I hope you had a restful and relaxing summer. At CAMH, we are ready for the new academic year and for continuing our efforts on our exciting research initiatives. We look forward to sharing research developments with you in brainbuzz™, a monthly e-newsletter that keeps the CAMH Research Committee members connected and informed between our meetings. If you have any questions or feedback, please reach out at any time.
CAMH receives first Canadian federal (CIHR) grant to study psilocybin
Researchers to explore whether psychedelic effect is required to treat depression
The Centre for Addiction and Mental Health (CAMH) has just been awarded Canada’s first federal grant to study psilocybin—the chemical component of “magic mushrooms”—with regard to its effect on treatment-resistant depression. More specifically, researchers will explore whether experiencing psilocybin’s psychedelic effects are required for it to have antidepressant effects.
“There has been a growing interest and body of knowledge regarding the use of psychedelic drugs for the treatment of mental illness and addictions,” said Dr. Ishrat Husain, Head of the CAMH Clinical Trials Unit and principal investigator of the new CAMH study. “Previous clinical trials have reported large and sustained antidepressant effects of psilocybin when combined with intensive psychotherapy. If this study shows that psilocybin is still effective at treating depression without inducing a psychedelic state, it could remove the time-intensive and costly need for psychological support during the treatment. This would make the treatment more accessible both for healthcare funders, and for those seeking treatment.”
This new clinical trial, entitled “A proof-of-concept randomized controlled trial to show that the antidepressant effects of psilocybin do not require psychedelic effects,” will recruit 60 adults with treatment-resistant depression over three years. Over the course of the study, a random third of the participants will be administered a full dose of psilocybin plus a blocker for the 5-HT2A serotonin brain receptor, inhibiting the drug’s psychedelic effect. Another group will be given psilocybin plus a placebo. The final group will receive a placebo plus the serotonin blocker. All participants will also receive 12 hours of psychotherapy as per current practice in psychedelic research. Clinical trial results will serve as preliminary findings on the antidepressant effect of this drug combination, which will lead to future research to validate this potential approach for treatment of depression without the use of intensive psychotherapy.
CAMH researchers have already led studies involving psilocybin and ketamine. Recently, CAMH was the only Canadian site for the world’s largest clinical trial of psilocybin in mental health to date. This study was instrumental in providing further support for psilocybin as an emerging treatment for depression.
“As Canada’s largest mental health research hospital CAMH is ideally positioned to be at the forefront of psychedelic science research that focuses on safety, efficacy, and accessibility,” said Dr. Aristotle Voineskos, Vice President of Research and Director of the Campbell Family Mental Health Research Institute at CAMH. “Moreover, it is crucial that moving forward we bring to bear state-of-the-art research technologies, like neuroimaging and molecular assessments to get a better understanding of how compounds like psilocybin induce their antidepressant effect or psychedelic effect, and overall safety (or benefit) considerations related to brain health.”
Anyone interested in participating in this particular clinical study should first connect with their healthcare provider, then seek a referral to CAMH for further assessment of eligibility to participate in this trial. Visit Research Connectto learn more about participating in research at CAMH.
“We’re very grateful to the Canadian Institutes of Health Research (CIHR) for affirming CAMH as a leader in psychedelic science research and funding this important study,” added Dr. Husain. “This is an exciting and growing field of research with the potential to help many people.”
Related News Articles:
Policies regarding police involvement in the care of students in mental distress at Ontario universities differ widely
New study reveals handcuff use is routine when students are transferred to hospital from some Ontario university health clinics
The chances that police will become involved in the care of a student who seeks help for their mental health on campus at an Ontario university health clinic depends on which university they attend, according to a new CAMH-led qualitative study published today in the journal CMAJ Open. The study is believed to be the first in the world to conduct in-depth interviews with physicians to examine policies and processes for transferring students experiencing mental health emergencies from university clinics to hospital. Investigators found that some Ontario universities mandate the use of police restraints in all circumstances when students need emergency mental health hospital care, while others have policies that handcuffs only be used in rare circumstances as a last resort.
“We wanted to identify university policies that facilitated most dignified transfers to hospital from campus for students in need of emergency mental health care. We hoped such policies could serve as models for other universities,” said lead author Dr. Andrea Chittle, a family physician who has worked in a university health clinic. “We learned that at some universities, handcuffs are being used every time. It is routine to convey students to hospital in handcuffs in all situations.”
This work is especially timely, as mental illness among Canadian post-secondary students is increasing and mental health transfers ー when a student experiencing a mental health crisis is transferred from university health clinics to hospital for emergency psychiatric assessment and/or care ー are becoming more common.
The authors conducted interviews with 11 physicians at nine university health clinics in Ontario between July 2018 and January 2019. The interviews were confidential and the clinics were not identified to allow physicians to speak candidly about hospital transfer policies for students with mental health emergencies. At five of those clinics, police were always called to assist when a student needed to be transferred to hospital. At two of those clinics, police policy was to routinely use handcuffs during transfers of students to hospital.
Surveyed physicians at clinics where the handcuffing of students was common expressed concerns that it was traumatizing for students in a way that could deter them from seeking mental health supports in the future.
“To be taken in handcuffs and loaded up in a police cruiser seems brutal and traumatic for the patient and sends all the wrong messages about a caring, supportive environment,” said one interview participant.
