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Mr Deputy Speaker (Mr Nigel Evans)
We are now moving on to the final debate before the Adjournment, on the motion on access to—is it psilocybin? [Hon. Members: “Psilocybin”]—psilocybin treatments. I have learned something today, and I will learn a lot more, I suspect.
Charlotte Nichols (Warrington North) (Lab)
I beg to move,
That this House welcomes the development of treatment options in mental health; further notes there have been no new pharmacological treatments for depression, with the exception of Esketamine, in over 30 years; recognises that psilocybin, a naturally occurring compound, has the potential to revolutionise the treatment of many of the world’s most hard to treat psychiatric conditions such as depression, PTSD, OCD, addiction and anorexia nervosa; recognises that no review of the evidence for psilocybin’s current status under UK law has ever been conducted; regrets that psilocybin is currently more controlled than heroin under the most stringent class and schedule under UK law which is significantly stalling research; and calls on the Government to take steps to conduct an urgent review of the evidence for psilocybin’s current status as Schedule 1 under the Misuse of Drugs Regulations 2001 with a view to rescheduling, initially for research purposes only, in order to facilitate the development of new mental health treatments and enable human brain research for the benefit of researchers, patients and the life sciences sector in the UK, and to deliver His Majesty’s Government’s commitment to be world-leading in its approach, with evidence-led and data-driven interventions, and building the evidence base where necessary.
Psilocybin is a psychoactive substance found in more than 50 species of fungi, including many native varieties of mushroom that grow wild across the UK. There is a certain irony in the fact that this debate follows on from the debate on access to nature, because in many respects our debate is also about that.
Psilocybin is a naturally occurring substance and produces a window of neuroplasticity that lasts for a number of hours. When administered in a controlled environment with psychotherapeutic intent by trained professionals, psilocybin could be a powerful and effective tool to help treat society’s most complex mental health conditions, and that is what we call on the Government to make possible.
The evidential basis for psilocybin’s current status as a schedule 1 substance has never been reviewed since it was first controlled more than 50 years ago, and there is an urgent and medically justified need to reschedule psilocybin under the Misuse of Drugs Regulations 2001. It is unethical to deny that any longer. A review of the evidence of psilocybin’s harms and utility should be undertaken immediately, with a view to rescheduling it.
The use of psychedelics in medicine is not novel; they have been used throughout human history to treat the sick, from peyote ceremonies in Mexico to ayahuasca in the Amazon basin, and the San Pedro cactus in Peru. The earliest evidence of psychedelic use can be found in a cave in the Tassili-N’Ajjer region of the Sahara desert in Algeria, with a mural depicting what is referred to as the “mushroom man” or “mushroom shaman”, a bee-headed figure with mushrooms identified as Psilocybe mairei, native to the region, sprouting from his body. The mural has been dated as being between 7,000 and 9,000 years old.
The Selva Pascuala mural in a cave in Spain features mushrooms that researchers believe to be Psilocybe hispanica, a local species of psychedelic mushroom, and is dated as being approximately 6,000 years old. We can also date back to the 13th century western scientists first discussing the use of psychedelics in healthcare in Latin America. None of this is new.
Modern psychedelic research began when Albert Hofmann first synthesized lysergic acid diethylamide, or LSD, in 1938, causing something of an explosion in interest among psychiatrists and psychologists, with studies from the period showing the safety and efficacy of psychedelics, including psilocybin, in treating a whole range of psychiatric conditions. However, all that progress was stalled by the counter-cultural movement of the 1960s, which ultimately led to the criminalisation of the drugs. Since then we have been in stasis, until in recent years something like a psychedelic renaissance has taken place among researchers.
Today, there are serious and considerable barriers to legitimate research associated with the schedule 1 regulations. While current legislation does not preclude scientific research with the drugs, it does make them significantly more difficult, time-consuming and costly to study. I will share with the House just one example of this, from Rudy, a psychology PhD student whose thesis is investigating psychopharmaceutical treatments for addiction—a noble avenue of study, as I am sure we would all agree.
Rudy was first motivated to undertake this research after reading incredible findings that psilocybin administration was associated with sustained nicotine cessation in humans, with 80% of participants abstinent after 6 months. Rudy wanted to see whether those results could be replicated to treat other addiction disorders. However, he ran into problems due to the schedule 1 status of psilocybin. He says that
“in order to undertake my research, I would have had to spend upwards of £20,000 applying for Home Office Schedule 1 licences and retrofitting my laboratory to the correct security standards. Meanwhile, I can work with heroin, cocaine, and methamphetamine with no qualms. In light of this, I had to modify my experiment to instead investigate the effects of ketamine. I find it shocking that this government is willing to throw life science research under the bus and push life scientists out of this country with an outdated and downright illegitimate understanding of the medical benefits psilocybin can provide. Please do what you can to fix this!”
That is just one example. At a recent seminar at the Royal Society of Chemistry with some of the country’s most eminent neuroscientists, psychopharmacologists and psychiatrists, I spoke to countless researchers who have run into the same issues, making their research either needlessly more expensive or so prohibitively difficult to do that it has had to be abandoned. There is a huge credibility gap between psychiatry and politics for that reason; psychiatrists cannot understand why, at a time when we claim to be listening to the experts in the field of health, and when this country is facing a mental health crisis, we in Westminster are satisfied with doing nothing on this issue.
Why do we set up expert bodies and not listen to them? It is dangerous, immoral and unethical, and it is frankly offensive to both psychiatrists and their patients that we seem to think that as politicians we know better because of some moral panic 50 years ago. Multi-criteria decision analysis shows the comparative harms of various different kinds of drugs. Psilocybin is physiologically non-toxic and consistently found to be one of the safest controlled drugs, with the broader category of psychedelic compounds it falls into considered relatively safe physiologically and not drugs of dependence. The idea that psychedelics, including psilocybin, are dangerous is a myth, created and perpetuated to justify keeping them illegal.
Psychiatrists tell me that psychedelics are the best clinical tool and the best bit of psychiatric equipment they have, altering states of consciousness to allow for deeper processing and exploration of trauma and opening a therapeutic window where treatment can work, versus sub-optimal treatments with maintenance medications and substandard psychotherapies.
Moving on to patients, there is not a single other field where we would accept a 90% failure rate as acceptable, yet in mental health treatment that is where we are. There are a number of mental health conditions, including borderline personality disorder, that we seem to be satisfied with having no proper treatments or cures for. Psilocybin has been shown in numerous studies globally to have a profound and lasting effect over placebos for a range of different mental health conditions including treatment-resistant depression, post-traumatic stress disorder, anorexia nervosa and addiction.
I want to talk first about one of those conditions, PTSD. I have referred previously to living with PTSD, and that is where my interest in the potential promise of psilocybin as a treatment first began—so please consider this a declaration of interest, Mr Deputy Speaker. I was first diagnosed almost two years ago, after being the victim of a crime, and I cannot overstate the impact it has had on my life.
PTSD is a condition that I can expect to live alongside potentially indefinitely, and that can only ever be managed. It is a condition that has, for me, proved almost fatal. I manage it through a combination of a powerful serotonin and norepinephrine reuptake inhibitor, Venlafaxine, taken daily, benzodiazepines taken for sleep and to stave off a dissociative episode if I am triggered by something, and regular therapy, following an almost month-long period as a psychiatric inpatient, having been sectioned in 2021 for my own safety. I am not telling the House this for sympathy, but because I hope my experience can be illustrative of just how debilitating a condition such as PTSD is.
