For better or for worse, cannabis legalization is on its way. The recent Project Claudia raids in Toronto and the ongoing criminalization of possession for small amounts of cannabis throughout Canada, in spite of the government’s promise to legalize in spring 2017, has many criticizing the government’s first steps.
In some ways, our institution’s attitudes towards Cannabis are more harsh now than before our government’s legalization promise. However, international reactions remain generally positive. Perhaps this positivity has something to do with Canada’s potential to establish a more open market than the currently limited legalization models used in the United States, where federal law limits cannabis-based businesses from using banking systems. Regardless of the outcome, the ongoing legalization debate could set a useful precedent for other medicines, many plants among them, that are difficult to access because of their legal status. Psilocybin, Ayahuasca, LSD, and MDMA have all been shown to have a positive impact on well-being in various scientific studies. Some correlational studies even find positive relationships between mental health and psychedelic use in populations that use these substances for non-medicinal purposes (see here and here). Using the building momentum of cannabis legalization, the psychedelic therapy movement might be especially well-positioned to continue to change attitudes and correct the long-standing bureaucratic barriers to optimal healthcare that cannabis legalization activists have long been trying to overcome.
Psilocybin and alternative healthcare
Consider this 2011 pilot study that was performed at John Hopkins University School of Medicine. The purpose: to evaluate the potential of psilocybin in treating end-of-life anxiety experienced by terminal cancer patients. The results showed that administering psilocybin in conjunction with ongoing psychotherapy sessions reduced symptoms of anxiety, and elevations in mood lasted 6 months or longer. Compare these results to a study from 2008 that examined both Cognitive Behavioural Therapy (CBT) and the common antidepressant Sertraline as two distinct treatment methods for end-of-life anxiety. It was found that patients treated with CBT – which focuses on intervening in and changing the perceptions that are characteristic of anxiety or depression – did not respond well to CBT if they had a poor perception of their own health. This presents an obvious potential difficulty for using this method with someone diagnosed with terminal cancer. The group that was treated with Sertraline in this study showed greater reduction in anxiety symptoms compared to the CBT group, but no improvement was found after discontinuation of the medication. This indicates that Sertraline might best be considered a palliative (symptom-focused) treatment but not a curative (cause-focused) treatment for end-of-life anxiety. Given that psilocybin resulted in alleviation of anxiety for extended periods after only a single exposure to a therapeutic dose, there is reason to believe that it is a curative medication when used alongside therapy.
More recently, psilocybin has been used to treat depression with positive results, and a few small neuroimaging studies, including one with LSD published just this year, have gained much attention for the apparent capacity that psychedelics have to “shut off” a major network in the brain associated with conditions such as depression and anxiety. Commonly referred to as the Default Mode Network, this regular set of neuronal interactions is responsible for functions such as past and future thinking and self reference. The Default Mode Network is absent in infancy and develops over the course of childhood and into early adulthood. In the case of certain mental illnesses, the Default Mode Network becomes ‘entrenched’ in the brain and it can become progressively more difficult for the brain to break out of this network and visit other network spaces in the brain. This is detrimental because the Default Mode Network is only good for certain sorts of tasks, and cognitive flexibility, or the ability to switch between different task relevant brain networks when needed is crucial to well-being and optimal functioning. As anyone with depression can tell you, it is very difficult to solve the multitude of life’s problems exclusively by ruminating on them. The general idea is that psychedelics disrupt entrenched networks of activity, and the corresponding patterns of thought and behaviour that go with them. This allows a person to reconstruct these patterns of thought and behaviour by enabling conditions in the brain where new network pathways can be explored and eventually utilized beyond the psychedelic experiece. Given these results and the additional benefits of needing to take the medication only several times instead of on a daily basis basis – as is needed with more or less all psychiatric medications – it seems uncontroversial to claim that in exploring psychedelics, we are exploring viable and potentially curative medications for mental health. This means that psychedelic medications can fundamentally change the current paradigm of prescribing psychiatric medication, which is beneficial not only to those in need of treatment, but to society as a whole.
