Are legal psychedelic drugs inevitable?

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Jordan Heath Rawlings I haven’t tried it, yet, but there is a store, a couple of blocks away from me, that will sell me shrooms, not the shiitake kind. It is a psilocybin dispensary. It’s been around a couple of months now. It hasn’t been touched by the cops. And it is not hiding it either. There are giant neon purple mushrooms lit up in its blackened windows. It is amazing how quickly things change when it comes to drugs, and especially right now when it comes to psychedelics.

But then again, as we will learn today, some things never change. The past few years have been a whirlwind of breakthrough research into medical application of the drugs once linked to hippies and bad trips and raves. MDMA and psilocybin have been given special status by the American FDA, and there are various levels of access, either approved or coming soon here in Canada.

Most of the research and access centres around mental health, specifically PTSD, and severe depression. But if the saga that ended with legal recreational marijuana has taught us one thing, it’s that every door that gets opened to crack when it comes to drugs tends to eventually end up blown off its hinges. So here comes the psychedelic renaissance, and it has been brewing literally for decades.

I am Jordan Heath Rawlings. This is The Big Story. Erika Dyck is a historian and a professor. They’re the Canada Research Chair in the history of health and social justice. Erika, how are you?

Erika Dyck I’m great, thanks.

Jordan Heath Rawlings I know that we could spend, because we have spent, and people who are interested in the long history of psychedelics in Canada can go back and listen to our previous episode that we recorded together. But I do want to briefly touch on the history of psychedelics in this country because it’s so relevant to what’s going on today. So maybe just start when did psychedelics gain the awareness of scientists and researchers in Canada? What happened?

Erika Dyck Yeah, you know Canadian researchers were interested in psychedelics in the early 1950s, and probably Canadians in a larger sense gained access to this. When there was a Macleans magazine article published in 1953 and it introduced this kind of colourful world of hallucinogenic medicines that were being experimented on in Canada. And so Canadians have been involved in this for quite a long time.

Jordan Heath Rawlings And what is the history of using these drugs, for you know, for research or for issues like mental health, and trying to treat them as medicine. Because this is what’s happening now, it’s not the first time this has happened, I guess.

Erika Dyck Absolutely. I mean, I think there still is some stigma and cultural characterization of psychedelics as these recreational drugs or substances or experiences that people have reached out for to enhance the listening at a Grateful Dead concert, for example. But there’s this earlier period of medical experimentation, really through the 1950s and some of which took place in Canada and of course all around the world, where psychiatrists were really keen to search for different kinds of ways of treating persistent disorders, major disorders, we might think of them today with language like major depression, post-traumatic stress disorder, addictions, and even some of the vocabulary was a bit different in the past.

But nonetheless, these persistent and hard to treat mental disorders were the object of study by a number of psychiatrists and psycho pharmacologists and some of them started looking at psychedelics as a way of sort of seeing outside of the regular paradigms that were available to them in psychiatric medicine at the time. And even to the extent that researchers and trainees were taking psychedelics themselves in an effort to appreciate what it was like to experience psychosis or what it was like to experience a hallucination, those kinds of, we might think of them as brave or some may now see them as unethical or really part of that earlier history.

Jordan Heath Rawlings How did it come full circle? And I guess the first part of that question is why didn’t that really continue? Was it just like the counterculture wave of the sixties? And they took on a different stigma and so they were ignored for research purposes for a while, or has it always been happening in the background?

Erika Dyck Yeah, I think it’s a little bit of both. You know, I think the counterculture, the sort of, hyperbolic expressions of people taking drugs in a recreational way certainly contributed to a backlash against psychedelic research. But there were also methodological problems. There were challenges that psychedelic researchers were really struggling to find a good way of measuring the efficacy of psychedelics.

How do you measure something where, some people see God, other people have a psychotherapeutic experience or a mystical one. And the language of medicine and the, methods available to pharmacologists were not really well suited for establishing meaning in psychedelic experiences. So I think those two things kind of work together to challenge the continuation of psychedelics.

Jordan Heath Rawlings How did that change, when did that start changing? I know we’re gonna talk in a couple minutes about, the last couple years and what’s coming now, but you know, you’ve referred to it and I’ve seen it referred elsewhere as psychedelic renaissance. When did that begin?

