Why Don’t We Just…
reschedule psilocybin?

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The psychedelic renaissance is upon us! Psychedelic medicine could provide much needed treatment options for some mental health and neurological disorders in the near future. However, our drug laws impede research and deny patients access to these highly effective medicines.

Psychedelics include plant medicines such as psilocybin (the active constituent of magic mushrooms), Ayahuasca (a powerful psychedelic used by indigenous populations for thousands of years, often consumed as a tea), and those synthesised in the laboratory, including LSD and MDMA (ecstasy). Psilocybin is a naturally occurring molecule found in over 200 species of fungi. It is structurally similar to serotonin – a human neurotransmitter that regulates mood and perception. When administered in clinical settings with extensive psychological support (a treatment we call Psychedelic Assisted Psychotherapy, or “PAP”) psilocybin may be a safe and effective treatment for mental health disorders, particularly when other treatments have been ineffective. These disorders include severe depression, anxiety and depression occurring in terminal cancer patients, alcohol and nicotine dependence, and PTSD (post-traumatic stress disorder).

There are a number of differences between PAP and current treatment approaches.

Firstly, psychedelics are administered infrequently in controlled settings with up to only three treatments shown to produce long lasting benefits in clinical trials so far.

Secondly, people report being healed. In psychiatry we manage symptoms and rarely heal people. In fact, in some cases, patients no longer meet the criteria for having a disorder following PAP.

And lastly, infrequent dosing removes the burden of side-effects, while the clinical setting reduces risk.

Further research is essential before PAP can become a medicine available on the NHS. Unfortunately, researching psychedelics is particularly difficult in both human and animal studies. It is extremely expensive (over £20,000 for one clinical trial), bureaucratic and incurs large time delays (up to one year). These drugs cannot be stored, prescribed or researched without possession of a Controlled Drugs (CD) licence from the UK Home Office.

This is because of the status of psychedelics as Schedule 1 drugs, under the Misuse of Drugs Regulations 2001. These detail the scheduling of controlled drugs at the international level, specifying how national jurisdictions should govern such activities as import, export, production, supply, possession, and record keeping. Current scheduling suggests these potential medicines have no medical value and a high likelihood of harm and misuse, which is not based on scientific evidence.

One common misconception about psychedelics is that they are addictive – this is not the case. In fact, their pharmacology is such that, with daily use, they stop having an effect. On the contrary, they can be effective to treat drug dependence. Paradoxically, drugs in Schedule 2, such as cocaine, diamorphine (heroin) and ketamine, which are considered to have medical value but a high likelihood for harm and misuse, do not require a CD licence for research. Many scientists who want to research psychedelics cannot do this much needed work because of these unnecessary and unscientific Schedule 1 restrictions.

The most obvious benefit of rescheduling will enable research into the effectiveness of psilocybin for mental health and neurological disorders. Mental health has reached crisis levels during the Covid-19 pandemic. Twenty-one per cent of adults experienced depression between 27 January and 7 March 2021 – an increase of 11 per cent from pre-Covid levels (10 per cent). PAP is one of the most promising innovations for the treatment of depression seen for decades, with greater than 70 per cent long-term efficacy in small-scale trials to date. These long-term effects could result in a reduction in future spending on mental health treatments, and can also contribute to workforce health and productivity. Poor mental health currently costs the UK economy upwards of £100 billion per year due to losses in productivity.

While PAP could contribute to a general improvement in mental health outcomes, it could also have enormous benefits for service veterans and first responders. Currently, some veterans who return from their active duty suffer from mental illnesses, most commonly PTSD, and the lack of effective treatments available on the NHS forces them to seek help elsewhere. Many British veterans travel abroad in order to self-treat their PTSD, to nations where psilocybin is legal, thus incurring significant costs in order to access help. It is utterly shameful that, we as a nation, cannot offer effective treatments for those who have sacrificed for its protection, free
of charge on the NHS.

In order to enable research into PAP, to enable patient access, this government needs to remove psilocybin from Schedule 1 of the Misuse of Drugs Regulations 2001.

Jo Neill (@b_neuro) is professor of psychopharmacology at Manchester University and chair of the Drug Science Medical Psychedelics Working Group. She is on the panel at An Afternoon of Psychedelic Assisted Therapy, with Dr Sara Tai and Keith Abraham, at Manchester University, 2pm, 16 March (free tickets from eventbrite.co.uk)

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