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As a group of terminally ill patients in Canada awaits word from the minister of health on whether they can legally access psychedelic mushrooms for end-of-life care, their team of clinicians has tacked on an additional request: The therapists want to be able to dose themselves, too.

The group behind the request, Victoria, B.C.–based TheraPsil, a nonprofit that aims to expand access to psilocybin-based psychotherapy in Canada, says the additional step of providing safe access for therapists will ensure they gain firsthand experience into the psilocybin’s effects and its applications to psychotherapy.

“The fundamental reason to expose therapists to their own experiences with psychedelics is that, unless you have visited these realms, you are unlikely to understand their importance.”

“Part of ensuring a very high-quality psychedelic treatment for patients is to ensure high-quality training for therapists,” Spencer Hawkswell, TheraPsil’s executive director, told Marijuana Moment in an interview. “It’s greatly beneficial if therapists have had psychedelic therapy themselves.”

Few people, he offered by analogy, “would advise going to a sex therapist who’s never had sex before.”

TheraPsil, founded by clinical psychologist and psychotherapist Bruce Tobin, has been fighting for expanded access to psilocybin end-of-life care for years. In 2017, the group first filed a petition to exempt patients with certain terminal conditions from Canada’s ban on psilocybin. It was reportedly the first time a therapist had asked the Canadian government for such an exemption.

It wasn’t until this past January that TheraPsil finally heard back, Hawkswell said. “After three years of back-and-forth, they got back to us and said, ‘We’re going to be rejecting this application.’” The agency said there was no obvious medical necessity for the psychedelics.

TheraPsil was undaunted. “They say there’s no necessity,” Hawkswell said. “Maybe it’s because they haven’t met that person yet.”

In April, the group helped four more people with terminal illnesses file petitions with Health Canada and Health Minister Patty Hajdu seeking exemptions that will allow them to access psilocybin. In an interview with Marijuana Moment, Hawkswell said patients had gone months so far without a word from Hajdu, who with a stroke of a pen could allow the patients to access the drug.

“What we are working on right now is ramping up our messaging,” Hawkswell said. “We are going to try everything we can to get to the minister to make sure she sees these patients and responds to them.”

Dear @PattyHajdu, today marks the 75th day that palliative Canadians have been waiting on a reply from YOU re: their section 56 exemptions for compassionate access to #psilocybin. In the words of Dr. Bruce Tobin, TheraPsil’s founder: “Please, do not make them wait any longer” pic.twitter.com/JRITGwtcMR

— TheraPsil (@TheraPsil) July 6, 2020

Efforts to allow TheraPsil’s clinicians to use psilocybin themselves are more recent. Dr. Sean O’Sullivan, an emergency room physician and psychotherapist who serves on TheraPsil’s board of directors, said the exemptions are necessary so that therapists can be better trained and more familiar with how psychedelics work in a therapeutic setting.

“The fundamental reason to expose therapists to their own experiences with psychedelics is that, unless you have visited these realms, you are unlikely to understand their importance,” O’Sullivan told Marijuana Moment. “The point is to allow therapists to understand the field they’re plowing in.”

Therapists need to be alert and able to recognize how psychedelic experiences manifest themselves in therapy, O’Sullivan said. Patients might bring up material having to do with their own birth, a traumatic experience or interactions with otherworldly beings. “If you’re not attuned to this possibility, not aware of this possibility, then it’s just going to slide by you,” he said. 

“It’s a bit like describing Beethoven’s Fifth,” O’Sullivan added. “You can describe it all you like, but at some point you have to play the music.”

As psychedelic therapy is more widely sought by patients, O’Sullivan said, demand for qualified therapists is likely to go up. “We are expecting that as we get more permission for patients to access psilocybin at the end of life,” he said, “that there will be an increase in demand for therapists that have had that psychedelic experience.”

Public opinion in Canada generally supports allowing access to psilocybin therapy for the terminally ill, TheraPsil says. A poll released by the group last month found that 59 percent of Canadians support legal access. Including respondents who said they were “ambivalent,” TheraPsil said, acceptance increased to 78 percent.

“What’s unreasonable is the political decision” to deny patients access to psilocybin, Hawkswell argued. “It’s not a scientific one, it’s not a democratic one. It’s political.”

