This bulletin provides an introduction into psychedelics and their potential therapeutic applications and describes the legal process through which companies can become involved in this developing field, classified by many as a "psychedelic renaissance."1
What are psychedelics?
Psychedelics are a class of drugs that affect the brain's serotonin receptors, triggering a variety of changes in perception, cognition, mood, and behaviour, with some psychedelics producing an altered state of consciousness2. These include drugs such as psilocybin, ecstasy, lysergic acid diethylaminde ("LSD"), and ketamine.
Historically, psychedelics have been at the forefront of religious and spiritual healing practices. The effects of these drugs and their potential applications were investigated by scientists as early as 1877, with LSD and psilocybin being discovered by Dr. Albert Hoffman in 19433. By the 1950s, psychedelic substances showed promise as therapeutic treatments in many research studies in North America and in Europe for a multitude of mental illnesses, including addiction and mood disorders4.
As free love and anti-war attitudes gained popularity in the 1950s and 1960s5, and as psychedelic substances became more widely available for recreational use, regulators were no longer able to control drug abuse. Political parties in power at the time experienced a significant threat and began to push back against psychedelic substances. The dangerous and negative effects of such substance use were sensationalized by the media, and negative publicity chilled any authority or credibility for medical researchers investigating potential applications of psychedelics6. Any future for greater scientific inquiry and discovery came to a halt when most countries in the world, including Canada, wholly criminalized psychedelic substances7 .
Since the 1990s and 2000s, society has experienced a liberalization of political attitudes and an increase in technological advancements, resulting in a drastic change in public and government perspectives towards the use of psychedelics in medical and scientific research8. Another contributing factor to the revitalized investigation into psychedelic therapies stems from the mixed results that available pharmacotherapies for those experiencing mental illness can have: selective-serotonin reuptake inhibitors (antidepressants that boost the level of serotonin in the brain) can take months before becoming effective, with the first prescription being effective about 30% of the time. Up to 15% of benzodiazepine users become addicted, and adults on antidepressants are 2.5 times as likely to attempt suicide9. Therefore, a growing number of scientists and researchers are conducting clinical trials using psychedelics to treat various psychological illnesses including depression and post-traumatic stress disorder10.
Which psychedelics are being applied or investigated as psychedelic therapies?
Psilocybin is the active ingredient in "magic mushrooms", a term used to describe mushrooms which contain hallucinogens11. Psilocybin is being studied for its potential to treat various conditions such as anxiety, depression, obsessive compulsive disorder, and addictions. For example, psilocybin has been shown to cause a rapid and sustained reduction in anxiety and depression in a group of patients with life-threatening cancer12, with 80% of cancer patients experiencing reduced anxiety and fear of death a minimum of six months after a single psilocybin treatment13. A combination of psilocybin and cognitive therapy enabled 80% of one study's participants to curb their nicotine addiction for at least six months14. In Fall 2019, the University of Toronto launched the Centre for Psychedelic Studies, which will host the world's first clinical trials on microdosing psilocybin15.
Ecstasy, also known as "molly" or "MDMA", is a drug that releases a high level of serotonin, which plays a role in regulating mood, energy levels, and appetite16. Ecstasy can be dangerous because makers often use cheaper ingredients, including cornstarch, soaps, and detergents. Other substances may also be mixed into the substance, including LSD, ketamine, cocaine, and methamphetamine17. Results from one clinical trial observing the use of ecstasy in treating Post-Traumatic Stress Disorder ("PTSD") show sustained remission from symptoms in over 70% of participants one year after treatment18.
The British Columbia Centre on Substance Use will conduct Phase III of MDMA-assisted psychotherapy trials in Vancouver as part of a larger research project overseen by the Multidisciplinary Association for Psychedelic Studies, a non-profit pharmaceutical company based in California. The hope is to have legalized psychedelic therapy in Canada and the United States by 202119.
LSD, also known as "acid", is a potent hallucinogen derived from a fungus, which alters a person's perception of reality and vividly distort the senses20. A clinical study conducted at the University of Toronto confirmed that microdoses of LSD improved mood and focus21. LSD has also been shown to be helpful in treating disorders like alcoholism and depression, particularly in patients whose conditions are the result of life-threatening illnesses22.
