In diverse cities, provinces and states throughout North America, local governments are defining their stance on psychedelics, deliberating over questions of recreational decriminalization and therapeutic legalization. Alberta represents one of the most recent regions to usher in legal change: The province made history on October 5th, 2022 when the government became the first province in Canada to regulate psychedelic therapy.
Alberta’s new regulatory rules amend the Mental Health Services Protection Act and provide guidance for the therapeutic use of a wide range of psychedelic substances including psilocybin, psilocin, MDMA, LSD, mescaline, DMT, 5 methoxy DMT, and ketamine. According to the Alberta government, the regulations, which will take effect on January 16 2023, have been designed to safeguard individuals receiving psychedelic therapy and ensure proper medical oversight of any psychedelic sessions.
Some of the amendments made to the Alberta Mental Health Services Protection Act include the provision that medical directors and researchers must apply for a license from Health Canada to use psychedelics in research or for therapeutic uses (for example, in circumstances where conventional treatments have failed). The regulations also mandate that a psychiatrist must oversee the treatment or at least consult on the prescription, and that sessions can only be administered in a medical facility with the exception of individuals who are in palliative care. These rules remain steadfast for all listed psychedelic substances with the exception of specific uses of ketamine, which has already been approved for use outside psychedelic-assisted therapy as an anesthetic for pain management.
Progress on psychedelic access, but with potential issues
While a shift to permit psychedelics in therapeutic settings appears progressive, there are concerns about some aspects of the regulations. For Leah Mayo, PhD, The Parker Psychedelic Research Chair at The University of Calgary, for example, the regulations raise a number of potential issues.
Mayo believes the focus should first be on determining whether psychedelic compounds are safe and effective and then developing a regulatory framework for their implementation.
“On the one hand, it’s great that people are thinking of how to implement psychedelic-assisted psychotherapy in a safe, ethical way,” reflected Mayo. “However, one of my main concerns is that we still don’t have the evidence yet to be administering these compounds outside of clinical trials – with the exception of ketamine – so I feel like we are putting the cart before the horse.”
Another fundamental concern that has been raised by a number of commentators, including Mayo, is accessibility and inclusion. Do these regulations facilitate straightforward access to treatment for those who may benefit most?
“Psychedelic-assisted psychotherapy is already resource-intense,” commented Mayo. “The drug administration sessions are long, they require trained monitors for the duration of the session, and psychotherapy also requires trained specialists. We desperately need to consider how we formalize training in this domain to ensure that these treatments are indeed accessible following approval. No treatment can be useful if it is not accessible to those who need it.”
For example, the requirement to have a psychiatrist overseeing the treatment may be restrictive.
“It seems like there will be a heavy reliance on psychiatrists, with a psychiatrist required to prescribe the medications, or at least be in consult with the prescription,” said Mayo.
“However, with ketamine being a psychedelic-like compound used together with psychotherapy that can already be administered in the clinic, I would argue that other physicians, like anesthesiologists, already have the knowledge and experience needed to administer this kind of treatment.”
Since only psychiatrists will be able to issue prescriptions for psychedelics, there is a potential that patients may face delays to undertake psychedelic-assisted therapy. Alberta is already known for long wait times to schedule an appointment with a psychiatrist. Such delays could be detrimental to a number of populations, such as individuals living with terminal conditions who would be using psychedelics to ease end-of-life anxiety.
“Limiting the pool of physicians who can prescribe the treatment could impact the time to receiving treatment, and also impact the cost”
Similar issues are also a talking point in other regions that have recently moved to regulate psychedelic-assisted therapy. While Alberta is the first province in Canada to regulate psychedelics for therapeutic use, it’s not the first place in North America. In November 2020, voters made Oregon the first state in the US to allow the supervised use of psilocybin under Measure 109, which will be implemented in January 2023. The regulations released by the Oregon Health Authority differ in some ways from those of Alberta, but there are also concerns over accessibility.
Oregon has determined that only state-trained facilitators will be able to administer the psychedelic in licensed service centers. Facilitators don’t have to have a medical background, but they must have completed high school and undergone 160 hours of training approved by the Oregon Health Authority. It’s possible that training could be priced from $10,000-$20,000, which may discourage people who aspire to become facilitators. What’s more, a single psilocybin administration session could cost as much as $1,000. Such fees could inhibit access to treatment for Oregonians who could benefit most.
Ultimately, both Alberta and Oregon are setting foundational legal precedents for the emerging therapeutic psychedelic landscape. The regulations that govern access to psychedelic therapy in these regions are significant as they will profoundly influence if such initiatives are successful, and whether other cities or states choose to follow suit.
Come January 2023, many will be watching to see how these regulations play out.