We all know that being an MP can be a difficult job at the best of times. However, I ask hon. Members to consider for a moment what it is like living with a condition such as PTSD and the myriad subtle and unsubtle ways my body lets me down: having to put my best face on and go into a meeting after a panic attack; having the energy to make it through our long working hours after a virtually sleepless night plagued by night terrors, where I try to fight my attacker off me and wake up covered in bruises; seeing someone who looks like my attacker on a tube platform and feeling a terror so acute that I want to jump in front of the oncoming train to make it stop; going for walks until I am exhausted and my feet are bleeding in order to burn through the nervous energy that fizzes up inside me; finding myself in dangerous situations and being more vulnerable as a result; hearing a car going past playing the song that was playing when my PTSD began and vomiting; dissociating and losing time; being angry, messy and erratic; crying at everything and nothing; being snappy with my loved ones and becoming convinced that ending my own life would be a kindness to all those who have had to deal with me throughout the worst period of my PTSD, from my staff to my family. Even at its best, it is a living hell. There is nothing I would not give, nothing I would not do, to go back to who I was before my diagnosis.
My experience is not unique. This is the reality of living with a serious mental health condition. I am making it through as best I can because of the love and support of friends, colleagues and psychiatric intervention, but I know that, just as I am a million miles better than I have been, and there are many more good days than bad these days, I could easily relapse because of something I can neither plan for nor prevent.
I am hopeful that this sort of treatment may offer a light at the end of a very dark tunnel and finally give me my life back. The evidence shows that psilocybin, as with other psychedelics, can be such an effective treatment for PTSD that following a successful course of psychedelic-assisted therapy, many patients no longer even fulfil the diagnostic criteria any more—they are all but cured. But this Home Office, and its scheduling policy, which says against all the evidence that this is not allowed, is stopping that. It feels like institutional cruelty to condemn us to our misery when there are proven safe and effective treatment options if only the Government would let us access them.
Just as that is one story—my own experience—consider the millions of people in this country and around the world living with the same, with no hope that things can or will ever get better. Depression is one of the most socially, medically and economically burdensome diseases of the modern world. It is the single largest cause of global disability and the leading contributor to suicide. An average of 18 people take their own lives every day. Up to one third of people with depression do not respond to multiple courses of medication; an estimated 1.2 million adults in the UK live with treatment-resistant depression.
The direct treatment and unemployment costs to the UK associated with depression in 2020 have been estimated at £10 billion. The human and economic burden of that condition is profound, and there are clear benefits to supporting development of therapies that may be effective where all other treatments have failed. Mental health costs the UK £117.9 billion a year—around 5% of GDP—yet that is not nearly enough money to address our current crisis. Waiting lists for specialist treatment are often years long. There is both a moral and economic imperative for the Government to act.
We are being left behind as a nation. Some US states have legalised the use of psilocybin in mental health treatment. In 2018 it was granted “breakthrough therapy” status for depression by the United States Food and Drug Administration, expediting the research and approval process, with expected approval by the FDA in 2024. In Australia, from 1 July this year,
“medicines containing the psychedelic substances psilocybin and MDMA can be prescribed by specifically authorised psychiatrists for the treatment of certain mental health conditions.”
In Canada, healthcare practitioners may be able to access psilocybin for emergency treatment under a special access program when a clinical trial is not available or suitable.
We have charitable organisations in this country, such as Heroic Hearts, which take veterans abroad to be able to access treatment that they should be able to get in this country on our NHS. We have scientists, including the brilliant Dr Ben Sessa, leaving the country to pursue research and treatment abroad. That is utterly, utterly shameful. The real-world data from those countries will only make avoiding change in the UK even less justifiable.
The motion would make no difference to the laws around recreational use or supply of psilocybin or magic mushrooms. Further, there is no evidence of diversion of schedule 2 substances from clinical research. Use of psilocybin-containing mushrooms is low, and there is no evidence of users developing a dependency. As psilocybin mushrooms grow wild throughout the United Kingdom, psilocybin does not represent an opportunity for profit-motivated gangs and criminal individuals. These proposals do not risk increasing drug-related harms but will allow us to assess and access the benefits of psilocybin as a substance.
Of all of the psychedelic compounds that show promise in this area, psilocybin has the lowest risk profile across all metrics, so there is little reason not to reschedule it but plenty of reasons to make the change as soon as possible. The overwhelming scientific consensus is that psilocybin does not pose a major risk to the individual, to public health or to social order. Its schedule 1 designation is not morally, medically or economically appropriate.
We are supported in our call today not only by politicians from across the House, but by the Royal College of Psychiatrists, the Campaign Against Living Miserably, the Conservative Drug Policy Reform Group, Drug Science, Heroic Hearts, Clusterbusters and SANE, among many other organisations. I thank the Backbench Business Committee for having the political courage and will—those are, sadly, too often lacking in this place —to grant us this important debate so that we may move ahead on rescheduling psilocybin. Now it is the Government’s turn to show that political courage and will.
Psilocybin’s current status as a schedule 1 drug is incommensurate with the evidence of its harm and utility. I beg the Government to support our motion and finally, finally right the historic wrong of its scheduling.
Madam Deputy Speaker (Dame Eleanor Laing)
I think the whole House will wish to commend the hon. Lady for her courage in bringing this matter before the House and for the way in which she has put her case this afternoon.
Crispin Blunt (Reigate) (Con)
I wholly concur with your words, Madam Deputy Speaker, about the speech of the hon. Member for Warrington North (Charlotte Nichols). I also offer my thanks to those on the Backbench Business Committee for granting this debate. They were plainly moved by the brilliant words crafted by the hon. Lady, which I was privileged to deliver to the Committee on her behalf. I also thank the 25 parliamentary colleagues from across the House who supported the application for this debate on a technical and—as we heard from your predecessor in the Chair, Madam Deputy Speaker—tricky-to-pronounce subject, which is of astonishing potential importance to the future of mental health treatment.
The debate helpfully falls during Mental Health Awareness Week. The Government are formally committed to evidence-based policymaking; that is stressed in the White Paper of 22 August 2022. There is an immediate need to act on all available evidence in respect of psilocybin. Having spent the last six years specialising in this country’s failing approach to drugs and drugs harms, and setting up a think-tank on the subject to provide me with expert advice on the issue, I know the challenges all too well.
On 14 March 2023, the Minister with responsibility for drugs, the right hon. Member for Croydon South (Chris Philp), and I debated this very issue on the Adjournment. I purposely used that debate to raise the principal issues involved in this narrow question. I did not seek answers from the Minister on that occasion, but sought to give him a little time to look at options to resolve the question. It was already my intention to follow up with this debate to demonstrate publicly that this is not just my view but one that is widely shared, as the hon. Member for Warrington North said, including by the Royal College of Psychiatrists; mental health charities CALM and SANE; veterans’ charity Heroic Hearts, of which I happen to be a trustee; cluster headache organisation Clusterbusters; Drug Science, a drug charity chaired by the former chair of the Advisory Council on the Misuse of Drugs, Professor David Nutt; and across this House.
