., 2023). Also of note, group models require fewer therapists per participant than individual approaches, thereby further contributing to the scalability and economic accessibility of psychedelic therapy.

Contemplative and reflective practices: Pathways to engagement

The importance of contemplative practices embedded within Indigenous Knowledge Systems, which foster a deep sense of connection among individuals, communities, and the natural and spiritual world cannot be overstated. These practices—such as vision quests, ceremonial fasting, chanting, rattling and drumming—serve as methods for cultivating insight, spiritual balance, resilience, and community cohesion (Celidwen, 2024). Meditation and prayer, often intertwined with music, dance, sweat lodges, water ceremony, and nature immersion, form a holistic approach to cultivating the self-regulation and self-awareness that aligns with contemplative practice in psychotherapeutic models of healing experiences. These traditional practices reinforce the benefits of integrating contemplative dimensions into contemporary psychedelic therapy.

From an Indigenous perspective, reflective practices—a form of contemplative practice—are also of importance to investigators themselves. Reflection fosters the self-awareness and critical inquiry that guide researchers to engage with their own positionality and ethical responsibilities. Brian Rush compellingly argues that taking on these responsibilities requires not only education but deep emotional engagement. In psychedelic science, reflective practices emphasize the importance to deeply feeling the historical harms of colonization (Taussig, 1987). He explains, responsibility goes beyond intellectual understanding—it requires emotional knowing, which comes from ceremonial participation, community immersion, and listening intently to Indigenous lived experiences (Brian Rush, co-author, personal communication, March, 2025).

Implementation science and Indigenous ways of knowing: Two-eyed seeing approach

An opportunity to advance Indigenous-informed psychedelic research is the integration of implementation science with the Etuaptmumk or Two-Eyed (or Multi-Eyed) Seeing approach. This framework, developed by Mi’kmaw Elders Albert and Murdena Marshall, recognizes the value of both Indigenous knowledge systems—including storytelling, oral traditions, and participatory research methods—and evidence-based scientific methods (Bartlett et al., 2012).

Marlena Robbins, Diné (Navajo) scholar at the UC Berkeley School of Public Health, suggests, Two-Eyed Seeing as a key framework that encourages balancing Indigenous ways of knowing with dominant scientific paradigm. In the context of psychedelic research and policy, this means recognizing and respecting Indigenous knowledge systems, such as traditional natural medicine practices, while also engaging with contemporary scientific methods. Rather than seeing them as competing perspectives, this approach allows for a more holistic understanding of how psychedelics can be integrated into healing practices in a way that respects Indigenous sovereignty (Marlena Robbins, co-author, personal communication, April, 2025).

Participatory knowledge creation is central to ethical psychedelic research. Indigenous methodologies feature knowledge transmission through oral tradition, relational accountability, and community consensus. Integrating these approaches with randomized controlled trials and qualitative ethnographic studies can enhance research depth while respecting both Indigenous epistemologies and biomedical precepts (Anderson et al., 2020; Lin et al., 2020). This dual approach fosters mutual learning and facilitates research outcomes that serve Indigenous community needs rather than solely advancing biomedical academic agendas.

We recognize that biomedical and neuroscientific research has developed complementary principles and methodologies that can stand in respectful dialogue with Indigenous approaches. These include structured interpersonal support, thoughtful dosing strategies, container design, and curated music programs (Johnson et al., 2008; Kaelen et al., 2018). Such practices, while inspired by or convergent with Indigenous frameworks, have been adapted within clinical protocols in ways that have advanced safety, efficacy, and reproducibility. Just as Indigenous communities have generously shared ritual frameworks and ecological ethics, researchers working within biomedical and neuroscientific paradigms have contributed knowledge on pharmacokinetics, neurobiological mechanisms, and measurement development. Ethical collaboration entails mutual respect and the possibility of bidirectional exchange of practices. For example, researchers might respectfully receive Indigenous ceremonial music or set and setting principles while reciprocally offering their own clinically relevant contributions. Such contributions could include safety and medical preparedness training, for instance, protocols for recognizing and managing serotonin syndrome when participants taking selective serotonin reuptake inhibitors (SSRIs) enter Indigenous-led ceremonies.

