The UK is undergoing a burgeoning mental health crisis. Prescriptions for antidepressants more than doubled between 2006-2016, mental illness costs some £100 billion per year, and, distressingly, suicide is the leading cause of death among the young. Although the contributory causes are manifold, it is noteworthy that there has been no major breakthrough in drug development for depression and other psychiatric disorders since the discovery of SSRI antidepressants three decades ago. More alarming is the fact that research into the most promising new treatment is being stymied by outdated legislation that can be undone with a minimal amount of bureaucracy in Westminster.
In the last few years, findings from a small corner of psychiatric research have bubbled up to the mainstream news cycle a few times. But so far, the scale of their implications for mental health care has not properly registered. Among researchers, there is a growing sense that the practice of psychiatry is set to be fundamentally changed by psychotherapy assisted by psilocybin, the active component in ‘magic mushrooms.’
Perhaps the most striking evidence that explains this optimism comes from a study undertaken in the UK as part of the Beckley/Imperial research programme, a collaborative endeavour between Imperial College London and the Beckley Foundation, an Oxford-based NGO that researches the mechanisms of action, and clinical applications, of psychoactive substances. In their 2016 study they administered two sessions of psilocybin-assisted therapy to patients with treatment-resistant depression: these volunteers had suffered for an average of more than 18 years, without adequate response from between two and fifteen different treatments.
Each patient started the study with moderate or severe depression, and one week after their second treatment session, every single patient had experienced a measurable reduction in symptom severity, with more than half of them in remission - no longer on the depression scale. More compelling than the quantitative result, the patients’ own accounts make for some of the most inspiring reading recorded in a scientific article. They speak of a wholesale change in the nature of their consciousness after the treatment: a light switch being flicked on in a dark house, a dark fog clearing after some two decades, and the return of an appreciation and gratitude for being alive.
Although two psilocybin sessions did not amount to a lifetime cure for depression - one third of the strongest responders had relapsed six months later - anyone who knows a loved one with depression will appreciate the potential value of this treatment, which might well be developed into a biannual treatment regimen. For many, this may be far more attractive an option than the current first-line treatment - a daily antidepressant - which offers little-to-no relief in as many as a third of the people who use it.
The potential for psilocybin-assisted therapy extends far further than treating depression. Alongside the early evidence for treating a laundry list of conditions including alcoholism, PTSD, OCD, hoarding disorder, and eating disorders, two indications with the most developed research programmes should give the public and policymakers alike pause for thought. Addiction to tobacco - which kills some 6,000,000 people per year worldwide and is linked to some £2 billion of annual costs to the NHS - is treated significantly more successfully with psilocybin-assisted therapy than any known alternative.
Perhaps more importantly, a number of psilocybin studies have shown significant success in treating end-of-life anxiety in those with terminal diagnoses, a condition that robs any real quality of life from people’s final days. Death is something each of us will face, and patients have credited psilocybin-therapy with allowing them to do so with a renewed sense of optimism, acceptance, and meaning.
Sceptics may rightly wonder how one treatment could impact so diverse an array of conditions. Although neurobiological theories abound, the success of psilocybin-assisted therapy is best explained by an account that also explains ‘bad trips’ in the recreational use of psychedelics. When times are tough, many people self-medicate, seeking to numb the pain with drugs: cannabis, heroin, or, though some may be unhappy to acknowledge it, alcohol. These drugs can often be a source of relief or escape from difficulties, at least in the short-term. But an escape from your troubles is far from assured with psychedelics like magic mushrooms or LSD.
The very term psychedelic means ‘mind-revealing:’ whatever source of internal distress you are seeking to run from, a psychedelic is very likely to force you to confront it, head on, in a sometimes powerful manner. In the wrong context, an unprepared user can be overwhelmed by what they are forced to face. Patients in psilocybin-assisted therapy also face the source of their distress, but in a supportive and safe environment, with known, trusted therapists on hand to supply reassurance. For many mental health conditions, people get better from addressing the psychological roots of their distress, rather than taking a pill every day, and psilocybin-assisted therapy is a particularly powerful means for confronting a cause and not just a symptom.