I wanted to give the forewarned drugs Minister the opportunity, in responding to the debate, to show that His Majesty’s Government understand the potential improvement to mental health treatment, and that they are straining every bureaucratic and regulatory sinew to follow up the strongly indicative research evidence to date about its potential. I put that in terms in the previous debate. I said:
“I do not want or expect an answer this evening; these matters demand careful consideration. There will shortly be an application to the Backbench Business Committee, supported by more than a score of colleagues from across the House, for time for a fuller consideration. I hope by the time that debate is secured we can enjoy the news that this Minister is taking the available opportunities of his very tough policy inheritance.”—[Official Report, 14 March 2023; Vol. 729, c. 805.]
It is now two months since that debate and almost six years since the Advisory Council on the Misuse of Drugs was first commissioned to look at the problem, so it is frustrating, to put it mildly, that it is the drugs Minister’s colleague who has been put forward to reply to this debate. I have the highest regard for the Minister for Immigration, my right hon. Friend the Member for Newark (Robert Jenrick), and the quality of his attention to detail on issues he has been responsible for, such as planning, which is of immense importance to my constituency of Reigate, but this issue needs the policy Minister across the complexities engaged, and with the authority and confidence of his colleagues to carry them with his strategy, to enable the benefits that only bureaucratic inertia prevents.
Where is the drugs Minister? Having told him in terms of today’s opportunity and the date of this debate, when I had notice of it from the Backbench Business Committee, and of my expectation that he would have spent those ensuing two months engaged with these issues and able to come to the House today, what are we to make of his absence? What has he prioritised over Parliament, with notice? Does it remain his view that this issue is not a priority? Has he nothing new to say? Has he so little regard for the people who are raising this that he has prioritised the apparent visit scheduled for today, having initially tried to palm it off on the Minister for medicine, my hon. Friend the Member for Colchester (Will Quince), in the Department of Health and Social Care?
The Immigration Minister is now having to reply to this debate, and I already know the speech he is going to give on officials’ advice. The irony is that it should be the Minister for medicine replying to this debate, but the Department of Health and Social Care does not own this policy—the Home Office does—and that is part of the reason our drugs policy is in such an unforgivable mess. I am not sure who should be more insulted and put out by the drugs Minister’s dereliction of parliamentary duty: my right hon. Friend answering, with no new defence to offer, or myself, who tried to create this opportunity and deliver an incentive to his colleague to get the necessary focus to clear the bureaucratic hurdles to enabling this potential medicine.
What we can certainly conclude is that this Home Office, with the collective responsibility of all Government Ministers, can now be held accountable for the delay in delivering psychedelic-assisted psychotherapy and psychiatry as a new mental health treatment in the United Kingdom. Having heard the powerful opening speech from the hon. Member for Warrington North, it must be clear to any reasonable person that the duty on His Majesty’s Government to act and act now has been established.
The hon. Member for Warrington North, with personal courage of the highest order, has used her own massive trauma to advance the public interest engaged. She speaks for tens of thousands suffering from apparently untreatable, life-changing mental health trauma. How can my right hon. Friend the Minister look our parliamentary colleague in the eye and read his prepared script? She also speaks for 1.2 million of our fellow citizens with depression. One hundred and twenty five people end their battle every week by killing themselves. Knowing what they know, that makes the Government guilty of joint enterprise in those decisions, because we could and should now be on a path to avert them.
The hon. Lady speaks for about 2,500 veterans of Iraq and Afghanistan who have PTSD from their service that is currently untreatable. She speaks for Scotty, the ex-paratrooper medically discharged after 15 years of service who presented himself with military dignity on my train home last week to his fellow passengers. He gave his Army number and his service record of five tours in Iraq and Afghanistan as he asked for food, not money, understanding his health condition to be untreatable. He was apparently medically discharged after 15 years’ service due to an untreatable mental health condition and a borderline personality disorder. His dignity in these appalling circumstances, when simply under the care of his GP, being prescribed every kind of chemical cosh going but with no hope of cure, was humbling. It is the absence of hope that I found so distressing.
The current cost of depression alone to the United Kingdom economy is estimated to be about £110 billion a year—5% of our GDP. Even if psilocybin delivered a fraction of what is hoped, the benefits to the economy would be immense, and giving hope to those suffering without it today would be priceless. The ask is simple: that psilocybin be placed in the same schedule as heroin and cocaine through an urgent review by the Advisory Council on the Misuse of Drugs of the evidence of its harms. The original controls were not based on a review of the available evidence but simply on the fact that no product had yet reached market, which itself is an accident of history. No review has ever been conducted since, for over half a century. In what other area of policy would that be acceptable? Where it has been assessed—in Australia and the United States, for example—change has happened.
It is especially shocking that psilocybin has never been subject to analysis of harm and utility, when the Government admit they are aware of the many studies regarding its potential therapeutic applications. Adding insult to injury, the Government have confirmed that they have no plans to commission the Advisory Council on the Misuse of Drugs to assess the scheduling of psilocybin because it is “not currently a priority”. The potential treatment of thousands, if not hundreds of thousands, of mental health patients is not a priority—really? Does the word “scandalous” do that position justice? If psilocybin treated a physical health condition such as cancer or epilepsy, Government inertia not to swiftly lift barriers to research and treatment would not be tolerated, given the level of clinical potential and safety.
Let us not forget that in the last four months alone, His Majesty’s Government have commissioned the ACMD to conduct rapid reviews of the evidence of the harms of both nitrous oxide and monkey dust. In the case of nitrous oxide, it took the ACMD four weeks to reply. It took the Home Office about four hours to formally ignore that advice, but we know it is possible to commission a rapid review of harms, so why not do so for psilocybin? The Royal College of Psychiatrists and various mental health charities wrote to the drugs Minister to say:
“It is unethical to wait any longer. Psilocybin’s schedule 1 designation is not morally, medically or economically appropriate.”
Now let me address the speech that we shall hear from the Immigration Minister. He will explain that research trials are possible under schedule 1. While research into schedule 1 drugs is possible, only a tiny fraction of the possible research actually takes place, almost all of which is conducted by large pharmaceutical companies trying to bring drugs to market. This red tape not only discourages competition, as only very big companies can afford to conduct the research; it also means that, as the research is unnecessarily expensive, it will be the taxpayer who ultimately picks up the bill through higher drug prices for the NHS. Moreover, leading UK academics have had to relocate to North America and Australia, where the research is easier, which is leading to a brain drain in this vital bioscience area, despite our desire to be a science superpower. Put simply, the Home Office is the enemy of the Prime Minister’s aim to make Britain a centre of global bioscience.
The Immigration Minister, reading his script, will explain that barriers to research are already being investigated and that the ACMD is currently undertaking a review of the barriers to research into controlled drugs beyond cannabinoids. We are told that the drugs Minister is apparently pressing for urgency on psilocybin, but it was six years ago, in 2017, that the Government first asked the ACMD to review this. There is no current deadline for the completion of the current report. In 2017, the Government rejected the ACMD’s recommendations, just as they did with nitrous oxide recently.
In the meantime, since 2017, 40,000 people with depression and trauma have taken their own lives. As butchers’ bills for Government inaction go, I hope that statistic alone will gain some attention. Are the Government hoping that this issue will simply go away? Let me tell them: it will not. Under the current procedures, even if the ACMD is supportive of rescheduling, the Government will still need to issue a further review to reschedule psilocybin under statute to the same schedule as heroin and cocaine, as the current review does not look at the evidence of harms for rescheduling specifically, meaning more delay, more deaths and more misery for those people suffering from depression, who will eventually get treated with pharmacology accompanying psychotherapy and psychiatry.