Successful implementation of scientific models includes community-driven research that incorporates Indigenous research methods and integrates spiritual and ecological dimensions of healing. Establishing Indigenous healers as equal partners in clinical research can elevate the credibility and applicability of findings. For example, studies on ayahuasca-assisted therapy have successfully combined Indigenous healing frameworks with clinical mental health approaches, leading to culturally attuned interventions that address intergenerational trauma as seen in the intercultural clinic in Mexico described above. In fact, the integration of PATs with Indigenous healing practices has garnered increasing interest as a holistic approach to mental health care (Metzner, 1999). Programs such as Roots to Thrive in Canada exemplify this integration by offering evidence-informed, multi-week group therapy that combines ketamine-assisted therapy with community-based, trauma-informed practices. Founded through a collaboration of caregivers, curriculum designers, Indigenous elders, and experts, Roots to Thrive addresses trauma and promotes resilience by reconnecting individuals with their true selves and communities (Manson et al., 2023). Indigenous Elders are intricately involved in both the co-design of the program and in guiding of ceremony, storytelling, and spaces for intergenerational healing. Their presence supports cultural safety, strengthens relational accountability, and connects participants to traditional ways of knowing, contributing to a more full-circle approach to healing for both Indigenous and non-Indigenous participants (Manson et al., 2023).

Decolonized research frameworks

Psychedelic science has predominantly framed research through biomedical paradigms, often sidelining Indigenous methodologies (Bravo and Grob, 1989). Indeed, a recent examination of 59 psychedelic research centers from around the world found that only one included any Indigenous representation in its top leadership (Kuiper et al., 2024). There are corrective measures forthcoming. A key objective of WHO’s forthcoming Global Strategy on Indigenous Health is to enhance the ethical collection, analysis and use of data on Indigenous Peoples’ health while promoting Indigenous-led research to inform evidence-based policies and governance (WHO forthcoming). Accordingly, a shift toward respecting Indigenous knowledge and decolonized research requires:

• Respecting Indigenous sovereignty in knowledge production.

• Utilizing Indigenous research, including data collection, interpretation, analysis, and publishing such as participatory action research methods to support community-driven study designs.

• Investing in Indigenous research capacity.

• Ensuring the protection and stewardship of sacred sites and lands under Indigenous governance.

• Recognizing Indigenous epistemologies and biomedical science as legitimate and equal methods of inquiry (Bouso and Sánchez-Avilés, 2020) inquiry, and incorporating both into scientific inquiry.

Decolonization entails centering Indigenous worldviews, requiring scientists to acknowledge the historical harms—such as criminalization and/or theft of Indigenous psychoactive medicine practices—and actively work to restore Indigenous autonomy over traditional healing knowledge (Rhoades, 2009).

Indigenous rights, including the rights to their traditional medicine and to maintain their health practices as enshrined in Article 24 of the United Nations Declaration of the Rights of Indigenous Peoples, are universal obligations. This includes respecting Indigenous governance structures, honoring Indigenous ways of knowing and research methodologies, establishing rights of data ownership, and safeguarding the traditional rituals and worldviews that inform them.

Cultivate allyship and ethical collaboration between Indigenous peoples and researchers

Allyship is not a title one claims but a position one is invited into by Indigenous communities. Effective allyship in psychedelic science involves ongoing learning, humility, and a commitment to dismantling oppressive structures (George et al., 2023). It includes amplifying Indigenous voices in policy discussions, prioritizing the funding of Indigenous-led research, and advocating for the protection of traditional healing practices against exploitative commercialization, not as a member of that group, but rather in solidarity with its struggle and point of view, and under its leadership.

Allyship must be long-term and relationship-based, rather than a one-time acknowledgment. This means continually engaging in self-reflection, addressing unconscious biases, and centering Indigenous collaborators as having decision-making power in all aspects of psychedelic research and application. Allyship develops over time through relationships—indeed it is a form of relationship itself—rooted in responsibility, respect, and reciprocity. It weaves these elements together in a sustainable way for mutual and global benefit. To better achieve this, it will be important to create opportunities for collaborative engagement, including joint meetings, co-designing of research protocols, cultural immersion experiences, joint teaching, mutual capacity-building exchanges where researchers learn from Indigenous partners who also provide access to technical training, and co-authored publications between researchers and Indigenous practitioners.

Recent years have seen a range of initiatives aimed at articulating ethical frameworks for psychedelic research and practice and how they interact with living ancestral knowledge systems, including academic consensus processes (e.g., Jacobs et al., 2024), Indigenous- and community-led statements (e.g., Celidwen et al., 2023), and practitioner-driven biocultural conservation efforts such as the Indigenous Medicine Conservation Fund. While these efforts illuminate a growing recognition of equity, reciprocity, and Indigenous rights within the psychedelic field, they also vary in inclusivity, transparency, and scope. Taken together, these initiatives demonstrate growing recognition of the need for equitable and respectful frameworks for engagement within the field, while also stressing the continued need for more formal, transparent, and globally legitimate convening processes, such as those modeled on WHO global consultations.

