WEEK 11 - Holistic Cancer Care: Psychedelic Therapy for Anxiety and depression

Question 1

What is the issue with current UK drug legalities

Answer 1

Have high levels of drug related deaths due to legislation surrounding drugs
- Psychadelics classed as Class A / CD Sch 1 ~ but can have potential health benfits

• Lecturer wants to push point of legalising and regulating supply of these CD 1 drugs for further research
  - requires CD licens from home office before can research

Question 2

Solutions to reducing Drug Related deaths

Answer 2

• State regulation (de-criminalising drugs)
• Drug checking
• Safe injection facilities
• Diamorphine (heroin) assisted treatment
• Improve treatment services-funding
• Psychedelic assisted therapy
• Compassionate access (use of unauthorised medicines due to specific circumstance)
• Education, evidence-based drug policies

Question 3

Synthetic drugs

Answer 3

ISSUE: found in many drugs now, i.e. contaminants

• Are lethal, can lead to death
• e.g. Synthetic opioids: Nitazenes
• e.g. Synthetic Cannabinoid Receptor Agonists (SCRAs, Spice) found in THC vapes

Question 4

Mental Health

Treatment resistant depression

Answer 4

Has reached crisis levels in UK

• Treatment resistnat depression (TRD) is becoming an increasing problem
  - TRD = have tried at least 5 of standard line of anti-deppressants e.g. SSRIs, SNRIs
• Rate of suicde is rhigh ~ 30% of population may attempt suicide once in their life
• Up to 12% may develop PTSD following trauma, rises to 31% in veterans

Question 5

What are the 5 objectives of medical psychadelics

Answer 5

1. Rescheduling
2. Research
3. Education
4. De-stigmatisation
5. Legislation

Question 6

What are Psychedelics

Answer 6

Plant medicines
- they come from plants
- e.g. magic mushrooms, peyote, ayahuasca-DMT
- can have synthetic versions e.g. LSD Delysid

• When consumed, have psychedelic expereince
• Some cause purging (vomitting, bowel movements etc.) believe this is body releasing trauma
• e.g. Psilocybin and Psilocin
  - have similar structure to Serotonin-5-HT (an SSRI)

Question 7

What are the 4 key features of psychedelic assisted psychotherapy (PAP)

Answer 7

1. Healing
   
   • Psychiatry doesn’t heal, medicine is prescribed to manage symptoms
   • Psychiatry medicines have to be taken daily for long time = ↑ SE burden, only a few go into complete remsission
2. Dosing paradigm (1-3 high doses only)
   - Differs to Psychiatry (daily dosing)
   - Given 1-3 high doses that are space out over couple of weeks = no SE burden
   - A one-off treatment
   - Doesn’t need to be taken continously due to neoplasticity and effects it has on brain
3. Long-lasting- neuroplasticity
   - Alters state of consciousness
   - Can be intense, traumatic experience for some
4. Safe-set & setting
   - If pt is in right mindset (prepared mentally + physically)
   - Have holistic preparation for a few months before starting
   - Need to be in a safe space
   - Are safe, stigma around people loosing mind, thinking they can fly etc.

Question 8

What are issues with Psychedelic Clinical Trials

Answer 8

• Hard to run
• Hard to interpret as pt knows they have got a psychedelic
  - i.e. hard to blind pts, have placebo controls
• Ego death (loosing part of who you are)
• Small trials ran
• Ethics very difficult: Schedule 1
• Huge expectancy effects

NOTE:
- There are now more clinical trials into psychedelic use

Question 9

What are the health risks of Psychedelics

Inc. why

Answer 9

CV effects:
- ↑ in BP
- ↑ in HR
- Heart valve hardening / damage
- if hits 2b or 2c receptors, needs to be seelctive for 2a

WHY:
- Works on serotonin system as they are 5HT-2a receptor agonists
- Receptors are found on blood vessles = when bind get vasoconstriction

Question 10

Are Psychedelics Addictive

Answer 10

NO

• People use it a couple times in a year (2-3 times) at most

Question 11

Psyhedelics for existential anxiety and depression in cancer patients

Psychdelic used = Psilocybin

Answer 11

• Use alters pts thoughts / feelings towards diagnosis, death etc.
• Clinical trials found effects to be long lasting (> 6 months)
• In some countries its legal for:
  
  • End of life in cancer
  • Existential anxiety and depression
  • Severe depression
  • PTSD
• Commonly investigated psychdelics = LSD-2, MDMA-1, Psilocybin-3

Question 12

MoA of Psilocybin

Answer 12

Psilocybin is a 5-HT2A receptor agonist
- enables new connections to form = synaptogenesis, neuroplasticity
- causes release of glutamate

• 5-HT2A receptors are found deep in cortex of brain
• Psilocybin stimulates receptor = ↑ excitation
• Cascade of intracellular events = clinical benefits

Question 13

What are the 3 key effects of Psilocybin use in Cancer patiens

Answer 13

1. Somatic Healing Needs Met
   - Helps Psychological Burden of Cancer
   - Change from Conventional Mental Health Interventions
2. Outlawing Nature
   - Stigma behind criminilastion of psychdelics = people feel bad when use it but has helped improve thier health
   - conflict between wanting to use but legally can’t as its a Class A drug
3. Experiencing Connection
   - Between mind, body, nature and death

Question 14

What are the SE of ketamine

Not a psychedelic

Answer 14

• Induces liver enzymes
• Bladder destruction (irreversible if using hevay levels)
• GI issues
• K cramps
• Bladder pain

NOTE:
- Develop tolerance very quickly due to induction of enzymes that metabolise it
= have to take more to get same effe
- People then take more to manage pain etc. = addiction / abuse
- Legal in private clinics for severe depression
- DOSE: once a month
- Unlike psychedelics need to keep taking