there is an undeniable paradox at the heart of modern medical discourse: while societies tirelessly regulate which substances enter the body, they seem far less concerned with the deeper question of why certain forms of intoxication are deemed more tolerable than others.
consider this: a heart transplant patient dies after consuming psilocybin mushrooms. the official cause? “psilocin toxicity”—a phrase that carries an air of self-evidence, as if the case closes with its mere utterance. but does it? if we scratch beneath the surface, the real question emerges: was it really the drug that killed them, or the conditions under which they were forced to navigate their own bodily autonomy?
this is not about denying physiological causality. rather, it’s about interrogating the ideological assumptions that shape our definitions of harm.
if the body is a battlefield, then intoxication is one of its most contested terrains. the consumption of psychoactive substances, whether for pleasure, enlightenment, or mere escape, has long been entangled with power structures that regulate, discipline, and punish. but the deeper question remains: who decides which states of consciousness are permissible, and which must be pathologized or criminalized?
the pharmakon: poison, cure, and the state’s paradoxical logic
the ancient greek concept of the pharmakon captures the essential contradiction at play here. a substance can be both remedy and poison, salvation and destruction. yet, the state, in its infinite wisdom, delineates these boundaries with arbitrary precision. alcohol, a depressant responsible for countless fatalities, is celebrated in the social sphere; cannabis, a relatively benign psychoactive, remains illegal in numerous jurisdictions. opioids, administered in clinical settings, are therapeutic; the same compounds, when consumed outside state-sanctioned spaces, become weapons of self-destruction.
this is the paradox of biopolitics: the regulation of life through selective mechanisms of care and abandonment. those who consume sanctioned substances are folded into the fabric of managed health; those who venture outside these boundaries enter the realm of necropolitics, where they are left to die—or worse, punished for surviving.
the politics of altered states: why do some forms of consciousness threaten power?
why does the state fear the psilocybin-induced hallucination but endorse the productivity-boosting stimulant? why is the opioid epidemic addressed with punitive measures rather than systemic reform? at its core, the regulation of psychoactive substances is about controlling subjectivity itself. to intoxicate is to alter perception, to momentarily escape the rigid frameworks of capital’s demand for efficiency, to question the inevitability of dominant narratives.
hallucinogens, in particular, have long been the target of state repression precisely because they offer a mode of perception that destabilizes normative reality. the 1960s counterculture, fueled by lsd and psilocybin, was not merely a cultural movement; it was a fundamental threat to the docile, disciplined worker-consumer. the subsequent war on drugs was not about public health—it was about reinstating cognitive hegemony.
prohibition as a moral technology
but perhaps the deeper logic of prohibition is not simply about control, but about morality. intoxication, in its various forms, poses an ethical challenge to the foundational myths of western civilization: the protestant work ethic, self-discipline, the primacy of rationality. to consume without utility, to enter altered states without clear economic or moral purpose, is to break an implicit contract with society. this is why certain drugs—those associated with marginalized communities, countercultural movements, or alternative epistemologies—are treated with disproportionate hostility.
meanwhile, the substances of capital—caffeine for productivity, alcohol for social lubrication, pharmaceuticals for stability—are seamlessly integrated into the market, their consumption encouraged so long as they sustain the rhythms of labor and compliance. the criminalization of certain forms of intoxication, then, is not about harm reduction, but about maintaining a specific social order.
intoxication and the necropolitical order
to be intoxicated is to be at risk—not merely physiologically, but politically. those who consume the wrong substances, in the wrong ways, in the wrong contexts, become disposable. the so-called opioid crisis, for example, is framed as an individual failing rather than a systemic catastrophe, despite its origins in corporate greed and overprescription. those who succumb to addiction are cast out of the sphere of care, subjected to punitive mechanisms rather than medical intervention.
meanwhile, the growing enthusiasm for psychedelics in elite circles—microdosing ceos, ketamine therapy for the affluent—reveals another contradiction: when intoxication serves capital, it is rehabilitated, rebranded, and legitimized. the very substances criminalized in one context are medicalized in another, their legitimacy determined not by pharmacology but by power.
the case of the heart transplant patient: a failure of control
let’s return to our opening case: a heart transplant recipient consumes psilocybin mushrooms and dies. the immediate assumption is that the substance was “too dangerous.” but this interpretation glosses over a more fundamental issue: how medicalized bodies become sites of hyperregulation.
organ transplant patients live under strict regimes of pharmaceutical control. their immune systems are suppressed to prevent rejection. their bodies are, in a very real sense, no longer entirely their own.
but instead of questioning why this person was driven to seek a psychedelic experience—perhaps as an existential confrontation with mortality, perhaps as a form of personal liberation—the discourse stops at the point of biological failure. “they shouldn’t have taken the drug” becomes the official verdict, absolving the broader system of its role in shaping risk.
towards a new politics of intoxication
what would it mean to reclaim intoxication from the state? to insist on the right to alter consciousness without moral judgment or legal sanction? to treat addiction not as a crime, but as a consequence of deeper social and economic fractures?
such a shift would require dismantling the carceral logic that underpins drug policy, replacing prohibition with harm reduction, decriminalization, and a radical rethinking of public health. but beyond policy, it would demand a cultural reckoning: an acceptance that intoxication, in its myriad forms, is a fundamental part of human existence—not a deviation, but a possibility.
ultimately, to defend intoxication is to defend autonomy over one’s own perception, to resist the biopolitical management of consciousness itself. in a world increasingly dictated by efficiency, optimization, and control, the right to be altered—on one’s own terms—may be the last true act of freedom.
rethinking harm, rethinking autonomy
if harm reduction is truly the goal, then prohibition and punishment must be abandoned as guiding principles. medical discourse often assumes that people must be protected from themselves. but this infantilizes those who seek altered states of consciousness and obscures a deeper reality: the true danger lies not in the substances themselves, but in the structures that limit our ability to engage with them safely.
what would a world look like where intoxication was treated not as a moral failure, but as a legitimate—perhaps even sacred—part of human experience?
what would happen if we extended the same compassion to the psychedelic user as we do to the wine connoisseur?
and most importantly: who benefits from our current refusal to ask these questions?
