Written by Bani Rikhraj for the Medical Law Section.
Whilst psychedelic drugs are known for their potential negative effects, this article will investigate its lesser known, or less-exploited, postive effects. Further, Rikhraj asserts that this is a new area of human development that begs the law to reconsider its position on.
This article examines the legal landscape surrounding the use of psychedelic drugs in the UK and delves into the ethical implications, particularly focusing on the vulnerability of patients in meeting informed consent standards.
The World Health Organisation estimates that one in eight people globally live with a mental disorder.[1] Mounting evidence suggests immense therapeutic potential for these substances in treating mental health conditions like depression, anxiety, and addiction. For instance, research conducted by Imperial College London demonstrated that patients suffering from severe depression showed self-reported improvements just weeks after using psilocybin (found in magic mushrooms), an effect which was not seen when using conventional antidepressants.[2]
While research indicates promising outcomes for certain mental health conditions, the lack of extensive, long-term studies raises ethical questions about the unknown consequences of these treatments. Australia recently legalised LSD and MDMA for medical purposes, a move which was seen as a paradigm shift in mental health treatment. However, it is arguable that by not properly researching the long-term effects of these drugs, Australia has ‘jumped the gun,’ potentially exposing patients to a variety of unknown risks.[3] Taking this as a cautionary tale, the UK could choose to study the long-term effects and potential risks associated with psychedelic therapy, before making it accessible to the public. However, for that to occur, these drugs must be made available for clinical trials – an action in which the UK is currently lacking.
The legal status of psychedelic substances in the UK is primarily governed by the Misuse of Drugs Act 1971. This legislation classifies substances into three categories (Class A, B, and C) based on their perceived harm. Historically, psychedelic drugs such as psilocybin (found in magic mushrooms) and LSD have been classified as Class A, indicating the highest potential for harm and strict legal controls. Additionally, the United Nations’ Convention on Psychotropic Substances classifies these drugs under Schedule 1, meaning they are not seen to have any therapeutic value. This makes these drugs incredibly difficult to access, not just for provision of treatment, but even for clinical research in the UK. To advance psychedelic research responsibly, the UK must reevaluate its legal framework to facilitate legitimate clinical trials. A cross-party group of MPs recommended that the UK government should downgrade the Class A psychedelic drugs from Schedule 1 to Schedule 2. [4] This would enable academics and other researchers to test the “therapeutic value” of these psychedelic drugs more easily. A nuanced approach that allows controlled experimentation while prioritizing patient safety can pave the way for a more informed adoption of psychedelic therapies.
Ethical Considerations:
If a change in the law were to occur, allowing for clinical trials to commence and a new treatment in the form of psychedelic therapy to be made available in the UK, there are still various ethical hurdles that would need to be considered.
Vulnerability of Patients: Is it informed consent?
Informed consent is a fundamental ethical principle in medical research and treatment, ensuring that individuals are adequately informed about the potential risks and benefits of a particular intervention. Psychedelic therapy often involves altered states of consciousness and intense psychological experiences.[5] Patients undergoing such treatments may be in a vulnerable mental state, raising questions about their capacity to fully comprehend the information provided during the consent process. Vulnerability can stem from the severity of the mental health condition itself or the emotional intensity associated with psychedelic experiences, the latter raising questions about whether the patient would be able to withdraw consent after the treatment has commenced. Patients with severe mental health disorders, such as treatment-resistant depression or post-traumatic stress disorder (PTSD), may be particularly susceptible to exploitation or coercion. The nature of their conditions may impair their judgment, making it challenging to obtain valid, informed consent. Moreover, the emotional and psychological impact of psychedelic therapy may exacerbate the vulnerability of these individuals. To address this, a robust and thorough informed consent process is crucial. Multiple sessions, independent advocates, and accessible information can empower patients to make informed decisions. Specialised training for healthcare professionals and ongoing monitoring are essential to ensure the well-being of vulnerable individuals participating in psychedelic therapy.
Equity and Access Issues:
The potential availability of psychedelic therapies also brings forth concerns about equity and access. History has shown that groundbreaking medical treatments, like medical cannabis in the UK, can become inaccessible to those who need them most.[6] The risk of psychedelic therapies being limited to wealthy patients exacerbates existing healthcare disparities. To mitigate this, policymakers must proactively address issues of equity and access. Implementing measures to ensure affordability, subsidising treatments for those in need, and fostering a diverse range of treatment providers can help prevent psychedelic therapies from becoming a privilege of the few. Finally, steps will need to be taken to ensure that the provision of these drugs is only for medical purposes. While research does indicate that the chances of addiction to these substances is low (due to the ‘unpleasant’ process of undertaking them), supply of these drugs at a high price for recreational purposes could create a potential shortage in supply for clinical trials and prescriptions.
In conclusion, evidence has shown that the use of psychedelic therapy has a quick and positive impact on patients suffering from mental health disorders, however, the development of laws surrounding psychedelic drugs in the UK still has a long way to go. There are numerous ethical issues which need to be considered before making these drugs available for medical purposes. It has been argued that the UK should take a more cautious approach than Australia and should ensure proper clinical trials and testing occurs. However, for that, the UK needs to take quicker action to make the drugs available to scientists. It is recommended that the classification of these drugs be moved from Schedule 1 to Schedule 2, so that they become easier to access, in hopes that the trials will produce effective results and pave the way for a revolution in how we treat mental health conditions.
References
[1] World Health Organisation, Mental Disorders Fact Sheet, 2022
[2] R O’Hare, Magic Mushroom Compound Increases Brain Connectivity in People with Depression, (Imperial College London, 2022)
[3] R Haridy, Australia to prescribe MDMA and Psilocybin for PTSD and Depression in world first, (Nature, 2023)
[4] A Forrest, MPs call for magic mushrooms and psychedelic drugs to be downgraded, (The Independent, 2023)
[5] C Grob et al., Pilot Study for psilocybin treatment for anxiety in patients with advanced-stage cancer, JAMA Psychiatry 2011
[6] K Koram, The NHS can prescribe medical cannabis. So why are desperate patients being forced to go private? (The Guardian, 2023)
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