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Sensemaker: Psychedelics on the NHS?

Sensemaker: Psychedelics on the NHS?

What just happened

Long stories short

  • Dozens died off Florida when a boat thought to be operated by people traffickers capsized.
  • Police said they were investigating party attendance during lockdown in Downing Street, where according to one loyal Conservative MP Boris Johnson was ambushed by a piece of cake. 
  • Joe Whale, a 12 year-old from Shrewsbury, signed a doodling deal with Nike. 

Psychedelics on the NHS?

Plan B restrictions will be lifted in England tomorrow. It’s finally some good news. But as the health secretary, Sajid Javid, says: “it’s not the end of the road”. 

There is a tidal wave of mental health disorders heading towards an already floundering NHS. Treatments exist but with a flagging workforce and reduced capacity, could offering psychedelics – better known for recreational use – help? 

The tidal wave. 

Modelling from the Royal College of Psychiatrists forecasts…

  • 230,000 new referrals for post-traumatic stress disorder (PTSD) before 2023 as a result of the pandemic. 
  • 35 per cent of Covid patients who were put on a ventilator and 40 per cent of intensive care staff to have symptoms of PTSD, double the level typically seen in combat veterans. 

On top of that…

  • Eight million people in England are drinking alcohol to a level that is harmful to their health. In 2019, that level was closer to five million. 
  • One in six adults experienced some form of depression last summer in Great Britain, compared with one in ten before the pandemic, according to the Office for National Statistics. 

Of course, mental illness isn’t only triggered by the pandemic. Stress, trauma, genetics and other factors can also lead to mood and addiction disorders. The result is a “catastrophic” backlog of over 1.6 million people waiting for support from the NHS.

What can be done? There is already a range of treatments available for mood disorders and addiction – from Cognitive Behavioural Therapy (CBT, a more active form of talking therapy) and medication (usually to support serotonin levels) to more intensive treatments such as in-patient wards and electrical brain stimulation. 

Do they work? For some, yes: 

  • Studies of antidepressant medications found they can work for around 60 per cent of patients, but results can take two months to kick in. 80 per cent are also likely to stop taking the drugs after a month, usually due to side effects. 
  • NHS England data on talking therapy indicates that barely 50 per cent of referrals for anxiety and depression moved to recovery. 

There has been a notable lack of innovation in these treatments over the last decade. Psychedelics, on the other hand – like ketamine – have seen a boom in research: 

Ketamine and Alcohol Use Disorder (AUD). 

  • AUD, also known as alcoholism, affects nearly 4 million people in the UK and an estimated 390 million globally. It can be fatal for individuals and destructive to those around them. Current regimens still see three out of four people back drinking at dangerous levels within a year. 
  • “There is an urgent need for new treatments” according to Celia Morgan, Professor of Psychopharmacology at the University of Exeter – which is why she’s studying the potential of injecting ketamine alongside therapy for treating AUD. 
  • Results released this month from her phase II clinical study known as KARE – ketamine for reduction of alcoholic relapse – saw an increase in alcohol abstinence from around 2 per cent before the trial, to 86 per cent six months after the treatment. Mortality also improved from 1 in 8 likely to have died within a year, to 1 in 80.  

Why ketamine? Although it’s more commonly thought of as horse tranquiliser and recreational party drug, the NHS already uses ketamine as an anaesthetic. At lower doses, it has an anti-depressant effect and its dissociative/hallucinogenic properties, according to Morgan, can act as a “catalyst for the therapy”. Similar theories underpin research into other psychedelics. 

There are limits to ketamine’s usefulness. MDMA (ecstasy) is more effective in some circumstances. But ketamine’s existing usage in hospitals and shorter ‘high’ could make the path to NHS approval easier. The end goal is to increase the speed of treatment, put less strain on health services and end up with better patient outcomes. 

Other drugs: 

  • Psilocybin. Researchers believe the active ingredient in ‘magic mushrooms’ could have powerful therapeutic uses for PTSD and treatment-resistant depression (TRD). Topline figures from the largest clinical study of synthetic psilocybin use to treat TRD are already positive. And a smaller study from 2020 at John Hopkins University saw results “four times greater than is typically seen in traditional antidepressants”. 
  • MDMA. A study published last year in Nature found 90 per cent of a group that had MDMA-assisted therapy for chronic PTSD saw a “clinically significant” reduction in symptoms and 67 per cent no longer qualified for PTSD diagnosis. 

Red tape. Ketamine can technically already be used as an off-label treatment for depression. But for an NHS rollout, Morgan and her team would need a larger Phase III trial. Then, the National Institute for Health and Care Excellence (Nice) and the Medicines and Healthcare Regulatory Agency would have to approve ketamine as a cost-effective, marketable treatment and safe treatment. It’s a slow process and will be a similar story for licensing psilocybin and MDMA – with the added obstacle that they aren’t yet licensed at all in medical settings, only for research. 

Psychedelic renaissance. Research into psychedelics isn’t new. Initial studies in the 50s saw positive results. The surge in the use of psychedelics in the 60s meant government crackdowns: a war on drugs. That also meant restrictions on research. Professor Allan Young, Chair of Mood Disorders at Kings College, London, who started researching psychedelics 30 years ago, describes it as being “sat at the children’s table”. That’s all changed – and rapidly. 

Business of psychedelics. The KARE treatment for AUD is licensed by Awakn Life Sciences, a biotech company that researches and develops “psychedelic medicine to treat addiction and other mental health conditions”. It has already opened a private ketamine and MDMA clinic in Bristol to host research and, it hopes, NHS-referred treatment, with plans for more across the UK in the next few years. The potential returns are big. Compass Pathways, which supports Young’s psilocybin research at King’s and similar research in the US, floated on the Nasdaq in 2020. It’s now worth over $1.3 billion. 

