Drug Science was invited to give expert commentary on:
Thematic session 3: The availability of internationally controlled substances for medical and scientific purposes, including for the relief of pain and palliative care, remains low to non-existent in many parts of the world; (21 October 2020)
After earlier speakers focused on the availability, or lack thereof, of internationally controlled substances for medical treatment (for instance for palliative care and pain), Prof David Nutt focused on the limited availability of controlled substances for scientific and research purposes. Prof Nutt highlighted that there are significant problems in current drug policies.
The 6 major flaws in the current international drug regulation policies are:
Drug policies are not based juts on harms but rather reflect moral and political choices
Punishment is put above harm reduction- which is again a moral choice
It many countries, these punishments are disproportionate to the harms
Current drug policies severely limit treatment (largely with opioids) and research, with cannabis and psychedelics. This is especially detrimental as these substances are showing significant promise as alternative treatments to opioids, in areas such as pain and palliative care.
Policies encourage the use of more toxic compounds, such as fentanyls
They waste a huge amount of money.
Drug Science believes that, in many cases, cannabis and psychedelics can offer alternatives to the use of opioids and that they can offer a different, and often safer, way as they have particular utility for chronic syndromes.
Considerable research has been done into the efficacy of these treatments, such as LSD and psilocybin, up to the 1971 UN convention when these were banned.
The dramatic decrease in research is shown below:
The same pattern is shown in relation to cannabis- the regulations have had a very detrimental effect on research on the therapeutic value of these substances. While it is questionable whether these regulations have reduced recreational use, they certainly reduced research possibilities.
This is unfortunate because some of the work up to 1971 showed enormous potential in disorders which are particularly disabling. As an example, a recent meta-analysis of 6 trials of LSD for the treatment of alcoholism, shows an effect size greater than any we have for any current therapy for alcoholism. Yet there never has been a single additional trial subsequently because the current UN regulations- while not banning research per se- they do so in practice.
Today, despite these challenges, there has been some resurrection in researching psychedelics for psychiatric, as well as neurological conditions, which is relevant to today’s discussion. Two recent positive open trials of psilocybin for palliative care (end-of-life anxiety/depression) took place at Johns Hopkins and NYU. Likewise, psilocybin has been studied as a successful treatment for addiction to tobacco (at Johns Hopkins University; a double-blind RCT study is underway) and alcohol (New Mexico). There are planned studies in pain syndromes, chronic neuropathic pain, and cluster headaches, as well as opioid addiction. These are small studies which are very expensive to conduct because the illegal status of these substances profoundly limits research and increases costs.
Drug Science would like to offer the following solutions:
Revise UN Conventions to expressively facilitate research into scheduled drugs- especially cannabis and psychedelics, where there is growing evidence of efficacy
Re-schedule those substances with clear therapeutic evidence into a schedule which makes research easier
Revise/remove the current limitations on the production and distribution amounts, which are currently making research with psychedelics very difficult
This would be a major advance which could benefit many millions of people who are suffering, whether in relation to pain syndromes and palliative care or other related disorders, such as addiction or depression, and who may not have access to opioids or who may not benefit from current available treatments. Such innovative approaches are badly needed, especially in light of the current global health crisis, which is only likely to worsen as a result of the COVID-19 epidemic. Drug Science has launched the Drug Science Medical Psychedelics Working Group to address this issue.
You can access Professor Nutt’s slides from the United Nations Office on Drugs and Crime – Commission on Narcotic Drugs presentation here.