Original Toronto Star Post by Omar Mosleh
Thomas Hartle is a 52-year-old IT technician from Saskatoon who doesn’t smoke, rarely drinks and never dabbled in drugs before trying medicinal cannabis. As part of his profession, the soft-spoken, detail-oriented father of two typically spends much of his time planning and researching.
But these days his preparations have taken a devastating turn — planning for his family’s future as he awaits his imminent death.
Hartle was diagnosed in April 2016 with stage-four colon cancer. It went into remission, but last year he learned it was back, had spread and will ultimately kill him. What followed were crippling panic attacks triggered by worries for his family and the uncertainty of not knowing which day could be his last.
“What caused the anxiety for me was the fact my cancer is completely invisible to every test they do. So I literally have no idea the extent or severity of my cancer right now … and neither do the doctors.”
But now Hartle is no longer spending his life worrying about death. He has come to terms with the concept of dying thanks to an unconventional treatment: Psychedelic-assisted psychotherapy.
Hartle was one of the first four Canadians approved by the federal government in August to use psilocybin, the active ingredient in magic mushrooms, for end-of-life anxiety treatment. He is one of the first known patients in Canada to be granted permission to use the drug for non-research purposes since it was criminalized in 1974.
The federal government says since August it has granted 11 exemptions for patients to use psilocybin and expects to make a decision soon on therapist use.
Researchers say the government’s recent decision to allow terminally ill Canadians to use psilocybin is an example of the psychedelic sphere opening up, leading some to say the class of drugs, also known as hallucinogens, is having its moment in the mainstream.
And amid the growing buzz around psychedelics, there’s been an exponential explosion in research into LSD, psilocybin, MDMA and ketamine to treat conditions such as depression, post-traumatic stress disorder (PTSD), anxiety and substance-use disorder. This comes at a time when Canadians are experiencing more mental health challenges due to the COVID-19 pandemic.
In the 1950s and ‘60s, there was a wealth of research into the efficacy of psychedelics in treating mental health conditions and to better understand psychosis and hallucinations in patients with schizophrenia. But the counterculture of the 1960s led to the class of drugs being demonized and criminalized. Most research into their potential has since stalled.
Advocates of psychedelic-assisted therapy emphasize that the drugs themselves are just one part of the treatment and must be used within a therapeutic context under the supervision of a trained professional to be effective. Psychedelic drugs are not for everyone, they say, and could be destabilizing or detrimental for certain people.
For some, however, there is evidence psychedelic drugs can be useful in psychiatry. Despite this, the medical establishment and governments have been apprehensive about embracing psychedelics for psychotherapy. And because the drugs are still illegal in most of the world, research and treatment are difficult or prohibited.
For Hartle, much of his anxiety revolved around his family. His children, 19 and 21, are both on the autism spectrum. Since he learned his cancer is terminal, he’s been consumed by thoughts of how his family will cope without him.
“They have some challenges regular kids don’t have. And as a result, you kind of have to plan a little more extensively. For me, unfortunately, those plans have a limited calendar,” Hartle said from his home in Saskatoon.
Since his first psychedelic therapy session in August, Hartle said his anxiety levels are “markedly lower.”
During the session, he sat in bed blindfolded and listened to music under the supervision of a therapist. He described the experience as calming and serene and said experiencing different states of consciousness helped him accept “this isn’t all there is.”
He said the session largely eliminated the constant negative chatter in his head and made him feel he can actually live in the moment.
“Just imagine you’re out at a nice supper with your family, your family’s having fun, but the only thing in your head is worrying about what’s going to happen next. Now … I’m actually there.”
It was Hartle’s dedication to meticulous research that led to him finding TheraPsil, an organization that has been lobbying the federal government to allow psilocybin to be used by palliative-care patients and therapists to treat end-of-life anxiety. He decided it was worth trying, after finding relief from chemotherapy side effects with medicinal cannabis.
The federal government is now considering granting an exemption so therapists can also use psilocybin for training purposes. TheraPsil’s CEO Spencer Hawkwell said they’ve been told a decision is coming soon.
There are indications big pharma wants a piece of the psychedelic pie. Meanwhile, industry is taking notice.
