“The acknowledgment of the pain and anxiety that I have been suffering with means a lot to me…[I] hope this is just the beginning”
– Laurie Brooks, one of four patients awarded an exemption to use psilocybin medically
On August 4th, Canada’s Health Minister Patty Hajdu approved four terminally ill patients’ requests to be allowed to legally use psilocybin, the active ingredient of magic mushrooms; also known as shrooms. Psilocybin-assisted therapy has been gaining traction as a tool to help patients cope with the distress of their diagnosis, and to achieve a higher quality of end-of-life care. The announcement was made by TheraPsil, a non-profit coalition advocating for patients to have access to psilocybin therapy, which assisted the patients in making their claim.
These are the first medical patients to legally use psilocybin since the compound became illegal in Canada in 1974, and their journey into the therapeutic uses of illegal drugs might remind us of the first medical patients to legally use cannabis. But how much do these new developments really mirror how medical cannabis regulation started, and what can we expect moving forward?
First, we need to understand a bit of background around medical cannabis legalization. Advancements for the legal use of medicinal cannabis were made through notable court cases, in particular, that of Terry Parker, which began in 1996, and of Jim Wakeford in 1999. Much like the patients who have been allowed legal use of psilocybin, Parker and Wakeford were granted an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA), legislation that regulates drug use, possession, and distribution in Canada. Section 56 reads as follows:
56 (1) The Minister may, on any terms and conditions that the Minister considers necessary, exempt from the application of all or any of the provisions of this Act or the regulations any person or class of persons or any controlled substance or precursor or any class of either of them if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose or is other- wise in the public interest.
But just because the exemptions are the same doesn’t mean these patients’ situations are. Ivy Zmuda, Vice-President of Regulatory Affairs for Tantalus Labs and freelance consultant, has closely followed the development of the medical and recreational cannabis industry, and now the nascent psychedelics space, and has outlined several similarities.
However, the differences are also substantial. As Zmuda explains, we must also consider how patients are obtaining their medicine: “While cannabis was also first decriminalized for medical purposes under Section 56 exemptions, there was no licensing system in place that allowed legal sources before the creation of these regulations (formerly Marihuana Medical Access Regulations) in 2001”. This is different for psilocybin and psychedelics in general, as Zmuda adds that our current regulations “provide for a legal supply of psychedelic substances.” Indeed, certain companies already have licenses to conduct research using psilocybin.
Another difference in allowing patients to access psilocybin directly through a Section 56 exemption is that this does not establish the same court precedent as for medical cannabis. In other words, with a Section 56 exemption, individuals were granted permission to legally use psilocybin, but for medical cannabis, the conversation was much broader and centred around people’s rights to access the medicine that works for them. This leaves patients across the country in a bit of a grey zone, as Zmuda notes we are still lacking “a definitive court precedent outlining if Canadians have a constitutional entitlement to psychedelics.”
For medical cannabis, it was clear. In the Parker case, the Ontario Court of Appeal stated (at para 80):
[I]t is open to Parker to challenge the validity of the marijuana prohibition not only on the basis that it infringes his s. 7 rights because of his particular illness, but that it also infringes the rights of others suffering other illnesses.
So, it’s clear that legally, although there are considerable similarities in patients receiving exemptions to enhance their quality of life, there are stark differences that may affect what we can expect the world of psychedelics to look like in Canada in the next few years. Central in this conversation is also the culture that accompanies the advocacy around these substances. Zmuda explains that we cannot forget their respective histories:
“Absent in psychedelics is the long history that cannabis enjoys with institutions such as compassion clubs. Combined with the fact that psychedelics are being embraced to some degree by medical professionals, rather than shunned as cannabis was, it is likely that the evolution of access will be driven by the medical establishment rather than patient advocacy.”
Despite these differences, it stands to reason that August 4th’s ruling by Health Minister Hadju may, in fact, be the catalyst in a medical movement towards compassionate care. And although the specifics might differ, we’re recognizing a movement toward better understanding how illicit substances provide undeniable medical benefits, and that this is to be prioritized over a historically-entrenched perspective of treating these drugs through a lens of criminality.
Perhaps, the precedent set by these cases will be the beginning of a healthcare culture where practitioners and patients, laboratories and legislature are able to engage in a person-centred, science-informed dialogue for the benefit of all Canadians.