This study is the third collaboration of co-authors Drs. Andrea Chittle, CAMH Emergency Department Psychiatrist Juveria Zaheer and Shane Neilson, a student health clinic physician, examining mental health transfer policies at Ontario universities. Their first paperidentified the issue of police handcuffing of students in mental distress as an area of concern. The second paperreviewed policies and processes for transferring people experiencing a mental health crisis from community-based clinical settings to hospital. This latest study examined the decision to involve police and use handcuffs during mental health transfers, and alternatives to that practice.
The researchers found that the involvement of police and the use of restraints when students are in need of a transfer to hospital for psychiatric assessment is often due to non-clinical factors, such as understanding of staff roles and responsibilities, human resources constraints, and staffing implications of long emergency department wait times.
“Before I was in the system, I didn’t realize how intertwined policing was with mental health,” said undergraduate university student and study contributor Gina Nicoll, who has lived experience of mental illness including being transferred by police to hospital for assessment. “It just felt really disheartening and I felt defeated and powerless. It made me feel I was doing something wrong just by being unwell and I felt I was criminalized for it.”
The authors conclude that routine police involvement in student mental health transfers to hospital is harmful. They suggest engaging police only in rare circumstances when the risk of a student fleeing or becoming violent during transfer to hospital is assessed to be high. They recommend that province-wide policies to minimize police use of restraints during mental health transfers from Ontario university clinics be developed in collaboration with university administrations, municipal and provincial governments, hospitals, police departments, and people with lived experience of mental illness.
“As an emergency department psychiatrist, I see people on the worst days of their lives,” said senior author Dr. Juveria Zaheer. “People experiencing suicidal thoughts. People experiencing psychosis. They may be afraid. They may have trauma. They may not want to be there. Similarly, in university settings, we have people presenting in distress and crisis in a myriad of different ways, including students who are racialized and had experiences of oppression and negative interactions with police. Although we can’t say that we never need to use restraints, they need to be used rarely and judiciously as a last resort. It should not be the default, because that is stigmatizing and frightening. We need to be trauma-informed and safe and to minimize restraint, just as we need to do in all healthcare settings.”
Dr. Chittle added that she hopes a public discussion over the role of police on campus will persuade universities to examine their policies and processes for students in mental health crisis. She notes that following her and her co-authors’ previous work examining the practice of routinely engaging police and routine use of handcuffs at the University of Guelph, a more flexible procedure for hospital transfers was developed. At the same time, changes to police policies enabled the discretionary use of restraints when police were engaged in transfers.
“I think we are seeing society move more broadly away from police involvement in mental healthcare,” said Dr. Chittle. “There are some pilot projects being undertaken that are non-policing models of mental health crisis care. My hope is that this is where we are going to move towards.”
Large numbers of regular drug users report increased substance use and heightened fear of relapse and overdose during COVID-19
CAMH survey indicates drug users are being disproportionately impacted by COVID in a variety of ways, in large part due to supply disruption and other COVID-related societal changes.
People who regularly use psychoactive substances report experiencing a variety of negative impacts since the COVID-19 pandemic began, including increased usage and fear of relapse or overdose, highlighting the need for improved supports and services, including better access to safe supply programs, according to a new CAMH survey published in the International Journal of Drug Policy.
“People who use drugs have been negatively impacted by the pandemic in ways that put them at greater risk for experiencing substance and health-related harms, including overdoses and a decreased ability to mitigate risk behaviours,” writes lead author Dr. Farihah Ali. “These findings warrant the need for increased accessibility of safe supply programs, take-home naloxone and drug-testing kits, as well as novel approaches to help ensure they have the necessary tools available to make informed choices and mitigate risk.”
Key Survey Findings
“One of the potential factors in relapse is all the time spent alone and isolated with all the pandemic restrictions,” said survey co-author Dr. Tara Elton-Marshall, Independent Scientist at the CAMH Institute for Mental Health Policy Research. “Using alone itself was a real concern. We know that people who use alone are more likely to die of an overdose, in part because there is nobody there to administer naloxone or call emergency services.”
Principal Investigator Dr. Jürgen Rehm, Senior Scientist at the CAMH Institute for Mental Health Policy Research, says that sudden disruptions in the supply of street drugs when the pandemic began were associated with an increase in overdose deaths and other harms. In British Columbia, the number of illicit drug overdose deaths increased by 72 per cent during the first four months of the pandemic between March and July 2020 compared to the year before.
Dr. Rehm believes that the unprecedented circumstances caused by COVID-19 requires unprecedented action, including changes to existing drug laws.
“We need everything from good treatment and harm reduction measures to realizing that we are in an environment where everything is different during COVID and we need different solutions. We need to consider now how to decriminalize drug use. This survey lends strong support for the need for an integrated drug policy strategy including harm reduction.”
“People who use drugs feel like they have been a forgotten entity throughout the COVID crisis,” said survey co-author Sean LeBlanc. “There was already an overdose crisis in Canada before COVID and it has just gotten worse since then. They are not just numbers. They are all individuals with individual stories and individual losses and individual victories.”
LeBlanc, formerly dependent on opioids, has been actively involved in drug use advocacy groups for many years in Ottawa. He had a relapse himself just a few weeks after the pandemic began. He says the experience and his successful recovery emphasizes how fragile the recovery experience can be in the face the blunt force of COVID.
“These are people who are at their most vulnerable now,” said LeBlanc. “I think about the people who helped me the most when I needed it. That time when someone has the possibility to change, that is sometimes very fleeting. There is so much potential that is being unrealized right now because people aren’t getting the help they need when they need
it. For me that’s the saddest thing right now.”