Psychedelics, also known as hallucinogens, are a class of psychoactive drugs that produce changes in one’s perception, mood, and cognitive processes (1). Psychedelics can affect all the senses, causing hallucinations and changes in perception of time and emotions (1). There are many types of psychedelics, including those that are naturally derived from trees, seeds, and fungi, as well as others that are created syntheticallly in the laboratory setting. Examples of commonly used psychedelics include psilocybin (the active component in magic mushrooms), lysergic acid diethylamide (LSD), N-methoxybenzyls (NBOMes), and ayahuasca. This article will focus on the potential of psilocybin as a therapeutic.
From a legal perspective, psychedelic drugs, including psilocybin, are prohibited in Canada. This is highlighted in Section III of the Controlled Drugs and Substances Act (CDSA), which states that the sale, possession, or production of psychedelic drugs is prohibited unless it is authorized for clinical trials or research purposes (2). However, psychedelic substances are used recreationally at events such as raves, clubs, and parties, especially among youth (3).
Although stringent restrictions limit the use of psychedelics in medicine, several studies have shown that psilocybin can be a promising therapeutic for a wide range of psychiatric diagnoses, including depression, anxiety, and addiction. In a study by Carhart-Harris et al. (2018), 20 patients with (mostly) severe, unipolar, treatment-resistant major depression received two oral doses of psilocybin in a supportive setting. Results demonstrated that psilocybin treatment was well tolerated and led to marked reductions in depressive symptoms for the first 5 weeks post-treatment (4). Similar effects were seen in a study by Ross et al. (2016); terminally-ill cancer patients with cancer-related anxiety and depression who received a single dose of psilocybin along with psychotherapy had improved attitudes towards death, which persisted to the 6.5-month follow up in 60-80% of patients (5). In terms of addictions, a study done by Johnson et al. (2014) showed that 80% of nicotine-dependent smokers who received psilocybin doses in a smoking cessation treatment protocol showed a 7-day point prevalence abstinence at the 6-month follow up, which substantially exceeds smoking cessation rates of other behavioral and pharmacological treatment programs (6). Therefore, there is evidence that psilocybin, and psychedelics in general, have potential as a therapeutic for a range of psychiatric conditions.
So why do psychedelics matter? Well, the world is suffering from the COVID-19 pandemic, and the impacts go beyond just physical health. Experts are warning of a potential mental health crisis in the post-COVID-19 world. In Ontario, many people believe that their mental health has been negatively affected by the pandemic and are more likely to feel that their mental health has worsened as opposed to their physical health (7). Almost one quarter of Ontarians are consuming more substances, including alcohol, tobacco, and cannabis (7). There are also heightened feelings of depression and anxiety relating to contracting COVID-19, dealing with the loss of loved ones, socially distancing from friends and family, and the economic downfall that is occurring. Taken together, it is imperative that public health officials, healthcare professionals, and the healthcare system at large be prepared for a post-COVID-19 mental health crisis with innovative, effective approaches. And this is where psychedelics show promise.
Already, some companies are using the COVID-19 pandemic as an opportunity to provide psychedelic-enhanced treatments. For example, FieldTrip Psychedelics is a mental wellness company in Toronto that strives to combine the wisdom and science of psychedelic medicine with personalized psychotherapy and mental health wellness practices (8). FieldTrip Psychedelic’s 5-step regimen includes the following: “an initial consultation; preparation by working through exercises to optimize the patient’s experience and outcome; ketamine-enhanced therapy sessions; integration sessions to develop an individual behavior-focused action plan, combining medications and mindfulness tools to deepen self-awareness with additional exercises at home; and continued follow-up” (8). Although psilocybin cannot be used therapeutically immediately, now is the best time to start considering it as a focus of research initiatives and clinical trials. Using it alongside existing clinical regimens may prove to be extremely advantageous in the face of the anticipated mental health crisis in the post-COVID-19 world.
Going forward, raising awareness about psychedelics and their promise in psychiatric medicine is imperative. It can harbor greater public awareness and acceptance of psychedelic substances as therapeutics, which can lead to a greater number of studies and clinical trials being done. Psychedelics can be combined with traditional psychiatric approaches to enhance the efficacy of current treatments and substantially advance patient care and wellbeing. Psychedelics could represent the face of a new era of medicine.
Psychedelics. (2020, May 18). Retrieved June 10, 2020, from https://adf.org.au/drug-facts/psychedelics/
Health Canada. (2020, April 3). Government of Canada. Retrieved June 10, 2020, from https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/magic-mushrooms.html
What is the history of psychoactive mushrooms? (2020). Retrieved June 10, 2020, from https://www.drugpolicy.org/drug-facts/history-psychoactive-mushrooms
Carhart-Harris, R. L., Bolstridge, M., Day, C. M. J., Rucker, J., Watts, R., Erritzoe, D. E., ... & Rickard, J. A. (2018). Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology, 235(2), 399-408.
Ross S, Bossis A, Guss J et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J. Psychopharmacol. 30(12), 1165–1180 (2016).
Johnson MW, Garcia-Romeu A, Cosimano MP, Griffiths RR. Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. J. Psychopharmacol. 28(11), 983–992 (2014).
New data shows majority of Ontarians believe mental health crisis will follow COVID-19 impact. (2020, May 11). Retrieved June 12, 2020, from https://ontario.cmha.ca/news/new-data-shows-majority-of-ontarians-believe-mental-health-crisis-will-follow-covid-19-impact/
Zehr, L. (2020, May 19). COVID-19 presents opportunities and challenges for Field Trip Psychedelics. Retrieved June 12, 2020, from https://biotuesdays.com/2020/05/12/covid-19-presents-opportunities-and-challenges-for-field-trip-psychedelics/