Should “magic mushrooms” be legalized? Experts weigh in

There’s no question that data shows psilocybin is a great drug that has the potential to be an important tool for psychiatrists.

With psilocybin, the data has mostly been on treatment-resistant depression. This is really good news because these disorders are traditionally very difficult to treat, and we haven’t seen a lot of new medications coming through in recent years. But we also have to remember that the data includes a significant amount of psychotherapy. It’s not just taking the mushrooms themselves that are causing these results. It’s taking mushrooms along with pre-treatment therapy, going through proper protocol and spending eight hours with a therapist, and then the integration therapy afterward. This generally means about 20 hours of therapy, which obviously comes at a substantial cost.

Regardless, these drugs should become medications that are available to people. But until we go through the process of having Phase 3 clinical trials, it doesn’t make sense to bypass all the usual regulatory processes.

There’s also the question around decriminalization. I’m of the mindset that decriminalization is important for all substance use. Criminalizing the most vulnerable and those struggling with addiction by turning a health disorder into a crime is a problem.

It’s not always the best thing just to turn something into a profit narrative and commercialize it.

I struggle to see anybody who would argue against decriminalizing products like psilocybin, MDMA or any of the other psychedelics. There’s been several studies showing that the harms of psychedelics are extremely low, as is risk of addiction. It doesn’t really make sense that it sits in the criminal market.

But when it comes to regulation and legalization – and even more so to commercialization – I think we need to learn from cannabis. It’s not always the best thing just to turn something into a profit narrative and commercialize it. We’ve got to take a look at what we’re doing and why we’re doing it. Are we doing it for a profit? Or because it’s the right thing to do? When we decriminalize, we’re doing it because it’s the right thing to do. When we legalize and commercialize, I think that’s largely driven by a profit narrative.

There was a recent study showing that emergency department visits due to cannabis in Ontario grew 190 per cent between 2016 and 2021. The increased use among youth went from 12 per cent to almost 30 per cent. This is really worrisome. In legalizing cannabis and putting it into the recreational market, we basically castrated the scientific foundation for the medicalization of cannabis where it could have fit. We’ve got to remember the more access people have, the more they will use it and the more possible harms could come from it.

In the case of psychedelics, the harms are pretty limited. But it’s important to decriminalize these drugs and be sure to differentiate legalization for medical purposes from legalization for commercialization.

We should move toward legalizing and regulating psilocybin. TheraPsil is advocating for this to be rolled out as a legal, regulated psychedelic system under the umbrella of a doctor-as-gatekeeper model. For us, the medical model is really the only model.

We’ve arrived at this conclusion because it’s based on evidence. The degree of agreement between studies from UCLA, Johns Hopkins University and New York University, for example, is really astounding. This model offers a scientifically rigorous and evidence-based approach to legalizing psychedelic medicines.

I’ll break it down into a few major categories.

First, safety and efficacy. This model, because it relies on empirical research, establishes safety and efficacy for psychedelics for specific medical conditions. It provides a solid foundation for their use and ensures safety for the patients that are taking them.

The second is professional supervision. With the medical model, trained health-care professionals play a crucial role in ensuring the patient’s well-being and psychological support.

The third is a standardized dose and administration. The medical approach really establishes standard dosages and administration protocols.

These substances have tremendous therapeutic potential.

The fourth is patient access. Our main priority is prioritizing patient access. This is a cornerstone of the medical model, especially for those suffering from conditions like depression, end-of-life anxiety and PTSD. This model acknowledges that these substances have tremendous therapeutic potential, and it aims to make them as accessible as possible as legitimate treatment options. We want patients getting medical answers from a trained health-care professional, not from, for example, a store that’s illegally operating.

This model also encourages further research into psychedelics, into their therapeutic potential, safety, and to monitoring long-term effects.

It’s also really important to mention de-stigmatization. Psychedelics need to be framed as valid medical treatments. There’s tremendous societal bias on psychedelics stemming from years of misuse and ultimately bad PR. We believe that governments will be more inclined to support medical legalization due to the potential benefits to public health, reduced health-care costs and improved mental health outcomes.

Finally, with the acceleration of medical death through MAiD by our government, we really believe that the medical community should be leading the way for psychedelic access. Beginning in March, people whose sole underlying medical condition is a mental health illness will gain access to MAiD, providing broader availability compared to alternative options like psilocybin therapy. It’s crucial to note that within the current framework, known as the Special Access Program (SAP), access to psychedelics is restricted to individuals with “serious or life-threatening conditions.” The extent to which someone’s life is deemed threatened or in a serious condition is not specified. Additionally, under SAP, prescribers must demonstrate that patients have exhausted all other forms of treatment, which contrasts greatly with the accessibility of MAiD. This highlights the lack of education surrounding these issues. It underscores the urgent need for medical professionals to receive comprehensive education on alternative therapies and for increased government involvement in addressing these matters.

I absolutely believe that psilocybin should be medicalized. Which, to me, is a little different from just legalized. I think of legalized as being sort of a free-for-all much in the same way as cannabis is legalized and is now largely recreational. I feel the difference with psilocybin is that its real value comes as a therapeutic tool.

