Oregon voters passed a ballot measure Tuesday that would establish a legal psilocybin (“magic mushrooms”) administration program, while South Dakota and Mississippi became the latest states voting to legalize medical cannabis. Voters in several other states also approved initiatives to legalize recreational marijuana, and a measure in the District of Columbia passed that would decriminalize psilocybin and certain other psychedelic agents.
While the broad and immediate impact of these measures on the medical community remains largely unclear, some experts cited them in urging providers to expand their minds more.
Oregon became the first state to legalize psilocybin — or any psychedelic — for its citizens to consume. The state voted 55.8%-44.2%, as of Wednesday afternoon, to craft a program allowing it to be administered in some form of therapeutic setting to adults 21 and older, with details to be ironed out over the next 2 years. There will not be a dispensary system, however, like those in many states for medical cannabis.
Oregon has only decided to create a program, cautioned Matthew Johnson, PhD, associate director for the Center for Psychedelic and Consciousness Research at Johns Hopkins University in Baltimore. So it is too soon to know how people may get the psilocybin or how precisely medical professionals could be involved.
The program could include therapeutic use and treatment for some disorders, Johnson said. Assuming it unfolds as he expects, including coordination with federal authorities, Johnson predicts medical professionals will be needed during patient sessions to respond to potential emergencies and conduct follow-up care.
“The practice of medicine is something that needs to be regulated,” Johnson said. “The concern is if it’s not done right and could cause public harm. …It needs to be supervised.”
Psilocybin is under investigation, Johnson added, with one trial in phase III and other clinical trials underway, and some observational studies completed. But it is not an FDA-approved medicine.
As it happens, JAMA Psychiatry on Wednesday published a randomized trial, with Johnson among the authors, indicating that synthetic psilocybin was effective in major depression.
If Oregon’s program mirrors the results Johnson has seen in his own and other clinical research, “I think it does have a chance of helping patients, with an acceptable level of risk.”
The American Psychiatric Association and Oregon Medical Association both opposed the Oregon measure.
Johnson expects the state’s decision to lead other states to adopt similar measures. Efforts to decriminalize psychedelics — such as in D.C. — are still more popular then initiatives to legalize and foster use.
With South Dakota and Mississippi now on board, 36 states have now approved or implemented medical cannabis programs. Also this week, South Dakota, New Jersey, Arizona and Montana approved recreational marijuana — making South Dakota the first state ever to simultaneously approve medicinal and recreational cannabis. And a separate measure passed in Oregon that would decriminalize all currently illicit drugs including heroin, cocaine, and methamphetamine.)
Experts cautioned healthcare workers in South Dakota and Mississippi to be prepared for patients’ questions about cannabis, and to monitor patients who are consuming cannabis separately. They recommended physicians and others improve their education using online resources including some offering CME credit. A slew of new resources was released earlier this fall, including two textbooks and guidelines.
“This is not all smoke and mirrors. There’s a lot of data now” supporting cannabis for a few conditions, said Bryon Adinoff, MD, clinical professor at the University of Colorado School of Medicine, speaking on behalf of Doctors for Cannabis Regulation. That includes anecdotal as well as more systematic evidence.
Medical cannabis still has largely not been integrated into medicine, said Karen O’Keefe, director of state policies with Marijuana Policy Project, but it is important for patients to be able to discuss their cannabis consumption with their physicians. “For the medical community to engage in this would be beneficial,” she said, suggesting helping produce warning labels, for example.
All of the pro-cannabis measures on election ballots this week passed, including those in conservative “red” states. “It’s reached critical mass,” O’Keefe said. Physicians must accept “that this is a reality now, and for many people it’s had a dramatic improvement on their quality of life.”
“They not only passed but they passed quite remarkably, given the divisiveness in the country,” Adinoff said. “I think the message is overwhelmingly clear.” Adinoff said he knows physicans are trained to follow evidence and the FDA, and are often conservative by nature. But they may not have weighed social justice issues associated with cannabis, he argued: “I would like to say hopefully they get the message and they should consider where many people in this country are coming from.”
Adinoff wants more physicians to lead in the medical cannabis space, rather than being pulled along for the ride; he noted the California Medical Association and American Heart Association both support it.
Cannabis has medicinal properties but needs to be approved by the FDA like other drugs, countered Kevin Sabet, CEO of the policy firm Smart Approaches to Marijuana: “Medicine isn’t a popularity contest; it’s not determined by vote,” Sabet said. “But that’s what happened in these states.”
Proponents are also pushing for federal change. Cannabis remains federally illegal and on the DEA’s Schedule I list, considered “drugs with no currently accepted medical use and a high potential for abuse.”
Adinoff favors full federal legalization “so we don’t have this bizarre situation where the majority of people in this country are living under two laws that are in complete contradiction.” Another issue caused by the federal situation: Physicians cannot prescribe specific products, only recommend cannabis in general.
Sabet doubts cannabis will be legalized federally during the next Congress, noting the Republicans are likely to hold on to the Senate and neither President Trump nor Joe Biden is pro-legalization. (Biden has expressed support for rescheduling cannabis, not descheduling it, Sabet said.) Marijuana’s legal status is also not now a high-profile issue, he noted.
Source: MedicalNewsToday.com