The Government have also taken the view that specific compounds will be rescheduled once a drug containing psilocybin reaches market authorisation. Nowhere in law, nor in the standard scheduling operating procedures for the ACMD, is that required. In truth, there are three routes to rescheduling: one is that market authorisation triggers a review of the scheduling of that product rather than the generic compound, as was the case with Sativex in 2018, but rescheduling can also take place through the ACMD self-commissioning a review of the evidence or the Home Office commissioning an ACMD review of the evidence. Waiting for a product to reach market authorisation produces a Catch-22 situation where a product cannot be researched in the first place because the barriers of schedule 1 are too high. More importantly, rescheduling only patented products could create a pharmaceutical monopoly on a compound that grows naturally in the United Kingdom, increasing waiting times for patients and costs to the NHS and, ultimately, the taxpayer.
The Home Office has the power to commission a review of the evidence, and there is precedent for commissioning such a review in cannabis-based products for medicinal use. Indeed, in 2018, the wretched situation of just two epileptic children enabled change to start the deployment of cannabis-based medicines, but the regulatory treatment of the psychedelics—psilocybin in particular—remains unaddressed. Perhaps the Minister might like to have a go at advancing an explanation of why 1.2 million people with depression can go hang, compared with the very deserving but relatively few epileptic children.
There is some good news, in that thanks to the Chancellor’s Budget measures, psychedelics will benefit from the expedited approvals of medicines via the Medicines and Healthcare products Regulatory Agency announced in the Budget. While welcome, that would still leave UK patients without access until approval has been achieved abroad, leaving the UK trailing behind Canada, Australia and the United States. In this scenario, the United Kingdom has become a world bioscience follower and not a leader, with the Home Office seeking to deny competitive advantage to our prestigious universities and research companies—indeed, to impose disadvantage on them.
Finally, psilocybin has been consistently found to be one of the safest controlled drugs. It is physiologically non-toxic, and there is no evidence of diversion from schedule 2 substances of whatever danger from clinical research of any kind. Use of psilocybin-containing mushrooms is low, and there is no evidence of users developing a dependency. Psilocybin mushrooms grow wild throughout the United Kingdom, meaning that psilocybin does not represent an opportunity for profit-motivated gangs and criminal individuals. To argue that they might conceivably cause excessive damage to the population, especially when the ask is for medical use under medical supervision, is nonsense—not least when tobacco and alcohol are already legal.
If the Home Office is not prepared to act, it is surely now crucial that the ACMD demonstrates its independence and a proactive approach by prioritising the wellbeing of patients in the UK, particularly given that it is chaired by a practising psychiatrist who enjoys the support of his royal college. But today, Madam Deputy Speaker, it is perhaps time to reveal the Home Office’s true regard for the advice and guidance of the regulatory body responsible for advice on drugs policy, set under statute by this House. That body reports its total expenditure in 2019-20, the last year for which figures are available, as £46,067.34. That is to guide the Government on drugs harms that cost the country an estimated £20 billion a year. It is perhaps unsurprising that proactive advice from the ACMD is somewhat rare.
Surely now the Minister, who has so kindly stood in for his colleague, is appreciating the scale of the hospital pass he has received this afternoon. Add in the modest consideration that the size of the psychedelics market is set to grow to $10 billion by 2027, and the fact that today’s proposition enjoys four to one support with the public and has the potential to revolutionise the lives of millions, and the Minister is invited to defend the Government’s position, which is unethical, immoral and wholly counter to the national interest, however we express it. It will not stand the test of time—change it now.
Ronnie Cowan (Inverclyde) (SNP)
It is a rare privilege for me to rise in this place and follow two such magnificent speeches from Members across these Benches, and it is a fact that when we find ourselves with cross-party support on something, we tend to be able to back off and just talk sense about things, and stop trying to score political points off each other.
Then I look at the Government Front Bench, and I understand that the Minister must be asking himself the question, “Why on earth am I here today?” The Government have a history of doing this. When we bring forward debates that are clearly issues for the Home Office, particularly about drugs, they send a Health Minister. When it is clearly something about health, they send a Home Office Minister—this is not new. Sorry, Minister: you are not the first to be put in this position, but you are here today and you will answer the speeches that have been made. I am not going to rehearse everything that has already been said so eloquently today. There is no need: if you have been listening, you have heard the points. You have heard about the number of people who suffer from mental health conditions and can benefit from psilocybin, and the lack of research—I do not have to tell you it again.
Madam Deputy Speaker (Dame Eleanor Laing)
Order. It would assist me if the hon. Member would say “he” and not “you”, although we will not make a fuss about it.
Ronnie Cowan
Thank you very much, Madam Deputy Speaker, for once again correcting me.
Since announcing that I was taking part in this debate, I have been inundated with briefings from a wide range of individuals and organisations, every one of which was welcome. Not being medically trained, it took me some time to read through and absorb what I was being told. I have my own views on the issue and the path forward, but it is always worth while listening to those who agree and disagree with me—how else can I develop a well-rounded and balanced approach?
That is why it is interesting to note that the motion we are debating states that
“no review of the evidence for psilocybin’s current status under UK law has ever been conducted”.
As has been said, it currently has schedule 1 status under the Misuse of Drugs Regulations 2001, which—in the view of the UK Government, with no review of the evidence—makes psilocybin, a drug that cannot be overdosed on and has low addictive qualities, more dangerous than heroin or cocaine. We have legislation that is based on preconceptions rather than evidence. That is nonsensical—well, I think it is, but clearly the UK Government do not. They actively support the current situation.
Psilocybin has been pushed to the back of the drugs cabinet and left there, almost—but not quite—forgotten. In the USA, especially in Oregon and Colorado, they are way ahead of us in producing medical research; I also note that Australia has taken a lead in the field. In the UK, a drug being schedule 1 does not completely prevent research, but the researchers themselves have raised the issues of increased administrative and financial costs. We should not be placing barriers in the way of research: we should be supporting and encouraging it, and using it to help us legislate properly. It is not just me saying that. This month, the Royal College of Psychiatrists wrote to the Minister for Crime, Policing and Fire, the right hon. Member for Croydon South (Chris Philp), calling for the same change as this motion. People are suffering from mental health issues that existing evidence tells us would benefit from psilocybin administered by the right people in the right way. We should be pursuing that avenue of research and developing the support and professional skills required.
Before the Minister responds, I hope that he considers that the motion is not about recreational use. It is not about dictating the uses of psilocybin, or those who would benefit. All we are asking in the motion is that the UK Government conduct an urgent review of the evidence for psilocybin’s current status as schedule 1 under the Misuse of Drugs Regulations 2001. That is it; that is what we are asking for. That would allow better opportunities for the required medical research to be completed. That research would help us to provide appropriate medical support for those suffering from a range of conditions. Why would the UK Government not want that? Why would they continue to obstruct the research? I look forward to the Minister’s response.
