Why Canada must amend the Controlled Drugs and Substances Act

In less than seven months, the implementation of new federal legislation will qualify Canadians suffering from certain mental illnesses to pursue medical assistance in dying (MAiD). Patients experiencing severe anguish with all other (legal) treatment options depleted may find solace in MAiD as a last resort.

However, before making such irreversible measures accessible, the federal government must consider amending the Controlled Drugs and Substances Act (CDSA) to provide access to possibly life-saving therapies.

Treatment-resistant depression (TRD) is among several mental illnesses that will be eligible for MAiD. In this context, TRD is characterized by persistent feelings of sadness, hopelessness, and disinterest in life, paired with exhaustion of available treatments. However, recent advances in psychedelic-assisted therapy illustrate the disparity between research findings and treatment accessibility in Canada.

Psychedelic-assisted therapy is a psychopharmacological approach that combines the use of medical-grade psychedelic compounds such as psilocybin and ketamine with cognitive behavioural approaches to treat mental illness. Among the psychedelic therapies studied, psilocybin therapy exhibits strong prospects for TRD treatment, with statistically significant reductions in symptom severity, few adverse drug reactions, and sustained treatment responses/remission.

Canada’s prohibition on psychedelic therapy – unless specifically exempted as outlined in subsection 56(1) of the CDSA – limits potential treatment avenues for consenting patients before presenting MAiD as a final option. It is deeply regrettable that emerging legislation will allow this measure to be exercised before considering alternative treatment methods for the mentally ill. This begs the question – why does our government appear to regard death as a reasonable medical treatment yet continue to restrict Canadian physicians from prescribing psychedelic pharmacotherapies?

Recently, psilocybin therapy has sparked interest and garnered support in Canada’s Senate and House of Commons. The parliamentary report from the Special Joint Committee on MAiD published earlier this year includes a statement of support and recommendation to improve access to therapeutic psilocybin (Recommendation #9. The Senate Subcommittee on Veterans Affairs heard testimony from Canadian Armed Forces Chief of Psychiatry, Rakesh Jetly, who spoke to psilocybin’s drug safety and the necessity of expanding research. In May 2022, former Vancouver Mayor and Senator Larry Campbell reported tremendous improvement in his depression and post-traumatic stress disorder symptoms while receiving microdoses of psilocybin.

Petition 441-01450 was tabled in the House of Commons on May 15, 2023, requesting unrestricted access to therapeutic psilocybin as per subsection 56(1) exemptions to the CDSA. Conservative Member of Parliament Garnett Genuis stated, “It is paradoxical and unethical to allow MAiD in these cases [of mental illness] while preventing the same physicians from using this kind of psychedelic-assisted therapy for those in this situation.” Liberal MP and former Health Minister Patty Hajdu is also among the voices calling for the government to at least explore psilocybin-assisted therapy further.

“If left unamended, a depressed patient may pursue death before access to effective therapy.”

The CDSA recently was amended to introduce the “Special Access Program” that permits access to certain psychedelic therapies (e.g., psilocybin and MDMA) under revised subsection C.08.010(1) of the Food and Drug Regulations. Only through this class exemption can physicians request psilocybin for patient use under practitioner supervision after completing a patient-specific request form and receiving case-by-case approval from the Minister of Health of Canada.

Health Canada publicly recognized the merit of psilocybin therapy in a release to stakeholders earlier this year. While these actions paint an optimistic future for psilocybin’s integration into our treatment landscape, they do little justice to the suffering patient in need of immediate aid. If left unamended, a depressed patient may pursue death before access to effective therapy. By limiting treatment options, the government unnecessarily limits patient autonomy.

Parliament referred to psilocybin as a “promising therap[y],” yet simultaneously neglected commensurate action in further amending the CDSA. Given recent attention and findings in the field of psilocybin-assisted psychotherapy, this public policy matter needs urgent sober second thought. It is hard to comprehend the wisdom of a legal framework that eschews exploration of every possible therapy in favour of death as a remedy to a patient’s suffering.

Canadian legislators and policymakers should consider the promising studies by the scientific community and actions by governmental agencies on psilocybin-assisted therapy while exercising their utmost due diligence. Canada could become a world-leader in innovative approaches, but its current position fulfills neither the principles of preservation of life nor alleviation of suffering enshrined in medical ethics.

Increased access to psychedelic therapy with cautious regulations and safeguards must take place prior to March 17, 2024. Shouldn’t our government seek to reflect the best scientific data while appropriately supporting vulnerable Canadians?