For all its promise, scientists wishing to investigate the therapeutic potential of psilocybin in the UK have to overcome a series of mammoth bureaucratic and financial obstacles laid down by the Home Office in order to conduct research. This is because psilocybin sits in Schedule 1 of the Misuse of Drugs Regulations, which lay out the restrictions imposed on legitimate (research and medical) uses of controlled drugs. Drugs with vastly worse harm profiles than psilocybin, including cocaine and heroin, sit in Schedule 2, and can be stored and researched by any university. As a Schedule 1 drug, those seeking to use psilocybin must apply for special licences, the stringent requirements for which make them expensive and administratively difficult to acquire.
Moreover, the psilocybin must be made-to-order by a chemist with their own expensive, difficult-to-acquire Schedule 1 licence, further adding to the costs associated with research. The first Beckley/Imperial psilocybin studies ultimately cost £1500 per dose, whereas acquiring psilocybin mushrooms might have cost £20 from a street dealer, or nothing, if the researchers could have availed themselves of the wild-growing mushrooms found throughout Britain during the autumn. As it stands, many clinical researchers wanting to explore the healing properties of psilocybin cannot do so, with research only possible for the most doggedly determined and well-resourced scientists.
This regulatory state of affairs is much the same across the world, with psilocybin research shackled everywhere by the tightest restrictions and highest entry costs. As collateral damage of the ‘War on Drugs’, psilocybin was placed in Schedule I of the UN’s Single Convention on Psychotropic Substances, and all signatory nations were quick to follow suit. A naturally-occurring compound first synthesised in 1958 by Albert Hofmann, the discoverer of LSD, psilocybin is not patentable. As such, and coupled with the needlessly high operating costs for research, the pharmaceutical industry has not shown nearly as much enthusiasm for investment as might be expected given the striking treatment results.
The appropriate response, therefore, is to cut the red tape for psilocybin research. The Home Secretary has the authority to move to psilocybin to Schedule 2 of the Misuse of Drugs Regulations, just as he rescheduled cannabis-derived medicinal products within four months in 2018. No drawn out process of multiple readings, committees, and report stages is required.
It is surprising that psilocybin has not already been moved to Schedule 2 by a Home Secretary like Sajid Javid. Both his early libertarian instincts and later business nous should recognise the value in cutting red tape where it is holding back not only the advance of scientific progress, but also the development of a world-leading industry: with every state making it difficult to undertake this life-changing research, the first country to facilitate studies of psilocybin will capture the global research budget. Not only would doing so be the single most positive influence on British science that a Home Secretary can hope to have, it is a much-needed move in response to a mental health crisis which is subject to much discourse but very little action.
Nor would rescheduling risk a characterisation as ‘soft on drugs.’ Magic mushrooms are counted among the very safest of recreational drugs by experts and users alike, and subject to the lowest rate of emergency treatment-seeking, so psilocybin’s class A status is hard to justify in comparison to cocaine and heroin. Nonetheless, by moving psilocybin to Schedule 2 while keeping it in class A, access for researchers can be facilitated without loosening the restrictions on, or consequences of, recreational use.
Whatever your position on the wider reform of drug policy, the case for facilitating psilocybin science is quite clear. The current approach to controlling psilocybin, born amidst the fervour of the War on Drugs, has been more successful at blocking research than stopping recreational use. The rewards for reviewing moral panic legislation can be significant. In 2009, the Labour government reviewed and loosened 250-year-old regulations governing the production of gin, originally introduced as a hand-wringing response to London’s ‘gin craze.’
The resultant gin renaissance of the last decade has led not to licentiousness nor moral or economic decline, but rather to a revitalised British gin industry which, thanks in part to a buoyant export market, has doubled in size to more than £2 billion. An even greater prize is within reach for the government that takes a fresh look at psilocybin.