Magic mushrooms?

Candace Necyk, a Vancouver community pharmacist and associate professor in the faculty of pharmacy at the University of Alberta, has spent the past five years doing a deep dive into the therapeutic potential of the psychedelic psilocybin, otherwise known as magic mushrooms.She has lectured pharmacy students on the topic, helped lead psilocybin clinical trials and worked as the director of clinical research at Vancouver-based Numinus, a clinic with an interdisciplinary team of health providers engaged in psychedelic research and therapy.But it wasn’t until her husband began taking psilocybin to treat his bipolar disorder that she truly understood the potential of psilocybin to relieve mental anguish.“It helped him work through the traumatic childhood experiences” of illnesses and surgeries that kept him in hospital for long periods of time, she says. “He was able to release all of that and today he’s a different person.” Today, her husband microdoses psilocybin when he starts to feel sad. “He’ll take a therapeutic dose and be lifted out of his depression by the next day.”This kind of anecdotal reporting of the power of psilocybin to heal mental distress is backed up by significant research demonstrating that when administered in a therapeutic setting, psilocybin can alter the brain’s pathways to provide relief to those suffering from depression, anxiety, PTSD, substance abuse issues and the existential dread of having a terminal illness diagnosis. Research has also documented that psilocybin can act on the brain to induce mystical experiences that can lead to greater spiritual well-being.“When I saw all this evidence, I thought, ‘Why are we labelling this a drug of abuse?’’ asks Necyk. “Human beings carry a lot of trauma. Antidepressants treat things on a surface level but don’t get into the root of what is going on inside someone. After watching my husband’s journey, I saw the potential for psilocybin as another avenue to help people in need.”Frontline role for pharmacistsNecyk is among a growing number pharmacists advocating for the inclusion of pharmacists as key stakeholders in the development of research, regulations, prescribing protocols, and public health education and safety measures (see sidebar: Fungi pharmacists).“If anyone is going to be asked about psychedelics it’s going to be pharmacists—they are the medication experts—and they need to be equipped to answer questions,” she says. “If we are going to be part of this process we need to get involved in legislation and advocacy efforts. We have to talk to stakeholders and lawmakers to make sure that they are aware of what we can do as pharmacists and how to include us and our expertise and knowledge as new rules and regulations get created and implemented.”Michael Haichin, a Canadian pharmacist who is co-founder of the Psychedelic Pharmacists Association (PPA), based in Oregon, is also working to ensure pharmacists don’t get sidelined on this new frontier of treatment.“Pharmacists have a lot to contribute in the area of psychedelics, but we’re being left out of the conversations. We found that there was no place for pharmacists with an interest in the subject to find each other,” he explained in an interview published in the Psych Congress Network newsletter, about why the PPA was launched.“Most of the focus on the actual delivery of psychedelic-assisted therapy has been on psychiatrists and therapists. Rightfully so, given the involvement of the intensive therapy process. However, since it also has a drug component, pharmacists need to be included.”Jaden Brandt, a clinical homecare pharmacist in Winnipeg, has published a proposed policy and operations approach for controlled access to select psychedelics for the treatment of mental illness in Drug Science, Policy and Law. Titled “A roadmap for psychedelic pharmacy in Canada,”1 it outlines federal drug scheduling considerations, the Food and Drug Act approval process, ongoing clinical trials, a collaborative care approach between psychiatry and pharmacy and why pharmacists need to be involved in psychedelics. He writes: “[It’s] important to convince the public, other professionals, policymakers, and government officials (beyond the obvious logical flow of reasoning that “psychedelic drugs” are “drugs” and that pharmacists “dispense drugs”) of the benefits of having pharmacists involved in the psychedelic treatment process.”There’s a lot of hype touting psychedelics as a magic bullet for mental health issues, but, like any drug, they have their dangers: there’s the rare but potential serious adverse event of psychosis among those with a history of schizophrenia, psychosis, bipolar disorder and borderline personality disorder, as well as the risk of serotonin toxicity, increased heart rate and elevated blood pressure. Pregnancy and breastfeeding are also contraindicated.Even though they are illegal in Canada, the demand for psychedelics and psilocybin-assisted therapy is growing and access is fairly easy in major urban centres thanks to random suppliers with mushroom shops popping up across the country (see sidebar: An $8 billion market by 2028).“Microdosing is everywhere,” says Jagpaul Kaur Deol, a pharmacist consultant and lead clinical pharmacist with TheraPsil, a non-profit coalition based in British Columbia that advocates for legal access to psilocybin, “To think that they [pharmacists] aren’t already encountering patients who utilize these medications…it’s a naïve way of thinking.”Deol, who also works as a clinical instructor at UBC’s faculty of pharmacy, is a co-author of the paper, “Therapeutic use of psilocybin: Practical considerations for dosing and administration,”2 published in Frontiers in Psychiatry (the paper received 90,000 views after being featured on the Huberman Lab Podcast, among the world’s top health podcasts). It details the pharmacology of psilocybin, examines contraindications and reports on the conditions that have the most positive therapeutic evidence with psilocybin (i.e., cancer-related anxiety, treatment-resistant depression), those that have some evidence for improvement (i.e., alcohol use disorder and tobacco addiction) and those that have smaller amounts of evidence for relief (i.e., OCD, cluster headaches and migraines).“I don’t think it’s okay any longer to label patients as having treatment resistant depression. ‘Treatment-restricted’ is a more accurate term,” says Deol.Comparisons with cannabisBrandt says pharmacists “fell by the wayside” when cannabis was legalized and he doesn’t want to see that happen with psychedelics. “Cannabis got legalized first and then we learned about it after. As frontline professionals, pharmacists had a lot of questions from the public. Many of them really struggled with how to recommend it to patients.”Canadian pharmacy regulatory bodies need to “have their eyes to the future” and begin preparing policies around storage, dispensing, and counselling of psychedelics such as psilocybin, urges Brandt. “If these drugs become licensed in a few years and pharmacists don’t have policies in place, the rollout could exclude them if they aren’t prepared…I wouldn’t want to see that happen.”“Our role is to be informed healthcare professionals and provide patients with the best evidence,” he continues. “To say we don’t know [about psychedelics] is not ethical because there is a lot of research available.”“We can’t keep our heads in the sand. We have to wake up and get involved in this.”

Magic mushrooms?

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