The wonder drugs

The wonder drugs

Therapists in Halifax want to offer their patients psychedelics, as healers have for millennia. Will the federal government let them?

BY PHILIP MOSCOVITCH

For years, Dr. Grayson Lloyd has used ketamine to help put people under for surgery. Then, he realized maybe it could do more. An anesthesiologist at the Valley Regional Hospital in Kentville, Lloyd is also co-owner of NovaKet, a ketamine infusion clinic in Halifax, where patients receive the drug intravenously at sub-anaesthetic doses to treat depression and PTSD.

“It's a marvellous drug,” he says. “I still find amazing things about that drug every time I use it.”

Developed in the early 1960s, ketamine became well-known as a party drug with dissociative effects. “It's structurally similar to psilocybin and LSD, so it has some similar psychotropic effects,” Lloyd explains. “What we’re looking for is patients being in this fairly narrow band of disassociation where they're feeling kind of floaty, a little bit off into space, a little bit separated from themselves and their body.”

For decades, psychedelics have had a reputation for, at best, sending people on hallucinogenic trips, or at worst, being downright dangerous. But the use of psychedelics is “a tradition that’s been within human cultures for thousands of years,” says Jeff Toth, a psychiatric nurse.

He works at a public clinic for veterans and is president of the Halifax Psychedelic Society: a group of health-care workers advocating for access to psychedelicassisted therapy. “There's a long tradition of using these medicines to access healing states.”

Now, after decades of prohibition, interest in psychedelics is booming.

In May, the Centre for Addiction and Mental Health, the Canadian Centre on Substance Use and Addiction, and the Mental Health Commission of Canada co-hosted a global summit on psychedelic-assisted therapies and medicine, in Toronto. Next year’s Psychedelic Science conference in Denver is already being billed by organizers (the Multidisciplinary Association of Psychedelic Studies) as “the largest psychedelic gathering in history.”

“Maybe this whole psychedelics renaissance is my fault,” jokes Halifax-based filmmaker Connie Littlefield.

Twenty years ago, the National Film Board released Littlefield’s now-classic documentary Hofmann’s Potion, about LSD and the extensive research during the 1950s and ’60s into its effectiveness as a treatment for addictions and mental illness. That research — some of which took place in Saskatchewan, under Tommy Douglas’s reformist government — came crashing to a halt with the war on drugs and fears about psychedelics. (She has continued to chronicle the world of psychedelics, and her latest film, Better Living Through Chemistry, premiered last year at the Fin: Atlantic International Film Festival.)

Littlefield says after the release of Hofmann’s Potion people would regularly tell her how LSD had changed their lives for the better. “That’s something a lot of people didn’t think about,” she says. “They would mainly think of these things as escape routes, checking out of reality, and not as having anything to bring back to our daily lives.”

Legal limbo

While ketamine is legal in Canada, it's only authorized for anaesthetic use. Using it to treat depression and PTSD is off-label, but still legal if done by a qualified physician. In contrast, access to substances like psilocybin (found in so-called magic mushrooms), MDMA (AKA Ecstasy), and LSD remains extremely limited.

There are only three ways to receive them for psychedelic-assisted therapy: as part of a clinical trial, under Health Canada’s Special Access Program (which allows doctors to request drugs “for treating a patient with a serious or life-threatening condition, where conventional treatments have failed, are unsuitable, or are not available in Canada”), or through a direct appeal to the federal health minister.

This state of affairs is “wrong. It’s completely wrong,” says Spencer Hawkswell, a Dalhousie alumnus and CEO of TheraPsil, a Vancouver-based non-profit that provides training for health-care professionals, and advocates for patients to receive psilocybin for end-of-life care, in particular to reduce anxiety and distress.

“Why are we making something that grows on Citadel Hill illegal?” says Hawkswell, referring to mushrooms. “It's nonsense. We should educate people on its use instead.”

TheraPsil plans to file a class-action lawsuit against the federal government in July, arguing that the decision to prescribe psilocybin should be between doctor and patient, and that preventing patients from getting safe and legal access is unconstitutional.

“An amazing gift”

Psilocybin shows promise for treating a range of psychiatric conditions, including anxiety and “existential distress” among patients with terminal illnesses, Toth says, because it fosters “deep connection, a deep sense of peace, love, and a sense of wholeness.”

After experiencing psychedelic therapy and “integrating” it through discussion with a qualified therapist, many people feel “more connected and at ease,” he says. “I thought that this is an amazing gift, not just to the patient but to the patients’ families as well.”

