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A Public-Health-Based Vision for the Management and Regulation of Psychedelics Mark Haden, M.S.W.A,B, Brian Emerson, M.D., M.H.S.C.C,D, and Kenneth W

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A Public-Health-Based Vision for the Management and Regulation of Psychedelics Mark Haden, M.S.W.A,B, Brian Emerson, M.D., M.H.S.C.C,D, and Kenneth W JOURNAL OF PSYCHOACTIVE DRUGS 2016, VOL. 48, NO. 4, 243–252 http://dx.doi.org/10.1080/02791072.2016.1202459 A Public-Health-Based Vision for the Management and Regulation of Psychedelics Mark Haden, M.S.W.a,b, Brian Emerson, M.D., M.H.S.C.c,d, and Kenneth W. Tupper, Ph.D.a aAdjunct Professor, School of Population and Public Health, University of British Columbia, Vancouver, Canada; bChair of the Board of MAPS (Multidisciplinary Association for Psychedelic Studies) Canada, School of Population and Public Health, Vancouver, Canada; cChair of the Psychoactive Substances Committee, Health Officers Council of British Columbia, Victoria, Canada; dMedical Consultant, Population and Public Health Division, Ministry of Health, Victoria, Canada ABSTRACT ARTICLE HISTORY The Health Officers Council of British Columbia has proposed post-prohibition regulatory models for Received 19 October 2015 currently illegal drugs based on public health principles, and this article continues this work by proposing Revised 10 May 2016 a model for the regulation and management of psychedelics. This article outlines recent research on Accepted 16 May 2016 psychedelic substances and the key determinants of benefit and harm from their use. It then describes a KEYWORDS public-health-based model for the regulation of psychedelics, which includes governance, supervision, Drug policy; drug regulation; set and setting controls, youth access, supply control, demand limitation, and evaluation. psychedelic; psychoactive; public health The prohibition and criminalization of certain psychoac- are likewise illuminating and constructive (Boire 2000; tive substances generates harmful unintended conse- Walsh 2016). While these models have much to offer, the quences (Health Officers Council of British Columbia purpose of this article is to explore the management and 2005, 2011). As a result, there is growing interest in regulation of psychedelics using the lens of public health. alternative approaches to drug control (Canadian Drug Public health leaders have called for the development of Policy Coalition 2012; Global Commission on Drug post-prohibition models of drug control (Buxton, Haden, Policy 2014; King County Bar Association: Drug Policy and Mathias 2008; Canadian Public Health Association Project 2005; Rolles 2009). Psychedelic drugs are one class 2014). This approach is organized, comprehensive, multi- of substances garnering increased attention among scien- sectoral, and directed at maintaining and improving tists (Langlitz 2013), physicians (Tupper et al. 2015), the health of populations (Frank, Di Ruggiero, and spiritual leaders (Richards 2015), and the general public. Moloughney 2004;Last2006). The public health perspec- These trends warrant discussion in terms of post- tiveisbasedonanethicalframework(Wodak2007), social prohibition options for regulation and management of justice (Mitchell 1986), human rights (Barrett et al. 2008), activities associated with these substances. For the pur- equity (Chambliss 1994), health promotion (World Health pose of this article, “psychedelic” substances include LSD, Organization 1986), harm reduction (Rhodes and Hedrich psilocybin, MDMA, DMT, ayahuasca, peyote, mescaline, 2010), and evidence-informed policy and practice (Ritter and other psychoactive substances based on the trypta- 2009). mine or phenethylamine classes of compounds. The Health Officers Council of British Columbia Many frameworks can be used to understand concerns (HOC-BC), which represents the public health physi- with the existing prohibitionist approach and to explore cians of BC, proposed a public health framework for alternatives. For example, religious freedom has been a basis regulating psychoactive substances (Health Officers for one kind of psychedelic legalization, with accommoda- Council of British Columbia 2011, 2005). This frame- tion of the importation and use of ayahuasca sacraments of work has been used in the articulation of drug-specific, the União do Vegetal and Santo Daime in the U.S. and post-prohibition regulatory models for cannabis some European countries. More broadly, the human rights (Haden and Emerson 2014) and smokeable and inject- model has been effective in supporting individual freedoms able stimulants (Haden 2008). It is important to include and can be applied to drug policy issues (Van Ree 1999). psychedelics in regulatory discussions, as drugs in this Discussions about cognitive liberty offer perspectives which class are among the top five psychoactive substances CONTACT Mark Haden [email protected] University of British Columbia, School