Danny Kruger (Devizes) (Con)
May I add my voice to those who have paid tribute to the speech of the hon. Member for Warrington North (Charlotte Nichols)? She said she was not asking for sympathy, but she has the sympathy of the House and, I am sure, of anybody who watches that speech on film, which I hope many will do. My heart goes out to her for all that she has been through. I also hope more people see the speech of my hon. Friend the Member for Reigate (Crispin Blunt), which deserves wide circulation. He is a tremendous campaigner on many issues, not all of which I join him on, but I sympathise with what he is trying to do today. I particularly acknowledge and want to add to my voice to his point about the suffering of our veterans. As a Member with a large military community, I echo that. Too many of our former servicepeople suffer appallingly from PTSD and we need to do more to help them. Psilocybin might be part of the answer.
Both the hon. Lady and my hon. Friend cited studies suggesting that the efficacy of psilocybin is similar or superior to that of pharmaceutical interventions, and selective serotonin reuptake inhibitor drugs in particular. That is significant and we need more research to test that because, if true, it is tremendously positive news. Crucially, the evidence suggests that psilocybin is not dependency-forming and not toxic. I speak as the chair of the all-party parliamentary group for prescribed drug dependence. Research by colleagues supporting that APPG has laid bare the degree of dependence on prescribed drugs that exists in our country. I am talking not about illegal drugs here, but about drugs administered by doctors, generally in response to mental health conditions, and depression most of all.
A fifth of the adult population is on some sort of dependency-forming drug, such as SSRIs. Many of those are absolutely appropriately prescribed—the hon. Member for Warrington North mentioned that she takes an SSRI—but that is a very high rate. Crucially, and most worryingly, many people who are taking prescribed drugs were only prescribed them, according to the guidance that accompanies them, for a certain number of months. However, because doctors repeat prescriptions and we have such an inadequate system of withdrawal support for people in this country, they are prescribed these drugs for years and years, well beyond the healthy and safe guidance that was given. Of course, if they try to withdraw on their own without the support they need, they suffer terribly. Often they are re-prescribed the drugs because the doctor thinks they are having a relapse, when actually all they are doing is going through the agonies of withdrawal.
We need to do so much more to support people who take these prescribed drugs. There is also a huge amount—at least £500 million a year—spent on prescribed drugs for people where the prescription has gone beyond the period in the guidance. They should not be receiving these drugs, but they are doing so and it is costing the taxpayer half a billion pounds a year. We can think of the knock-on effects in terms of the health costs, and my hon. Friend the Member for Reigate mentioned huge figures there, the welfare costs and the human cost. We need to go beyond these pills. We need to get to an approach to mental health that does not only rely on what he calls the chemical cosh.
I have some concerns about psilocybin being the next big thing or the next SSRI, treated and imagined as if it will be some sort of silver bullet—another pill and another shortcut to what is a profoundly complex set of mental health circumstances, which derive in many cases from trauma and deep-rooted adverse social and emotional conditions that cannot just be wished away by the administration of a new pill.
Danny Kruger
I am happy to give way. I am about to repeat my own argument, but my hon. Friend will do it better than me.
Crispin Blunt
My hon. Friend was kind enough to reference the work that has already gone on. I could cheerfully read into the record the list of 15 separate studies where the evidence is gradually being developed, despite the schedule 1 status, about efficacy. That addresses his proper concern about treating this as another mythical silver bullet that solves the issue. There is only one way for us to fully establish this, but it is already evidentially established sufficiently that we should be doing everything we possibly can to enable this treatment to get under way.
Danny Kruger
I echo that point. The point I am making more generally is that I am concerned that we withdraw from a medicalised model. It is a bigger topic, but the way we approach health in general can often be over-medicalised, and that is particularly so for the mental health field. I echo my hon. Friend’s point that we have sufficient evidence to justify a more official review and I support the call for that. The hon. Member for Warrington North put the point very well. What we understand to be the case with psilocybin is that it creates this therapeutic window where talking therapies can be even more effective, or can be effective, because frankly often they are not effective at the moment.
If the administration of this non-toxic, naturally occurring substance can create an opportunity where talking therapy can be effective, that should be welcomed, and there is sufficient evidence to justify us looking at that. I am open to suggestions, and I am interested to hear what the Minister says—not from his script—about what might be done. It may be that the chief medical officer is the best office to review this. We need to be careful, and I retain my note of caution about leaping for another solution that might not deliver what we hope it will, but I also share the hope and inspiration that Members have mentioned.
I recognise the point—I do not know whether the Minister will make it—that it is possible to conduct research under schedule 1. As my hon. Friend the Member for Reigate said, it is difficult and expensive. In fact, it is usually just done by pharmaceutical companies that see the opportunity for big profit from new drugs. I am concerned that we do not class this research in that guise. In fact, I hope there will not be big profits to be made from this naturally occurring substance. This is another topic, but I am concerned about the MHRA, how it is funded and how it licenses treatments. I am not entirely sure we are doing the right thing by giving it the power to rubber-stamp licences that have been given abroad. I am not sure that speeding up approvals is always right, but in this case we need to conduct the research.
I find myself in the strange position not only of agreeing with my hon. Friend—actually, I do agree with him on many important matters, just not on others—but of taking inspiration from places such as Oregon and Colorado that I regard as unhelpful places, given the other things they are up to; they are the leading jurisdictions promoting assisted suicide, of which I strongly disapprove. I notice that Australia is also in the gang, and presumably Canada, if it is not so already, will be full steam ahead for psilocybin. Liberals do not get everything wrong, I suppose is my conclusion, because these places are paving the way and in this case we should follow them.
Martin Docherty-Hughes (West Dunbartonshire) (SNP)
Thank you, Madam Deputy Speaker, and it is good to see you in the Chair. It is a pleasure to speak in the debate today and to follow the hon. Member for Devizes (Danny Kruger) on a subject about which I have to admit I had no great prior knowledge. I had some knowledge, although not great prior knowledge, so getting my nose into briefings and articles about a most poorly understood topic, at least I think for Members in this House, and hearing the various contributions today has been most enlightening.
I will come on to those contributions in a moment, but I would like to pay tribute to my good friend, my hon. Friend the Member for Inverclyde (Ronnie Cowan), who is a co-sponsor of today’s debate. He is certainly a fan of the road less travelled, and I find the tenacity and good humour with which he approaches the sometimes unfashionable subject of drug reform—not only in this Chamber, but at home in Scotland—to be a breath of fresh air. As we know, the subject can often be too dominated, especially in this place, by preening truism pedlars who do not challenge either elected Members or the general public, who expect us to be able to have debates of substance on topics that, as the hon. Member for Devizes indicated, have no easy answers, but are none the less valuable.
I thank the hon. Member for Reigate (Crispin Blunt) and especially the hon. Member for Warrington North (Charlotte Nichols) for showing that there is cross-party support in this House for a sensible evidence-based approach to drug law reform. To come first to the hon. Member for Warrington North, who talked about the prior debate on access to nature, we live in these islands surrounded by psilocybin. Importantly, the hon. Member brought in the lived experience of their condition and how this research, or rescheduling to schedule 2 would have a profound impact on those suffering from PTSD. I hope not only that the Minister is listening, but that all of us on the Front Benches are listening, as well as those who advise Ministers in Government in Whitehall. I am sure Government Ministers will be taking their advice and I hope they are listening to the lived experience so well and eloquently expressed by the hon. Member.
