Renaissance of psychedelic therapy

Melaney White, RSW

Psychedelic substances have been used for millennia around the world, notably by many Indigenous traditions, for a wide range of purposes such as healing, improved well-being and communing with the divine. Promising scientific research had been carried out during the 1950’s and 1960’s regarding the potential therapeutic benefits of psychedelic substances in treating a wide range of mental health disorders however much of the research ceased when the rhetoric of the “war on drugs” began and these substances became illegal, both clinically and at the street level.

In recent years however there has been a massive resurgence of interest in the therapeutic potential of psychedelic substances as mental health clinicians and clients alike recognize the limits in the efficacy and extensive time frames of traditional treatments such as talk therapy and pharmaceuticals.

An ever-growing body of research is exploring the safety and efficacy of a wide range of psychedelic substances such as LSD, DMT, psilocybin, MDMA and ketamine for the treatment of mental health disorders ranging from anxiety, depression, addictions and PTSD to end-of-life anxiety in clients who have been diagnosed with terminal illnesses.

One non-profit organization heading clinical trials is the Multidisciplinary Association for Psychedelic Studies (MAPS) which has been studying the safety and efficacy of MDMA as an adjunct to therapy for veterans experiencing PTSD. Dubbed an “empathogen” and not considered a “classical psychedelic,” MDMA has shown much promise in treating socalled “treatment resistant” PTSD as an adjunct to Cognitive Processing Therapy (CPT) as MDMA’s effects include increased feelings of safety, trust and pro-social experiences that allow the therapeutic relationship to access long defended thoughts, feelings and memories without the client becoming overly dysregulated.

The Johns Hopkins Center for Psychedelic and Consciousness Research has been studying the safety and efficacy of psilocybin, commonly referred to as “magic mushrooms,” for the treatment of depression and end-of-life anxiety in clients diagnosed with terminal cancers, providing encouraging results.

A particularly interesting study was published in the New England Journal of Medicine in April 2021 by Dr. Robin Carhart-Harris and his team which compared the safety and efficacy of psilocybin and escitalopram, a commonly prescribed SSRI antidepressant medication. The researchers found that the reduction of self-reported depression symptom scores was more significant and occurred more quickly in the psilocybin group than those in the escitalopram group, however larger studies are needed. While this was a small study, comparing the safety and efficacy of psychedelic substances with traditional pharmaceuticals marked an exciting development in psychedelic research.

In May 2022 a phase 2 clinical out of University Hospital Basel in Switzerland found that large doses of LSD were safe and effective in treating anxiety in a rapid manner. In June 2022 a study published in Scientific Reports demonstrated that microdosing psilocybin, the practice of regularly consuming a sub-perceptual dose of a substance, resulted in improved mood and mental health. In July 2022 a study published in Molecular Psychiatry called into question the widely accepted theory that depression is caused by a “chemical imbalance” in the brain, namely the imbalance of the neurotransmitter serotonin. The serotonin theory of depression has been the underlying assumption behind SSRI pharmaceutical treatment for decades and this new review of the literature could lead clients, clinicians and physicians alike to explore other treatment options such as psychedelic therapies. In August 2022 a study published out of NYU offered compelling evidence of the significant therapeutic potential of psilocybin when used as an adjunct to psychotherapy for the treatment of alcohol use disorder.

A Canadian non-profit organization called Therapsil is interested in “the use of psilocybin in the compassionate treatment of end-of-life emotional distress” associated with terminal illnesses, while honouring the Indigenous traditions in which psilocybin ceremonies originated. Therapsil has created a Health Canada approved treatment modality and has been offering psilocybin therapy for clients who have been granted federal permission to have and use psilocybin under a section 56 exemption of the Controlled Drugs and Substances Act.

Therapsil also advocates for expanded access to psilocybin for the treatment of other mental health concerns and for a move from the exemption model to a regulation model, arguing that Canadians are supposed to have a right to choose their treatments. As of January 2022, Health Canada amended its Special Access Program however the process for clients wishing to access this treatment remains challenging and inaccessible for many.

Continued advocacy is needed to spread awareness, reduce barriers to and challenge long standing stigma associated with psychedelic therapies. Master’s level social workers with training and experience in psychotherapy are able to complete Therapsil’s training program to offer therapeutic support to clients who are receiving psilocybin via section 56 exemptions, though barriers remain for clients wishing to access this revolutionary treatment as several Therapsil trainees including social workers, physicians and nurses were recently denied section 56 exemptions which are needed to complete the experiential component of the training. A large number of clients await this treatment as the demand for the therapy currently outweighs the number of trained therapists.

While social workers do not prescribe medicine, and are not qualified to administer psychedelic substances themselves, research and advocacy in this areas might be considered part of our larger decolonization work. The mechanisms of colonialization – including displacement, forced assimilation, and Eurocentric medical and legal systems – have discredited and criminalized Indigenous wisdom regarding these medicines. As research and practice continue to develop, it’s important that those Indigenous traditions be recognized and honoured without being appropriated.

In safe sets and settings with trained therapists, psychedelic therapy offers a promising and expedited alternative to the treatment of mental health symptoms. As the body of research grows more and more compelling, there is much hope that evidence of safety and efficacy of psychedelic therapies will also serve to challenge the current prohibition model of substance use in Canada, based on the failed “war on drugs” rhetoric, and usher in a trauma-informed harm reduction approach to drug policy that could save lives and improve quality of life, while potentially easing pressures on both the healthcare and the legal systems as calls for decriminalization and regulation continue to grow in volume.

MELANEY WHITE, RSW is a social work clinician in Halifax, Nova Scotia. Her specializations include assessments and therapeutic interventions for people experiencing addiction.