What Makes a Psychedelic Medicine? Cancer Patients Get to Decide

I had never thought of cannabis as a psychedelic medicine.

As a person living with cancer, I knew cannabis well. Familiar with its role in easing nausea, stimulating appetite, for managing pain. I'd watched other patients use it. I'd heard oncologists recommend it. But a psychedelic? No. Psychedelics were psilocybin, LSD, ayahuasca. Psychedelics were substances that made walls melt and consciousness expand.

Cannabis was something different. Wasn't it?

My recent podcast conversation with Angela Amirault, a psychedelic-assisted therapist who works primarily with cannabis, challenged everything I thought I understood about these medicines. 

And it raised a question I hadn't considered: Who gets to decide what is classified as a "psychedelic medicine"?

The Definitional Debates

Right now, important conversations are happening in research communities about how to classify and name these substances. The debates are nuanced. They matter. And they're far from resolved.

On the classification question, some researchers define "classic psychedelics" based on specific receptor interactions—substances that primarily work on serotonin 5-HT2A receptors. This category includes psilocybin, LSD and DMT. It's a clean, mechanistic definition grounded in pharmacology.

But it immediately runs into problems. What about MDMA, which works to release norepinephrine, dopamine and serotonin? What about ibogaine, which hits multiple receptor systems including opioid receptors? What about ketamine, which works through NMDA receptor antagonism rather than serotonin pathways?

All of these substances are often referred to as ‘psychedelics’. They produce similar consciousness-altering experiences that feel psychedelic. They're being researched in similar therapeutic contexts. They're used in similar ways by practitioners and patients. But they don't necessarily fit within the narrow receptor-based definition.

So is the mechanistic classification the right framework? Or does defining psychedelics solely by receptor binding miss something essential about what makes these medicines ‘psychedelic’?

This isn't just academic hairsplitting. How we classify these substances shapes which ones get researched together, how regulatory frameworks develop, and which medicines might be considered alternatives when one doesn't work for a particular patient.

And beyond classification sits a related but distinct issue—what we call these things. Language matters. Words carry explicit meanings, but also semantic associations and cultural connotations.

"Psychedelic" literally means "mind-manifesting." It's the term most people recognize. But it's also weighted with decades of drug war propaganda, counterculture associations, and recreational use. For some communities, "psychedelic" carries stigma that makes honest conversations harder.

And there are other words that have been used for these substances: entheogens, psychoplastogens, empathogen, etc. The list can go on and on. And each name emphasizes different aspects. Each carries different cultural meanings.

These conversations about taxonomy and lexicon matter. The researchers and linguists and cultural workers engaging with these questions are doing important work. Getting the taxonomy right helps us understand how these medicines work. Getting the lexicon right helps us talk about them honestly across different communities.

And there's real risk in getting it wrong. Imprecise language can lead to imprecise research. Cultural insensitivity in naming can perpetuate harm to indigenous communities whose medicines and practices have been appropriated. Overly medicalized terminology can strip away dimensions of experience that matter deeply to people using these substances.

I respect these discussions. They're important. They're necessary.

But I also need to be honest: I'm not sufficiently informed to weigh in on them authoritatively. I'm not a pharmacologist. I'm not a neuroscientist. I’m not a linguist. I can't resolve debates about receptor binding profiles or optimal terminology.

And here's the thing: we're not going to settle this taxonomy today. Maybe not for years.

So in the absence of a consistent and universally accepted definition, I'm going to do something that might seem radical but feels necessary: I'm going to defer to the individual.

If your subjective experience with a substance feels psychedelic—if it changes your relationship with yourself, if it catalyzes healing, if it creates the conditions for psychological transformation—then for you, in your journey, it's a psychedelic medicine.

You get to decide.

When the Internal Experience Matters More Than External Effects

This is what Angela helped me understand about cannabis.

"A lot of people don't view it as a classic psychedelic, because when your eyes are open, the walls aren't melting," Angela explained. "It's a very internal experience. It's not external."

But Angela explains that if you close your eyes in a properly-dosed cannabis journey, in a safe container with therapeutic support, then the experience is unmistakably psychedelic. Profound. Transformative. Consciousness-altering in the deepest sense.

"If you were to eat a bunch of edibles and close your eyes, there's no one that can tell me you don't feel like you're on a roller coaster or that you won't start seeing things or hearing things," Angela said. "All of that reminds me that it very much is a psychedelic."

So if the subjective, inner experience feels psychedelic to the individual—if it facilitates the kind of deep exploration and healing associated with other psychedelic medicines—then who am I to say it's not?