Politics may still cause problems. The UK government’s 10-year drug plan released at the end of last year focused largely on drugs as “bad and dangerous”, as the prime minister put it. But there are signs of movement. Conservative MP Crispin Blunt was told in October by Boris Johnson he would get an answer “as soon as possible” on psilocybin reform. General Sir Nick Carter, former Chief of the Defence Staff, has also called for more MDMA trials to treat PTSD in veterans, mirroring a similar push from military groups in America.

The National Institute for Health Research, the UK government’s research funding agency, is supportive. A spokesperson said these studies were examples of “bold, cutting edge research that could lead to new practices and ways of thinking for people living with mental health issues”.

This doesn’t mean psychedelics aren’t dangerous.

  • The trials use a combination of psychedelics and therapy in controlled, safe settings. Accidents can happen with recreational use and the potential for medical benefits doesn’t prevent the possibility of abuse. 
  • There are also jitters about the unregulated use of psychedelics for mental illness – from wellness retreats using psilocybin to private ketamine surgeries cashing in on psychedelics going “mainstream”. 
  • And it may not be the best treatment for everyone. Psychedelic treatments can be intensive and aren’t necessarily cheap. Esketamine, a form of ketamine formulated to treat depression by Johnson & Johnson has yet to be approved by Nice, mainly because of its high cost. 

Psychedelics aren’t miracles. They’re drugs. But a miracle might be what’s needed to tackle the mounting mental health crisis.


Wealth investment, fairness, prosperity

Personal for Putin
The big question for the West as Putin positions an invasion force on Ukraine’s border has been what sort of economic threat might actually deter him from using it. The answer may be personal sanctions on Putin himself. Targeted sanctions on his cronies have been in place for six years and achieved nothing. Broader sanctions to punish Russia for annexing Crimea may have taken about 2 per cent off GDP but they have not noticeably altered the Kremlin’s behaviour. So might the US try targeting the person of the president? “Yes,” Biden said yesterday. “I would see that.” Meaning? Not clear. Numbers floated to describe Putin’s personal billions – from 20 to 200 (USD) – are pure speculation. He never has to flash a credit card and there are no foreign accounts in his name – only informal IOUs from friendly oligarchs to whom he’s handed giant slices of the Russian economy. But the US Treasury’s Office of Foreign Assets Control will have granular detail on his assets that aren’t yet widely known. Expect to hear more about the OFAC. 


belonging identity, society, beliefs, countries

Money for Myanmar
At least $1 billion a year in oil and gas revenues flows to Myanmar’s military junta, and Human Rights Watch is urging banks to stop that flow. Sanctions are already in place on the generals who drove Myanmar’s elected government from power a year ago, and last week Chevron and TotalEnergies said they were withdrawing from the Yadana offshore gas project that provides power for Yangon. But the project still produces gas. Thai and South Korean operators still work there and royalties and export earnings still accrue to the Myanmar Oil and Gas Enterprise, aka MOGE. These payments are in US dollars. They’re handled by correspondent banks in the US and EU, which HRW says could and should refuse to play ball. It seems a reasonable request. 


New things technology, science, engineering

Liability switch
Two British legal bodies say liability for minor moving violations involving driverless cars should rest with the manufacturer, not the non-driving human. The joint opinion issued by the Law Commission of England and Wales and the Scottish Law Commission says the key distinction in what is sure to be a long and costly argument with manufacturers is between full autonomy and mere driver-assist technology. It wants a “bright line” between the two. When the former is a reality – which won’t be for a while – the document says the human “user in charge” can’t be held responsible for anything that goes wrong. When sensors are just helping drivers park or stay in lane, the drivers are fully in charge and liable. This is a 290-page report commissioned four years ago and intended to give the UK a legal leg up in the race to autonomous driving, even if in terms of hard- and software British boasts of leading the world have so far been largely empty. Jarndyce and Jarndyce would be proud. If the report’s recommendations are adopted, self-driving car makers will presumably pass on the costs of their premiums to customers.  


The 100-year life health, education, living, public poliCY

Cannabis v Covid
There’s a chance – no more than that – that a substance found in cannabis could help prevent or treat Covid infection. A study led by the University of Chicago found that small doses of highly purified cannabidiol, or CBD, help prevent the SARS-CoV-2 virus replicating itself having entered host cells. The caveats: the effect has so far only been seen in test tubes and mice and there’s no reason to assume it would be repeated in humans. The CBD doesn’t prevent the virus from entering the host cells in the first place, and it doesn’t have the suppressive effect if administered in combination with tetrahydrocannabinol, the ingredient in marijuana that makes you high. Still, count on the relatively newly legalised cannabis trade in the US to find a way to leverage this study in shop windows. 

covid by numbers

32 – low and middle-income countries have used less than half the vaccines they’ve received from the Covax program, bilateral donations and other sources. 


Our planet environment, natural resources, geopolitics

Not a lot of axolotls
There are about a million axolotls in homes and labs around the world, but hardly any in the wild. In fact the only place on the planet where they still live and die without (too much) human interference is a highly canalised southern suburb of Mexico City called Xochimilco. Axolotls are small members of the salamander family that used to breed throughout the vast, high-altitude basin that holds the Mexican capital. But as the city has expanded, the axolotl’s habitat has shrunk. Vox has the story. It’s a quest. It turns out that even when you know where to find a wild axolotl in principle, it takes persistence and patience in practice. 

Thanks for reading. Do share this around, and let us know what we’ve missed.

Phoebe Davis
@phoebe_ivy

With additional reporting by Giles Whittell.

Edited by Giles Whittell and produced by Phoebe Davis. 

Photographs Getty Images


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