Jessica Cadoch, executive director of the Montreal Psychedelic Society, told MTL Blog that momentum really "mushroomed — for lack of a better term" when Michael Pollan’s book about the science of psychedelics, How to Change Your Mind, came out in 2018, the same year recreational cannabis became legal in Canada.
With 2020 (mostly! finally!) behind us, Quebecers are looking to the future, wondering, "What's next?" — particularly, in the world of health and wellness.
The psychedelics movement is one answer. But it's also more than that. According to Cadoch, it's "a revolution."
How are psychedelics used in therapy?Eskymaks | Dreamstime
Field Trip Health, a psychedelics-centred wellness company, co-founded by former Montrealer Joseph del Moral, describes psychedelic medicine on its website as "various techniques using psychedelic molecules for improving mental health and overall wellbeing."
The most commonly used molecules come from psilocybin, which can be found in "magic" mushrooms, and other molecules in drugs like MDMA and ketamine, which produce varying degrees of psychoactive effects.
Field Trip is also in the process of developing its own psychedelic molecules to be used medically.
FT-104, for example, aims to be as potent as psilocybin with a shorter trip time — useful in medical settings when patients don't want to be holed up in a clinic for hours while high.
"There really hasn't been much advancement in the treatment of chronic mental health conditions, especially depression, in the last 30 years," del Moral told MTL Blog.
"The science behind psychedelics shows very high response rates on the order of 50 to 70% and the effects are often long-lasting. Ketamine on the order of weeks to months. Psilocybin and MDMA on the order of months to years."
What would a psychedelic-assisted therapy patient experience?
Del Moral described the process for a patient being treated with ketamine at a Field Trip clinic — located in Toronto, New York, Los Angeles, or Chicago — step-by-step.
The patient is screened by a psychiatrist to make sure they're suitable for this treatment.
The patient comes in for an initial meeting with a therapist who prepares them for their psychedelic experience.
The patient comes in for their first dosing day. At the appointment, del Moral says "they're sitting in this super comfortable zero-gravity chair that reclines all the way flat, they have an eye mask on, they're listening to a specially curated list of psychedelic music, they have a weighted blanket on them. They're in this experience with their own thoughts for an hour... we spent a lot of time and effort designing the clinics to be beautiful comfortable spaces."
When the patient comes out of that part of the experience, the therapist — who's in the room with them — engages them in a light form of therapy called "exploratory therapy," during which they discuss thoughts the person had under the influence. A course of ketamine-assisted therapy is typically six doses over three to four weeks.
The insights patients develop during the psychedelic experience are written down by the therapist and used in future therapy sessions. This is called integration therapy.
"What we hear most often from our patients is they thought about the [life experiences causing them suffering] in a whole new way. They looked at it from a different angle they'd never been able to consider before," del Moral said.
What’s currently available in Montreal?
At this point, ketamine is the only psychedelic drug doctors can legally prescribe in Canada, so it's the only form of psychedelic-assisted therapy being offered in the country.
Earlier this month, Mindspace, a Montreal-based wellness clinic, announced it was launching the first psychedelic-assisted therapy program in Quebec with plans to begin treating patients using ketamine before the end of 2020.
Mindspace founder Dr. Joe Flanders told MTL Blog the clinic is administering doses of ketamine using SPRAVATO, a nasal spray recently approved by Health Canada.
This is the first time ketamine has been approved for this purpose.
"It allows us to start helping our clients by enhancing therapy with a psychedelic compound, but doing it in a totally legit and above-board context," Dr. Flanders said.
Mindspace has also been offering "Psychedelic Harm Reduction and Integration" for the past year-and-a-half.
This program coaches people who "intend to or have had psychedelic experiences" on their own time, but does not provide access to psychedelic compounds.
What can we expect in the near future?
"What we’re really waiting for is the green light to use psilocybin and MDMA because those are the most impactful tools," said Dr. Flanders.
He estimated that we’re three to five years away from "totally mainstream above-board access" to psilocybin and MDMA.
First, the drugs need to "cross the finish line" of phase three clinical trials, then be approved by the FDA and Health Canada.
After that, Dr. Flanders said there will be an enormous need for mental health professionals trained to deliver this new kind of psychotherapy.
Then there's the question of how these drugs will be regulated in Quebec.
"The rest of Canada tend[s] to land in similar places around regulating certain medical practices. Quebec always sort of does its own thing and it’s very hard to predict if they’ll be ahead of the curve or behind the curve," Dr. Flanders said.
In addition to medical use, del Moral said Field Trip is preparing for the non-medical wellness uses of psychedelics.
The company is growing and studying 25 species and strains of magic mushrooms in Jamaica through a partnership with the University of the West Indies.
They want to learn how to make extractions and quantify amounts of psilocybin in the mushrooms so people know how much they're dosing.
"That was an investment we made thinking that sometime in the next five to 10 years there might be a wellness market opening up around the world [...] but these jurisdictions are opening up much faster than we had anticipated," he said.
Dr. Flanders agreed in terms of hoping psychedelics become available to a broader spectrum of people, including those who are "really stressed out" or facing "the kinds of ups and downs many of us face without qualifying for a psychiatric disease."
Cadoch told MTL Blog psychedelics could lead to a paradigm shift, "forcing us to reimagine concepts of care."
"The difference... is that we live in a world where [patients say], "Hey, I have a symptom. Treat my symptom.' But with psychedelic therapy it’s, 'Let’s get to the root cause of things,'" she explained.
"Psychedelics do not fix you. [...] Psychedelic-assisted therapy with proper preparation, proper integration and the proper tools to make sense of your experience can provide you with an opportunity to start working on yourself. But you still have to do that work."
Cadoch said activists in the psychedelics community are worried about for-profit companies entering this grassroots space without concern for existing morals.
She said she'd like to see professionals in the field sign the North Star ethics pledge, a promise to focus on shared values and ethics when making psychedelic products.
Cadoch also said she hopes for equal access to treatment — something Mindspace committed to in launching its accessibility program.
This type of therapy isn't currently eligible for insurance coverage. Between the cost of new drug formats and hours of specialized therapy, "it is a really expensive process," Cadoch said.
"We have to make sure we do it carefully."