Does the UK support psilocybin research?
Public perceptions of psilocybin-assisted therapy have been revealed in a new YouGov poll, commissioned by Drug Science. This is the first nationally representative poll of UK attitudes towards the medicalisation of psilocybin and support for policy changes (such as rescheduling psilocybin) to make this happen.
The YouGov poll asked 1,763 adults, representing all demographics, political leanings, and regions of the UK, questions about psilocybin-assisted therapy and found rather surprising results. The questions were drafted by PsiloNautica and approved by both Drug Science and YouGov.
The results were far more positive than we had expected, and indicate that there is widespread support for psilocybin research amongst the British public. The YouGov poll found that a majority of every individual demographic, political, or regional population supported reform of psilocybin policy and would likely support a decision to reschedule psilocybin.
Most importantly, there was almost no opposition to psilocybin policy reform, indicating that a move to reschedule psilocybin would be a politically safe decision for the UK government.
Is the UK ready to reschedule psilocybin?
We asked the public:
To what extent would you support or oppose the government relaxing restrictions on research into the medical use of magic mushroom-based treatments (psilocybin- assisted therapies) for mental health conditions if this didn’t affect how it was classified in criminal law (e.g. as a class A drug)?
Breakdown of public support for psilocybin applications
In addition to general questions about psilocybin research, we asked the public if they would support psilocybin therapy for veterans, patients in end-of-life care, and if they would accept the treatment themselves.
How does this compare to current mental health treatments?
We asked the public about their opinions on current mental health treatments. There was limited confidence in traditional treatments such as antidepressants and talking therapy. In fact, if they had a condition for which there was strong evidence it would be effective, more Brits (59%) would ‘probably’ or ‘definitely’ consider psilocybin-assisted therapy than felt confident about current mental health treatments.
How does psilocybin’s schedule 1 status affect the UK?
Mental health conditions remain the single largest cause of disability in the UK, representing not only a significant source of distress and suffering, but are also responsible for a wider economic cost estimated at more than £100 billion per year.
Our first line treatments for a number of mental health conditions, pharmaceutical antidepressants, cost the NHS nearly £650,000 every day, despite high levels of incomplete response or non-response, and unpleasant side-effects that reduce patient adherence.
Yet there is hope. Psilocybin-assisted therapy shows great promise in the treatment of a wide range of the most difficult-to-treat mental health conditions. A recently completed phase 2 trial found that psilocybin had equal antidepressant effects to the leading prescription antidepressant, at far fewer doses and with a few side effects.
One might assume that the government would be supportive of developing treatments that could alleviate the enormous economic burden and mental health crisis. Unfortunately, the government have designated psilocybin as a schedule 1 substance.
While research with Schedule 1 drugs is legally possible, it involves substantial bureaucratic delays, financial burdens, and myriad regulations which cause significant barriers to performing research with psilocybin. To date, only a few of the most well-resourced and persistent scientists have been able to overcome these hurdles and conduct research with psilocybin.
When challenged about the significant extent to which Schedule 1 status hampers research into psilocybin in July 2020, the Home Office responded that:
"The current classification of psilocybin under Schedule 1 does not prevent research or clinical trials under a Home Office licence."
– UK Home Office
This response fails to engage with the realities that researchers face. The problem is not that psilocybin research is absolutely prohibited by law. The problem is that the excessive costs, delays, and administrative burdens associated with acquiring the multiple licences that are needed to run a single study artificially compound the entry barriers to pursuing legitimate, potentially life-saving research.
For this reason, the evidence-base for psilocybin-assisted therapy remains small despite the vast majority of completed trials reporting positive results.
What about psilocybin in palliative care?
Perhaps the strongest evidence base so far obtained in contemporary psilocybin research is for the treatment of depression and anxiety secondary to a cancer diagnosis, with placebo-controlled trials finding positive results in studies at UCLA, NYU, and Johns Hopkins University. Patients credit psilocybin-assisted therapy with providing them with a renewed sense of optimism, acceptance, and meaning, with the long-term follow-up of the NYU study finding that the positive effects on well-being from a single dose of psilocybin could last as long as four and a half years.
“It took one small dose of psychedelics, lasting no more than a few hours, to help me cope with the crippling thoughts, fear and anxiety around my cancer diagnosis. Years later, I continue to lead a fuller life because of it. I know that these drugs could really help people at the end of their life. The rules need to change.”
