Who gets to be a psychedelic expert?

Without proper certifications, patients and experts are forced to fight for appropriate treatments

OpinionsMegan Mills Devoe — Published October 22, 2024 3 minutes

In Quebec, one in five people will experience mental illness in their lifetime, but 20 to 60 per cent of those who seek treatment will be labelled “treatment resistant.” This means that conventional methods may not be effective for these patients. For some of them, psychedelics might be the answer. 

Psychedelic-assisted psychotherapy (PAP) utilizes psilocybin and other hallucinogens and is increasingly being recognized as a breakthrough treatment for a number of mental health concerns. Unfortunately, the experts behind it aren’t being recognized at all. Although PAP is now legal in Canada, the lack of certification is creating unnecessary roadblocks for patients trying to access potentially life-altering treatment. 

In Quebec, there is currently no formally recognized certification for PAP prescribers or administrators. There is also no regulation stating which medical professionals are allowed to prescribe or administer PAP. So far, Alberta is the only province requiring psychiatric training to perform or prescribe PAP. Many independent organizations offer training and certification courses, yet none have been formally recognized by Health Canada or the Institut national de santé publique du Québec (INSPQ). 

While psychedelic medicine is still considered experimental, experts in this field do exist. Without formal recognition of their expertise, they are beholden to Health Canada to make important decisions about patient health and safety. 

In 2022, Health Canada expanded their Special Access Program (SAP) to allow medical professionals access to psilocybin—the active ingredient in magic mushrooms—and MDMA—also known as Molly—for patients with “serious or life-threatening conditions.” The SAP is not a standard prescription method; it’s specifically for experimental or otherwise unapproved drugs that cannot be legally accessed in Canada. Your doctor cannot prescribe you psychedelics, but they now have a new method to request them from Health Canada. For patients, this means providing an eight-page form detailing their personal medical history to a complete stranger. 

The SAP is a step forward but the application process is riddled with issues; it’s limited, invasive, time-consuming and generally confusing for patients to navigate. Since the drugs it approves are considered experimental, each patient needs to be approved on a case-by-case basis. 
The program is designed specifically for patients who have exhausted all other conventional treatments, but even extreme cases can be rejected for lack of evidence.
 
The lack of official PAP certification brings into question the qualifications of the people reviewing SAP applications. Thorough knowledge of psychedelic medicine is not standard for most doctors and pharmacists. Without certification, patients applying for access to PAP cannot guarantee that someone with sufficient knowledge of these drugs will review their case. 

The process for appealing a SAP rejection is lengthy and comes at a great cost to patients, most of whom have already exhausted considerable resources seeking conventional treatment. In many cases, creating an official standard of competency for prescribers, administrators and reviewers can mitigate the need to appeal. 

Over the last few years, Quebec has seen huge milestones in the field of psychedelic medicine. Psychedelic therapy is now eligible for coverage by RAMQ and last year the first legal PAP group therapy session took place in Montreal. This progress has only been made possible by the knowledge and advocacy of psychedelic specialists, none of whom are officially recognized as such. 

Right now, we are at a tipping point for mental health care in this country. PAP is far from a cure-all, but for many patients the results are revolutionary. The INSPQ and Health Canada cannot continue to stall on creating policies that could get this medication into the hands of patients who desperately need them. 
    
 

This article originally appeared in Volume 45, Issue 4, published October 22, 2024.