Opinion Leader: Psychedelic agents open up new therapeutic frontiers

By Dr. Marshall Ross

Dr. Marshall Ross is Chief Scientific Officer at The Newly Institute based in Calgary, a practising emergency physician, and a clinical lecturer in the Department of Emergency Medicine at the Cumming School of Medicine.

As we begin to “get over” COVID-19, another pandemic in the form of a mental health crisis continues to rage. Depression, anxiety, post-traumatic stress disorder and substance abuse are affecting more people than ever.

Sadly, many patients fail to respond to standard treatment. Fortunately, and mercifully, a new type of intervention is showing impressive results in research studies conducted at top-tier institutions, such as Johns Hopkins and Imperial College London.

Treatment modalities which incorporate psychedelics, especially psilocybin and MDMA (also known as molly or ecstasy) are proving to be effective in combatting a wide range of mental health disorders.

For example, a 2020 study conducted by Johns Hopkins’ Center for Psychedelic and Consciousness Research found that a majority of 24 adult participants suffering major depression showed an improvement in symptoms after two separate doses of psilocybin along with psychotherapy.

In another example, a 2021 phase III clinical trial, funded by the California-based Multidisciplinary Association for Psychedelic Studies, involved 91 patients suffering from severe post-traumatic stress disorder. Sixty-seven per cent of PTSD sufferers who had MDMA with an intensive course of psychotherapy no longer qualified for a PTSD diagnosis following the trial, compared with 32 per cent of those who received a placebo with psychotherapy. And 88 per cent of subjects in the MDMA group experienced a “clinically significant improvement” in symptoms.

Psychedelics can open otherwise restricted neural pathways, and thereby provide patients with new insights into their subconscious mind. Drugs like psilocybin can help patients better understand past trauma and, through a transformational experience, facilitate long-term healing. A psilocybin treatment is often reported to be extremely affecting, on par with the birth of a child or the death of a parent.

The full potential of these medications is only beginning to be understood by medical science.

Psychedelics, however, are not a panacea or magic bullet for all aspects of mental health. The efficacy of psychedelics has been shown only in controlled clinical settings, administered by healthcare professionals and accompanied by evidence-based psychotherapy.

Self-medicating with magic mushrooms will not improve a person’s mental health. It may, in fact, be harmful. In some patients, or at the wrong dosage, an otherwise safe medication like psilocybin can cause serotonin syndrome leading to seizures, coma, and even death. Similarly, psychedelics can sometimes precipitate life-long struggles with psychosis.

How do we ensure patients have access to much needed treatment while protecting them from harm?

Make physicians the “gatekeepers” for psychedelics

Simple decriminalization is not sufficient, because it does nothing to improve access to a clinical environment with the necessary healthcare professionals. Instead, we should make physicians the gatekeepers for psychedelics and support the science necessary to educate them in this role.

Public policy and government funding should focus on: (1) research; (2) the education of regulated health care professionals; and (3) providing the clinical infrastructure necessary to deliver, at scale, therapy incorporating psychedelics.

Firstly, we need to work towards allowing physicians to prescribe the necessary medications. The opening of Health Canada’s special access program to psychedelics was an important first step.

The government should fast-track the ability of physicians to prescribe drugs such as psilocybin and MDMA once research has demonstrated the requisite efficacy and safety, but not before such assurance has been offered. Funding should be made available to support this effort. By placing physicians in charge of access to these medicines, substantially all of the potential harm will be prevented.

Secondly, we should develop the infrastructure necessary to deliver high volumes of psychedelic-assisted psychotherapy. Training programs at credible institutions should be established and a specific credential system developed to ensure that patients are being cared for by professionals, accountable to a regulatory body.

Public health care will likely be inadequate to meet the demand for widespread psychedelic-assisted psychotherapy. Private clinics will therefore be required. Private therapy providers, such as The Newly Institute, with a proven track record of providing effective and safe mental health care, could be contracted by the public system.

Outcomes should be meticulously monitored and only those private clinics providing the safest and most effective treatment should be used by the public system.

The potential economic benefit offered by psychedelic-assisted psychotherapy is enormous. Successful treatment of long-term patients could permit tens of thousands to return to work and get off long-term disability. The cost savings to the public health care system through reduced demand for psychiatric and emergency care could be very significant.

The outlook for psychedelic-assisted therapy is promising. The case for moving ahead with important research and the establishment of the necessary regulatory regime, training, and infrastructure is compelling. The quality of many, many lives can be improved and, as a society, economic benefits recovered.

Developing the expertise and infrastructure to deliver widespread, controlled psychedelic assisted therapy would also make Canada a world leader in the provision of mental health care.

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