The cost of prescription healthcare
In 2011, Stats Canada reported that the second most costly component of healthcare spending was on prescription medications, accounting for 14% of overall spending at around $29 billion dollars. Among youth (ages 16-24), the leading classes of prescription medications were for ADHD, depression, and contraception. Among people age 25-79, antidepressants were the leading prescription medication amongst women, and at 45, usage of antidepressants peaked for both sexes (17% among women and 8% among men). Given the fact that psychedelic medication is required only several times in conjunction with psychotherapy in order to treat anxiety, depression, PTSD, addiction, and perhaps other mental illnesses, this could amount to a difference of millions, if not billions of dollars saved annually in the healthcare system. It can also reduce some of the harms associated with some psychiatric medications, such as long term health complications and the possibility of addictions. Benzodiazepines are prescribed for anxiety disorders, yet are quite addictive and overdoses are not uncommon. Stimulant medications – which are often unquestioningly prescribed to children for ADHD – are also highly addictive and can damage major organs, as well as cause psychotic symptoms if used long term. Most importantly though, we may be able to develop treatments more effective at combatting the personal and social costs associated with the difficulties of mental illness, such as increasing the capacity people have to connect with their communities. Support networks are very important in how mental illness plays out and unfortunately they can be quite difficult to maintain for someone who is struggling with depression, anxiety or psychosis for years on end. At a wider scale, we can reduce the costs associated with people being unable to motivate themselves to work or find work and facilitate a more productive and positive culture. If psychiatry was really accomplishing its goals in treating the suffering and pathologies of the individual, this would be the inevitable end result. However, psychiatry is currently not having these maximally prosocial effects on society. It can only achieve this if the field becomes engaged in caring more about effective treatments than about the arbitrary cautions and conservatism that ground the general apprehension to researching psychedelic compounds. In fact, the methods and medications of psychiatry up until this point are in no small part responsible for prescription drug abuse, and the opioid overdose epidemic involving fentanyl. It’s time to explore alternative options!
Psychedelics and harm reduction
All documented clinical trials so far have shown MDMA, LSD and psilocybin to be safe when administered in a therapeutic setting. While there are certainly risks to consider, they are nowhere near extreme enough to justify the barriers to research that are only now beginning to be dismantled. When weighing the potential risks against the possible benefits, it becomes fairly apparent why it is imperative to focus on psychedelic medicines as a major research project. Some, like Charlotte Walsh, even argue on the grounds of human rights and cognitive liberty that psychedelics should be available to any and all who feel inclined to use them. It is certainly arguable that the regulated availability of psychedelics could have a more positive effect on society than tobacco and alcohol. Incidentally, psilocybin has even been shown to be successful in treating nicotine addiction in a small pilot study, while LSD was identified as being helpful for alcoholism since the very beginning of psychedelic research, back in the 1950s. Recreational psychedelics might therefore be able to prevent the harms associated with the use of alcohol and tobacco and prevent addictions before they manifest. As is often the case when it comes to psychedelic plants, Terence Mckenna said it best:
“The pro-psychedelic plant position is clearly an anti-drug position. Drug dependencies are the result of habitual, unexamined and obsessive behavior; these are precisely the tendencies in our psychological make-up that the psychedelics mitigate.”
Psychedelics and mental health
Though there have been major advancements in understanding mental health and arriving at evidence-based treatments, there are still many populations for whom we do not have adequate care. This includes victims of sexual assault, veterans, people with addictions, anxiety, and treatment resistant depression. The World Health Organization predicts that depression alone will become the second leading cause of disability in the world by 2020, second only to heart disease. Even though 80% of people treated for depression respond well to treatment, depression is still on par with smoking as a predictor of mortality, so undeniably there is much work to do in arriving at effective treatments. The percentage of Canadians who agreed that they are getting the best treatment for depression is only 28%, with 45% saying that they somewhat agree that they are getting the right treatment. This statistic shows an unsurprising lack of faith in mental health treatments. I would go so far as to say that this lack of faith is quite justified – until researchers begin to seriously look into psychedelics as a medicine with potential to treat the underlying causes rather than the symptoms of mental illness. As long as researchers are prevented from accessing psychedelic medications through unnecessarily restrictive drug scheduling policies that don’t accurately reflect the nature of these compounds, the government is posing a direct barrier to the well-being of its citizens that is not only unjustified, but directly harmful.
Researching better healthcare
The suppression of research into psychedelic compounds has been compared to the suppression of research into astronomy by the Catholic church after the invention of the telescope. Such a comparison should not be taken lightly. We have at our disposal a profound tool for healing and for scientific inquiry into the mind, and yet there are immense barriers for researchers to access psychedelic plants and compounds; whether they be sheer cost (David Nutt was quoted the equivalent of $1,710 Canadian for a single dose of psilocybin) or the endless bureaucratic requirements needed to deal with a highly controlled substance. While the legalization of cannabis is an important step forward, it’s certainly not the end. However, it can set an important precedent and its legalization can perhaps turn cannabis into a gateway drug of an unexpected kind; a gateway to truly effective healthcare.