Research, medicine and regulation: the changing dynamics of psychedelic therapy in Alberta | Catch My Job

Earlier this month, in the final days of the Jason Kenney government, Alberta released the first provincial regulations for psychedelic therapy.

Interest in the potential of psychedelics to treat mental health is growing, with studies emerging around the world and in Canada.

Psychedelic drugs, as defined by the province, include psilocybin (the active ingredient in magic mushrooms), MDMA (amphetamine also called ecstasy or molly), mescaline (peyote) and ketamine.

New Alberta regulations would require providers to apply for a license before treating patients with psychedelics for mental health disorders. A psychiatrist would have to oversee any treatment, under regulations that come into effect in January.

“To fully realize the potential of this emerging field, we must have high standards of care to protect Albertans who access care and ensure the legitimacy of therapy,” said Mike Ellis, then Alberta’s Assistant Minister of Mental Health and Addictions, Ellis became Minister of Public Safety during the cabinet reshuffle on Friday.

“These new quality standards create a strong foundation for the safe and effective use of psychedelic therapy in Alberta as the field moves forward.”

But what is happening in Alberta with psychedelic therapy? Here’s what we found out.

How are psychedelics used in therapy?

Psychedelics have been investigated for the treatment of various mental health disorders.

Dr. Peter Silverstone, professor of psychiatry at the University of Alberta and author of the book The promise of psychedelicssays there is evidence that taking medication can make patients’ brains more flexible and receptive to psychotherapy.

“I’ve been doing psychopharmacological drugs on the brain for 35 years,” he said.

“The reason I’m more excited about psychedelics than anything I’ve seen in my career is that they seem to affect brain plasticity.”

Silverstone said the drug’s effect can open a person’s mind in unusual directions, sometimes leading to insightful experiences, but they are not therapeutic in themselves.

However, when combined with psychotherapy sessions, they can produce results for those most difficult to treat.

“I’m still in psychiatry and seeing patients every day, I think, ‘Oh, I wish I could have new tools.’

“And I wonder if psychedelics won’t be those agents, because we have so many patients who, unfortunately, don’t respond to our current treatments.”

Silverstone, who helped found the biopharmaceutical company Zilorian last year, says Alberta is well-positioned to be a center for psychedelic research, alongside British Columbia and Ontario.

“To date, we haven’t been able to do as much research as we’d like, but the landscape is starting to change,” he said.

“And in the next one to two years, I think we’re going to see a lot more studies in Alberta using psilocybin and psilocybin-like compounds.”

What kind of research is happening in Alberta?

Research in the province is still in its early days.

Last year, natural gas trader Jim Parker invested $3 million to create the Parker Chair in Psychedelic Research at the University of Calgary.

Lea Maio, a neuroscientist and assistant professor who serves as the first Parker Chair, says interest in the study of psychedelics is growing in Alberta and Canada.

“We can go back with ketamine and look at tons of safety data and various things that have been collected over the several decades that ketamine has been available,” Mayo said in an interview.

“But we don’t have that ability with psilocybin or MDMA or other compounds because they’re not available for prescription in any situation, except for now we have exceptions for end-of-life distress.”

The production, sale and possession of psilocybin is illegal, but Health Canada issues individual exemptions. In 2020, it did for four Canadians with terminal canceropening the door to additional applications for both patients and professionals.

There are 20 patients in Alberta who have received a therapeutic exemption. Another 20 people in the province have been granted permission to use through Health Canada’s Special Access Program, which began eligibility earlier this year, according to the agency.

Researchers must also apply for a license to conduct clinical trials with psilocybin.

A total of 15 clinical trials involving psilocybin have been authorized by Health Canada. He states nine clinical trials in its online database, most of which are still pending. Of the nine, four are sponsored by groups based in Ontario, three in BC and one in Nova Scotia, and the last comes from an organization based in London, UK

Mayo has just applied for an exemption to start a clinical trial to examine how psilocybin can be used to treat alcohol use disorders. It could start already in the spring.

