TORONTO (AFP) - To manage her stress and fears, Ms Andrea Bird - who is suffering from terminal cancer - uses psychedelics, which are seeing a sudden re-emergence in Canada as a possible treatment for mental health conditions such as anxiety and depression.
The 60-year-old Canadian was diagnosed with breast cancer in 2012. Despite aggressive treatment, the disease returned five years later, spreading to her lungs, bones and brain. As she tries to cope with her incurable ailment, Ms Bird uses psilocybin, the psychoactive substance of hallucinogenic mushrooms that was banned in the 1970s.
"I found it to be the most helpful thing that I did in coming to terms with the fact that my life is ending much sooner than I thought it would," Ms Bird told AFP. "I'm still dying," she said matter-of-factly, but added that psilocybin "makes me feel like I can stand up".
"I really love my life and I really don't want to die, but I have to find a way to surrender to what is actually happening." Ms Bird, who lives in Ontario province, is among about 30 Canadians, most of them struggling to face the end of their lives, who have received federal dispensation since August 2020 to use psilocybin for therapeutic purposes.
TheraPsil, a non-profit organisation based in British Columbia, has helped most of them get exemptions to Canada's controlled substances and drug Act for "compassionate treatment". The group also has connected patients to doctors and therapists who oversee their use of the drug. These trial cases come amid mounting interest from researchers and investors, as well as a public push to reconsider bans on psilocybin, LSD, DMT, mescaline and other mind-altering substances such as MDMA, commonly known as ecstasy. The US state of Oregon legalised psilocybin for therapeutic use last November.
'Revolution in psychiatry'
Psychedelics have been used by indigenous peoples for millennia, but Western researchers started delving into their properties and potential uses in earnest only in the middle of the last century. But that work came grinding to a halt when the substances quickly became symbols of the anti-establishment counter-culture movement of the 1960s and were banned.
Over the past 20 years, however, the persistence of some researchers, a mental health crisis and a shift in public opinion towards greater tolerance of drugs such as cannabis - which Canada legalised for recreational use in 2018 - paved the way for a psychedelics renaissance. "Now there are more people who are willing to just look at the facts rather than the political weight they may carry," explains Dr Rotem Petranker, associate director of the University of Toronto's Psychedelic Studies Research Programme, which looks at the effects of micro-dosing on mood and creativity.
Researchers are studying the potential benefits of these substances for treating depression, anxiety, post-traumatic stress disorder (PTSD), substance addictions and anorexia. The most advanced clinical trials are focused on using psilocybin for severe or treatment-resistant depression, and MDMA for PTSD. Some of the studies have yielded promising results. A recent clinical trial from Baltimore's Johns Hopkins University - which has just opened a research centre dedicated to psychedelics - showed that two doses of psilocybin, accompanied by psychotherapy, produced "large, rapid and sustained" effects in patients suffering from serious depression.
Of the 24 participants, 71 per cent showed a reduction of more than 50 per cent of their symptoms after four weeks and half went into remission, the study revealed. Another small-scale study involving 59 participants, conducted by Imperial College London's Centre for Psychedelic Research, showed psilocybin was "at least as effective" as conventional antidepressants, the research team said this week, though adding that larger trials were needed. "We're experiencing a revolution in psychiatry," Dr Alexandre Lehmann, a cognitive neuroscientist who teaches at McGill University in Montreal, told AFP. "There are new approaches to alleviating and curing serious and disabling mental health problems, which affect a large number of people, and for which there are currently no good solutions."
Since their discovery in the 1950s, drug treatments for depression have hardly changed at all. Conventional antidepressants - which notably target serotonin, a key hormone that regulates mood - have been criticised for being slow to act and for their side effects, including dulling emotions and reducing creativity. They also do not always work, explains Dr Nisha Ravindran, psychiatrist and professor at the University of Toronto.
"We know that standard antidepressants don't help a significant proportion of the population. In fact, more than 30 to 40 per cent simply don't respond and require alternatives," he said. For some patients, psychedelics could come to the rescue through a new model of therapy involving a limited number of doses providing a "transformative experience" that might address their core issues. Psychedelics can cause a profound alteration of perceptions and consciousness. The experience is unpredictable.
For some, it can seem otherworldly. Although much is still not known about how the drugs work, researchers believe they act on the brain's default mode network, associated with introspective thoughts and ruminations, by "temporarily lulling the ego", explains Dr Lehmann. Animal studies suggest they enhance brain plasticity, helping to re-organise neural connections, he says.
Learning to face death
Psychedelics have low toxicity and are generally not addictive, but they can cause paranoia and anxiety attacks, especially in high doses. Researchers are still unsure about the addictive nature of MDMA, a derivative of amphetamines. For therapy uses, doses are prepared in labs and the experience is supervised, so the "risks are limited", says Dr Lehmann. The substances make patients more sensitive to their emotions and allow them to examine their thoughts from a new perspective.