Erika Dyck The coining of the word psychedelic or the psychedelic renaissance, comes from a child psychiatrist in the UK named Ben Sessa, and he published this in 2012. But it really refers to a phenomenon that I think a lot of us have been studying and recognizing that has been kind of brewing for decades.

And you, I think you asked before whether you know this halt of the medical research. And some did go underground. And I think this is really a fascinating part of the resurgence, that there has been a longer legacy of psychedelic exploration, some of which ties us back to, you know, much, much bolder traditions of Indigenous uses, ceremonial uses often of psychedelics.

But also underground users in the rave scene, for example, or underground chemists who introduced new compounds into this area that weren’t criminalized. So they were technically legal, although some of them were later criminalized. But there’s a whole psychedelic underground that kind of flirts with the law in a variety of ways that has also been promoting, resurgence or reemergence of psychedelics in medicine. And I think those things are coming together now in a really interesting and, kind of, I don’t know there’s a real urgency to the sense that psychedelics are now gonna help us to improve our healthcare systems in dramatic ways.

Jordan Heath Rawlings And it seemed, to come out of nowhere, at least in terms of that urgency to I don’t know if legitimize is the right word. Maybe it is. But in terms of like practical applications, towards especially mental health. I can’t count the number of research pieces or even just feature stories or documentaries I’ve seen in the last, what, five, seven years that seem to show that these treatments work?

Erika Dyck It’s really been dizzying. I started working on this kind of history in the early two thousands. And, the conversations were even kind of hushed at times, even of the contemporary scene. But now it’s really hard to keep up with the pace of research coming out and the media coverage of this. So whether it’s celebrity testimonials or breakthrough therapy designation, which we’ve seen now with MDMA and psilocybin mushrooms for PTSD and major depression. These are really big changes on this landscape that are adding to the momentum of psychedelic science and medicine. And like you say, it’s almost daily, we see changes both on the medical side but also on the regulation side.

Jordan Heath Rawlings You mentioned a couple of breakthroughs there, I know we can’t go through all of them, but maybe if you could just explain the breakthroughs in psilocybin for PTSD or any of the other drugs.

Erika Dyck Yeah, so both psilocybin and MDMA have been granted breakthrough status by the American Food and Drug Administration for their treatment of PTSD and major depression, respectively. And what it means to get breakthrough status is that, you know, based on, trials, so phase three clinical trials now, they find that these medicines, then this is in combination with psychotherapy, so this approach is better than anything that is currently available, sort of in the the marketplace or in the healthcare landscape. Those are very significant designations to now associate with drugs that have been criminalized and prohibited for, in some cases, almost 70 years. This is also changing, I think you’re putting pressure on researchers in the psychedelic community to identify some of those significantly better opportunities for other psychedelic drugs. But also to kind of compare that with some of the other standards like pharmaceuticals that are available. And I think part of this is just the tip of the iceberg in terms of maybe changing the way we think about the relationship between psycho pharmacology and mental health treatments.

Jordan Heath Rawlings What is Health Canada specifically, doing towards this right now? Can you tell us? I gather there’s some trials going on in Alberta.

Erika Dyck There are a few trials across Canada and that number is increasing, regularly. Health Canada has been doing, has of course been watching the space very closely and I think paying attention to both the trials. But also individual patient requests and individual psychiatrists requests for access to psychedelic medicines. Where we’ve seen the most movement in Canada, on the individual level, is in areas of palliative care or end of life anxiety associated with a palliative diagnosis. And I think that really dovetails or brings together different priorities in the Canadian health landscape. Right now we see conversations around medical assistance in dying or you know, the MAID policy. We see this focus on dying care, another area of the Canadian innovation, you know. Palliative care is a concept that was coined in Canada. Although, people have been dying in humane ways and other parts of the world of course, for a long time. It’s not a, a new thing. The Canadians are kind of proud of this and so bringing together elements of dying care and psychedelic care, I think seems appropriate. But Health Canada has started to move away from that particular focal area and look at trials now on a wider basis. So looking at some of the addictions research that we’re seeing in the United States, in particular, and looking at major depression, PTSD. And I think we’re maybe a little bit slower by comparison with the United States in terms of developing those trials. But as I say, I think Health Canada is very keenly aware of what’s going on in these other parts of the world and is starting to make room for broader based trials.