The hon. Member for Reigate exposed something that all politicians, especially those on the Front Benches, need to be very careful about, which is proposing White Papers that talk about an evidence-based policy-making approach. Well, the evidence seems to be self-evident. My good friend, my hon. Friend the Member for Inverclyde, talked about how the regulation we have is based on a preconception. I am maybe going to call it the “Mary Whitehouse approach”, because it seems to be founded on the Mary Whitehouse approach of the 1950s. I hope that those who advise Ministers—from the medical profession, but notably civil servants in Whitehall—will reflect that we now perhaps need to take our heads out of the sand.
I think it is clear from the contributions in general today that something does need to change with regard to the drug scheduling laws, particularly as they relate to psilocybin. It is a strange time for drug reform in many ways. We in this place seem a good decade, if not even further, behind the attitudes of the wider public—and, actually, other countries—who appreciate that the days of endless and expanding prohibition must surely be behind us and that the so-called war on drugs has been in so many ways not only unwinnable, but actually detrimental to the society it seeks to protect. I think all of us on the Front Benches really need to take our heads out of the sand and look at the opportunities that debates such as this now offer us to change our own views.
My party is one that I hope will always support sensible drug policies that uphold the rule of law and make communities safer. I am afraid that I now need to perhaps challenge the Minister about the UK Government’s continued reticence, for example, to even countenance an evidence-based change to drug laws, which, at least from my perspective, means letting people down. For those of us in Scotland, we have seen this in, for example, the safe consumption rooms. It is a policy with proven efficacy across the western world that enjoyed cross-party support as one possible way to reduce the terrible toll of drug deaths in many of our constituencies, yet I am afraid this was reduced to the level of party politics.
I mention the Government’s attitude to opiates there deliberately, because in many ways psychedelic drugs are more restricted, as we have already heard from various Members, with opiates being licensed for medical and research use, while substances such as psilocybin remain on the schedule 1 list with no medical potential. So this makes it an issue of pretty unique importance. I can understand arguments against, for example, safe consumption rooms, even if I disagree with them, but when it comes to psychedelic compounds, I do not think anyone can have the same arguments regarding addiction and societal breakdown that we would have heard around opiates.
Members who want a crash course in opiate addiction need only pick up the Financial Times today to see the profound consequences of opiate addition in the city of San Francisco in the United States. It is a harrowing article to read, and will have consequences for us all if we do not start to pick up on some of the issues highlighted by the hon. Member for Reigate about accessing new medical treatments. That is not, as the hon. Member for Devizes indicated, a silver bullet, but it is another tool in the armoury for those suffering from various conditions.
This is not just for mental health issues; there are a whole range of usages, and people are using psilocybin, or even micro-dosing with it, for many other issues. There are those who consider using it for attention deficit hyperactivity disorder, which is not a mental health issue but a learning disability. There are those using it who are pre-menopausal, menopausal and post-menopausal, to deal with the menopause. We have to take this out of certain silos and see it as the broadest opportunity. As the hon. Member for Devizes said, this is not a silver bullet but another element in our armour to deal with a whole range of medical conditions. I would like to hear what the Minister has to say, because I am not sure that that approach is yet cutting through, although I might yet get that wrong.
As we have heard from those contributing to the debate, there are certainly enough examples of the efficacy of psychedelic-assisted psychotherapy to merit further research, but the barriers put up by schedule 1 status make any investment in that research prohibitively expensive. SNP Members believe that needs to change. We talk about the shrinking number of industries—again, the hon. Member for Reigate made a fantastic speech to challenge the Government, and they made it very clear that the UK seeks to be a global player. After financial services, the example given is the pharmaceutical industry, yet in that area of relative competitive advantage the Government seem—I might be wrong; perhaps the Minister wants to get to his feet and change that opinion—to be choosing to cede to states, notably in North America and the rest of Europe, that do not share that head-in-the-sand approach.
At a time when it is becoming somewhat fashionable for Members to talk about the mental health crisis, catching up with the lived experience of so many in communities such as mine, and those described by the hon. Member for Warrington North, where people could take advantage of advances in psychiatric pharmacology to improve their lives, those of their families, and be better able to contribute to their community, is something I would recommend to Members across the House, to Ministers, and to those who seem to be advising them to stick their heads in the sand. To overcome such problems, we must rise to the challenge and grasp the opportunity offered by psilocybin and other areas like it, and not curtail what is a reasonable scientific proposal by sticking our political heads in the sand.
Let me conclude with a final appeal to the better judgment of the Minister and those advising him. They can be safe that they would be able to proceed with a solid trifecta of public support, a solid working hypothesis about how research into psilocybin would work, and a depth of industrial and academic capacity to bring this research forward. Let us see whether the Minister has the confidence to do so.
Karin Smyth (Bristol South) (Lab)
It is a pleasure to see you in the Chair, Madam Deputy Speaker. I thank my hon. Friend the Member for Warrington North (Charlotte Nichols) and the hon. Members for Reigate (Crispin Blunt) and for Inverclyde (Ronnie Cowan) for their incredibly moving and well-informed speeches, and the Backbench Business Committee for supporting their application. I recognise the work that they have done for many years on this subject. As we know, in this place many Members take up individual causes that often do not get the numbers and publicity that they might warrant, but we are dogged in continuing to do that. I managed to avoid the comments that the Minister had about whether he was the appropriate person or not. I say simply that I am here on behalf of the Labour party. I am pleased to be here, I serve, it is beyond my paygrade as to who or why someone is here, but I am pleased to be here.
Like the hon. Member for West Dunbartonshire (Martin Docherty-Hughes) I too needed to appraise myself of the details of this subject, and that is one advantage of being able to speak from the health team. For more than 50 years we have been investigating these drugs as potential treatments for a number of neurological and psychiatric conditions including, as we have heard, depression. There is now another wave of research into these drugs and the treatment of neuropsychiatric disorders such as treatment-resistant depression, anorexia and PTSD, and we have heard about that strongly today. Our priority is to improve treatment and prevention services and, in particular, to support research.
The point has been well made that this subject falls between Departments—Health and the Home Office—as is the case on many subjects. Wherever it falls, it is all of our responsibility, because at the heart of this, as we have heard strongly, is the needs of people—our constituents—for treatment of these conditions. As the motion says, we need evidence-led and data-driven interventions. That is why the last Labour Government established the National Institute for Health and Care Excellence to balance care with value for money, to deliver for individuals and society. That involved rigorous and independent assessment of complex evidence. That is why, for the use of psilocybin and other treatments in the NHS, I strongly support an evidence-based approach and those processes.
This discussion highlights the opportunities available to us and to our constituents through a vibrant life sciences industry. Labour is committed to supporting our health sciences industry to improve the health and wealth of our country. That is why I am proud and hugely supportive of our fantastic academic and clinical colleagues in the NHS and UK higher institutions. They are doing world-leading research through the use of both experimental and gold-standard clinical trials to look at whether such treatments, among others, are helpful for those with severe and enduring mental health conditions. That includes interesting work on the use of psilocybin alongside talking therapies.
We hear much from the Government about their commitment to research and development, but it would be helpful to hear from the Minister about what pragmatic support the Government are giving to the research sector, universities and pharmaceutical companies to enable more research into this area.