"Psychedelics are catalysts for psychotherapy," says Dr Lehmann. Before receiving government dispensation to use the drugs, Ms Bird had twice tried psychedelics on the sly, ingesting them at her home in the company of a "guide". She brewed and drank a hallucinogenic mushroom tea that led to several hours of "vivid" waking dreams. It took months of analysis to make sense of them, she says.
"Death showed up a couple of times but it was not at all scary... it was just waiting for me," she said of her first experience in late 2018. "It was the idea that this happens to everyone, that life is a gift that we get to have for a little while and then we have to give it back. And that became very clear to me." Since the cancer spread to her brain, Ms Bird has - on the advice of her doctors - reduced her intake of the drug and now takes micro-doses.
Investing in spa-like clinics
The potential medical benefits of psychedelics have piqued the interest of a growing number of investors in recent years. Some start-ups are developing treatments based on these substances, while others are opening psychedelic therapy clinics. Several are listed on stock exchanges, notably in Toronto and New York, which already trade shares in numerous cannabis companies. British firm Compass Pathways, one of the heavyweights in the sector, is currently valued at more than CAD$1.8 billion (S$1.92 billion) on the Nasdaq. Field Trip Health is one of those companies betting on psychedelics. Founded in Toronto in 2019, it has already opened five clinics in Canada and the United States and plans to build a network of 75 clinics in North America by 2024.
"Psychedelics are happening," Mr Ronan Levy, one of the founders, told AFP. The company offers psychotherapy enhanced by low doses of ketamine, a dissociative anesthetic that is legal for medical use, which can induce a trance-like state or a sense of disconnect between body and mind. Ketamine has been used in surgeries since the 1960s, and also became a fixture on the club scene. Some studies have suggested that it may allow rapid relief of depressive symptoms for people with treatment-resistant depression.
With moss-covered walls, essential oil diffusers and comfy armchairs, the Field Trip Health clinic in Toronto - located in a trendy neighbourhood, in a loft with exposed pipes and with a view of the iconic CN Tower - has the feel of a spa. The clinic is accessible to those whose depression or other mental disorder is clinically resistant to treatment, meaning patients must have already tried at least two types of conventional treatments. A typical course of treatment - costing CAD$4,700 (S$5,000) - includes six doses of ketamine and about ten sessions of psychotherapy.
Lying on a zero-gravity chair with a mask over their eyes and music in their ears, patients let a ketamine lozenge melt under their tongues and are transported on a "trip" of about an hour. A therapist stays in the room throughout the treatment, and then talks to the patients. Mathieu, a 35-year-old Canadian who underwent treatment in June 2020 and asked only to be identified by his first name, called the experience "really powerful". "I had the impression of breaking into a thousand pieces and being everywhere at the same time," he told AFP. "When I was going back down, there was an hour window where my emotions felt pure - what I had in mind came out without worry, I had no more filters."
Easing Covid-19 blues
Putting aside the hype and promising early results, the use of ketamine in mental health care is not universally backed. The length of its effects appear to be limited, and critics point to risks of dependence and other possible complications. There is also no consensus on the value of combining its use with psychotherapy. In the United States, many are worried about the boom in private clinics offering intravenous ketamine, without systematic psychiatric follow-up.
For Dr Jeffrey Lieberman, chief psychiatrist at Columbia University Medical Centre, it is a worrying sign that "the practice has leapt ahead of the research". More generally, others note that there is still a lack of solid evidence on the benefits of psychedelics. They say more and larger clinical trials are needed. Some researchers are also concerned that the current commercial craze and enthusiasm among top proponents are giving rise to a sense that psychedelics are a "miracle pill", leading some to try it alone or with low-quality substances. In Canada, reports have surfaced of people turning to unlicensed therapists and bootleg psychedelics for personal growth or to ease pandemic fatigue, leading to a blossoming black market.
Proponents of ketamine therapy say it helps lay the groundwork for the future use of classic psychedelics such as psilocybin, with the most enthusiastic projections suggesting that the first new treatments will be approved in the coming years. The US Food and Drug Administration (FDA) has already indicated that it is receptive to the idea: Since 2017, it has granted a "breakthrough therapy" designation for trials on psilocybin and MDMA.
'Remove the stigma'
In Canada, a pioneer of the cannabis industry, legalisation of psychedelics is not yet on the table, but Health Minister Patty Hajdu has said she is open to supporting research, saying it would "help move forward this conversation". In addition to exemptions for patients, the government has just authorised 19 health professionals to test psilocybin themselves in an effort to understand its effects and train themselves on how to use it in a therapeutic context.
The country has also announced its intention to restore access to restricted drugs including psychedelics through its Special Access Programme, which allows doctors to request the use of substances not yet approved for clinical use in dire situations. A public consultation ended in mid-February. If the proposal is approved, requests will be handled on a case-by-case basis, meaning access to these therapies for certain patients could be facilitated. Ms Bird says she hesitated before speaking publicly about her use of psychedelics, but she says she felt it was important to do so to help "remove the stigma" and "try to illuminate this option for other people".
"I'm not that adventurous, drug-wise," she said. "But it has been really helpful to me... So, why hide that?"