On Oct. 22, Numinus Wellness Inc., a Vancouver-based company researching and developing psychedelics for psychotherapy, announced it has completed the first legal harvest of magic mushrooms by a public company in Canada. It is the first publicly traded company to be granted a licence by Health Canada to conduct research into extracting psilocybin from mushrooms for research purposes.
Earlier this year in Toronto, Field Trip Health opened what has been called the “first psychedelic-enhanced psychotherapy centre in Canada,” using ketamine, an anesthetic and psychedelic that can provide out-of-body experiences, to treat depression as well as PTSD.
Toronto’s Mind Medicine Inc. is studying the use of LSD (lysergic acid diethylamide) to treat anxiety and as well as the effectiveness of microdoses of LSD in treating adult attention deficit hyperactivity disorder.
In the upcoming U.S. election, psychedelics are on the ballot in two jurisdictions. In the District of Columbia, a piece of legislation proposes making plant-based psychedelics such as psilocybin the lowest enforcement priority for law authorities. A measure in Oregon would go even further, creating a regulated industry for psilocybin therapy.
That’s exactly what Bruce Tobin, the therapist who was present for Hartle’s psilocybin session, is hoping to see in Canada. Tobin is the founder of TheraPsil, the organization that lobbied the government to approve the psilocybin exemption, and a psychotherapist for 40 years.
He said the government’s approval is historic and among the first examples of medical use of psilocybin being approved in North America for close to 60 years.
“I see psychedelics as a potential game changer. And we’re gonna look back on clinical psychotherapy and psychiatry in another 50 years and it’s going to seem like it’s in the dark ages,” Tobin said.
It is believed psychedelics have the potential to address mental health issues because they can unlock parts of our brain that have been buried deep into our subconscious, Tobin said.
He said psilocybin, combined with psychotherapy, can help patients with terminal cancer face “negative emotional material” and come to peace with the concept of death.
John Vervaeke, a cognitive scientist at the University of Toronto, said psychedelic drugs can “break the frame” that cage us to conditions such as depression. Think of it as a mental, spiritual and emotional reset.
“That’s what psychedelics largely do — they throw noises at the system2 that help you break up your normal framing,” he said. “They shut off a lot of the standard state of self and consciousness.”
He said the need to look at the potential of psychedelics to treat mental health conditions is even more pressing in the age of COVID-19.
“You know what COVID did? It made people feel like they were losing their homes, losing their connections. And at the same time, it put them in this weird almost mythological place where there was this ubiquitous invisible threat out there … and that really spins people out in a powerful way,” Vervaeke said.
Psychiatry is a discipline where lobotomies and shock therapy were once deemed reasonable methods of treating mental illness. But even today, most treatments come with a tradeoff, Tobin said.
Antidepressants most commonly come in the form of selective serotonin reuptake inhibitors, which work for some people, but not everyone. They also come with side effects such as sexual dysfunction, weight gain and loss of personality.
Benzodiazepines, the traditional treatment for anxiety, can cause severe dependency from long-term use.
Tobin said his greatest regret from his 40 years as a therapist is there were too many people he couldn’t help with traditional treatments.
“Depression, anxiety, PTSD, addictions — we don’t have very effective treatments for any of those,” Tobin said.
In some cases, the treatments caused more harm than good.
“I saw people get numbed out by them, I saw people that had tried for years to get off them and couldn’t, and years later are still experiencing really disturbing sensations like electrical currents going through their bodies when they would try and stop,” Tobin said. “It was a horror show.”
Cannabis legalization is certainly helping to pave the way for the acceptance of psychedelics as medicine. Just ask Tony Clement, a former Conservative federal cabinet minister who served as minister of health and voted against cannabis legalization.
Clement, who quit politics after a sexting scandal, recently became an adviser for a Netherlands-based company marketing microdoses of psilocybin. He told the Star he voted against cannabis legalization because he didn’t believe the government’s plan had enough protections in place for children and acknowledges some have accused him of hypocrisy.
But when it comes to psychedelics (which he said he hasn’t tried), he said he’s being swayed by a growing body of research that show psychedelics, in certain contexts, can improve mental wellness.
“If there’s a body of evidence that indicates something, when used properly, can help people, I think we’ve got an obligation to dig deeper,” Clement said.
“It was of interest to me that I could be part of something where I could help people deal with their demons.”
