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Clinical research on psychedelics appears poised for a shift in legitimacy.

Policy in focus: Is psilocybin the next cannabis?

Research interest in the therapeutic use of psilocybin, or “magic mushrooms,” is growing alongside a “wild west” of dispensaries in Canada and the United States.

The past decade has seen a revival of research exploring the clinical use of psychedelics in treating depression, addiction, eating disorders and other psychiatric conditions. Studies have shown potentially positive benefits with minimal safety concerns, but have often had major limitations, in part because of difficulties securing funding and regulatory approvals.

Now, the field appears to have gained a measure of legitimacy.

The National Institute of Health in the United States recently awarded its first federal grant for psychedelic treatment in more than 50 years to Johns Hopkins University School of Medicine.

Researchers at Johns Hopkins, along with scientists at the University of Alabama at Birmingham and New York University, received more than $4 million to study the use of psilocybin and psychotherapy to help people quit smoking.

In a pilot study, 9 of 15 people who had previously failed to quit smoking and then received psilocybin-assisted therapy were able to quit smoking and maintain that change over 2.5 years. According to lead author Matthew Johnson, the “deeply introspective experiences” associated with psilocybin appear to increase mental flexibility and openness to change, as well as reduce irritability and cravings in people quitting smoking.

In Canada, Toronto’s University Health Network (UHN) recently announced it would establish a psychedelic psychotherapy research centre with $5 million in backing from tech entrepreneur and venture capitalist Sanjay Singhal. According to Dr. Susan Abbey, psychiatrist-in-chief at UHN, psychedelics hold promise for difficult to treat disorders like post-traumatic stress and end-of-life distress. “Every major academic center in mental health in the world is trying to begin to conduct research in psychedelics, particularly psychedelic-assisted psychotherapy,” she told CTV News.

In Western Canada, the University of Calgary is conducting an international search for Canada’s first psychedelic research chair after establishing the position last summer.

Dr. Valerie Taylor, a psychiatrist and clinician-researcher at the University of Calgary, told The Globe and Mail that improving the quality of research on psychedelics is the next step to win over regulators. So far, most studies have been small and “haven’t been particularly designed to properly carry weight with the regulatory bodies,” she said. “We’re hoping to take it to the next level.”

Last year, Oregon became the first U.S. state to legalize the use of psilocybin under medical supervision to treat mental disorders. The U.S. Food and Drug Administration has also designated psilocybin and MDMA as “breakthrough” therapies for depression and post-traumatic stress disorder, respectively – an indicator that the agency is open to approving formulations of the drugs proven to be safe and effective.

Although psilocybin remains illegal in Canada, the federal government has started to grant legal exemptions, mostly to patients with terminal illness and depression that doesn’t respond to treatment.

Meanwhile, businesses and advocates for legalization appear to be cribbing from the cannabis playbook in their effort to expand access to psilocybin.

Companies like Schroom Room and Canada Mushrooms are openly marketing psilocybin products online, while brick-and-mortar dispensaries are selling it over the counter in major cities like Vancouver.

Although authorities appear to be ignoring these operations, some dispensary owners say they want to attract legal action to force the question of decriminalization before the courts.

Dana Larsen, who owns the Coca Leaf Care & Mushroom Dispensary in Vancouver, predicts the number of retail outlets selling psilocybin will mushroom in the next few years – just as cannabis dispensaries did prior to legalization.

Other companies, such as Field Trip Health, are setting up for-profit clinics offering psychedelic-assisted therapy with approved drugs like ketamine.

And manufacturers are racing to get their own formulations of psilocybin ready for market in anticipation of therapeutic approvals. Compass Pathways recently secured the first patent for a synthetic form of psilocybin that isn’t specifically intended for use in clinical trials.

One analysis by Data Bridge Market Research estimates the potential market for psychedelics will balloon to $7 billion by 2027.

In other health policy news:

  • Prime Minister Justin Trudeau announced Canada’s first ministry of mental health and addictions to be led by Carolyn Bennet, who previously served as minister of Crown-Indigenous relations. Bennet will likely be tasked with rolling out $4.5 billion in transfers to the provinces and territories aimed at supporting free, accessible mental health care over the next five years.
  • A class-action lawsuit in British Columbia alleges that hospital staff and social workers disproportionately flagged pregnant Indigenous women as being unfit parents, sometimes resulting in child protective services taking newborn babies from their families shortly after birth. Of 423 “birth alerts” issued by BC health and social workers in 2018 and 2019 prior to the province banning the practice, more than half the mothers reported to child protective services were Indigenous.
  • The proportion of Canadian and American teens vaping cannabis doubled from 6.1% to 13.6% between 2013 and 2020, according to a meta-analysis of 17 studies published in JAMA Pediatrics. The authors noted that the legalization of cannabis in Canada and many U.S. states may be behind the increase and vaping nicotine products could be a “gateway” to vaping cannabis.
  • An antidepressant commonly prescribed for agitation in people with dementia is ineffective for that purpose, according to research in The Lancet. The randomized, double-blind, placebo-controlled trial of 204 patients in the United Kingdom found that mirtazapine is no more effective than a placebo in treating agitation in dementia patients and may increase patients’ risk of death.
  • A pilot project in the United Kingdom will reward people for exercising and improving their diets in a bid to address high rates of obesity. Two in three adults in the U.K. are overweight or obese – one of the highest rates in Europe. Set to launch in January 2022, the pilot will track participants’ step counts and food purchases via a Fitbit-like device and offer rewards including clothing discounts and tickets to amusement parks for healthy lifestyle changes.
  • A proposed “soda tax” in Newfoundland and Labrador has drawn criticism from observers who say the move is unlikely to have much impact on obesity in the province. The 20-cent tax, set for implementation in September 2022, will see the province tax sugary drinks at a higher rate than gasoline. Critics say the tax will penalize residents of rural communities, many of whom do not have regular access to safe drinking water. Meanwhile, they say, soda companies with high profit margins can easily absorb the costs of the tax.

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