of Population and Public Health, 3155 W. 6th Ave., Vancouver, BC V6K 1X5, Canada. © 2016 Taylor & Francis Group, LLC 244 M. HADEN ET AL. used in Canada (Health Canada 2012), Europe increases in periods of abstinence. An open-label pilot (EMCDDA 2015), and the U.S. (Johnston et al. 2015). study of psilocybin-assisted treatment for tobacco dependence showed abstinence rates which were more than double typical tobacco cessation interventions Summary of current research on psychedelics (Johnson et al. 2014). Thomas et al. (2013) demon- strated a reduction of problematic alcohol and cocaine To contextualize the public health approach to regulating use in members of a rural indigenous community who psychedelics, we first summarize recent scientific evidence participated in ceremonial ayahuasca retreats. There is about these substances, as there has been an international growing evidence that ibogaine could be effective in the resurgence of interest in their potential medical and other treatment of addictions (Brown 2013; Schenberg et al. benefits. Work by Mithoefer studying MDMA-assisted 2014). In the anthropological literature, a reduction of psychotherapy demonstrated positive effects on post- problematic alcohol use is reported in indigenous or traumatic stress disorder (PTSD) symptoms (Mithoefer spiritual communities who participate in ceremonial et al. 2010). Ten of twelve (83%) individuals who received uses of peyote (Albaugh and Anderson 1974; Hill MDMA no longer met the DSM-IV criteria for PTSD, 1990; Stewart 1987) and ayahuasca (Grob et al. 1996; whereas only two of eight (25%) of the participants who Halpern et al. 2008). received only psychotherapy achieved this goal. Some These findings may be partially explained by studies participants who had been unable to work were able to which explored the psychopharmacological effects of psy- regain employment. A follow-up study demonstrated that chedelics in healthy human participants. Griffiths et al. the therapeutic benefits were still evident for most patients (2006) documented the effects of a single dose of psilocy- years after the treatment (Mithoefer et al. 2013). bin in healthy volunteers taken in a supervised, supportive Grob et al. (2011) found that psilocybin-assisted psy- session. They found that this experience had a profound chotherapy was associated with reduced anxiety and impact on participants’ sense of personal meaning and improved mood among individuals with advanced cancer, spirituality, which had a positive impact on attitude and corroborating findings from earlier research (Kurland behavior. A 14-month follow-up found this effect to be et al. 1973), including a decrease in the fear of death in persistent (Griffiths et al. 2008). MacLean, Johnson, and some participants (Pahnke 1970). Non-clinical use of psy- Griffiths (2011) observed that psychedelic use could affect chedelics has been associated with significantly reduced domains of personality which are usually understood to psychological distress and suicidality (Hendricks et al. be stable and fixed in adulthood; specifically, they found 2015), reduced recidivism for offenders under community that the trait of openness was significantly increased by a supervision (Hendricks et al. 2014), and reduced arrests clinically supervised experience with psilocybin. Carhart- for intimate partner violence (Walsh et al. 2016). Moreno Harris et al. found that clinically administered LSD in et al. (2006) observed psilocybin use to be associated with moderate doses, while producing acute psychosis-like acute reductions in core obsessive compulsive symptoms. effects, left participants with measurably increased open- Sanches et al. (2016) reported rapid and sustained reduc- ness and optimism, as well as overall improved psycholo- tions in depression from the clinical administration of gical wellbeing in the mid- to long-term (Carhart-Harris ayahuasca. Sewell, Halpern, and Pope (2006) found that et al. 2016). patients suffering from cluster migraine headaches The positive outcomes of psychedelic research need to reported symptoms either terminated or attenuated by be understood in context as, historically, the optimal LSD or psilocybin. clinical protocols for therapeutic uses of these substances The addiction treatment potential of psychedelic- have not always been understood or put in practice (Dyck assisted therapies has been observed in both historical 2008; Krebs and Johansen 2012). Today most researchers and contemporary scientific research. Early psychedelic understand that psychedelic-assisted treatments require research in the 1950s and 1960s yielded intriguing the context of a strong therapeutic relationship with a evidence for psychedelic therapies to treat alcohol and clinical practitioner who understands the importance of opioid addiction (Abramson 1967; Savage and McCabe managing the environment to maximize positive out- 1973). In a meta-analysis of six historical
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