Psychedelics: Experts Call for More Medical Education
What happens when public interest in or access to a promising therapy outpaces research and clinical knowledge? If the experience following the legalization of cannabis is a guide, then it’s time for Canadian health practitioners and medical schools to start focusing on harm-reduction practices and education related to psychedelics, experts say.
Psychedelics (ie, hallucinogens) such as psilocybin, lysergic acid diethylamide, methylenedioxymethamphetamine, and ketamine have shown potential for treating anxiety, depression, and existential distress in patients facing life-threatening disease. The Canadian Institutes of Health Research has allocated more than $4 million in funding to expand psychedelic research, and roughly 25 clinical trials are currently underway.
At the same time, small numbers of health practitioners have requested access to psychedelics for medicinal purposes via Health Canada’s discretionary exemptions (eg, the Special Access Program). And gray market dispensaries have been proliferating across Canada, operating in plain sight without consistent regulation or enforcement.
By and large, clinical awareness, knowledge, and training have not kept up, placing patients at risk.
“From a harm-reduction perspective, the public is curious about psychedelics. We’ve recently done a study in Canadian veterans, and many said that they asked their healthcare practitioner about them and were either told they were a bad idea or they couldn’t tell them anything,” Leah Mayo, PhD, Parker Chair in Psychedelics at the University of Calgary and member of the Hotchkiss Brain Institute, Calgary, told Medscape Medical News.
“A lot of people go to other sources for information, such as country retreat centers operating in gray zones with no follow-up care, or unregulated underground practitioners. To provide the best care for patients, we have to be able to give them advice or guide them to reliable resources,” she said.
Education First
Today, only a handful of Canadian universities offer comprehensive training and education in psychedelic-assisted therapy, including Vancouver Island University (VIU), Nanaimo, British Columbia, Canada; McGill University, Montreal; and the University of Ottawa, Ottawa.
“VIU’s program led the way in Canada,” said Pamela Kryskow, MD, medical chair of VIU’s Postgraduate Certificate Program in Psychedelic-Assisted Therapy, medical lead of Roots to Thrive, and founding member and chair of the Psychedelic Association of Canada. Roots to Thrive is Canada’s first multidisciplinary, nonprofit healthcare practice offering evidence-informed, multiweek psychedelic group therapy programs.
Kryskow explained that an important impetus for developing VIU’s program was the influx of commercial interests, which, according to the Associated Press and the Canadian Public Health Association, have included hedge funds and investment firms.
“We should be educating people in best practices, best science, shared resources, and collaborations that are team-based, interdisciplinary, and multidisciplinary,” she said. Clinicians should “honor indigenous ways so we are truly in service to people who will need these medicines,” she added.
Since its inception, VIU’s program has been well received and filled to capacity. Enrollees have included doctors, nurses, therapists, indigenous experts, social workers, and somatic therapists. Kryskow noted that the program is being incorporated into a master’s level program that will allow students to study nonclinical areas such as policy or research.
“The program also has a long tail on the other side, where we run two professional consulting groups for our alumni to come together, review current science and new studies, and collaborate on their own research,” she said.
Program Building Blocks
Kyle Greenway, MD, MD MSc, assistant professor of psychiatry at McGill University and attending psychiatrist at the Jewish General Hospital in Montreal, leads the Ketamine-Assisted Therapy Program. He was also integral to the development of the Montreal Model, a strategy that pairs ketamine infusions with conventional and psychedelic psychological care.
Developing research protocols and best practices for this pairing, otherwise known as psychedelic-assisted therapy, has been difficult. But this circumstance has not stopped the demand or need for clinical education and participation.
“The key is a bottom-up approach: Build clinical buy-in, then administrative buy-in,” said Greenway. “What was difficult was introducing our colleagues to the idea of psychedelic-assisted therapy,” he continued. “It was a slow process of building goodwill, collaborating actively with the pharmacy, with administrators, [and] with department leads. But I think what really made it possible was simply that patients for whom there wasn’t much to offer got better.”
It was patients who facilitated acceptance, removed treatment ambiguity, and demonstrated that the effects were real, not illusory, Greenway noted.
“It’s imperative that healthcare professionals look at the science, not the propaganda,” emphasized Kryskow. “If you can get beyond the political and cultural war on drugs and look at the results we’ve been getting, results that are often above and beyond those of other pharmaceutical measures, you can see that though psychedelics are not a panacea or for everyone, they are great therapeutic medications to be used in conjunction with therapy for some.”
Elephant in the Room
An important feature of psychedelic therapy is the need for psychiatric guidance and assistance during treatment, a challenge that researchers conducting clinical studies and practitioners have been grappling with.
Though training courses outside the academic setting are available, they can be risky, especially those that imply the need for experiential training in which guides or therapists are administered the drugs so that they can better understand their effects. Details from a recent case study underscored the danger of these types of underground facilitator training sessions, some of which require therapists to undergo multiple, high-dose drug exposures. The therapist in the case study had escalating sleep impairment, anhedonia, and suicidal ideation requiring hospitalization.
Greenway remains “firmly in the camp that it’s not necessary to dose people with psychedelics for them to become competent at this work. Basically, you need clear, structured, protocolized models taught in evidence-based ways about how you train people to become competent and then ensure ongoing mentorship and supervision that reflects what we know about how conventional psychotherapy is learned,” he said.
“We want psychedelics to be familiar to future practitioners,” added Mayo. “For example, this is what people are using, this is the current evidence, et cetera. Even if they’re not going to provide psychedelic-assisted psychotherapy, they will have patients who’ll ask and they at least have to be able to direct them to some sort of reliable evidence. I don’t understand why people don’t want to get ahead of this.”
The Canadian Medical Association and the Association of Faculties of Medicine of Canada declined the opportunity to comment on this topic.
Mayo, Kryskow, and Greenway reported having no relevant financial relationships.
Liz Scherer is an independent health journalist who frequently writes about psychedelics and cannabis/cannabinoid therapeutics for medicinal purposes.
