Alberta to Regulate Psychedelics; Roland Griffiths' Sage Advice; Psychedelics for Pain

Oct 07, 2022

Happy Friday to those who celebrate. For those with young children, happy Monday.

In today’s dispatch, we’re taking a look at the following:

Alberta’s move to regulate psychedelic therapy
Somber news from Johns Hopkins’ Roland Griffiths
Psychedelics for Chronic Pain: Lessons from the Opioid Crisis?

But first, a word from our friends at Horizons:

Next Wednesday, 10/12, Horizons: Perspective on Psychedelics will kick off its fifteenth annual New York City conference with incredible scientific, community, business, and policy programming.

I am particularly excited to see:

Patents, commons, innovation and competition on Thursday,
Emerging indications for psychedelic therapies on Friday and
Studying ayahuasca users and facilitators in neoshamanic settings on Sunday

Trip Report readers can use TRIPREPORT-NY-15 at check out for a 15% discount on tickets.

Alberta to Regulate Psychedelic Therapy

On Wednesday, the province of Alberta, Canada, unveiled plans to roll out a framework for regulated psychedelic-assisted therapy by January 16th, 2023, a very precise date.

From the CBC:

“Alberta will become the first Canadian jurisdiction to regulate the use of psychedelic drugs for people in therapy, the province announced Wednesday.
Associate Minister of Mental Health and Addictions Mike Ellis also introduced new rules to limit who can prescribe high-potency drugs to people with difficult-to-treat opioid addictions.
The changes are aimed at protecting the public, ensuring that patients receive high standards of care and preventing risky drugs from inadvertently ending up on the streets…
In a technical briefing Wednesday, Alberta health officials said they are laying out a regulatory groundwork in the province as it is anticipated the field will grow.
Alberta's new regulations would require medical directors to apply for a license before treating patients with psychedelics for mental health disorders. A psychiatrist would have to oversee any treatment, according to the regulations taking effect in January 2023. Health professionals could not charge money for the drugs, and a qualified professional must only give patients the drug at a medical facility – unless the person is in palliative care.”

I understand this as painting the lanes, erecting signage, and putting the guardrails up before opening the highway to traffic—not legalizing psychedelics.

Canadian Attorney, David Wood, had the best summary that I could find of what this means (emphasis added):

“The change in the law has zero to do with products that are or will be available in Alberta. If and when drug products that include psychedelics as an active pharmaceutical ingredient are available, whether through the pharmaceutical system or otherwise, this change in the law will affect the circumstances under which those products may be accessed. Put otherwise, the amendment to the MHSPR does not allow new products to provided to patients in Alberta – that would be determined under federal law and would be regulated both under the Controlled Drugs and Substances Act (the “CDSA”) and the Food and Drugs Act.”

From the limited research I could do, it seems that COVID restrictions hit Alberta particularly hard with regard to mental health and well-being.

Here is an excerpt from a Q2 2020 Quarterly opioid surveillance report in the province:

“Beginning in March 2020, the number of harms associated with opioid use began to increase significantly, reaching record levels not previously seen, in conjunction with a decrease in the utilization of treatment and harm reduction services…
Prior to the COVID-19 pandemic, provincial efforts to reduce unintentional opioid poisoning deaths had been having a positive impact. For example, there was an 8.6% decrease in the number of unintentional opioid deaths in the first quarter of 2020 compared to the same time period in 2019.

In other words, it seems like the provincial government had been making strides in addressing the mental health crisis until lockdowns, and these new measures are seen as continuing this effort.

Again, it does not appear that come January 16th, 2023, psychedelics will become available or legal but rather, like other efforts to create the requisite infrastructure ahead of regulatory approval.

Roland Griffiths’ Cancer Diagnosis

A few weeks ago, Roland Griffiths closed his presentation at ICPR with some somber news of a terminal cancer diagnosis he recently received.

I was moved by his remarks and thought you would be too.

“I came to recognize rather quickly that what I had learned about the nature of mind from both meditation and psychedelics was critical to how I might manage this. We don’t need to identify with thoughts or emotions as they arise, instead we can turn great interest to investigate the present moment, to cultivate this power of grattidue for the astonishing mystery in which we all find ourselves.
Just consider it for a moment that we are this highly evolved sentient creatures, we can see and taste and touch and feel, we’ve developed language, mathematics, scientific method for discovering something about the nature of reality. But most astonishingly to me is that we have this capacity to be aware that we’re aware; it’s actually the only thing we know to be true, we can’t valideate it in anyone else, and yet we don’t understand the nature of consciousness, we certainly don’t understand how this entire project started nor where its going.
So for me, the psychological off ramp from potential emotional misery has been this cultivation, this intentional cultivation of gratitude for the presciousness of the gift of life itself, of being conscious, of being awake for the mystery of the present moment.”