Jordan Heath Rawlings When you talk about breakthrough status for MDMA and for psilocybin, you also mentioned that Canadians and their doctors are starting to ask for permission to get these drugs. Is that possible in Canada? Like what’s actually the process right now if you have PTSD or severe depression and you’re reading these studies that come out daily, saying, you know, hey I think this could help me, or your doctor thinks it might help you.

Erika Dyck I think there are a few different routes, some of which are more legal than others. But I’ll start with the legal ones. For Health Canada, as I understand it, and I’m not a policy expert, I’m a historian looking at this, but as I understand it, there are at least two different routes that are open to a variety of things that are not specific to psychedelics whatsoever. Patients or, you know, individuals can apply for access through a section 56 exemption. And that’s where we saw the first, just under 200 cases I believe, of applicants to Health Canada. So this is an individual case by case, it’s not through doctor’s permission. It’s, you know, people like Thomas Hardell, who’s been featured a lot in the news media and is my friend here in Saskatoon who was granted access to psilocybin for his end of life anxiety. Now that doesn’t guarantee that he has access to a safe supply or that he has access to a therapist, but it does work on an individual basis.

But I think as word got out and as the studies are mounting, more and more people were applying for that, and it was no longer feasible for Health Canada to keep doing this on a one-to-one case by case basis. They’ve also allowed for some exemptions with a special access program, now physicians can apply for access to the special access program. Now, the liability under those circumstances lie with the physician to determine the safety and efficacy of any particular treatment that may not be otherwise sort of widely available. And psychedelics certainly fit into that category. So there, we’ve seen physicians or trials being granted access to psychedelics through a different application process, still under the ages of Health Canada. What we hear in the news these days, I haven’t spoken to Health Canada representatives to confirm this, but that there are backlogs on both of these processes. And so I think there’s some kind of ongoing frustration, and this is where we’ll get into the kind of quasi-legal aspect. We know that there are places in Canada that are turning a blind eye to access to some psychedelics.

Now, these are municipal laws in Vancouver, for example, where we’ve seen the most action here. But I believe Toronto may be in the same category, and there could be other places as well where you might be able to buy your own psilocybin. And some clinics are offering integration sessions. So this is a kind of gray area now, policy-wise, in that you or I might be able to find a legal supply of mushrooms, take it on our own, and then go and visit a sympathetic psychiatrist who doesn’t necessarily give us psilocybin mushrooms, but talks to us about our experience. And I think as access is restricted, where we may see more and more of that happening, which kind of creates, I think, both some policy and I think some, some safety issues that we need to be mindful of.

Jordan Heath Rawlings That’s what I was gonna get into next, which is, you know, as this becomes more widely available, or as you know, more doctors are able to access it, once we clear a backlog, are we heading for? And listen, I’m old enough to remember when we first launched medicinal marijuana in this country and, you know, people would go get prescriptions, kind of by any means possible, and get access to this stuff. And, it wasn’t always clear whether it was for real medicinal reasons or just because they had a sympathetic doctor. And you know, when you’re not all the way in on legalizing this or making access easy, how do you monitor who gets it in for what?

Erika Dyck I think this is a perennial issue, and again, not exclusive to psychedelics, but we’ve seen this play out in the past. That supplies are notoriously difficult to control and what counts as medicinal or health is really challenging to determine. I mean, if I feel better, if I take psychedelics and listen to music by myself. We probably don’t assume that that’s a health issue or that I’m doing it under sort of a prescription basis. But there are about 70 years and much longer of course, of people doing this on their own and developing strategies for staying safe, for taking care of each other. And I think some of that momentum is also beginning to push us to, to think more broadly about what counts as a safe environment or a healthy space, how we should use these. Those are big existential questions almost, or big kind of historical questions that I don’t think we’ve really reconciled with in this current regulatory landscape where there’s a tension, I think, about the urgency with which we want to make psychedelics available for healing environments. But we don’t, I think, have a clear sense of how those supplies will be controlled and how people will take them on their own.