Ketamine, also known as "special K" or "vitamin K", is a fast-acting anesthetic and painkiller used primarily in veterinary surgery and occasionally in human medicine. Ketamine can produce vivid dreams and a feeling that the mind is separated from the body (dissociative effects) 23. Ketamine can be dangerous because it is odourless and colourless, two characteristics which led to its more well-known moniker, the "date rape drug"24.
Ketamine is different than the other three psychedelics discussed, because it is legally available for veterinarians and medical doctors for medical uses. Therefore, its expansion into psychotherapeutic applications is not as radical as the applications of psilocybin, ecstasy, or LSD may seem to health regulators.
A physician is allowed under the respective drug control laws to administer ketamine for a medical purpose. For example, practitioners in Canada (including medical doctors) are allowed, under the regulations to the Controlled Drugs and Substances Act, to prescribe or administer ketamine to an individual where the individual is their patient that the practitioner is treating in their professional capacity and where the ketamine is required to treat the individual's medical condition25.
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1 Lucas Richert, The Psychedelic Renaissance (Aug 14 2019), online: https://www.psychologytoday.com/ca/blog/hygieias-workshop/201908/the-psychedelic-renaissance.
2 Kerry Banks, The Canadian Revival of Psychedelic Drug Research (June 14 2019), online: https://www.universityaffairs.ca/features/feature-article/the-canadian-revival-of-psychedelic-drug-research/ [Banks].
3 Desiree Smith, The Psychedelic Renaissance: The Historical Progression of Canada's Legal Regulations on Psychedelics, p. 5 (unpublished manuscript) [Smith]; Centre for Addiction and Mental Health, LSD, online: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/lsd [CAMH LSD]; Emily Witt, The Science of the Psychedelic Renaissance (May 29 2018), online: https://www.newyorker.com/books/under-review/the-science-of-the-psychedelic-renaissance.
4 Smith, supra note 3 at pp. 5–6.
5 Jeffrey O'Brien, Business gets ready to trip: How psychedelic drugs may revolutionize mental health care (Feb 17 2020), online: https://fortune.com/longform/psychedelic-drugs-business-mental-health/ [O'Brien].
6 Smith, supra note 3 at pp. 7–8.
7 Ibid at p. 7.
8 Ibid at pp. 13–14.
9 O'Brien, supra note 5.
10 Kristine Owram, Move over, pot: Psychedelic drug companies gear up to list on Canadian stock exchanges (Feb 11 2020), online: https://business.financialpost.com/cannabis/cannabis-business/move-over-pot-psychedelic-companies-are-about-to-go-public [Owram].
11 Health Canada, Magic Mushrooms, online: https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/magic-mushrooms.html#a6.
12 O'Brien, supra note 5; Kashmira Gander, FDA approves psychedelic magic mushrooms ingredient psilocybin for depression trial (Aug 23 2018), online: https://www.newsweek.com/fda-approves-psychedelic-magic-mushrooms-ingredient-psilocybin-depression-1086759 [Gander].
13 O'Brien, supra note 5.
15 Rachel Browne, What the future holds for medical psychedelics in Canada (Dec 27 2019), online: https://globalnews.ca/news/6291447/medical-psychedelics-canada/ [Browne]; See also: https://www.psychedelicscience.ca/.
16 Centre for Addiction and Mental Health, Ecstasy, online: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/ecstasy.
17 Health Canada, Ecstasy, online: https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/ecstasy.html.
18 Lucas Bird, MAPS Canada charts the way for psychedelic therapy (Feb 19 2019), online: http://www.mcgilltribune.com/sci-tech/maps-canada-charts-the-way-for-mdma-therapy-190219/ [Bird].
19 Banks, supra note 2.
20 CAMH LSD, supra note 3.
21 Elaine Smith, People who 'microdose' psychedelic substances report improved mood and focus: U of T study (July 11 2019), online: https://www.utoronto.ca/news/people-who-microdose-psychedelic-substances-report-improved-mood-and-focus-u-t-study.
22 Bird, supra note 18.
23 Centre for Addiction and Mental Health, Ketamine, online: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/ketamine.
24 Health Canada, Ketamine, online: https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/ketamine.html.
25 Benzodiazepines and Other Targeted Substances Regulations, S.O.R. 2000-217. The same is true in the United States: Natasha Tracy, How to Get Ketamine Prescribed (Aug 30 2017), online: https://www.healthyplace.com/depression/depression-treatment/how-to-get-ketamine-prescribed.
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