Patients facing their imminent death often experience feelings and fears that psychedelics can help to ease, he said. Among them are demoralization, anxiety and depression. Existing treatment includes pharmaceuticals, talk therapy and occasionally inpatient treatment.

Psychedelics play a role in treatment by inducing what Hawkswell and others refer to as a “mystical experience”—a collection of psychoactive and sometimes spiritual events that accompany a psychedelic journey. The experience can reorient a person’s way of thinking, dissolving barriers between an individual and the world around them. For end-of-life patients, he explained, it can help them embrace that death “is natural—just as natural as being born.”

Practitioners note that psychedelic therapy doesn’t work the same way as many other pharmaceutical drugs, such as antidepressants or even medical marijuana. Patients usually take those substances under their own supervision and allow them to work in the background. With therapeutic use of psilocybin and other psychedelics, patients typically take the drug and undergo guided psychotherapy. Psychedelics’ unusual, sometimes disorienting effects are believed to allow patients to better approach and engage obstacles, then emerge with a fresh perspective.

Another psychedelic therapy group, Field Trip, which uses ketamine in therapy, describes the treatment on their website as a way “to press reset on your mental health.”

The emerging promise of psychedelics in recent years have caught the attention of academics, public policy reformers and even the U.S. government. Last month, the University of North Carolina (UNC) announced a $27 million project funded by the department of defense to research and develop psychedelics-inspired drugs.

That project’s researchers seem to believe they can separate psychedelics from what they describe as “disorienting” side effects, despite what Hawkswell and others say about the importance of a “mystical experience.”

“Although drugs like ketamine and potentially psilocybin have rapid antidepressant actions, their hallucinogenic, addictive, and disorienting side effects make their clinical use limited,” said Bryan L. Roth, a professor of pharmacology at UNC School of Medicine and the research team’s leader. The government partnership, UNC said, “aims to create new medications to effectively and rapidly treat depression, anxiety, and substance abuse without major side effects.”

In September of last year, Johns Hopkins University announced the launch of the nation’s first-ever psychedelic research center, a $17-million project to study the use of psychedelics to treat conditions such as opioid use disorder, Alzheimer’s disease, depression, anxiety and post-traumatic stress disorder.

Meanwhile, activists in the United States have advocated for state- and local-level reforms to research, decriminalize and in some cases even legalize psychedelics themselves.

At the municipal level, Denver became the first U.S. city to enact such a reform, with voters in May 2019 approving a measure to effectively decriminalize possession of psilocybin mushrooms. Soon after, officials in Oakland, California, decriminalized possession of all plant- and fungi-based psychedelics. In January of this year, Oakland activists unveiled plans to allow go further and legalize the commercial sale of natural entheogenic substances. That same month in nearby Santa Cruz, the City Council effectively decriminalized psychedelics by voting to make the enforcement of laws against them among the city’s lowest enforcement priorities.

Reformers are now pushing for similar changes in other jurisdictions. In Washington, D.C. this month, Decriminalize Nature D.C. submitted signatures to qualify a measure for November’s ballot that would decriminalize all natural psychedelic drugs, including psilocybin, ayahuasca and ibogaine.

Other reform efforts are ongoing in Oregon, where voters later this year will decide whether to legalize psilocybin therapy—the very therapy TheraPsil’s patients are pushing Canadian Health Minister Hajdu to allow. Oregon voters will also see a separate measure to decriminalize the possession of all drugs and expand access to treatment for problem use on their November ballot.

Lawmakers in Hawaii earlier this year approved a plan to study psilocybin mushrooms’ medical applications with the goal of eventually legalizing access.

In Canada, for now, psilocybin remains illegal. Hawkswell of TheraPsil, however, believes a constellation of other national policies—including medical marijuana, safe injection sites, and physician-assisted dying—support extending psilocybin access to patients in palliative care. And Canada already permits certain religious groups to use ayahuasca as religious sacrament, Hawkswell noted.

“At this point psilocybin is a reasonable medical choice for these individuals,” he told Marijuana Moment. “This is about the minister being compassionate and using her ministerial abilities to help give patients access to something that’s going to help them.”

Patients waiting to hear back from Hajdu’s office, he said, don’t have time to wait for lengthy, bureaucratic processes. “We’re not just going to keep waiting,” he told Marijuana Moment. “We do have a legal team prepared, but that’s all I’ll say.”

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Photo courtesy of Wikimedia/Workman