In this article, Evan Lewis, director of the Neurology Centre of Toronto, VP Psychedelic Neurology for Numinus and an expert in cannabis and childhood epilepsy, discusses how Canadian doctors have the opportunity to be global leaders in psychedelic education.
On 5 January, 2022 Canada took a quiet, impactful step by amending its Special Access Program to restricted drugs. Canadian healthcare practitioners can now request access to psychedelic medicines such as MDMA and psilocybin (familiarly known as “magic mushrooms”) to treat patients with serious or life-threatening conditions on a case-by-case basis.
To say this is a monumental shift is an understatement. The real question is, are Canadian doctors ready?
Last August, Rick Doblin and Jennifer Ouyang Altman penned an LA Times Op-Ed warning that the US medical establishment is woefully underprepared to guide patients as psychedelic therapies emerge. We need only look to the medical cannabis field to understand what happens when prescribers lack education and exposure — especially to medicines with decades of cultural baggage. In Canada, medical cannabis has been legally accessible to physicians since 2001, yet 20 years later a 2021 survey demonstrated that Canadian physicians do not understand how cannabis fits within their respective fields
As a pediatric, epilepsy specialist I have treated hundreds of patients with medical cannabis, and I encounter this unfortunate consequence almost daily. Despite several positive research trials in the treatment of childhood epilepsy, I am still meeting parents who describe being dismissed by physicians and feeling judged for even considering cannabis to treat their child’s intractable seizures. It’s heartbreaking and I worry that we may be setting ourselves up to head down this same path with psychedelics.
Modern trials in adults are showing psychedelics to be safe with proper oversight, non-addictive and superior to our current treatments in tackling complex mental health conditions like treatment-resistant PTSD and depression. This work has captured the attention of major research centres worldwide, including $5m granted to the University Hospital Network in Toronto, Canada, this past year. The current research landscape is evolving and vigorous, and it has been dubbed the “psychedelic renaissance.”
But, as this renaissance gains steam, how does it fit into other areas of medicine?
This is a question doctors will inevitably have to tackle because it is not only the patient sitting in the psychiatrist’s chair who will be asking about psychedelics. Mental health issues extend into every field from neurology to gastroenterology and beyond and can be quite difficult to tease apart. Due to the long reach of mental illness, it’s critical that doctors understand how psychedelics integrate into their respective arenas to help these individuals. Otherwise, we will end up in the familiar territory of cannabis medicine with patients who have a significantly greater understanding of these compounds than their physicians because physicians have been left untrained.
The absence of a psychedelic medical education infrastructure, coupled with decades of stigma, will generate future disparate doctor-patient encounters where patients will feel anxious and physicians, naturally, will behave defensively. Ultimately, this type of cycle reinforces physicians’ skepticism and leaves patients out in the cold.
With the 5 January Special Access Program amendment, there is an opportunity for Canadian healthcare practitioners to be global leaders in psychedelic education by creating clinical champions who understand psychedelics within their respective areas of medicine and open this “door of perception” for specialists worldwide.
More than that, we have a duty to do better as a profession for ourselves and our patients by establishing how psychedelics integrate into all fields of medicine, so there is a top-down understanding of these compounds to complement the bottom-up, wide-base of knowledge that comes from our patients and families.
Not only can psychedelics potentially impact the health of people throughout the world more significantly than cannabis or any other novel therapy that has emerged in decades, but the therapies have been established, the evidence is robust and they are here to stay.
It’s time for us doctors to roll up our sleeves and get to work.
Dr Evan Cole Lewis is director of the Neurology Centre of Toronto and vice president of Psychedelic Neurology at Numinus.
REFERENCES:
- Special Access Program: https://www.canada.ca/en/health-canada/services/drugs-health-products/special-access/drugs/guidance.html
- CMAJ Survey of Ontario Physicians on Cannabis: https://www.cmajopen.ca/content/cmajo/9/2/E342.full.pdf
- LA Time Op-Ed: https://www.latimes.com/opinion/story/2021-08-29/op-ed-psychedelic-treatments-are-here-but-doctors-arent-prepared
- Cannabis Trials Review: https://journals.lww.com/clinicalneurophys/Abstract/2020/01000/Cannabis_for_Pediatric_Epilepsy.2.aspx
- Saskatchewan Psychedelic Research: https://www.thecanadianencyclopedia.ca/en/article/psychedelic-research-in-1950s-saskatchewan
- UHN Grant Press Release: https://www.uhn.ca/corporate/News/Pages/First_of_its_kind_research_centre_will_bring_psychedelic_psychotherapy_to_UHN.aspx
- Phase 3 MDMA Trial for PTSD: https://pubmed.ncbi.nlm.nih.gov/33972795/
- Phase 2b Psilocybin Trial for Depression (COMPASS): https://ir.compasspathways.com/news-releases/news-release-details/compass-pathways-announces-positive-topline-results
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