A blog by James Bunn, Communications Manager for Drug Science
Recently, an article was released in the Lancet that highlighted a particularly pertinent issue of patient autonomy and appropriate treatments. This comment - Reducing drug-related harm - responding to the evidence base, requests that policymakers adapt to the new realities of drug use. Now, more than ever, greater international cooperation is required to address the increasing number of deaths related to drug use. As humankind's understanding of addiction, self destructive behaviour and mental health, develops. We cannot continue to focus on responding to new, ‘deadly drugs’, we must focus more holistically on “factors that influence patterns of drug use over an individual’s life course”. This includes “more research …on how families, peers, and environment support recovery or minimise progression to harmful use and dependence.” An individual's battle with dependency is a uniquely personal experience. Creating initiatives that directly attempt to reduce drug abuse by focusing on the legal status of a particular substance is not addressing the route of the issue. Individuals that have an unhealthy relationship with any substance are unlikely to change their patterns of behaviour based on the legality of the substance that they are taking. A more holistic and effective approach would be to examine the aforementioned externalities of that individual on a case by case basis.
As we all know, “not all drugs are equal” and different therapies are required to address different substance misuse problems. Equally, “not all people are equal” and they will respond differently to the diverse range of therapeutic options available. Therefore, “health professionals and policymakers need to listen to what people who use drugs say about what therapies are desirable and how best they can be delivered”. By ignoring individuals that undergo various types of therapy, we learn very little about their ability to reduce problematic drug use. Furthermore, by invalidating contemporary therapies we deny an individual the opportunity to heal and develop using a therapy that works for them.
A therapy that has recently demonstrated its efficacy, is psilocybin-assisted therapy (psilocybin is the active ingredient in ‘magic mushrooms’, a schedule 1 substance). Patients are reporting that they are able to address lifelong mental health issues during these sessions which is something that they were previously unable to engage with. Furthermore, there is a body of persuasive evidence that psilocybin-assisted therapy may represent potential new treatment options for Substance Use Disorders. Despite its effective track record, this therapy has only been legally available to the chosen few who have participated in clinical trials. More research needs to be done into psilocybin-assisted therapy to legitimise its position as a respected therapy. However, this is financially implausible at the moment due to the encumbering time and costs associated with conducting this type of research. If psilocybin was rescheduled as a Schedule 4 drug, it would be substantially easier to conduct research into its benefits and side effects.
A study was conducted in 2008 by Dr Roland Griffiths in which 36 hallucinogen-naive adults were administered psilocybin in a controlled setting. Fourteen months after this trial was conducted, over 20 of the 36 participants considered their psilocybin-induced trip to be amongst the five most personally meaningful experiences of their lifetime. Surely, something that can have such an impact on an individual’s perception of the world (and of themselves) should be examined closely to see whether it could break cycles of addiction. In fact, this is already being demonstrated in a clinical setting. Johnson et al (2017) demonstrated that psilocybin holds considerable promise in promoting long-term smoking abstinence. Considering that 5,000 people die each day due to smoking, we must ask two questions:
1. What barriers are preventing the expansion of this research?
2. Why are we not exploring the therapeutic potential of psilocybin to aid in the cessation of other substances?
The answer to both of these questions is - unfair stigma. Psilocybin has been burdened with this stigma due to its legal status/scheduling. The fact that drugs such as cocaine are seen as having more therapeutic potential than psilocybin is ridiculous. The therapy being conducted at Imperial College, John Hopkins University and Maastricht (to name a few) has demonstrated this drug’s efficacy in treatment and patients deserve the autonomy to be able to receive this treatment if they believe it will address their substance misuse disorder.