It is clear that that work cannot sit in a silo. Following the Adjournment debate on this topic, which was responded to by the Minister for Crime, Policing and Fire, the right hon. Member for Croydon South (Chris Philp), I would like to know what conversations the Minister has had with counterparts in the Home Office regarding the controlled drugs licensing regime to support research and clinical trials in the UK. Additionally, will he update the House on part 2 of the Advisory Council on the Misuse of Drugs’ advice, which was commissioned in December? That would be helpful. This is a cross-cutting issue, so he may have had conversations with Health colleagues on it, but I understand that it falls under his Department. Members on both sides of the House have come here today with good will to work cross-party—we have seen that in evidence this afternoon—and it is crucial that the Minister echoes that sentiment and outlines how the Departments are working collaboratively on this matter.
We cannot ignore the lack of a wider Government strategy on mental health, particularly in Mental Health Awareness Week. For far too long the Government have been dragging their heels on mental health. Last year they lauded themselves for putting together a 10-year Government mental health plan. However, like so much that comes from them at the moment, after months of consultations, pages of evidence and vital input from the public and experts, again we have more backsliding on those commitments. The Government must stop pushing things into the long grass and get serious about mental health.
The long-awaited reform of the Mental Health Act 1983 is a much-needed step in the right direction on improving people’s experiences with mental health services, but, despite the Joint Committee publishing its report on the draft Bill, there is still little progress. If we want to see patients having greater control over treatment options and accessing care tailored to their needs, the Government must get more serious about mental health services.
More than 7 million people are waiting for NHS treatment, and they are waiting longer than ever before, in pain and discomfort. The NHS went into the pandemic with record waiting lists and 100,000 vacancies, and there are more than 1.6 million people awaiting mental health treatment alone. Adults are waiting 5.4 million hours in A&E while we are experiencing a mental health crisis. We have heard about some of those crises today, and that is not the place for treatment. Without a proper plan for prevention and early intervention, and without a suitable workforce plan, patients will continue to be left behind.
Even where patients do get a referral, the appropriate course of action for their specific treatment needs is often not available. That accessibility to tailored mental health support goes to the core of why we are here. Across the NHS, there are frequently supply issues with antidepressants—medication that is already licensed—that people are dependent upon. Without secure supply chains, how can patients be secure in the knowledge that they will continue to receive their prescribed treatment? The anxiety that disruptions to treatment can cause patients cannot be ignored. That is why it is crucial that Ministers understand the importance of a variety of treatment options and of research and development. If the Minister could give an update on those supply issues and the assessment of stock availability, that will be welcomed by the people watching this debate.
The Government need to get a grip on mental health services. If they do not, we will. We will put prevention and early intervention at the forefront of our approach to mental health. We will place a mental health specialist in every school and an open access hub for young people in every community. We will double the number of district nurses qualifying every year and create additional nursing and midwifery placements in the health service. We will double the number of medical places so that we have the doctors that our NHS needs. We will guarantee mental health treatment within a month by recruiting an extra 8,500 mental health staff. We will reform the NHS to shift its focus to early diagnosis and intervention, as well as preventing ill health in the first place. Working with leading figures from research, life sciences and patient care will be a huge part of that.
The Minister for Immigration (Robert Jenrick)
In the years that I have served as a Minister, I do not think I can recall a debate in which expectations were set so low about my response before I even stood up.
I thank my hon. Friend the Member for Reigate (Crispin Blunt), the hon. Member for Inverclyde (Ronnie Cowan) and the hon. Member for Warrington North (Charlotte Nichols) for securing the debate. I am grateful to them and to all the other Members who have contributed. This is the first debate that I have participated in on this subject, as colleagues have said. The House has raised the topic of psilocybin and other psychedelic drugs with the Minister for Crime, Policing and Fire, my right hon. Friend the Member for Croydon South (Chris Philp). I appreciate the disappointment felt by my hon. Friend the Member for Reigate that the Minister is unable to be with us today to respond directly to his concerns, but I am afraid he was drawn away on other departmental business. I recognise that this is a topic of substantial interest to Members of the House, who, again, have made the case with passion.
Crispin Blunt
Could the Minister give a bit of detail about the duties that have taken the drugs Minister away from the House?
Robert Jenrick
I am afraid I do not know the precise departmental visit that my right hon. Friend the Member for Croydon South is on. But knowing him, if he was here, he would certainly wish to be part of this debate and to continue the conversation that he has had with hon. Friend the Member for Reigate. It is only because of other departmental business that he was not able to join us today.
I want to begin by recognising, as others have done, the personal interest that the hon. Member for Warrington North has in this topic. I concur with your comments, Madam Deputy Speaker, that the hon. Member spoke with great conviction and very deeply. I have heard her speak on other subjects that we have a shared interest in, such as the fight against antisemitism, with the same eloquence and bravery that she showed today.
It may be helpful at the outset to remind the House that medicines policy, including the availability of medicines for prescribing, is led by the Department of Health and Social Care. Medicines are licensed and regulated by the Medicines and Healthcare products Regulatory Agency. However, the Home Office is responsible for controlled drugs legislation. Our controlled drugs licensing regime supports research and clinical trials in the UK. The two Departments work together on issues connected to controlled drugs in healthcare. I will endeavour to set out the Government’s position this afternoon.
Controlled drugs legislation seeks to prevent criminality while permitting access for legitimate use, including for medicines development. The Misuse of Drugs Regulations 2001 enable the use of controlled drugs in healthcare. The Home Office’s controlled drugs licensing regime enables the possession, supply, production, import and export of controlled drugs to support industry, pharmaceutical research and healthcare. These controls are subject to review in light of any emerging evidence and in consultation with the Advisory Council on the Misuse of Drugs, which has been referenced many times this afternoon.
There is an established process for medicines, including those that contain controlled drugs, to be developed, evaluated in clinical trials and licensed, based on an assessment of their quality, safety and efficacy by the MHRA. The MHRA supports the safe and scientifically sound conduct of clinical trials in this area, and provides regulatory and scientific advice to companies at all stages of developing medicines. Should a company submit an application for a marketing authorisation, otherwise known as product licence, it will ultimately be a decision for the MHRA whether to license a product based on a psychedelic drug as a therapy.
Charlotte Nichols
The Minister refers to marketing authorisation. In this case, psilocybin, as we have discussed, is something that grows in mushrooms across the UK. Is the Minister suggesting that people would be able to access psilocybin only if it were in another substance?
Robert Jenrick
I am by no means an expert in this field, but I think I am suggesting that were this to be a drug that is licensed, it would need to go through the MHRA process in the usual way.
I would like to come to a point made by the hon. Lady earlier around the costs involved in a first-time application for a controlled drug licence of the kind we have been discussing. She quoted a substantial figure, which would be concerning as it would be prohibitively costly for smaller manufacturers or researchers. The figures that I have been quoted are that first-time application for a licence costs £3,700 and a standard renewal costs £326. I will write to the hon. Lady with those figures and if she contests them in any way, then I or the Minister for Crime, Policing and Fire, my right hon. Friend the Member for Croydon South (Chris Philp) will be happy to respond.
Ronnie Cowan
The cost is not just about the licence. Because it is a schedule 1 drug, more dangerous than heroin, the way in which it is stored in a laboratory, so that people cannot get access to it, and the set-up needed around the laboratory has caused a lot of people to say that they simply cannot afford to make such modifications to their laboratories and start the investigation in the first place.
Robert Jenrick
I see that point. In a moment, I will come on to the work that the Government are doing in that regard, and more broadly, to facilitate research and make it more accessible to a broader range of organisations.
