The first time Ryan Patchett-Marble heard about psilocybin, a psychedelic compound found in fungi, was at the end of a 10-day silent-meditation course in 2016. “I spoke to someone who was a medical student at the time, and he told me that his interest in meditation came from a highly spiritual experience with LSD,” he says. “I remember thinking he was crazy.”
But, over the past four years, Patchett-Marble has researched the use of psychedelics — in particular, psilocybin — as a therapeutic treatment for people with life-threatening cancer or terminal illness, consulting studies from institutions such as Johns Hopkins University. “Those studies showed immediate, substantial, and sustained benefit in all kinds of markers, including existential and psychological distress, and that’s unparalleled,” he says. “This was with one or two treatments. That’s remarkable — like, nothing else in medicine touches that.”
Last summer, through an exemption under the Controlled Drugs and Substances Act, Health Canada granted a handful of terminally ill patients the right to use psilocybin to treat end-of-life suffering. In December, Patchett-Marble, a generalist physician in Marathon, became one of 16 health-care professionals to receive approval from Health Canada to use psilocybin for research and training purposes.
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TVO.org spoke with Patchett-Marble, also a clinical adviser at Therapsil, a non-profit group that advocates for patients seeking psilocybin treatment, to learn more about why he supports the treatment — and what he hopes to accomplish.
TVO.org: In popular culture, there’s this idea that using psychedelics can lead to a “bad trip.” What does the research say about that?
Patchett-Marble: The first thing about the research is that these are people that have been screened. If someone was thought to be at high risk for not benefiting clinically, or of a serious adverse event, they would typically be screened out. That would be someone who has a history of psychosis, for example. They would not be included in these studies.
Short term is a different matter. I think that it’s important to discuss that, and that’s the idea of a bad trip. It is expected, and arguably part of the experience, that anxiety comes up, because the way that psychedelics work, they drop your usual defences and allow stuff that you buried to rise up. So anxiety is common. About one in three people in the Johns Hopkins study would have anxiety. The other short-term adverse event, so to speak, would be nausea sometimes.
When people talk about a bad trip, they’re often talking about a very terrifying experience. If attention is paid to preparation — so that’s the set, and the context in which it’s used, being the setting — then the risk of that is very, very low.
Patchett-Marble: That’s a really important question, and I think that’s typically the first one that people ask: “Well, wait a minute, why do you need that? You don’t need it for chemotherapy or something else.”
I think it’s really important to note that this is not a typical medical treatment, in the sense that if I prescribe an antibiotic for urinary-tract infection, what matters is the drug and the dose. I mean, there are other things, too, like the metabolism of the specific person, but, generally, it’s the drug and the dose that will lead to the clinical outcome — whereas, with psychedelics, the drug and the dose are only one small part of it. The set and the setting are critically important, and you need training to facilitate that.
I would argue that you need experiential training — so, direct experience yourself in these states of consciousness — to help somebody effectively navigate through the experience, through the terrain. It’s like if you had a guide for anything else, any other terrain, would you want a guide who had a lot of book knowledge but had never experienced the terrain themselves? Or would you want a guide who had the book knowledge as well as the experiential knowledge? I think we all say, of course we want the person with experiential knowledge. They would be the one that could identify obstacles and tell you what to expect and help you navigate.
TVO.org: Psilocybin has been a controlled substance since the 1970s. What do you make of Health Canada granting these exemptions now?
Patchett-Marble: I think it’s a really progressive move on the part of Health Canada. It’s very consistent with the science that’s being done, including randomized controlled trials at prestigious institutions in the United States, like John Hopkins, UCLA, and NYU. It’s being done now because the science is there, and there’s more and more science coming. It’s also done out of compassion. I think it makes sense that the first group of people that have access is the group that’s in the greatest need, which is those people that have the most existential and psychological suffering.
TVO.org: What impact do you think that these exemptions, or the research conducted as a result, may have on the legal status of psilocybin and other psychedelics in Canada?
Patchett-Marble: It’s difficult to speculate, but I think that the bottom line is that what happens politically will probably follow the science. That’s what’s happened so far, and as the science grows — and if it continues to support the use of psychedelics for a number of different medical diagnoses — then I think that the policies will follow that.
This interview has been condensed and edited for length and clarity.
This is one in a series of stories about issues affecting northwestern Ontario. It's brought to you in partnership with Confederation College of Applied Arts and Technology. Views and opinions expressed in this article are not necessarily those of the college.
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