content warning: drugs, suicide, mental health
I have had anxiety for so long, I had sort of forgotten what it feels like to not have it. To experience the lack of anxiety I have had this week is beyond words.” This is what Thomas Hartle said when he became the first Canadian to be granted legal permission to consume psilocybin – a psychedelic compound found in “magic mushrooms” – for medical purposes. Following a terminal cancer diagnosis in 2016, Hartle had struggled with the existential dread he felt regarding the end of his life, until he became one of the first individuals in Canada to be granted a section 56 exemption to the Controlled Drugs and Substances Act for the consumption of psilocybin. Granted to only a handful of people, this act allows individuals to be provided with access to a controlled substance for medical reasons under strict governmental regulations – this is the only way that patients like Hartle have been able to benefit from psychedelic therapies in Canada. Psilocybin treatment has been successful in improving the mental wellbeing of patients like Hartle who suffer from serious illness, as well as for mood disorders and other mental health conditions. This success is evidence that a better standard of care is available for patients, if only we can get over the stigma preventing doctors from accessing it.
Psilocybin is a psychedelic compound found in different types of fungi. Throughout history, these psychedelic mushrooms have been used in a significant number of ceremonial traditions, as well as being a highly respected material in Ancient Egypt, where consumption of mushrooms was reserved for the priesthood and upper classes. Psilocybin has also been used for ritual purposes in modern history, with early research from R. Gordon Wasson in the 1950s examining the use of the fungi by Indigenous communities in the Oaxaca region of southern Mexico, a practice that was thought to have died out hundreds of years ago. This speaks to the significance of psilocybin throughout world history as a ceremonially and spiritually meaningful substance, and shows the ways in which psilocybin was historically received before mass stigmatisation of the mushroom.
As knowledge of the properties of psilocybin spread throughout the late 1950s and early 1960s, pharmaceutical companies, doctors, and legislative entities began to show interest in magic mushrooms, in terms of both benefits and potential risks associated with use. In 1958, chemist Albert Hofmann isolated the active ingredients from magic mushrooms, synthesized the compounds and sold them to Sandoz pharmaceuticals, marking the beginning of corporate involvement with psilocybin.
Projects to learn more about psilocybin continued, with medical professionals such as psychologist Timothy Leary travelling to Mexico to participate in ceremonial use. Working with spiritual leader Ram Dass, Leary founded the Harvard Psilocybin Project, a research project conducted on Harvard graduate students that sought to examine the effects of magic mushrooms on human consciousness. Despite an absence of laws preventing use of psilocybin at the time, ethical concerns halted the study in 1963, though not before large research institutions had taken an interest in the fungi, paving the way for future research.
The hope for psychedelic therapies becoming seriously helpful to patients was borne from the counterculture of the 1960s, which saw an increase in use of psychedelic drugs and substances. However, this hope was ultimately tarnished by the war on drugs in the 1970s, which resulted in the mass incarceration of millions of people, the majority of which being racialized communities and particularly Black people. The psilocybin molecule responsible for psychoactive effects was banned by the Nixon administration, meaning that labs and pharmaceutical companies researching the synthesized compounds for medical use were unable to continue research. This set back research on psilocybin care by decades, with the next study on psilocybin not taking place until almost 30 years later, in 1997. It is only in very recent years that research has ramped up again, with institutions like the University of Toronto and Johns Hopkins investing more in psychedelic substance research, and the FDA granting permission for study of psilocybin for depression.
There are years of lost ground to make up for in the emerging field of psychedelic research. The war on drugs has withheld psychedelic treatment options from millions of individuals that may have benefited from psychedelic therapy, and has resulted in further stigma surrounding the ancient use of psychedelic fungi in ceremonial practices. As modern research institutions re-engage with the study of psychedelic medicines, it is crucial that Indigenous use of psychedelic substances be respected and considered, and that researchers are cognizant of the impact of Indigenous use of psilocybin throughout history. As noted in the Journal of Psychedelic Studies, “the [I]ndigenous use of psychedelics cannot be mapped on to modern geographic and national boundaries. Rather, its history should be considered tied to a broader community of [I]ndigenous practices across North, Central, and South Americas that were ultimately appropriated primarily by Western clinicians and scientists.” Work by researchers like R. Gordon Wasson has been crucial for expanding psilocybin research, but future researchers should recognize that the knowledge imparted to Wasson came from Sabina, a ceremonial leader sharing the sacred practices of her Mazatec culture. Erasing figures like Sabina from the history of psychedelic research further distances sacred medicines like psilocybin from their ceremonial use, and contributes to the harms of Western imperialism.
As psilocybin research continues, professionals must consider the most appropriate way to deliver psychedelic care. TheraPsil is a Canadian organization pushing for medical access to psilocybin, primarily focused on representing Canadians seeking psilocybin use for end of life care. The organization advocates for “the professionally guided use of psilocybin (magic mushrooms) in combination with psychotherapy,” and promotes a “clinically tested treatment program” that focuses on “careful medical oversight of the medicine session, as well as intention setting and integration psychotherapy sessions (without psilocybin) that help prepare an individual for lasting healing.” The focus, from TheraPsil’s standpoint, is on providing long-lasting care programs that work in association with psilocybin use for proven results.