Jordan Heath Rawlings I could tell you that right now I can leave my house and walk down to Queen Street and walk into a place called Shrooms with a Z, and I have not purchased any, but you can buy psilocybin there. It’s a dispensary, just like those old pot dispensaries, before weed was legal, used to pop up. Nobody’s doing anything about it. It’s been open for months. How do I know that stuff is safe?

Erika Dyck It’s a very good question, and I think, you know, the same thing is happening in Vancouver. There are, you know, open advocates of developing mushroom dispensaries and, you know, small possessions. So long as you’re not selling large amounts or you’re not profiting off it in a large way seem to be handled in this kind of, quiet way. That doesn’t necessarily ensure that consumers have any confidence that those are good supplies. It’s maybe a better supply than when you buy in a less open environment. But I think this is a real gray zone, and I think it’s something that, we have to see more attention in this area, if psychedelics are going to sort of successfully make that move from a total underground black market space to something that might be integrated, whether even exclusively in medicine or not. Because I think, like you’ve alluded to, even if these only become something available to people after they get a prescription from a psychiatrist, let’s say, I think people may still find ways of taking them themselves

Jordan Heath Rawlings When it’s happening this quickly, how the heck can law makers get a handle on it? You know, like if you had told me last year that subway restaurant that closed down is gonna be selling mushrooms, next year, you know, my head would’ve spun. I’m sure that looking at this stuff every day, policy makers have to ask like, how do we control this before it gets outta hand?

Erika Dyck I think you’re absolutely right. I’m baffled. I have to say after working on this for over 20 years. The pace of change over the last two years has gone so rapidly. It seems slow, slow, slow. And then it seemed like it was going fast and now it’s almost frenzied. And I think it is really challenging to find the right way of determining not only, you know, which policy makers or what kind of policies we need, but even what areas are affected by this. So is this a health issue, a justice issue? Is this a harm? And how do we think about harm reduction? All of these things require coordination across a variety of policy areas. And I think that also presents some challenges. Cause it’s not, there’s not a sort of one stop obvious place where this decision needs to be made. And we see jurisdictions taking different approaches, both at the municipal level, but now also at the provincial level where places like Alberta have decided to go, kind of go on their own, recommending that psychedelics may be used by psychiatrists there. Which has not been approved at a federal level and yet still fits within our federalist framework when we think of our healthcare system.

Jordan Heath Rawlings So what will you be watching for next? And I mean, my guess, my question about that is what does history tell you that we might see next? Is it just does, does history tell us that drugs always get to the people who wanna do ’em?

Erika Dyck I think prohibition history would tell us, has also probably caused more harms than good. Hiding, being secretive, you know, not knowing where our safe supplies are. All of those things contribute to greater harms when we think about a drug supply that, you know, if people are going to want them, they’re gonna find ways of getting them. So opening that up, we know has better health outcomes. Psychedelics are not considered addictive. So they fall into a different category than we might think of as the flow of fentanyl, right? Where we’re not looking at drug overdoses in the same way. But I do think it requires cool heads to come together and think about how we harmonize areas around harm reduction. And I include in that safe supply, but also how to ensure that people are taking these with knowledge and safety. All of these kinds of harm reduction principles that have been developed over decades. That’s gonna be a difficult conversation to change or update our language to when should children take psychedelics or should children ever take psychedelics? And I think the, the conventional wisdom, it would still be no, but how do you determine the appropriate age? And I know we’ve had these conversations with cannabis as well. I think there’s still a lot of work that needs to be done in the background here.

Jordan Heath Rawlings Erika, thank you so much for this. It’s such a fascinating perspective.

Erika Dyck Thanks so much for having me. It’s fun to talk about. Erika Dyck, historian and professor, University of Saskatchewan. That was The Big Story. For more, you can head to thebigstorypodcast.ca. You can find previous episodes, including one I mentioned with Erika examining the entire history of psychedelics in the fifties and sixties, including the mental hospital that she mentioned. You can also follow this show on Twitter @thebigstoryfpn, you can email us hello@thebigstorypodcast.ca. Or you can call us and you can call us 416-935-5935. The Big Story is available wherever you get podcasts and of course, on a smart speaker if you ask it to play The Big Story podcast. Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.