In 2021 I was the victim of a crime that resulted in me being diagnosed with PTSD. I manage my condition – which I can expect to live with perhaps indefinitely – with venlafaxine, an antidepressant, benzodiazepines for my sleep, and regular therapy.
These drugs, at the moment, are about the best that the NHS can offer to people with PTSD. It is a similar picture for many, many other people in Britain who live with other mental health conditions – severe depression, addictions, eating disorders, and many others.
The odd thing is that there is an effective treatment for all of the conditions I have listed. This is psilocybin – the active compound found in magic mushrooms. It is a controlled drug, so cannot be prescribed outside clinical trials. This is why I am calling for the government to review the evidence for its Schedule 1 status.
For hundreds of thousands of people in the UK, this is urgent.
Over the last 30 years, few new treatments for mental health conditions have emerged. Mental health is the poor relative compared with other areas of medicine – think of the advances that are thankfully being made in cancer treatment, gene therapy, AI, or robotic arms already carrying out surgery.
Yet in mental health, very often the default answer remains antidepressants. For severe depression, you may be offered ECT (electric shocks).
The government places tight controls on research into controlled drugs. A long list of psychoactive drugs – precisely the chemical compounds you want to study if you are trying to develop a new mental health medicine – are currently designated ‘Schedule 1’ drugs by the Home Office. Schedule 1 status, in essence, labels them as having no potential for medical use.
It also makes them incredibly difficult and expensive to study.
I have just been invited to become co-chair of the Centre for Evidence Based Drug Policy, a think tank that assesses which drug policies actually work. It feels strange that such an obvious proposition needs a think tank to promote it – surely everyone agrees that we should do what works? Sadly, no. Right now, we don’t.
In other parts of the world, such as in Australia, and parts of Canada and the United States, politicians have cottoned onto this and people are now getting access to these treatments. In Australia, since July this year, psilocybin and MDMA have been legally prescribable for depression and PTSD respectively.
Psilocybin shows particularly significant potential as a treatment for severe depression, for people who have not responded to currently available treatment options. It is currently restricted under Schedule 1 of the Misuse of Drugs Regulations 2001. This means it cannot lawfully be prescribed outside of a clinical trial. You will not be surprised to read that getting a Home Office licence is an exceptionally expensive and time-consuming process. In practice, as a result, many UK researchers who wish to study the therapeutic effects of psilocybin are effectively unable to do so.
Change is sorely needed. There are signs that the Drug Minister, Chris Philp MP, recognises this. In October he wrote to the Advisory Council on the Misuse of Drugs (ACMD) asking them to advise the government on reducing these financial and administrative barriers to research into Schedule 1 drugs.
Research is important – I applaud the Minister (a Conservative!) for recognising this. But we need to go much further and urgently work out how to facilitate patient access to treatments like psilocybin. Taking away barriers to research is a bit like opening the stable doors once the horse has bolted – in Australia, doctors have already started prescribing psilocybin to their patients.
This medicine could already be transforming and saving lives in Britain. Suicide is a leading cause of death for young adults in the UK. Why should they not be able to access a potentially life-saving medicine that their Australian counterparts can?
Removing barriers to research, as recommended in the ACMD’s report, is welcome, but does not change this basic fact. Rescheduling would not only reduce barriers to research but also allow psychiatrists the ability to prescribe it where appropriate. For many, access to psilocybin-assisted therapy could offer a light at the end of a very dark tunnel, and enable thousands of people to live fuller, happier, better lives.
To look at the evidence and do nothing – our current approach – feels like institutional cruelty.
Without rescheduling and allowing patient access, we risk not only being left behind in this field of mental health research, but—far worse—we fail the many, many people who, like me, currently just do not have good treatment options available to us.
How strange that this is something the government could change, almost overnight, without spending a penny of taxpayer’s money. All the government would need to do would be to be brave enough to ask their advisers to give them the evidence.
Asking the ACMD for the evidence on rescheduling psilocybin is the first step on that road.
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