Helping people deal with their demons is a big part of what Anne Wagner, a psychologist and adjunct professor in the department of psychology at Ryerson University, aims to do with MDMA. Since 2014, Wagner has been researching using the drug, also known as ecstasy, for treating PTSD.
From military personnel and first responders to people who have experienced trauma such as childhood abuse, Wagner said MDMA has the potential to “untangle the knot that keeps people stuck” in negative emotions and experiences.
PTSD is often compared to a bad tape loop that plays over and over in someone’s head. One of its hallmarks is that instead of individuals facing difficult emotions and memories, they bury them, and subsequently have trouble accessing emotions in everyday life.
“With MDMA in a therapeutic context, you’re able to sit with the difficult emotions and memories as they come up and not turn away from them … You’re able to actually experience feelings like love and connection and empathy towards others,” she said.
These experiences have led to a renewed sense of purpose and quality of life for patients Wagner has worked with.
The potential of psychedelics to treat mental health is poorly understood because of prohibition and lack of research, said Mark Haden, an adjunct professor at the University of British Columbia and executive director of MAPS Canada (Multidisciplinary Association for Psychedelic Studies).
Haden was a clinical supervisor in addiction services for 30 years with Vancouver Coastal Health.
“I was aware that we actually weren’t very effective in helping people who came to our program. And I became insistent that psychedelic healing was probably the best thing we can do for people with addictions concerns,” Haden said.
When his employer grew uncomfortable with him talking about using psychedelic drugs to treat addiction, he quit and started MAPS Canada. Years later, Vancouver Coastal Health would invite Haden back to speak about the potential of psychedelics for therapy.
There is evidence psychedelic-assisted psychotherapy is effective in addressing substance-use disorder, alcoholism and quitting smoking. More research is needed to fully understand why.
“Anything that anybody says is speculative,” Haden said. “My speculation is that it has something to do with (forming) new neural pathways.”
What is clear is that we know remarkably little about psychedelics, how they work and the doors they can unlock in psychotherapy, Haden said.
Haden expects MDMA will be legalized for prescription use in a therapeutic context by 2022, followed by psilocybin for end-of-life anxiety. He said much of the recent research and attention has been focused on psilocybin because it doesn’t have the same stigma attached to it as LSD.
“But if you think about during the ‘50s and ‘60s all the researchers had access to both psilocybin and LSD and they tended to prefer LSD, which I find absolutely fascinating,” Haden said. “I personally think it’s time to bring LSD back.”
Haden envisions a world where people can get a prescription for psychedelics, to be used under the guidance of a “psychedelic supervisor,” a sort of modern-day shaman.
He is wary of the commercialization of psychedelics.
“Psychedelics within the context of carefully-managed experiences are fabulous and healing and spiritual and meaningful. And outside of that context they can actually be quite harmful,” he said.
Bright Minds Biosciences is a company in Toronto that is altering psychedelic molecules to try to tailor them for psychotherapy. For example, they are creating a version of psilocybin that lasts for one hour instead of six to eight.
The company is looking at different molecules to treat impulse control, binge eating, obsessive compulsive disorder, PTSD, anxiety and more.
They’ve started the process of getting U.S. Food and Drug Administration approval, with plans to seek Canadian approvals after. The company’s founder, Ian McDonald, said it’s looking promising.
“We’re already seeing interest from big pharma companies,” he said. “We were surprised that they were coming this early.”
Haden is apprehensive of big pharma making inroads into psychedelics. Unlike being prescribed a medication for life, Haden said the patients he works with usually experience long-term benefits after only two or three sessions. For this reason, he said there’s no business model to support mass production and sale of psychedelics.
“Current medical approaches to mental illnesses are about symptom management and long-term control of symptoms. They’re not about healing,” Haden said.
More than two months after his first and only psychedelic therapy session, Hartle said he’s still experiencing enduring effects. His daily anxiety is nearly completely gone, although he said he’s considering another session because it’s starting to creep back. He said he feels more empathetic and connected to others. And it’s vastly improved the time he spends with his wife and children.
He hopes to see Health Canada allow the use of psilocybin for training purposes among therapists so the treatment can become more accessible to more Canadians.
In his words, his experience with psychedelics was “life changing.” Because he’s no longer afraid of what comes next.
“I’m not in a hurry. But I’m not afraid of it either.”