Some health-care providers in Nova Scotia want more training when it comes to using psilocybin — commonly known as magic mushrooms — to help treat end-of-life distress and possibly other mood disorders.
But they say bureaucracy is stopping them from getting it. They say that hurts providers and patients.
“There’s a high need for this therapy among folks who are experiencing end-of-life anxiety … depression and existential angst,” said Jeff Toth, a registered nurse and advocate for psilocybin treatment.
“At this point not having therapists who are trained in this modality, it’s limiting [patient] access.”
Toth, along with 15 other health-care providers in the province, recently entered a psilocybin training course, but they won’t be able to finish it without an exemption from Health Canada.
The exemption permits people to take psilocybin, which is considered an illegal substance under the Controlled Drugs and Substances Act, in a safe and supervised setting based on medical or research needs.
In January, Health Canada changed it so that the onus is on a person’s physician to apply for the exemption though Health Canada’s special access program, and then secure a Health Canada-approved synthesized version of the drug.
Health Canada’s criteria for considering an exemption requires the physician to show their patient has “serious or life-threatening conditions,” and requires psilocybin “for the purpose of emergency treatment.”
Charlaine Sleiman, a spokesperson with Health Canada, said the department has notified 137 health-care professionals that it intends to refuse their requests since the change.
“There’s been an unfair regional disparity with the government approving exemptions for folks on the West Coast,” said Toth.
“There haven’t been any clinicians who’ve been approved east of Montreal, and so that’s setting up an unfair precedent.”
Sleiman said since granting some one-year exemptions to health-care professionals in 2020, Health Canada undertook further consultations. It concluded that clinical trials are the best approach for health-care professionals who wish to improve their knowledge of psychedelic-assisted psychotherapy.
“Health-care professionals interested in using psilocybin or other psychedelics for training purposes can explore whether they can participate in this trial or apply for their own clinical trial,” Sleiman said.
No clinical trials
But Toth said that’s the problem. There aren’t any clinical trials in the province and he said it isn’t clear how to start one.
“Health Canada hasn’t offered any specific criteria,” Toth said. “They’ve said in a more generic way that they’re recommending that we go through clinical trials for it, but there’s no real framework for that to happen.”
As of January, Health Canada approved only one clinical trial that examines the safety of administering psilocybin to healthy participants who are enrolled in a psilocybin-assisted psychotherapy training program.
“We’re at this administrative roadblock,” said Toth.
“I think it needs a bit more imagination and I think it needs more and more input from health-care providers on how to optimize the pathway.”
The course Toth is looking to take is offered by TheraPsil, a small non-profit group that aims to help Canadians access legal, psilocybin-assisted psychotherapy.
Dave Phillips, a course trainer, said the experiential aspect is integral to the training.
“It’s just very clear to us [people in the field] that, because we’re working with altered states, that the practitioner themselves has to have their own experience with being in an altered state,” said Phillips, a registered clinical counsellor with more than three decades of experience specializing in psychological health and safety, trauma and PTSD.
He said part of the training involves observing those partaking while they’re in an altered state, as well as the trainee keeping a journal of their experience.
Phillips said those in the training will be required to take five grams or more because that is generally what a patient taking psilocybin for end-of-life care would need.
Alexis Goth, a family doctor and palliative care specialist, said it’s healthy to have some level of concern when it comes to approving the use of novel treatments, and that careful consideration of pre-existing conditions such as schizophrenia or other mood disorders should be taken into account.
However, she said, with research in the area progressing, it’s important health-care providers get this kind of training now to better help new and existing patients in the future.
“We’re treating it a little bit like other pharmaceuticals or other types of therapy, and it can be very different because it can change your perception of reality and change your entire thinking strata,” said Goth.
“Nothing really else that we offer clients does that, and can predictably do that, so unless you’re knowledgeable of what that could feel like yourself, you really may not be able to serve a client, when they’re in that space.”
Toth and 12 of the other denied health-care providers have sent a letter to Canada’s Health Minister Jean-Yves Duclos. They hope to have their exemptions reconsidered in order to complete their training.
“In situations where there’s a medical treatment available that will reduce disease, and that does not have a negative impact on public safety, the government doesn’t have the option and has to grant the exemption, so we’re optimistic that the government will follow the law there,” said Nicholas Pope of Hameed Law, the firm that helped the group draft the letter,
Pope said if the exemptions aren’t granted he will take the case to federal court for review.