Canada may be the first G7 country to fully legalize cannabis for recreational use, but when it comes to psychedelics, they still have a long road ahead of them. This month, the country took one step closer to a possible future of legal psychedelics by making psilocybin and MDMA more swiftly available for medicinal use. This can make a world of difference considering the time sensitive needs of terminally ill patients such as Thomas Hartle, the first Canadian to receive approval for psilocybin for end of life anxiety for terminal bowel cancer back in 2020, who is still waiting for his next official approval from the Canadian government.
“The laws have not changed, and the placement of psychedelics in the Controlled Drugs and Substances Act has not changed,” explains Mark Haden, Adjunct Professor in the University of British Columbia’s School of Population and Public Health, Director of Clinical Research for startup Psygen, and formerly head of MAPS Canada, who has campaigned for access to psychedelics for decades. “Everywhere in the media people are saying Canada has legalized psychedelics – and we haven’t.”
Health Canada – the Canadian version of the FDA – has loosened restrictions for doctors to apply to facilitate treatments with MDMA or psilocybin for patients with either life threatening illnesses, such as terminal cancer, or treatment-resistant conditions, such as severe cases of PTSD. Through the Special Access Program (SAP), physicians can now apply to use a drug that is not yet available in Canada – a program initially set up in the AIDS pandemic thirty years ago, when life-saving antiretroviral drugs had not yet been formally approved.
Canada hasn’t decriminalized these two drugs – only made the route to access somewhat easier for physicians and patients, who already were able to apply for psilocybin therapy for “end of life anxiety” through a clause known as section 56, which allows individuals to apply to use an illegal substance for “research or health purposes.” Patients dying of cancer and other terminal illnesses have been able to apply psilocybin therapy in this way since August 2020 – just as patients suffering from chronic pain due to multiple sclerosis and other conditions were able to apply for medical cannabis licenses in the 1990s.
Now, rather than having to apply to Health Canada directly for bureaucrats to laboriously review on a case-by-base basis, physicians may acquire approval for their patients to receive psilocybin or MDMA therapy at an approved center by demonstrating they meet three criteria: that they suffer from a chronic or life-threatening illness; that they have tried every other available treatment to no success; and that their treatment will not be part of a clinical trial.
“It’s a very small change, and it’s significant, but it’s nowhere good enough,” says Spencer Hawkswell, CEO of non-profit donor-supported TheraPsil coalition of doctors, patients and therapists who have led the campaign for legal psilocybin therapy for end of life distress since 2019. “This doesn’t change anything for 90% of people who wish to work with psilocybin.” For example, people suffering from Treatment Resistant Depression do not technically suffer from a life threatening illness by Health Canada’s definition, and would not qualify – which Hawkswell argues violates the Canadian Charter of Rights and Freedoms. “Under Section 15, under no circumstances is any Canadian to be discriminated against due to age, sex, race, gender, or mental or physical disability. And isn’t a medical diagnosis a ‘mental or physical disability’?”
Psychedelics advocates say that the next step in Canada is to change the laws so anyone can access psilocybin or MDMA for therapeutic means – in a similar fashion to the changes to the legal code taking place right now in Oregon – without having to apply and spend months waiting for approval.
“There is no reason why people who are dying should have to wait for exemptions from either the SAP or section 56 because the process is too cumbersome for bureaucrats to speedily grant permission,” says Michael Kydd, the sole lobbyist for the psychedelic industry registered with the Canadian government, noting that Thomas Hartle, the first Canadian to receive approval for psilocybin for end of life anxiety for terminal bowel cancer, had to wait 106 days for approval. By contrast, patients who seek to end their own life through assisted suicide typically wait no more than 48 hours.
“For somebody who has stage four cancer, those hundred days could literally be the rest of their life,” says Hartle, who has been waiting more than four months for his second exemption from Health Canada under section 56 – longer than his first. Because exemptions only remain valid for one year, he had to reapply for approval to use psilocybin in 2021. “I could get access to the main assisted suicide program and end my life within three days. But if I want access to a therapy that will improve my quality of life, I have to wait months and months. That is just crazy.”
Hartle – 53 years old, father of two – has suffered from an aggressive and terminal form of bowel cancer since 2016. He has now received 66 chemotherapy treatments in total, enough to fill three bathtubs with poison. Every cancer diagnosis is devastating, but Hartle’s was perhaps even more abject. His physicians had mistaken his symptoms for Crohn’s Disease, and after a small surgery installed a colostomy bag. Driving to his follow up appointment a month later, the bag ruptured with a “volcano of poop” inside the car. “I certainly couldn’t go into the building, so my doctor came out to speak to me. Sitting in my own car covered in my own poop, I was told I had stage four cancer,” he says. “That was certainly a low point.”
You wouldn’t think anyone could maintain a sense of positivity following such an experience, nor with living with the sword of Damocles that is death by stage four lung cancer swinging over your neck for six years. Some therapies helped a bit, says Hartle, such as his regular meditation practice, plus some cognitive behavioral therapy. But when he first read about the research from Johns Hopkins University, he knew he’d found something that might make a difference. “They described ‘psilocybin mushrooms for end of life anxiety for terminal cancer’ – you can’t really get much more of an exact description of what I was looking for,” he says.
In August 2020 Hartle became the first Canadian to be granted access to use psilocybin – which he was able to do at his own home, with TheraPsil founder and psychiatrist Dr Bruce Tobin, who traveled from British Columbia to the prairie province to assist. Students of the history of psychedelic medicine will take note: Saskatchewan – Canada’s most leftwing province, the birthplace of Canadian public healthcare – is where psychiatrist Dr. Humphry Osmond administered LSD to alcoholics in his ground-breaking work on addiction and psychedelic therapy in the 1950s. (He also gave mescaline to Aldous Huxley, inspiring the groundbreaking book, The Doors of Perception.)
How would Hartle describe what the psilocybin did for him? “Psychedelics changed the way that I thought about the idea of life after death. I feel like the transition from this life to whatever comes next could be as gentle as the transition you experience from waking to dreaming – but without the sleep in the middle,” he says. Most of all, he says, the peace and relief from anxiety have allowed him to truly appreciate every day, rather than feeling consumed with terror.
“When you first get your cancer diagnosis, it makes you feel like you’re being dragged behind a horse – it’s an out of control situation” he says. “Every part of it is awful and painful, and makes you feel like you’re being dragged towards a cliff kicking and screaming. But after the psilocybin experience, it’s more like riding the horse now. You still have the same destination, but now you have the ability to appreciate the scenery and look around you and you’ll actually pay attention to the beauty around you – not just the end.”
Having had that experience, he knows anyone else facing death should have the right to have it too – without waiting four months. “When I look at the difficulties that I had trying to get the treatment, why wouldn’t I want to make their life a little bit easier? I wish somebody would have done that for me,” he says. “But if that’s the world I want to live in, that’s the world I have to create.”
Haden considers adding psilocybin and MDMA to the Special Access Program an important step – but just a small step. The biggest challenge will be funding the training for doctors and therapists to understand how to assist with psychedelic therapy.
Nonetheless, it’s still a significant move, says Haden. “The most important thing to me was the fact that Health Canada published, along with their announcement, a summary of their survey asking Canadians if psilocybin should be added to the SAP list, to which the answer was yes. So they explicitly said, Canadians want this to happen – meaning they are acknowledging the way the wind is blowing: legalizing psychedelics.”