To finish the point about the process involved, once granted a medicine licence by the MHRA, medicines can be assessed by the National Institute for Health and Care Excellence, which makes recommendations about routine prescribing on the NHS.
I thank the hon. Members who described the promising research emerging on the potential benefit of psilocybin. Studies in the UK include publicly funded research. For example, the National Institute for Health and Care Excellence is funding King’s College London to carry out a trial evaluating the feasibility, safety and efficacy of psilocybin for adults who are unresponsive to or intolerant of treatment for depression.
In January last year, King’s College London published the results of a small-scale study suggesting that psilocybin can be administered safely, under certain circumstances and to healthy individuals. That is clearly encouraging. However, the researchers acknowledge that larger and longer trials, including comparison with existing treatments, would be required to determine the efficacy and safety of psilocybin for this disorder.
Crispin Blunt
I hope by now, as he has read his text, my right hon. Friend is beginning to work out that the administration of drugs policy is suboptimal, shall we say. Can he explain why esketamine is approved in Scotland, but not in England?
Robert Jenrick
I do not know the answer to that question, but I will happily ask officials who are listening to respond. It sounds like a matter for the Department of Health and Social Care rather than the Home Office, but I shall be pleased to give my hon. Friend a full reply as soon as possible.
Robert Jenrick
If my hon. Friend already knew the answer to his question, I wonder why he asked it in the first place.
Crispin Blunt
As my right hon. Friend well knows, one does not ask questions to which one does not know the answer. That is not a very wise thing to do in politics.
A point was raised with me by the public affairs director of a subsidiary of a major pharmaceutical company about the differential between physical and mental health treatments. This illustrates the difficulty of getting mental health treatments to the necessary standard for assessment by NICE, and is a further illustration of the different priorities given to the treatment of mental and physical health conditions.
Robert Jenrick
My hon. Friend has made his point very powerfully. Of course the Government’s ambition is to ensure that NICE, the MHRA and all our regulators work in the most research-friendly manner, and that applies to mental health treatments as much as to anything else.
If a manufacturer is successful in being granted a marketing authorisation by the MHRA for a medicine containing psilocybin, the Home Office is committed to swift action to remove psilocybin from schedule 1 and make it available for prescribing, subject to advice from the Advisory Council on the Misuse of Drugs on the appropriate scheduling and safeguards for the medicine. The same scrutiny should be applied to all potential medicines to ensure patient safety. While it is legally possible to enable prescribing in advance of marketing authorisation, the Government currently have no plans to move to that position.
Charlotte Nichols
The Minister keeps referring to medicines containing psilocybin. He does not seem to understand that psilocybin is the medicine, in and of itself. It does not need to be added to something else to make it work. This is why we are running into the issue. The Government keep telling us about a licensing regime in which there is a requirement to add something to the compound in order to make it some sort of novel substance, rather than looking at the substance that already exists and, as we have said, has been used for thousands of years with demonstrated safety and efficacy. Will the Minister talk about psilocybin, rather than medicines containing psilocybin?
Robert Jenrick
I understand the hon. Lady’s point. As I have said, the Government are funding research into psilocybin and its effect on patients with certain conditions. What we are discussing today is the Home Office’s role in ensuring that that research, as it emerges, can be considered as part of our drugs legalisation framework.
The Government have commissioned the ACMD to consider how better to enable research with respect to all schedule 1 drugs, and that includes the potential to extend schedule 2 status for research purposes to all schedule 1 drugs including psilocybin. This, I believe, is the point that my right hon. Friend the Minister for Crime, Policing and Fire made in the Adjournment debate, and he has written to the ACMD asking it to consider, in particular, the potential options available to extend schedule 2 status for research purposes to all schedule 1 drugs. He highlighted psilocybin specifically in his letter. If the hon. Member for Warrington North, my hon. Friend the Member for Reigate or, indeed, other interested Members have not seen it, I shall be happy to ensure that they receive a copy and can see the instructions that my right hon. Friend has given to the ACMD. My hon. Friend the Member for Reigate asked earlier about the likely timetable for any advice from the ACMD. I have been told that, while the ACMD is independent of Government, it is understood that its consideration is well advanced, and we should expect its advice in the near future.
The approach that we have taken in this regard should deliver much of what my hon. Friend and others are requesting. I should make a distinction: prescribing will remain unavailable outside a clinical trial. It is not for the Home Office to determine medicines policy, and I am sure that my hon. Friend and others will accept the general principle that medicines should be assessed on the basis of their safety, quality and efficacy before being made available to patients.
The two Departments continue to support the ACMD’s review. The chief scientific adviser to the Home Office recently convened a discussion with her counterpart in the Department of Health and Social Care and the Government’s chief medical officer on this precise subject. I understand that they had a very positive discussion and I know that they will be advocating for the best outcome for researchers and, of course, patients. When the ACMD provides its advice, the Government will consider it carefully before deciding how to proceed.
I thank Members for their contributions to the debate. I can assure my hon. Friend the Member for Reigate and others that the Government have heard what they have to say. I will ensure that my right hon. Friend the Minister for Crime, Policing and Fire is fully apprised of what was said in the debate, so that he and others can continue their conversation on this issue.
I reassure the whole House that the Government agree with the intent of much of what has been debated today, but rather than developing a bespoke approach for psilocybin alone, we consider our approach to be more ambitious. We want to tackle this issue across all categories of section 1 drugs to reduce barriers to legitimate research, rather than focusing on individual drugs. Equally, we must keep a firm focus on the need to tackle drug misuse, which causes such harm across our society. Both are vitally important aims, and we will continue working to strike the right balance in the interests of the public.
Charlotte Nichols
I thank all Members who came to support the debate. Like my hon. Friend the Member for Reigate (Crispin Blunt)—he is a friend—I am disappointed in the Government’s response; yet again, we see a real lack of urgency from them on this issue. As we have heard, the ACMD review has been ongoing since 2017. In that time, at least 40,000 people have taken their own lives.
I am grateful for the fact that the Minister said he will take back the content of today’s discussion to the Minister for Crime, Policing and Fire, the right hon. Member for Croydon South (Chris Philp), who should have been here today but unfortunately was not, because I am really keen that we should finally progress this issue. I thank all Members who took part in the debate to make the case clearly and cogently to the Government that we cannot accept their inertia any longer.
Question put and agreed to.
Resolved,
That this House welcomes the development of treatment options in mental health; further notes there have been no new pharmacological treatments for depression, with the exception of Esketamine, in over 30 years; recognises that psilocybin, a naturally occurring compound, has the potential to revolutionise the treatment of many of the world’s most hard to treat psychiatric conditions such as depression, PTSD, OCD, addiction and anorexia nervosa; recognises that no review of the evidence for psilocybin’s current status under UK law has ever been conducted; regrets that psilocybin is currently more controlled than heroin under the most stringent class and schedule under UK law which is significantly stalling research; and calls on the Government to take steps to conduct an urgent review of the evidence for psilocybin’s current status as Schedule 1 under the Misuse of Drugs Regulations 2001 with a view to rescheduling, initially for research purposes only, in order to facilitate the development of new mental health treatments and enable human brain research for the benefit of researchers, patients and the life sciences sector in the UK, and to deliver His Majesty’s Government’s commitment to be world-leading in its approach, with evidence-led and data-driven interventions, and building the evidence base where necessary.