If it was a healing outcome and the experience is similar to other psychedelics, then it's a psychedelic medicine. I'll let the experts argue about the definitions, but I trust the individual to know for themselves.

My Working Definition

So what makes something a "psychedelic medicine" for me personally? I've developed a two-part working definition—one I'm sure will evolve over time, one that might not work for everyone else, but one that helps me navigate this territory. 

First-part: Intentionality for growth or healing.

Psychedelics can be used to numb. To escape. To avoid rather than process. I've used ketamine during medical procedures, and I would definitely not consider that a psychedelic experience. It was anesthesia. It was dissociation in service of medical intervention. There was no intention toward psychological work, no container for healing, no therapeutic purpose beyond making the procedure tolerable.

But close friends have used that same molecule—ketamine—as a psychedelic medicine for healing. Same substance. Different intention. Different set and setting. Different outcome.

The medicine itself doesn't make something psychedelic. The way we approach it does.

Angela described this perfectly in discussing her own relationship with cannabis: "I used cannabis sometimes to numb. I would love to smoke and then realize, I'd just really love to dampen down the emotion."

But when she came to cannabis with therapeutic intention, in a safe container, prepared to turn toward rather than away from difficult emotions—that's when it became psychedelic medicine.

"I turned towards that feeling," Angela explained about her first intentional cannabis journey. The difference between using to numb and using to heal is the difference between recreational use and psychedelic medicine.

Second-part: Changes in perception of self and non-self.

Psychedelic medicines disrupt our default ways of experiencing reality. They pull back the veil on the patterns and narratives that usually define us. The thought loops of anxiety and depression. The rigid boundaries between self and world. The certainty that our perception of reality is reality.

They help us step out of what neuroscientists call the "default mode network"—those habitual patterns of thinking and experiencing that become so automatic we don't even notice them anymore.

Angela described this with psilocybin patients: "These medicines bring those things to the forefront...they're like, okay, this is all fake. This is not the real world. This is an aspect of a reality we are living in. And the real world is the dream. The physical reality is the dream."

That's the psychedelic quality—the recognition that our normal experience of self and reality is constructed, malleable, not absolute truth.

Cannabis does this too, Angela explained, just differently. "It's really in the body, in the mind, in this inner space is where it feels psychedelic."

The walls don't have to melt. But your sense of self does. Your relationship to your thoughts does. Your certainty about how reality works does.

That's what makes something psychedelic for me.

Why Individual Authority Matters

I know this definition isn't scientifically precise. I know it privileges subjective experience over pharmacological mechanism. I know it opens the door for people to claim almost anything as "psychedelic" based on their personal experience.

But here's why I think that's okay—especially in the cancer context:

We've lived in bodies that betrayed us. We've navigated medical systems that often treat us as cases rather than people. We've made impossible decisions about treatments with brutal side effects. We've become experts in our own suffering in ways that no outside authority can fully understand. That suffering has made us wise. And we are empowered to decide what is ‘medicine’ and which of those medicines are ‘psychedelic’. 

If psychedelic medicines are supposed to be about healing, about reclaiming agency, about reconnecting with inner wisdom—then we need to trust people living with cancer to know what's working for them.

If someone experiences profound healing through cannabis but a researcher says "well actually that's not a true psychedelic because of receptor binding profiles"—whose perspective matters more for that person's journey?

If someone finds transformation through MDMA-assisted therapy but a taxonomist argues it's technically an empathogen not a psychedelic—does that change the healing that occurred?

I'm not arguing we should abandon scientific precision. I'm arguing we should hold scientific classification alongside lived experience without privileging one over the other.

The experts can—and should—continue debating mechanisms and definitions. That work is valuable. But it shouldn't override what people living with cancer know to be true about our own experiences.

The Definition Will Change

I'm certain my definition of "psychedelic medicine" will evolve. Maybe I'll discover substances that challenge these criteria. Maybe I'll learn about mechanisms that make me rethink the role of intentionality or perception shifts.

Maybe this definition is too broad. Maybe it's too narrow. Maybe it misses something essential.

But that's okay. The point isn't to establish the final, definitive taxonomy. The point is to claim authority over our own healing journeys. To trust our own experiences. To recognize that we—people living with cancer—carry wisdom in our bodies that complements and sometimes challenges scientific expertise.

You get to decide what counts as medicine in your journey.

You get to decide what's healing you.

You get to decide what's psychedelic.

Trust that knowing.

Let's journey together.

To connect with others exploring what psychedelic medicine means in their cancer journey, reach out to community@healingcancerjourneys.org