The opioid crisis has been felt throughout B.C. for decades with policymakers, advocates and researchers looking for new ways to help those with opioid dependency or opioid use disorder (OUD).
Two benchmark treatments exist: methadone and buprenorphine, both synthetic opiate derivatives. These treatments come with high risks of dependence and therefore trade one addiction for another, according to a 2022 study on OUD by Jones, G., Ricard, J.A., Lipson, J. et al.
Western biomedicine is seeing a renaissance in the use of psychedelics and psychedelic-assisted therapy to lower one’s risk of addiction.
Pamela Kryskow, a founding board member of the Psychedelic Association of Canada, medical lead of the Roots To Thrive Program and a family physician, sees psychedelic-assisted therapy as an opportunity for deeper healing.
“If you focus on the trauma, and healing the trauma, the addiction goes away. So, addiction is not to be treated. It is a symptom of trauma. And if we focus on that, and stop treating addicts like the addiction is the problem, we're going to be in so much better service to our patients, our clients and society,” she said.
Psychedelics and psilocybin as a breakthrough medicine
Among the psychedelics currently being studied, psilocybin, which is the active ingredient in magic mushrooms, has shown promising potential to lower the risk of addiction.
Elena Argento, a postdoctoral research fellow at the University of British Columbia and BC Centre on Substance Use, has been involved in notable studies that analyze psychedelic use in medicine.
She says that psilocybin works to lower the risk of addiction on two levels: the neurobiological and psychological.
“Psilocybin, like other classic psychedelics, are agonists of the 5-HT2A serotonin receptors in the brain. And this appears to work by enhancing neuroplasticity and psychological flexibility, which essentially really enable the brain to change and adapt more easily,” she said.
On the other hand, she says that psychedelics generate experiences of profound awe and ego-dissolution. These experiences allow for someone to find new ways of understanding and meaning in life. For addiction, these experiences might motivate someone to change.
In a recent longitudinal study from Argento and the BC Centre on Substance Use, 4,000 participants have been studied since 2006. They found that participants who had used psychedelics recently, or in the last six months, were significantly less likely to subsequently use illicit opioids on a daily basis.
Another 2018 study on marginalized women by Argento found that psychedelic use “had a protective effect on the relationship between using prescription opioids and against suicide risk.”
In the Jones et al. study, researchers also identified correlations between psilocybin use and reduced risk of opioid use disorder. This replicated findings from a 2017 study in which “44,000 individuals found that psychedelic use was associated with 40% reduced risk of opioid abuse and 27% reduced risk of opioid dependence in the last year.”
However, these studies have a caveat. The results are based on cross-sectional data or associations and as a result cannot be used to draw causal conclusions. They do, however, contribute to the growing evidence that psilocybin is worth investigating in a clinical trial, say the experts Glacier Media interviewed for this story.
Other studies that demonstrate the efficacy of psilocybin are being done at the Center for Psychedelic and Consciousness Research at Johns Hopkins University.
Albert Garcia-Romeu, a member of the psychiatry and behavioural sciences faculty and researcher at the centre, says that a component of OUD that isn’t discussed enough is the level of hopelessness and social despair that comes with “numbing themselves when they're using these substances”.
“I think psychedelics can help people to sort of come to terms with some of those issues in a way that they might not be able to through regular types of treatments that are available,” he said.
As Garcia-Romeu spoke to Glacier Media in an interview, he noted that two individuals down the hall were being administered psilocybin as part of their research.
Among his notable work is a pilot study that used psilocybin to help those with a tobacco addiction. The results showed that the classic psychedelic used in a structured treatment program “holds considerable promise in promoting long-term smoking abstinence.”
“At 12-month follow-up, 10 participants (67%) were confirmed as smoking abstinent. At long-term follow-up, nine participants (60%) were confirmed as smoking abstinent. At 12-month follow-up, 13 participants (86.7%) rated their psilocybin experiences among the five most personally meaningful and spiritually significant experiences of their lives,” the study said.
Matthew Johnson, who works alongside Garcia-Romeu, has a clinical trial plan to look into psilocybin use and OUD.
From a war on drugs to a renaissance in medicine
In the 1950s, psychedelic research was taking off with multiple studies being done on psychedelic use in medicine. This was halted as government regulations cracked down on substances that they deemed were harmful to human minds.
“I think there was a real searching moment within the history of psychiatry. There was an openness to looking for dramatic, significant, thinking-outside-the-box kinds of ways of approaching psychiatric disorders and mental illnesses and that openness or that kind of welcome atmosphere allowed for a whole lot of experimentation that went off in different directions,” said Erika Dyck, Canada Research Chair in the history of medicine at the University of Saskatchewan.
She says that in the 1970s and '80s, language regarding psychedelics focused on associations between psychedelics and brain dysfunction that linger today.
According to Argento, there is a need to think creatively about opioid use interventions and their root causes in patients.
“In medicine, we're never done. We're never at the final point. We haven't found the end of all medicines or the end of all therapies. We're always in iterations of advancing our knowledge,” said Kryskow.
For many patients the current pharmacological treatments for mental health and addictions are not enough, prompting a renaissance in psychedelic-assisted therapy as another avenue of treatment.
“I think the idea that mushrooms represent a plant and organic substance, I think is a softer, gentler way of moving this forward into the public discussion,” said Dyck.
Application in therapeutic settings
As more researchers embark on studies to show the merits of psilocybin in medicine, programs in Vancouver are applying these practices to therapeutic programs.
Roots to Thrive is a resilience development program through Vancouver Island University and Island Health that offers psychedelic-assisted therapy. They are currently offering programs for end-of-life care using psilocybin.
“We have had Indigenous Elders and Indigenous Knowledge Keepers on our Roots To Thrive team right from the very beginning. And so it's a fantastic weaving together of First Nations knowledge keepers, and the best of Western medicine and creating a new weaving of a basket together,” said Kryskow.
The program has seen notable transformations in their patients, but the substances they use for medicine are highly regulated causing issues for patients who may not qualify for an exemption.
"One of the things Roots To Thrive non-profit has done is we've applied to Health Canada to say, 'Can you give our whole program a psilocybin exemption? Because we're all regulated, insured health-care professionals,'" said Kryskow.
She says that when professionals are unable to access the therapies needed to help their patients, it can force them to go underground where there are no regulations.
"I think there are probably a lot of great skilled therapists in the underground, but they should be able to come up above ground, have insurance, have a licence and regulation. That's what we should have for patient safety. We want everything above board."
Individuals who want to access psilocybin for medical purposes can apply for an exemption with Health Canada under the Special Access Program. However, at this time, Health Canada said there are no approved therapeutic products containing psilocybin in the country or elsewhere.
“Health Canada recognizes there are times when access to unauthorized drugs may be appropriate. In some circumstances, with the support of a regulated health-care practitioner, it may be possible for individuals to legally access psilocybin,” they said in a statement.
Until more clinical trials studying the effectiveness of psilocybin are produced, individuals will have to continue to apply for personal health exemptions with Health Canada in order to get psychedelic-assisted therapy.
“We need courage... in health-care innovation, in policymakers and politicians. And really looking at [psychedelics] and asking, 'Do we need this level of regulation and control on this specific medicine right now?'" said Krykow.