Pharmacist advocates for pharmacy dispensing of psychedelics for mental illness

Pharmacist Jayden Brandt of Winnipeg Manitoba has developed a proposed policy and operations approach for controlled access to select psychedelics for treatment of mental illness in Canada. Psychedelics, such as psilocybin and 3,4-methylenedioxy-n-methylamphetamine [MDMA]), are being regarded as potential “breakthrough treatments” for a range of mental health disorders, including severe depression and anxiety, post-traumatic stress disorder, obsessive–compulsive disorder and addiction. In a recently published paper, Brandt proposes a future pharmaceutical access policy and operational framework approach whereby pharmacists in Canada would be involved in the medical distribution of these agents. To date, psychedelic medications have only been accessible to a small number of patients through Health Canada's Special Access Program. The article includes a brief overview that defines psychedelics, explains their pharmacology and reviews the current state of the evidence for psychedelic-assisted psychotherapy. Canadian trials for psilocybin and MDMA use to treat mental disorders in adults are also summarized in a table within the article. The author recommends creating a new regulation, under the Controlled Drugs and Substances Act (CDSA), specifically for psychedelic compounds. He suggests that formal registration with wholesale pharmaceutical distributors would be needed to establish ordering privileges for pharmacies that meet the criteria to dispense these agents, similar to the current CDSA regulations for benzodiazepines, narcotics and controlled drugs such as amphetamines. An interprofessional approach to establishing collaborative patient care models should be also investigated and negotiated between the psychiatric and pharmacy professions. The author provides four main reasons why pharmacy should be involved in the psychedelic distribution and treatment process: Similar to other prescription drugs, it is the pharmacists’ essential duty to provide quality pharmaceutical care dispensing services by ensuring that all prescription medications, including psychedelics, fulfill each of the criterion domains of the Indication, Effectiveness, Safety and Adherence (IESA) framework for pharmaceutical care practice. Pharmacists can scrutinize psychedelic prescriptions to screen for the appropriate agent and dose, check for drug–drug interactions and disease–state interactions, and promote adherence. Pharmacists can help clarify patient expectations and improve understanding and communication between psychiatrists and the patient prior to the psychedelic session. Pharmacists may enhance patient knowledge before the psychedelic session by addressing the questions or concerns that may remain after the patient receives a psychedelic prescription. Pharmacist involvement could prevent all liability from falling on the medical profession. Pharmacists could provide safe access to psychedelics and scrutinize psychedelic prescriptions, similar to what is done for other prescription medications they provide to patients in the community. Systematic reviews show that pharmacists have a positive impact on various outcomes when they become involved in collaborative mental healthcare in inpatient and outpatient settings. Brandt proposes that pharmacist involvement with psychedelics would require pharmacists to gain additional expertise in psychiatry or a complete a comprehensive training program on psychedelics. For example, the National Association of Pharmacy Regulatory Authorities (NAPRA) could be asked to establish accessible training requirements and practice expectations for the safe and effective utilization of the community pharmacy team in psychedelic dispensing. Possible policies that might govern pharmacy practice and dispensing of psychedelics are also discussed in the article. These include a clear and verifiable registration protocol for pharmacists to become authorized to order psychedelics from a licensed Canadian pharmaceutical wholesaler and measures to ensure that the dispensed psychedelic remains unopened until the patient is in the supervised clinical setting. Overall, the author outlines a future vision whereby Canadian patients, psychiatrists, pharmacists and other mental healthcare experts could work collaboratively toward high-quality psychedelic treatment. He concludes that members of the pharmacy profession should be involved in the development of policies and processes related to psychedelic treatment. Community pharmacies are well-placed for distribution of psychedelic medications, while community pharmacists can play a key role in the care of patients in the community who have mental health conditions that can be treated with psychedelics. Reference 1. Brandt J. A roadmap for psychedelic pharmacy in Canada: a proposed policy and operations approach for controlled access to select psychedelics for treatment of mental illness. Drug Science, Policy and Law 2023; Published online April 25, 2023. (accessed May 11, 2023).

Pharmacist advocates for pharmacy dispensing of psychedelics for mental illness

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