Psychedelics for Chronic Pain?

Readers are likely well acquainted with the opioid crisis, the disastrous consequence of a failed war on drugs, pharmaceutical profiteering, and a fee-for-service healthcare system.

But the origin story is instructive for the psychedelic field as it points to the potential tripwires we should be aware of.

Pain: The Fifth Vital Sign

The origins of the crisis go back to 1995, when a movement in medicine to better address pain gained momentum. At the American Pain Society’s annual meeting, Dr. James Campbell proposed that a patient’s pain level— along with blood pressure, temperature, pulse, and respiration rate—should be included as the “Fifth Vital Sign” in all clinical encounters.

This idea was adopted broadly in healthcare settings, including by the Veterans Health Administration, as part of their national pain management strategy.

Purdue Pharma

1995 also happened to be the year Purdue Pharma received FDA approval for Oxycodone controlled-release—aka Oxycontin— which was heavily marketed in the wake of the “pain as the fifth vital sign” movement as having an addiction potential of less than 1%.

The combination of a national movement advising physicians to ‘measure’ pain and a heavily marketed ‘miracle drug’ was the spark that lit the fire. The rest, as they say, is history.

But the opioid crisis is not the only consequence of this debacle—the prevalence of chronic pain has only increased!

Chronic Pain Stats

Chronic pain continues to be one of society’s most significant burdens and scientific medicine’s biggest failing.

Consider the following:

Psychedelics for Pain?

A recent article from the Pain Research Forum had the provocative title: Psychedelics: A Notable Absence in Chronic Pain Management? (emphasis added):

“Although research involving psychedelics for the treatment of mental health conditions has become increasingly popular over the past two decades, this same enthusiasm has not been seen in the context of pain.
There is one chronic pain condition, however, garnering attention within psychedelics research: headaches (i.e., cluster headaches, migraines).
Headache patients have reported the successful use of psychedelics such as psilocybin, LSD, and cannabis in treating their condition both proactively and abortively. Case studies and informal surveys have been used to demonstrate the anecdotal success of these substances and led to a substantial increase in empirical clinical trials in recent years. These studies have revealed that a significant number of patients with cluster headaches or migraines are dissatisfied with current treatments and that, for many, psychedelics were a source of significant, long-term pain relief.”

Bottom-up vs. Top-Down

One way of conceiving the difference between the development of pharmaceutical opioids like Oxycontin and the current resurgence of interest in psychedelics as therapeutics is in the direction of causality.

Consider the origin of the psychedelics for headache research: Clusterbusters—a grassroots collection of people suffering from cluster headaches that started in 1998 when someone posted to an online forum that LSD seemed to be helping his debilitating headaches.

Despite the recent investment into psychedelic research projects, the foundation of the resurgence and mainstream interest is bottom-up: grassroots, philanthropic, and underground. At the same time, opioids were force-fed from the top down by moneyed interests.

More Research is Needed

The above-cited article ends on a predictable note:

“Psychedelics hold a lot of promise, but we also need to learn from past mistakes. Rigorous, high-quality studies combined with continued exploration of the mechanisms of action of psychedelics will help ensure that psychedelics continue to help, but not harm, people living with chronic pain.”

But, unfortunately, what the author leaves out is an appreciation for and inclusion of the experience of people who have not waited for the ‘adults’ in the room, people who have learned from past mistakes, for whom institutional ‘continued exploration’ is too entrenched, bureaucratic, and costly and for which they cannot wait.

The phrase “more research is needed” is both true and a cop-out.

Of course, more research is needed; in the scheme of things, very little is known about psychedelics and pain, and history casts a long shadow, as evidenced by the ongoing deaths of despair.

But the example of Clusterbusters and other groups highlights the value and need for bottom-up organizing, knowledge sharing, and autonomy that is still eschewed for the apparent certainty provided by conforming to the conventional drug approval process.

*steps off soap box*

The Trip Report by Beckley Waves

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