Policy and regulatory implications

International drug control policies must evolve to acknowledge past overreach and harm, ensuring that traditional medicines are no longer restricted. Governments and institutions must reconcile the tension between regulation and Indigenous rights, protecting traditional practitioners from prosecution while promoting ethical frameworks for cross-cultural psychedelic research and therapy. This recognition would seem to be of mutual potential benefit and self-interest. For example, beyond improving research excellence and relevance, efforts to secure regulatory recognition and approval at the national and regional levels (e.g., U.S. Food and Drug Administration and European Medicines Agency), and internationally (the World Health Organization, WHO) can help integrate traditional knowledge into formal medical and scientific frameworks, fostering inclusive and effective therapeutic approaches. Recognizing and legitimizing Indigenous practices, such as the World Health Assembly Resolution on the Health of Indigenous Peoples (WHO, 2023) within these regulatory processes could also improve patient outcomes, expand treatment options, and support more ethical collaborations between Indigenous communities and the global psychedelic research community.

Both member states and civil society have highlighted the tension between state obligations to respect human rights, including the rights of Indigenous peoples, and the enforcement of global drug control treaties. In many countries, drug enforcement measures often violate fundamental human rights (Yellowlees and Doyle, 2023; HRW, 2021). Contradictory requirements of international drug control treaties and human rights law expose a lack of policy coherence. Even so, several countries, including Canada, Bolivia, and Portugal, have adopted public health-centered drug policies, including forms of decriminalization. Certain UN bodies, such as the WHO, have increasingly emphasized harm reduction, treatment access, and public health approaches over punitive drug control measures. These shifts are in part due to evidence documenting negative social consequences of global drug prohibition (Global Commission on Drug Policy, 2019).

International frameworks such as the Nagoya Protocol (Convention on Biological Diversity, 2011) on Access and Benefit-Sharing under the Convention on Biological Diversity, the WHO’s Traditional Medicine Strategy, and the UNDRIP establish safeguards to protect traditional knowledge holders and their rights (United Nations, 2008). These mechanisms are essential in ensuring that drug policy reforms do not inadvertently harm Indigenous communities, given contradictions. Decriminalizing or legalizing sacred plant medicines will achieve the much-needed reduction in criminal penalties faced by Indigenous peoples but could lead to environmental degradation and overharvesting of sacred plants (Convention on Biological Diversity, 2014; International Narcotics Control Board, 2022). The drug control treaties, such as the Single Convention on Narcotic Drugs (1961) and the Convention on Psychotropic Substances (1971) provide only limited guidance on how to ensure that Indigenous people are not unjustly restricted from practicing, expanding, and sharing their traditions on a global scale (UNODC, 2021; International Indigenous Policy Journal, 2020).

As policymakers and researchers shape future reforms, a balanced approach is called for—one that acknowledges historical injustices, ensures the ethical and sustainable use of traditional medicines, and upholds public health standards while prioritizing reciprocity. The draft WHO Global Plan of Action for the Health of Indigenous Peoples emphasizes strengthening Indigenous governance, advancing equity and human rights, and ensuring culturally safe services through Indigenous leadership, participation, evidence creation and knowledge systems. It provides a useful roadmap for Member States and stakeholders to embed reciprocity, benefit-sharing, and self-determination into health policy and implementation (WHO, forthcoming). Meaningful collaboration between governments, researchers, and Indigenous communities is a key to creating policies that respect both rights and responsibilities. Moving beyond extractive models toward such partnerships will not only enhance efficacy and safety but also secure agency and well-being of Indigenous communities.

The goal is to engage with those living practices that communities themselves affirm as ethical, safe, and culturally significant. Just as contemporary Indigenous ceremonial frameworks have evolved to address present-day community needs, Western research protocols continue to refine safety, therapeutic alliance, and environmental design. A truly reciprocal approach in psychedelic science recognizes the legitimacy and value of both, centering Indigenous sovereignty while welcoming mutual learning that enhances outcomes for all participants.

The collective thinking of the contributors to the commentary believe that much of this discussion is nicely summarized by Marlena Robbins, Diné (Navajo): Sacred plant medicines are more than psychoactive substances; they are deities and holy beings that unveil the interconnectedness of existence. In this framework, the self is intimately connected to the collective where the responsibility for the past, present, and future is shared. For the psychedelic renaissance to fulfill its promise, it must prioritize relational healing, equity, and the leadership of Indigenous peoples who have long stewarded these medicines… Indigenous Futurism invites us to imagine futures where Indigenous knowledge and traditions thrive alongside emerging innovations, including in the psychedelic space. We can move beyond the idea that Indigenous peoples are simply “subjects” of research and instead recognize them as leaders in shaping the future of psychedelic science and policy, by incorporating these perspectives… These steps are profound acts of inclusion needed in order for these medicines to achieve their fullest potential to heal and transform. (Marlena Robbins, co-author, personal communication, May, 2025).