Prior to having cancer, I really did not have any experience using illegal drugs. I was not aware of any therapeutic value to these things whatsoever. It was really quite a surprise to me when in 2018, I happened to read the Johns Hopkins study where they were using psilocybin for end-of-life distress. I really didn’t understand how it was possible that psilocybin could improve your mental well-being. But when I started to really experience end-of-life distress myself, I knew that the existing treatment options, like antidepressants, really weren’t for me. While they would take the peak off anxiety, they also took the peak off desirable emotions too, like happiness and love – the things we want for quality of life.

It was incredibly effective at turning down the dial on that whole cloud of anxiety.

Ultimately, I received approval to be the first Canadian to legally try psilocybin as a therapeutic tool. The end result is that it was incredibly effective at turning down the dial on that whole cloud of anxiety that was preventing me from being an active participant in my life.

This is how I describe it: Imagine it’s a hot summer day and you are sitting in your car, and you’re stuck in traffic. The windows are down. It’s hot and dusty and there’s noise from the other cars and construction. You may have the radio playing but you really can’t appreciate it because of all the other distractions and misery that are taking place at that moment. After the psilocybin therapy, you’re still in the car. I still have cancer. But now the windows are rolled up and the air conditioning is on. It’s quiet and you’ve got all the time in the world to get where you’re going. Your favourite song is playing on the radio and it’s just you enjoying the moment instead of you being stuck in the misery of things. It’s really like that.

I feel that perhaps the current regulations are a bit of an overreaction to the actual safety profile of psilocybin. If they were to reschedule it as something that was much more available, I think we would see even more research and information supporting what it is and isn’t good for.

I think mushrooms, and really all psychedelics, should be completely legal and readily available for adults to purchase, ideally with less regulation than we see with alcohol but with a similar model. I hope we don’t end up with a legalization that is heavily corporatized and monopolized and taxed like we have with cannabis, though I’d still take that over prohibition.

There are differences between cannabis and psychedelics, but there’s also a lot of similarities. I think that similar kinds of policies would work well in some ways. Certain psychedelics like mushrooms are probably less controversial than cannabis, due to the fact that you often smoke cannabis.

I hope that we don’t see mushrooms become so heavily taxed and controlled as cannabis.

Many people in the cannabis community, myself included, are happy about the positive parts of cannabis legalization: People aren’t being arrested for cannabis possession and its use is seen as more normal and mainstream. But the negative aspect of it was that we saw a lot of money being made off cannabis users. I hope that we don’t see mushrooms become so heavily taxed and controlled as cannabis.

The difference is also in the amount that people use. A heavy cannabis user will use cannabis every day, multiple times a day – I’ll raise my hand for that one. But even a heavy mushroom user is only really taking a small quantity once every week or so.

Part of the business around mushrooms would probably include offering safe spaces to use them and other auxiliary services. A dose of mushrooms will only really cost you $10 and that’s at a pretty high markup. But it’s hard to make a big business model out of selling something that costs $10 once every couple of months.

We’ll probably start to see a $10 mushroom sale along with a several hundred-dollar therapy session or paying for a safe space to be while you trip. That was part of the struggle with cannabis; because of the smoking aspect we couldn’t really see lounges for indoor use become more widely available. I think those things will play out differently when it comes to psychedelics.

One of the most straightforward and simplest ways to be consistent with a public health approach is to deprioritize the arrest and punishment and enforcement model for psilocybin. One way to do that is to make it the lowest priority policing offence. That has been the approach in the United States, for example, as well as in various other places where they tend to adopt fairly progressive views. That’s been sufficient as a way to allow for there to be some kind of distribution of the drug to people who want to access it for recreational purposes.

But it’s questionable whether we’re going to see legalization of mushrooms, in a broader sense. Would the government consider getting into the business of licensing and distribution as it has done with cannabis, for example? There are questions about whether there’s enough of a market to make that a viable proposition. With cannabis, there was a lot of speculation in advance among investors that the green rush would lead to massive profits and that hasn’t turned out to be the case. These are the complications that are relevant when discussing the potential legalization of mushrooms in a way that would involve government distribution.

We can look at examples of this in how long it took in the United States to get approval for the use of MDMA as a treatment modality for people suffering from depression, PTSD, end-of-life care, etc. It took 30 years and is still an ongoing process. Presumably we would be more open to it in Canada, and it would probably take less time, but it still is quite an arduous process to get a drug regulated for medical use and approved.

I would say a pragmatic way forward would be simply to pursue decriminalization.

That psilocybin is a hallucinogenic drug that’s also enjoyed recreationally shouldn’t mean that it detracts from its benefits as a form of therapy. But this does complicate things as it’s not as easily understood through the lens of medical science. It gets more into the spiritual realm. There’s a long history where we deem certain things allowable from the perspective of conventional medical science.

I would be an advocate for reducing psilocybin’s standing as a hazardous, illicit substance that requires policing and making it a low priority policing offence. I would say a pragmatic way forward would be simply to pursue decriminalization. This way we avoid some of the complications that come with legalization and creating a regulated marketplace.