The Future of Psychedelics and Lessons Learned From the Cannabis Industry

Michael J Verbora, MD, MBA, medical director, Field Trip Health, and Ben Medrano, MD, medical director, Field Trip Health, Toronto, Canada, discuss whether psychedelics will be used in a nonmedical context, future research, and lessons learned from the cannabis industry including it being an alternative to opiates. "When I look at the data on cannabis and I look at the risks benefits, it's a no-brainer to me that it's a safer option than drugs like opiates and benzos," says Dr Verbora.

Dr Medrano is also the chief medical officer at Aleafie Health, and assistant professor at Seneca College, Ontario, Canada.

This discussion took place at the 2021 Psych Congress in San Antonio, Texas.

Read the transcript:

Dr Michael Verbora: One last question for you maybe is, do you think the psychedelics will be used in a nonmedical context? I know we're maybe getting years ahead of ourselves, but there's that energy in the air.  

The community of psychedelics is one of the best communities I've ever been a part of and so honored to be a part of. How are psychedelics, and the legalization, decriminalization, and how do you envision them being used for people maybe who aren't sick or don't have a diagnosis? Is that something that's going to manifest, you think?  

Dr Ben Medrano:  Yeah, the betterment of the well conversation. I'm sure you have colleagues who have explored with these medicines at one point or another in their lives. The resounding feedback I've heard from those experiences is that it was one of the most top important experiences of their lives. You actually see that in the research.  

Johns Hopkins is starting to go into this realm of actually providing psychedelics for people who don't have a diagnosis and looking at how might that impact them in terms of meaning-making or fulfillment or reduction of potential symptoms later down the road.  

Personally, I would say, there is a place for psychedelics to be used for the betterment to the world. I also think that we need to get to a point of feeling very confident about the safety of this because we're still in our infancy. I know that's hard for some people in the psychedelic community to fully take in because there's been this research since the '50s.  

There's still a lot to study here and to make sure that we're going to be diligent about how we administer these medicines because they're not completely harmless either. That's where we need to do a little more research to see what are the potential harms of psychedelics, because when you have an enthusiastic group of researchers, sometimes those things get missed.  

Even right now, in this resurgence of psychedelics in the public, there is maybe a little bit more hype than it deserves, I would say, because the hazards that I think of, or if somebody has retraumatization, or if they're just administered unskillfully and there's nobody there to hold them beyond that, then it can really have some lasting challenges for people.  

Making sure that we are mindful and thoughtful about how to deliver them. It's going to take a little more time to get to that point to opening it up.  

Dr Verbora:  I couldn't agree more with somebody who's been involved in the Canadian cannabis industry, which is, become the wild west of the world with respect to cannabis regulation. I was involved in the medical channel for a year or 2, and then it became recreational.  

There's values there that I support, but what it did was it took away the funding from a lot of the research. Now, as a clinician, where thousands of patients come to see me to discuss cannabis, I wish I had a little bit more data on some of these conditions, a little bit better knowledge on the dosing, but the incentive for doing the research has diminished because of this approach.  

Regardless of what direction or path psychedelics takes, we need to fundamentally protect our ability to research and investigate and collect the data so that clinicians like you and I can accurately give patients information on being able to help them.  

Dr Medrano:  It's maybe a little bit like the cannabis industry, the cart's gotten ahead of the horse. I'm curious what lessons you've learned, other than the one you just shared, from that industry that might be helpful for people within the psychedelic community to take in?  

Dr Verbora:  Despite the fact that I don't have all the research at my fingertips or the research is limited in using cannabis, it doesn't mean that you still can't use it in a safe manner. You have to look at the risks and benefits, and you have to look at the patient in front of you. You have to do that calculation, and with the patient, make that shared decision making.  

You have to introduce more art. There's nothing wrong with a little bit of art in medicine. I feel like sometimes we're lacking a little bit of art and it takes out some of that humanity in medicine and also makes us very easily replaceable by [artificial intelligence] AI, but let's not get into that one. 

Dr Verbora:  It introduces a little bit of art. That can also be difficult to navigate because it will be frustrating if patients don't get better, but then you have another patient with the same condition that gets better. One of the lessons there is one, if you want to promote the research, you want to make sure that industry has incentives to do research.  

You want to partner, obviously, with the political community and get involved in that respect and see how they can regulate in a feasible, but smart approach. Then you also want to be able to know which patients can I still help without having all the answers because there are patients who don't have time to wait.  

Some could be extremely suicidal. Some could be sadly knocking on death's door with a terminal diagnosis. Should we really wait for all the answers to try to offer them something where we understand a little bit of the risk-benefit profile?  

We have to, as clinicians, also adapt to the fact that we have to be a little bit comfortable dealing with some of the unknowns which can be difficult because we're brought up in a training system that tries to give us the most evidence at which informs our decision making.  

Dr Medrano:  You alluded to it there a little bit, but the cart's gotten ahead of the horse for a reason because people are in dire need. We're in the midst of this mental health epidemic with growing depression, anxiety, and trauma. 

The one thing that I admire in working with you and others in our company is a great deal of heart that people bring to it. I'm curious also about your work with cannabis if you could talk a little bit of that?  

Dr Verbora:  I've been working with cannabis for the past six or seven years. That interest stemmed out of personal stories of very close relatives overdosing on opiates, which broke my heart at a young age to have 40 year-old uncle die from an opiate overdose. As I progressed and went through medicine and I graduated, I thought there's got to be something safer. There's got to be something better.  

Cannabis was just starting to become a hot topic in Canadian media and culture. I dove into it and learned as much as I could. I take that oath to do no harm. I take that above everything else. I understand that we have to get science. I understand that we want to practice evidence-based medicine. Again, that's not the oath that I took. My oath is to do no harm.  

When I look at the data on cannabis and I look at the risks benefits, it's a no-brainer to me that it's a safer option than drugs like opiates and benzos. The lens at which I came to cannabis was a harm reduction lens.  

Can I really help drugs substitute for patients suffering from chronic pain or chronic mental illness predominantly and try to lower their benzo doses or get them off or try to lower their opiate doses? I don't have all the answers because I don't have a lot of literature, but I could give it a try and it might work.  

What we have seen through our clinics across Canada is that we can reduce opiates 30 [or] 50%. Sometimes, we can reduce benzos by similar amounts. We published some observational studies through our clinic data. What I also found was that quality of life was dramatically improved when using cannabis appropriately. What does appropriate mean with cannabis?  

The challenges is people have been using cannabis for so long and they think they have a sense of the best way to use it. Also, things in the psychedelic community like set and setting could be brought in with cannabis. I feel like we don't consciously use cannabis to its fullest ability.  

People typically tend to smoke it, and they tend to ignore some of the potential changes in consciousness that could be utilized for benefit. I try to bring some of that psychedelic knowledge or wisdom into this space to help people also elevate their consciousness when they use cannabis.  

Then the one community that, for whatever reason, just unexpectedly fell on my lap, I guess you could say, as an early adopter of cannabis in Canada, is the pediatric community. A lot of people think cannabis in pediatrics is bad. I think if you're a psychiatrist, you probably that's all you see is the negative side of THC on psychosis for youth.  

From my perspective, I'm seeing some of the most resistant epilepsies brain disorders. I'm seeing horrible types of cancers in young children. I work with this probably about 2,000 pediatric patients. We utilized cannabis to try to reduce seizures. We utilize it to try to reduce exposure to opiates and benzos for some of their terminal illnesses. It makes a big difference when used appropriately.