Psychedelic therapy: A Roadmap for Wider Acceptance and Utilization

Abstract: Psychedelics have shown great promise in treating mental-health conditions, but their use is severely limited by legal obstacles, which could be overcome.

The COVID-19 pandemic has exacerbated a national mental-health crisis in the United States. For two decades, drug-overdose deaths have risen exponentially, and suicide rates have steadily increased. These trends reflect deep-seated problems with the healthcare system, including low investment in preventative mental healthcare and a lack of innovation in psychiatry. In search of more effective treatments, clinicians are exploring the therapeutic use of psychedelic compounds, a promising avenue for addressing the mental-health crisis. However, there are social and legal obstacles to making psychedelics a viable treatment option.

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Psychedelics are a class of natural and synthetic compounds that includes psilocybin, MDMA (3,4-methylenedioxymethamphetamine), ibogaine and DMT (dimethyltryptamine). Some psychedelics have been used by Indigenous communities for hundreds or thousands of years. Others were first synthesized in the early 20th century. By the middle of the 20th century, clinicians used psychedelics as adjuncts to psychotherapy, reporting a variety of benefits. However, in the 1970s they were categorized as schedule I controlled substances, which are said to have “no currently accepted medical use and a high potential for abuse”; this blocked mainstream research on these compounds for decades.

In the late 1990s, the US Drug Enforcement Administration (DEA) permitted some researchers to study limited amounts of psychedelics, which allowed research to resume. Clinical trials have now been conducted at leading universities, and a growing body of evidence supports the use of psychedelics, such as psilocybin and MDMA, in the treatment of depression, post-traumatic stress disorder and anxiety toward the end of life.

The schedule I status of most psychedelics imposes a ceiling on many policy recommendations. The evidence in support of rescheduling is strong, particularly for psilocybin, which is derived from fungi. Unlike other schedule I substances such as heroin, and schedule II compounds, including cocaine and fentanyl, psilocybin exhibits a low risk of toxicity and a very low potential for dependence or addiction. Psilocybin use is not criminalized in several countries, including Portugal and the Netherlands, and a study commissioned by the Dutch Ministry of Health found that over-the-counter sales posed minimal risk to individual people and the public.

Acknowledging its therapeutic benefits, the Canadian government made psilocybin available to people with life-threatening illness through compassionate-use regulation. On the basis of clinical-trial data, the US Food and Drug Administration (FDA) designated psilocybin a breakthrough therapy for major depressive disorder and treatment-resistant depression....[Full Article]