Psilocybin Treatments

Baroness Laing of Elderslie Excerpts

Thursday 18th May 2023 Commons Chamber

[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.

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[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.

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[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the SNP spokesman.

[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.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Minister.