How ecstasy and psilocybin could be used to treat mental health issues in CT
A bill paving the way toward the use of psychedelic substances as treatment for mental health has passed through a key state legislative committee.
The bill, intended to “increase access to mental health medication,” would allow for and fund three treatment sites dedicated to the use of MDMA, commonly known as ecstasy or “molly,” and psilocybin, the psychedelic substance in so-called “magic” mushrooms for use against treatment-resistant post-traumatic stress disorder, depression and other mental health concerns.
The bill was unanimously approved by the state Public Health Committee. Committee co-chair state Rep. Jonathan Steinberg, D-Westport, said he was surprised at the unanimous, bipartisan support.
“I think it's a testament to the fact that the people on our committee do their homework,” he said.
Psychedelic substances have been “stigmatized over the generations,” Steinberg said, but the committee “heard some really compelling testimony” that helped them understand it is “actually an effective therapy.”
State Sen. Saud Anwar, D-South Windsor, a practicing physician and one of the co-sponsors of the bill, said the committee heard how “in a selected group of patients, this had been a game-changer.”
“When you hear directly from the people who have been impacted,” Anwar said, “it has a deeper impact on you.”
‘Felt like a cure’
The U.S. Food and Drug Administration has already allowed the use of MDMA and psilocybin for research and limited treatment purposes.
A previous Yale study sought to evaluate psilocybin as a treatment of mental health and one study participant called the experience transformative.
“For me, it definitely felt like a cure,” said the study participant, whose name Hearst Connecticut Media Group agreed to withhold to protect their identity. “For me, it felt like getting to the very, very bottom of what was plaguing me and creating an enduring outcome.”
The participant said they had three depressive episodes over the course of their lives, the last of which “left me completely unable to work.”
“Not being able to do my work is just so horrible,” they said. “I found myself literally unable to pursue the most important thing in my life.”
Taking antidepressants, they said, does not deal with the root cause of the depression.
“When I was on antidepressants, it was the absence of symptoms. The best you can get out of them is eliminating the symptoms of depression,” the participant said.
Psychedelic-assisted therapy, though, is different. “The realm you’re thrust into is really magical,” the person said. “It gives you an entirely different vantage point on your life and allows you to see that life with empathy for yourself.”
Though MDMA and psilocybin have been used for recreational purposes, it’s different in a treatment setting. The patient wears eye shades, for example, and listens to unobtrusive, calming instrumental music so “it’s an entirely inward journey,” the study participant said.
“Instead of being at a rave or at a party or whatever the recreational setting would be, here you are in a safe environment,” the person said. “And, of course, you're with two experienced therapists which takes away a lot of the dangers.”
A narrow pathway
Jesse MacLachlan, a former Connecticut state legislator, said psychedelic-assisted therapy “could be likely one of the greatest developments in mental health care in decades.”
After he left the legislature, MacLachlan was appointed to the legislative committee examining the possibility of using MDMA and psilocybin for treatment of depression, anxiety, PTSD and other mental health issues.
MacLachlan now volunteers for Reason for Hope, which he described as “a nonprofit policy and advocacy organization that's focused on maximizing the public benefits of psychedelic assisted therapy.”
He also said he was surprised that a bill to allow psychedelic therapy was unanimously passed out of committee.
“It was surprising,” MacLachlan said. “This issue comes with a lot of stigma with it from years and years of misinformation.”
MacLachlan said the bill is intentionally very narrow. The FDA is expected to authorize MDMA as a treatment in 2023 and psilocybin in 2024. In the meantime, they’re both allowed under the FDA’s expanded access program.
This bill offers $1.5 million in funding split between three treatment sites, which have not been identified, to prepare for the FDA’s authorization in the coming years.
The bill, MacLachlan said, makes sure “the state is ready to accommodate the demand that will occur upon an FDA approval, because we have about 18 to 24 months to prepare for what is a form of treatment unlike anything currently available.”
The bill as written is intended for specific groups of patients: Connecticut residents who are veterans, first responders, direct care health care workers or are from “a historically underserved community, and who has a serious or life-threatening mental or behavioral health disorder and without access to effective mental or behavioral health medication.”
One of the issues is that psychedelic-assisted therapy is very labor-intensive. The drugs are cheap to produce, but the therapy requires hours of preparation in addition to the actual therapy.
Current protocols require, MacLachlan said, “anywhere from five to eight hours of preparatory therapy,” then there’s an “intervention session where the patient receives psychedelic-assisted therapy treatment,” which lasts six to eight hours.
“And then you have anywhere from five to eight hours of integration therapy,” he said. “So you're looking at anywhere from like 20 to 30 labor hours, and that's expensive.”
The therapeutic model “doesn't fit neatly within our existing mental health care framework,” MacLachlan said. “What other treatment combines both the work of the clergy and of psychiatry and cognitive behavioral therapy?”
That means the state “is in a position where we need to start thinking about how to license and credential therapists, we need to start thinking about how to approve treatment sites, we need to start thinking about patient safety protocols, diversion prevention methods and patient aftercare,” he said.
‘Phased approach’
Steinberg said a bill that had unanimously passed through committee would usually have a “pretty good” chance at becoming law. This year, though, is a short legislative session.
“The really biggest challenge that we have is that in this very short session, not every bill is going to get heard,” he said.
It might not have been heard at all if not for the pandemic, which Steinberg said has highlighted and exacerbated existing mental health issues around the world.
“Most of us are aware that we had both access and quality issues with mental health before the pandemic hit us,” he said. “It took the pandemic to highlight the real gaps and shortcomings in supply and access to mental health care. It obliged us to be more open-minded, a little creative. It also led us to look with fresh eyes at alternative therapies.”
This measure might be combined with others into “some amalgamation of bills,” Steinberg said, but if it does pass, Anwar believes it’s only phase one.
Though the treatment is promising, it’s “worthy to take slow steps and also watch closely what’s happening,” Anwar said. “This is going to be a phased approach.”
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