She notes that a big challenge in this area is paying for research. It’s getting some encouragement from the federal government in the form of three grants totaling $3 million from a federal agency, the Canadian Institutes of Health Research.

“There’s a lot of interest, people have submitted grants for it,” Mayo said. She said there are also local companies that deal with psychedelics, either classic forms like psilocybin or MDMA, but also “next generation” drugs that have changed the chemical composition for safety.

However, Mayo cautions the public against getting too caught up in the media-fueled hype cycle that heralds new science as the be-all and end-all.

“You think it’s going to cure everything, and then you’re disappointed because it doesn’t cure everything, and then it’s useless.”

“And then the reality is somewhere in between.”

What about ketamine therapy?

Ketamine has long been used as an anesthetic. Despite not technically being a psychedelic, it can still be used to put people in unusual states of mind.

Its wide availability and legal use in a medical context means that there are several groups that provide ketamine-assisted psychotherapy in Alberta.

Wayfound Mental Health Group’s Calgary clinic began incorporating ketamine into treatment under the supervision of a psychiatric medical director two years ago.

Clinical psychologist Megan McElheran, executive director of Wayfound, says the clinic primarily works with military veterans, police officers and firefighters who have suffered psychological injuries in their profession.

“Because of the group of people we work with who are persistently and severely exposed to potentially psychologically traumatic events, these are often people who may not fully respond to our traditional intervention,” McElheran said.

Usually the clinic will work with referrals. From there, patients will undergo an initial assessment to see if this is an appropriate treatment.

“Ketamine is not a treatment for all mental health, I think it’s important to emphasize that,” McElheran said, adding that it is specifically used to treat resistant depression and depressive states.

A positive initial intake is followed by a psychiatric evaluation with the medical director prior to administration of the controlled test dose. Only after all this, clinical doses of ketamine begin, again under supervision.

This is followed by sessions with a psychotherapist, usually within 24 to 48 hours after dosing.

“Because the literature would tell us that’s when patients have the greatest malleability to actually process the material that came up during the ketamine session,” McElheran said.

Ketamine treatments are usually not covered by medical plans and can cost between $4,000 and $6,000, depending on the number of sessions.

How might regulations change things?

Alberta’s new regulations do not apply to clinical research or psychedelics prescribed for conditions other than psychiatric disorders, such as pain, palliative care or cancer.

Some practitioners of ketamine-assisted psychotherapy are concerned that the new regulations could limit access.

“There is an over-reliance on psychiatry,” said Philip Lucas, president of Calgary’s SABI Mind clinical group. He believes that giving psychiatrists sole control of the field is a mistake.

Lucas supports the need for psychiatric experts to be included in discussions about mental health psychotherapy, but says there are others in the medical field with expertise in psychedelics, including anesthesiologists, neurologists and some general practitioners, who are just as good. position for assessment and prescription of treatment.

According to the new regulations, a psychedelic drug can be prescribed by a doctor, but only after consultation with a psychiatrist.

“The new regulations and over-reliance on psychiatry will create an inevitable bottleneck that will have a serious negative impact on access problems for patients in need,” he said.

He expects that problem to worsen if Health Canada approves the use of MDMA for treatment, which he predicts will happen within the next 18 months.

MDMA is currently being tested in Toronto and Montreal for use in the treatment of post-traumatic stress disorder.

Vancouver nurse Madison Nobbs, head of the Canadian Association for Ketamine-Assisted Therapy, says the provisions will place an increased burden on psychiatrists.

She also disputes the requirement that a psychiatrist be the medical director of any facility that provides psychedelic therapy.

“It limits these objects that can be assigned to.” And that is already a very inaccessible treatment at a price.

“And what this actually does is increase costs.”

Nobbs said she hopes there will be further consultation with experts — an announcement that shocked many in the field — especially as the organization expects others to follow Alberta’s lead.

“Whenever any province comes out with new regulations, especially when it comes to health, we see it has an impact on other provinces,” she said.

“So we would anticipate that other provinces may begin to adopt some of the same regulations.”