Toth and Halifax-based registered counselling therapist Nathan Torti are part of a group trained through TheraPsil. (Other health-care workers in Nova Scotia have received training through Atma, a Calgary-based psychedelic clinic.) While they have completed what Toth called the “didactic” part of the training, they haven’t been able to do the retreat portion, which involves using psychedelics themselves and taking turns role-playing as therapists and clients. That’s because the government has made the necessary substances harder to access.

The “assisted” part of psychedelic-assisted therapy refers to having a qualified professional help people make sense of, or integrate, their experiences.

Understanding the effects of psychedelics is an important part of the training, Torti says, because psychedelic experiences can be so unlike everyday life, and because patients need to be able to discuss them with knowledgeable people.

“Having an altered state of being can be hard to integrate because there's no language for it, or there's no context for how to even bring that balloon down to earth,” he says. “Having the framework to be able to speak the different languages of spiritual psychology and understand how the psyche can integrate that... that’s really a skill set.”

Or, as one Halifax-based psychologist who asked to remain anonymous says, “If you are a therapist who is super uncomfortable with any spiritual talk, this is probably not for you.”

The therapeutic process

NovaKet does not have therapists on-site, but Lloyd says that’s because the clinic’s patients (90 per cent veterans) come from health-care professionals with whom they already have relationships.

“They are comfortable with the person they've been seeing for years and years and years,” Lloyd says. “We're trying to keep in touch with the patient's psychiatrist or psychologist to make sure they get seen fairly soon after their treatments, while the drug still has an effect and allows them to be a little bit more open.”

“It’s not like you take a psychedelic and have a ball,” Torti says. “The integration of an experience is absolutely vital for it to last. Otherwise it becomes a stale postcard, just some sort of cocktail party story of some crazy experience you had. If people actually want it to ... make change in their life, they have to have a therapeutic process alongside of the medicine. I don't think that can be understated.”

"If people actually want it to ... make change in their life, they have to have a therapeutic process alongside of the medicine" — Nathan Torti

With growing interest in psychedelics, there is a danger in keeping them in a grey zone legally. Littlefield says if the field is not regulated, “anyone can hang up their shingle and call themselves a psychedelic therapist, when they may or may not have the training.” And in the absence of qualified therapists, people are accessing psychedelics for therapeutic purposes on their own, which can be risky.

“It can go wrong, and you have to have a skilled leader,” Littlefield adds. For that reason, she’s skeptical of apps like The Trip, which claims to “help you prepare for, deepen, and integrate these consciousness-expanding experiences and self-discoveries.”

Business case

The current psychedelics explosion doesn't surprise Littlefield.

“I think everybody working in the psychedelic field knew it would become mainstream at some point,” she says. “But,” she adds, “I don’t think anyone really anticipated the huge influx of venture capital that has soaked the scene in the past few years.”

Mushrooms may grow wild in Nova Scotia, but that doesn’t make them accessible to everyone, and companies are rushing to fill the gap.

“There's the inevitability of corporate capitalism coming in to profit, commercialize, and to generate revenue from (psychedelics). It's just the reality that we're in,” Toth says. “There are some benefits to that in terms of being able to change the regulatory framework, for insurance and governments to be able to offer these type of medicines to a wider audience. But I think one of the dangers is when it becomes overly commercialized and people develop intellectual property and proprietary rights over particular substances, and there's the ability to increase the cost. So that's a concern.”

Lloyd notes, “There are dozens and dozens of companies that are trying to put together a proprietary compound based on psilocybin that they can market for patients with mental health issues. That is a business model. And I don't begrudge those companies from, you know, trying to find new therapies that are profitable.”

But he also worries about cost to patients. He notes that ketamine’s patent has expired, “so no drug company is going to market ketamine as a therapy, because it's a generic drug and you can't make any money off it.”

Health Canada’s clinical trials database shows eight pending or ongoing psilocybin trials for alcohol-use disorder, depression, PTSD, and bipolar depression. Windsor, N.S.-based firm Halucenex launched one of those studies, investigating the therapeutic effects of psilocybin in treatment-resistant PTSD. Brenda Perks, a registered nurse with Halucenex, says in an email that the study would include over 20 people and would focus primarily on veterans.

The company’s goals, according to its website, include “researching novel psychedelic compounds, developing and licensing psychedelic compounds for the pharmaceutical and nutraceutical markets, and conducting clinical trials on the medical benefits of psychedelic medicine.”

Toth says the current “gold standard treatments” for PTSD are only about 50-per-cent effective. So if psychedelics show promise, it makes sense to thoroughly investigate them.

“The need is massive,” Lloyd says. “There are going to be other clinics that open in Halifax. It's only a matter of time, and I think that's a win for everybody, really — more patients get this kind of therapy and are supported in their health goals. I think that’s really, really important.”