Victoria-based therapist Anne-Marie Armour has seen nothing short of miracles in her psilocybin-assisted therapy sessions with clients. She remembers a man who fully accepted and made peace with his own death and a patient in remission from cancer whose dependency on alcohol completely vanished after one session.
Psilocybin puts the “magic” in magic mushrooms. The drug is not a panacea and it certainly isn’t life-changing for everyone. But according to Armour, “people are desperate and deserving of more treatment options,” apart from traditional healthcare.
Psilocybin is a naturally occurring psychedelic compound found in over 200 types of mushrooms and it is being studied to a great degree in a current wave of research. According to experts, it is showing much promise for a variety of mental health conditions, but several practitioners are concerned about patients' access to the drug today.
16 Canadian wellness and medical research companies have publicized significant plans this year for researching psilocybin’s effects on a wide array of psychological conditions – ranging from obesity and PTSD to depression, substance abuse, and mood improvement.
The substance, however, is illegal in Canada and is reserved on a case-by-case basis for end-of-life and critical patients who are able to access it through Health Canada’s Special Access Program. The SAP was amended in January to allow physicians to request access to psilocybin-assisted therapy for their patients. With the new research taking place across Canada and psilocybin’s inclusion in the SAP, varying treatment choices could be a viable option for patients in the future.
“Research will help us to gain a clearer sense of who the most suitable candidates for psilocybin-assisted therapy are, whom it is not a safe option for, and what conditions it is most effective at treating. I feel very optimistic about the healing potential of psilocybin-assisted therapy for various treatment-resistant conditions,” said Armour.
Researchers at the University of Toronto will be starting phase two trials in April to study the efficacy and safety of micro-dosing psilocybin on subjects with persistent depressive disorder (PDD).
Rotem Petranker, the sponsor of the study, attributed the reason for using psilocybin versus drugs like LSD because of the less stigma associated with it, the lesser half-life time (time required for a quantity to reduce to half of its initial value), and its effectiveness in mood disorders.
Psilocybin shows much promise for a variety of mental health conditions but according to Petranker, the research is still nascent. “Psilocybin has been studied heavily in the current wave of research but still probably fewer than 1000 people have been administered psilocybin since the year 2000,” he said.
Now, however, the market demand for psilocybin is increasing, intended specifically for analysis and use in human clinical trials. Successful trials will leave companies placed to progress a number of potential opportunities in the therapeutics sector. According to a report by Credence Research, the therapeutics sector for PTSD alone is expected to reach a market value of $10 billion by 2026.
Despite this, Carson Kiwari, founder of Thrive Downtown Counselling Center, is against expanding his clinic and pursuing growth outwards. He is instead focused on looking inwards and deepening the training of his existing team.
“A big part of what companies are doing is patenting treatment protocols and combinations of compounds. This is where the money will be at. Mushrooms on their own are not a great financial model since a typical patient may only need one or two treatments a year,” said Kiwari
He is also curious about how well this will work since these compounds are counter addictive and don’t work like psychiatric drugs. “They tend to release people from the imprisonment of obsession with money and vanity. It's a beautiful and poetically ironic experiment if you think about it,” he said.
The therapist's Armour and Kiwari work to integrate and support individuals through a safe and meaningful experience with psychedelics. A psilocybin treatment varies in style based on the clinic you consult, but in principle consists of a comprehensive intake plan adapted to the client’s need that can span over weeks or even months. Harm reduction measures like a thorough screening process, supportive co-sitters, therapy, and integration are a key part of the healing process.
“I hope that the research continues to highlight the importance of the adjunctive psychotherapy so we don’t start to see clinics offering stand-alone psilocybin treatments without adequate preparation and integration support,” said Armour
Since announcing the amendments to the SAP on January 5, 2022, Health Canada has stopped granting individual section 56 exemptions to patients and even some healthcare professionals seeking access to psilocybin for therapy and training. This lack of access to psilocybin today is something experts are voicing their concerns over.
TheraPsil, a small non-profit that advocates for patients’ rights to psilocybin treatment, has over 1500 patients on their waiting list for psilocybin therapy. To date, over 100 healthcare professionals enrolled in TheraPsil’s training cohorts have received an ‘intent to refuse’ their section 56 exemption for training purposes. In response, they made a submission to Health Canada and started a fundraiser to take the issue to court.
“We are helping as many patients as we can, and we also know we are failing. We are a small non-profit with one nurse who is doing all patient intakes,” said Spencer Hawkswell, CEO of TheraPsil.
Hawkswell pointed out that the SAP is a completely different bureaucratic process which can be even more difficult to navigate than the section 56 exemption. “Many healthcare professionals are unwilling or unable to navigate it for their patients due to the increase in labour and time it takes, not to mention the increased liability doctors must take on with an SAP request,” he said.
The SAP application is eight pages long and can take up to two hours to complete. It requires the prescriber (physician or nurse practitioner) to take full responsibility for the patient’s treatment.
According to Health Canada’s spokesperson, Mark Johnson, to date, Health Canada has received 14 SAP applications for psilocybin. Of these, six requests have been authorized, four are still under review, and four were withdrawn by the physician before a decision was rendered. The SAP authorizations for psilocybin granted to date were issued following a six-week review by Health Canada.
Health Canada states that it is typical for SAP requests involving new products to take longer to process because of the verifications required with the manufacturer regarding product quality and their willingness to provide the drug.
“SAP authorizations, and their timing, are dependent on the information made available to the SAP at the time of the request, including sufficient evidence supporting the requested use, information on the drug, the nature of the medical condition, and the extent to which the information submitted in support of the request is relevant to the specified medical condition,” said Johnson.
Armour suspects this will lead to reduced access and devastating change for end-of-life patients. “Most prescribers do not have this kind of time, nor do they have enough knowledge and specialized training around the benefits of psilocybin to feel comfortable prescribing this to their patients,” said Armour.
Her suspicion is akin to TheraPsil’s affidavit submitted to Health Canada which states that most of the qualified practitioners are clustered in just a few areas of the country, effectively inaccessible to most patients seeking treatment.
According to Hawkswell, the only way this can be corrected is by expanding the program with increased resources and empowering other healthcare professionals on how to submit requests to Health Canada on behalf of their patients.
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