Over 55 Canadians have obtained section 56 exemptions to allow legal use, possessions and transportation of magic mushrooms for psilocybin therapy. This number is an immense achievement, with TheraPsil being one of the only Canadian organizations lobbying for psilocybin to be made legal for medical use. However, the organization also notes that they are attempting to help many more Canadians that have been left without an answer from Federal Health Minister Patty Hajdu regarding their potential approval for psilocybin use. They report frustration with the system, explaining that the current method of approval restricts patients from choosing psychedelic care with approval from their healthcare provider, instead allowing patients’ medical care to be left to “ad-hoc exemptions granted by a politician,” according to the October 14 newsletter.
“While beneficial to open the door to compassionate access,” TheraPsil notes, “section 56 exemptions granted on a case-by-case basis are not a sustainable model to offer healthcare – ” TheraPsil asserts that some patients have now been waiting for over 200 days for a verdict from the Minister of Health. This means that while some compassionate care is approved, the bureaucracy of the Controlled Drugs and Substances Act ultimately prevents patients from receiving potentially beneficial care. As TheraPsil argues, “section 56 exemptions are arbitrary, discriminatory, and infringe upon patients section 15 charter rights – ” it is time for upheaval of the Controlled Drugs and Substances Act instead of the slow process of granting exemptions.
Realistically, section 56 exemptions represent a very small number of therapeutic psilocybin users in Canada. The vast majority of approved exemptions have been for palliative care, particularly for those experiencing “end of life distress,” the “psychological complex of extreme anxiety, depression, hopelessness and demoralization that can occur when a patient is diagnosed with an incurable illness or is receiving palliative care.” Psilocybin has helped a large number of patients ease their end of life distress, however the long and uncertain process of being granted an exemption is disheartening for many individuals. In a similar fashion to the lengthy period of proposed Bill C-7 alterations of the Criminal Code to change the criteria for Medical Assistance in Dying (MAiD), vulnerable people are left in the dark with prolonged periods of silence regarding the future of their care. As well as cases like these, there are large numbers of individuals using psilocybin for non-terminal medical reasons, and these individuals face barriers to accessing the substance, given the illegality and the lack of information regarding safe consumption. Individuals must therefore buy from dealers or online, meaning they must place their trust in these individual vendors rather than in a regulated system. This creates understandable trepidation for many individuals that might benefit from psilocybin use but who would prefer to only purchase from a government-regulated system.
In a letter to Federal Health Minister Patty Hajdu, TheraPsil argues that “regulated access is not only important but also urgent because Canadians are already using psilocybin for therapeutic purposes.” Instagram account @realdrugstories posts submissions of individuals’ experiences with different substances. Users have submitted their experiences with psychedelic substances on the account: “I had struggled with trauma memories and intrusive thoughts for over 10 years […] I had contemplated suicide numerous times and came close twice. I suffered alone and even my therapists couldn’t help me to combat these thoughts. Using cannabis and mushrooms has literally changed my entire life […] for over six years I have experienced internal peace and I am free from experiencing the debilitating effects of the thoughts. I did not intend to use cannabis or mushrooms for this reason, I used it for recreational purposes however it literally changed my life.”
An individual such as this would not be approved for a section 56 exemption, as thus far the criterion for this exemption has been a terminal illness diagnosis. However, the individual’s mentions of suicidal thoughts and claims that psilocybin changed their life is testament to the life-saving potential of the substance, and proof that the substance could be used for individuals suffering from long-term depression, including treatment-resistant depression and other complex mental health issues. Leaving psilocybin off the table as a treatment option for these mental health concerns is illogical, given the inclination of doctors to prescribe antidepressants and opioids to individuals suffering from similar concerns. Both of these medications have long lists of side effects as well as serious risks of addiction, whereas psilocybin has “extremely low toxicity” with practically no deaths attributed to the drug, according to the Drug Policy Alliance (DPA). The DPA also notes that ongoing epidemiological studies are showing lower rates of mental health disorders and suicide amongst psilocybin users – in contrast with the increased addiction and death rates of individuals over-prescribed legal opioids in the US.
The DPA argues that the risks from psilocybin are “dependent on set and setting” rather than toxicity, and “the consequences of negative or challenging experiences can be minimised by education and awareness of psilocybin’s effects.” Unfortunately, it is difficult to access educational resources regarding psilocybin, especially due to the illegality of the substance and the subsequent hesitation to have open discussions about how to use and where to source. One anonymous individual speaking with the Daily notes, “microdosing is something I’m willing to try, even though it’s not legal, because [my mental health issue] is so bad I’m kind of desperate. I’m only hesitant because I don’t have anyone to sit with while I try it, and I don’t know where is safe to procure it from, and I know that hesitation makes it more likely to go wrong.” Individuals who could seriously benefit from low-risk use of psilocybin are unable to guarantee their safety in use – the Canadian government’s inability to recognise the urgency of regulated access is contributing to this danger.
Psilocybin use for recreational and medicinal purposes is potentially as old as mankind itself. Stigma surrounding use of the substance is not. The man-made perception of psilocybin as a dangerous drug incapable of medical or therapeutic benefit is an archaic product of Nixon’s war on drugs, and it is time for governments and medical professionals to do better in offering therapeutic psychedelic alternatives for medicine in a regulated way. Individuals can look to TheraPsil for more information regarding section 56 exemptions for Canadians and to sign onto their petitions and letters. You can find examples of real lived experiences with drugs and substances from @realdrugstories, and information regarding drug policy from the Canadian Students for Sensible Drug Policy. For individuals located in Montreal, local organization@makingdrugsmoreaccurate can be found on Instagram, where testing kits can be ordered and delivered within 48 hours. Supporting the work of TheraPsil also advances treatment options for Canadians, and individuals can follow templates on their website to contact local MPs regarding psilocybin legalization as well as donate to the organization.