– Dr Lauren Macdonald, a stage IV cancer survivor, travelled to the Netherlands to access psilocybin legally
Currently in the UK, the only legal route to accessing psilocybin-assisted therapy is through one of very few, limited-scale and oversubscribed, registered clinical trials. Although the introduction of large- scale, routine use of psilocybin-assisted therapy into the NHS should wait for the drug to be licensed at the conclusion of phase 3 clinical trials, there is already a strong scientific consensus that psilocybin is of very low toxicity, and is not associated with dependence or withdrawal. Nor have there been any serious adverse events reported in contemporary clinical trials with psilocybin, in which the drug was taken in a safe, controlled environment.
With this in mind, there are strong grounds for immediately allowing limited access to psilocybin- assisted therapy for some patients with exceptional clinical need, as is currently the case in Canada. Perhaps unsurprisingly, our research found that the British public very strongly supported changes to the law to allow terminally ill patients to access psilocybin-assisted therapy. 58% of people are in favour of such a change, including majorities in every age bracket, and amongst the 2019 general election voters for each of the three main political parties. Less than 1 in 8 of the population (12%) are opposed to such a move, with 30% unsure.
Does the UK support psilocybin-assisted therapy for veterans?
More than half of Brits (55%), including majorities in every region of the UK, support moves to make psilocybin-assisted therapy available to armed forces veterans suffering from PTSD, depression and anxiety, with less than 1 in 7 (13%) opposed, and 32% not sure.
There is a particularly urgent need for effective treatment options among military veterans, a population known to suffer from complex, multi-layered psychological distress . As such, mental health treatment outcomes in this group are poor in comparison to the general public.
However, despite personal testimony from veterans, and pre-clinical evidence supporting the use of psilocybin-assisted therapy to treat PTSD, data from clinical trials of psilocybin is not yet available as it is for other conditions, reducing the appeal to sponsors and pharmaceutical companies of investing in this research.
By removing unnecessary obstacles to open-label, exploratory trials of PTSD in veterans, moving psilocybin to Schedule 2 will simultaneously facilitate the generation of the clinically robust data, and offer a lifeline to a patient group for whom conventional treatments are often ineffective.
Drug Science calls on the government to reschedule psilocybin
Drug Science calls upon the government to reschedule psilocybin into schedule 2, which includes heroin and cocaine. Schedule 2 drugs are subject to rigorous record-keeping and storage requirements to minimise the risks of diversion and other harms but are much more easily held by university research departments and hospital pharmacies.
The US Federal Drugs Administration has awarded psilocybin ‘Breakthrough Therapy’ designation given its potential to treat major depressive disorder and treatment resistant depression. Without similar actions by the UK government, the UK is likely to fall behind in this highly promising area of research and treatment development.
Simply by rescheduling psilocybin, the UK can become a world leader in psychedelic research, capturing a significant portion of the global research budget. If the UK government aims to support the Life Sciences as a major industry in the post-Brexit economic landscape, we cannot miss this opportunity.
“Schedule 1 restrictions hinder our efforts whilst being unlikely to provide any meaningful reduction in the risk of diversion, when compared to Schedule 2 restrictions. The UK has an internationally recognised reputation in developing new treatments. We have an opportunity to be world leaders here as well, if the government acts to reclassify those treatments that are showing therapeutic promise into Schedule 2.”
– Dr James Rucker, Head of the Psychedelic Trials Group at King’s College London
For some time now, scientists and researchers, as well as a variety of politicians, have called for psilocybin to be rescheduled, in order to cut the red tape that slows potentially transformative research, and ultimately impedes access for those with exceptional clinical need. The mental health conditions that psilocybin can treat are responsible for widespread suffering that is too frequently resistant to available treatments. Moreover, a substantial economic case can be built for establishing the UK as the world’s leader in psychedelic science: a research-supportive regulatory structure, coupled with the country’s existing expertise, will make the UK a clear favourite for investment and scientific talent.
We now know that the majority of the public are supportive of such a move. It is time for the Home Secretary to act.
It is time to reschedule psilocybin.
In line with statutory procedure, we call upon the Home Secretary to commission the Advisory Council on the Misuse of Drugs to review the scheduling of psilocybin, with a commitment to act on its recommendations.
Below, you can access a summary of the YouGov results, along with the full report and the survey data which was collected: