Alberta to be 1st province to regulate psychedelics for therapy, government says

Alberta will become the first Canadian jurisdiction to regulate the use of psychedelic drugs for people in therapy, the province announced Wednesday.

Associate Minister of Mental Health and Addictions Mike Ellis also introduced new rules to limit who can prescribe high-potency drugs to people with difficult-to-treat opioid addictions.

The changes are aimed at protecting the public, ensuring that patients receive high standards of care and preventing risky drugs from inadvertently ending up on the streets.

Dr. Rob Tanguay, a psychiatrist who specializes in addiction medicine and pain medicine, said patients are vulnerable while taking psychedelics and need protection.

"The risk is much lower with a regulated psychologist who is registered with their college than someone who printed [a certificate] off the Internet, and then went on to the Internet to advertise, 'I'm a psychedelic therapist, come see me,' " Tanguay said at a news conference in Edmonton Thursday.

Researchers are increasingly studying the use of psychedelic drugs like psilocybin (magic mushrooms), LSD and ketamine to help people with post-traumatic stress disorder, anxiety or depression resistant to conventional treatments. 

Although these drugs are illegal in Canada, doctors and researchers can apply to Health Canada to use them in clinical trials, get special access for therapy, or seek an exemption that's in the public interest.

Health Canada was unable to provide information on Wednesday about how many people are authorized to prescribe the drugs. Advocates for their use have previously said gaining permission is rare.

In a technical briefing Wednesday, Alberta health officials said they are laying out a regulatory groundwork in the province as it is anticipated the field will grow.

Alberta's new regulations would require medical directors to apply for a license before treating patients with psychedelics for mental health disorders. A psychiatrist would have to oversee any treatment, according to the regulations taking effect in January 2023. Health professionals could not charge money for the drugs, and a qualified professional must only give patients the drug at a medical facility – unless the person is in palliative care.

Staff must supervise the patients while they are in an altered mental state, and must report any serious injuries or deaths immediately to the government.

The rules are looser for doctors prescribing ketamine or drugs at doses too low to cause psychedelic effects.

Dr. Peter Silverstone, an Edmonton psychiatrist who was not involved in Thursday's announcement, said Alberta's new standards are good news for patients.

Silverstone, who authored a book called The Promise of Psychedelics, says there is evidence that taking the drugs can leave patients' brains more malleable and receptive to psychotherapy. The regulations are a pragmatic way to prevent harm while the field evolves, he said.

"It's just fantastic to have the potential for new tools," he said. "The promise is huge. Let's not do it in an unsafe manner."

Prescriptions for opioid addictions

Sometimes, doctors prescribe patients with opioid addictions precise doses of less harmful opioids to help gradually reduce their dependency on the drug.

However, some people don't seem to respond to more common treatments, including methadone or buprenorphine.

In those cases, doctors may prescribe more potent drugs, including hydromorphone, diacetylmorphine or fentanyl for a shorter time. They come with more risk, but may help a patient eventually transition to a safer course of treatment for addictions.

The Alberta government says obtaining these high-potency drugs to treat addictions will soon be available only through the Opioid Dependency Program run by Alberta Health Services (AHS). Officials are also pledging to expand the clinics offering the service beyond Edmonton and Calgary to Grande Prairie, Red Deer, Lethbridge and Medicine Hat.

Dr. Nathaniel Day, medical director of Alberta's Virtual Opioid Dependency Program, says the province must balance making more treatment options available to people with addictions while preventing the dangerous drugs from falling into the wrong hands.

He said expanding access to more powerful opioids will help to stabilize people with the most severe, hard-to-treat addictions, so they can move on to more conventional treatments.

"There is hope," he said at the government news conference. "People can and do recover from this challenge every day."

Patients will have to take the drugs in front of health professionals on site. Doctors prescribing the drugs will need to indicate why they're being prescribed, and must try to transition the patients to a less risky course of therapy as soon as possible.

A month from now, family doctors that prescribe these drugs and work outside AHS clinics will no longer be able to start new patients on these high-risk therapies.

Day said, despite these new restrictions, the goal of the program is to expand access across the province, not limit it.

The changes will be phased in over the next five months.

The regulations do not apply to doctors prescribing the drugs to treat pain.

Associate Minister Ellis also announced a $500,000 investment in a provincial pain strategy, that should help doctors more responsibly prescribe opioids for pain management while preventing addictions.