Scientists comment on a position statement on clinical guidance on the use of psychedelics for mental health disorder treatment from the Royal College of Psychiatrists (RCPsych).
Prof David Nutt, The Edmond J Safra Chair and Head of the Centre for Neuropsychopharmacology, Division of Brain Sciences, Dept of Medicine, Imperial College London, said:
“It is good that this report recognises that research on psychedelics has been severely limited by legal restrictions around the use of these substances in research. I had hoped, therefore, that the report would go further to recommend a change to the schedule 1 status of the most promising of these substances which would be the most effective way to remove these research barriers and collate more evidence in this space. Such a change was made in Australia nearly two years ago with considerable benefit to patients and no untoward effects.”
Prof Celia Morgan, Professor of Psychopharmacology, University of Exeter, said:
“This is a very encouraging development for the onward progress of psychedelic assisted therapy within mental health treatment in the UK. We welcome the guidance from the RCPsych as a professional body and hope that psychological professional bodies such as the British Psychological Society and BABCP follow suit.
“The emphasis on the environment in which the therapy given is particularly ground-breaking, given the lack of focus of this in traditional mental health trials and the exquisite sensitivity of participants to the environment during the administration of psychedelic drugs.
“It is intriguing the focus on transpersonal approaches to therapy that are largely not evidence-based but have come from underground therapeutic practice and key figures such as Stanislav Grof. The guidance also suggests the need for two therapists, as such it remains to be see how this approach will be integrated in currently under resourced healthcare systems.”
Prof Rupert McShane, Consultant Psychiatrist at Oxford Health NHS Trust and Associate Professor of Psychiatry at University of Oxford, said:
“It is great news that RCPsych says : “We recommend the use of ketamine in specialist settings with appropriate oversight and long-term monitoring arrangements in place”. The Norwegian equivalent of NICE have just published an exhaustive review and agreed that use of IV racemic ketamine in their health system should be reimbursed, especially as an option for people considering ECT. The Norwegians will be setting up systems for monitoring long term use which is sensible. Two large trials show that ketamine works as well as ECT in people under 50 years, but doesn’t cause the cognitive side-effects. We badly need more acceptable alternatives for the people with most severe illness.
“Ketamine should be available and used in NHS settings through the ECT teams, using spare capacity. The only reports of bladder issues occurring with medically prescribed and controlled ketamine are where it given in high, daily doses as an oral at-home medication. However, tolerance can be an issue, especially if used more than every two weeks, so it needs specialist management. Other psychedelics are years away. Ketamine costs £7 a vial, which will typically treat up to 7 people in a session.
“RCPsych is correct also in saying that “There is a clear need for multi-agency collaboration within the UK agreement between the Medicines and Healthcare products Regulatory Agency (MHRA), the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS), private providers, the British Association for Psychopharmacology (BAP), and the relevant royal colleges”. It is a shame that the NHSE Medicines Repurposing Committee, which included NICE and MHRA and was designed to consider relicensing of generics was recently disbanded following the abolition of NHSE.”
‘Psychedelic and related substances (PARS) for medical use (including pharmacologically assisted psychotherapy’ and ‘Psychotherapy assisted by psychedelics and related substances (PARS): Guidance for psychiatrists taking part in approved research trials’ was published by the Royal College of Psychiatrists at 00:01 Uk time on Friday 19th September.
Declared interests
Prof David Nutt: DJN via the Imperial College psychedelic research group has received support in kind from Compass Pathways and Usona for psilocybin research.
Prof Celia Morgan: My NIHR grant receives additional arms length funding from Solvonis Therapeutics and have done some consulting for them
Prof Rupert McShane: Rupert McShane was previous Chair of the RCPsych ECT committee and has led his local ECT service for the last 30y. He is a member of the RCPsych psychopharmacology committee. He has runs a ketamine clinic at Oxford Health NHS Trust for the last 14 years treating over 450 patients https://www.oxfordhealth.nhs.uk/ips/ketamine-trd/
This Roundup was accompanied by an SMC Briefing.