Between 2019 to 2020, 117,678 people exited the drug and alcohol treatment system. While there were 104,880 individuals in treatment for alcohol during this period, it is estimated that close to 500,000 who required treatment did not receive it.
Less than half the people who left drug and alcohol treatment services (47%) were discharged as ‘treatment completed’, most of the rest leaving treatment early, with around 1% dying in treatment. Those receiving treatment for alcohol alone had the highest rate of treatment completed discharges (59%), with opiate users having the lowest rate of completion (25%).
With alcohol dependence relapse rates of higher than 80% within the first year post treatment, we can see that current models are, in the majority of cases, ineffective.
Most drug and alcohol treatments require inpatient care followed by on-going outpatient care, both of which are time consuming and expensive. Those who did complete treatment for opiate problems were undergoing treatment for nearly 3 years (1,056 days) on average, whereas for alcohol 187 days were spent in treatment before a ‘treatment completed’ discharge. In a 2013 report by the Centre for Social Justice the UK was named the “addiction capital of Europe.” The report showed that issues relating to drug and alcohol abuse cost the county £36 billion every year.
In 2014 treating drug misuse was estimated to cost the NHS around £500m a year, with alcohol-related harm, its misuse being the biggest risk factor for death, ill-health and disability among 15-49 year-olds in the UK, estimated to cost the NHS around £3.5 billion annually. Along with the huge health costs, there are significant social costs associated with failure to respond to and treat addiction such as policing and acquisitive crime.
Researchers have found evidence to suggest that a number of psychedelic substances have potential as agents of treatment for a variety of dependency issues.
LSD was found to be promising when administered as part of a residential treatment for heroin addiction (Savage & Mccabe, 1973) and a 2012 meta-analysis across 6 trials, including 536 participants, showed that a single dose of LSD in conjunction with psychotherapy decreased alcohol misuse (Krebs & Johansen, 2012).
More recently, psilocybin is being researched as a treatment for Alcohol Use Disorder (Bogenschutz et al., 2015) and Tobacco Addiction (Johnson et al., 2017) - the 15 participants in this trial had smoked, on average, 19 cigarettes a day for 31 years and had failed attempts to quit on six previous occasions. After receiving 15 weeks of psychotherapy and 2 doses of psilocybin (with the option of a 3rd), 80% of these participants remained abstinent from smoking for at least 6 months.
A case report published in the International Journal of Mental Health and Addiction in 2020 provides evidence that psilocybin may also be useful in the treatment of Stimulant Misuse Disorder (Johnson & Black, 2020). Cutting edge research coming out of the University of Bristol and Imperial College London is showing that MDMA is particularly effective at treating Alcohol Use Disorder: at the 9 month follow up participants’ average units of alcohol consumption had dropped from 130.6 units per week to 18.7 units per week (Sessa, et al., 2021).
The study team was chaired by Awakn’s chief scientific advisor Professor David Nutt, Dept of Medicine, Imperial College London.
A retrospective analysis has found Ibogaine, a naturally occurring alkaloid, to be effective at treating dependency on alcohol, cannabis, cocaine and crack cocaine (Schenberg et al., 2014). Another study highlights preclinical research and observational studies that support anecdotal claims that ibogaine attenuates withdrawal symptoms and reduces drug cravings, and has potential in treating opiate addictions (Brown, 2013).
The mechanisms of psychotherapeutic action of these substances are diverse: psilocybin and LSD have similarly cascading neuropsychopharmacological effects which disrupt the default mode network of the brain in such a manner that rigid patterns of thought and behaviour become more malleable; MDMA affects the amygdala and prefrontal cortex such that traumatic memories underpinning PTSD and Alcohol Misuse Disorder (and potentially other dependencies) can be remembered and worked through in psychotherapy without the concomitant negative emotions, leading to the resolution of conflict and release from the grip of addiction; comparative phenomenological analyses show that ibogaine transports the user to an "unspoiled state in personal history" (Rodger, 2018), acting as a reset from which they are able to start afresh.
Research into the possibility of these and other psychedelic substances that may prove to be revolutionary in the treatment of addictions is being thwarted by their status as Schedule 1 substances. The possibility that even one of these medicines could be effective in treating any substance misuse disorder or addiction is justification enough to reduce barriers to research on them all. The opportunity for the UK represented by onshore research into these medicines, in terms of the reduced suffering of millions, the reduced economic burden of addiction, as well as the invigoration of the life sciences sector, is beyond enormous.
Barriers Incurred by Schedule 1 status
Schedule 1 research typically requires multiple Home Office licenses per study, incurring significant administrative costs and delays. Compliance with Schedule 1 safe custody and security regulations add further substantial burdens of cost and time. Additionally, stigma associated with Schedule 1 negatively impacts funding, ethical approval, and collaboration; these issues do not apply to Schedule 2 drugs.
CDPRG Policy Council member Prof David Nutt notes that in his psilocybin study at Imperial “each dose cost around £1,500 – more than ten times the amount if the [Schedule 1] restrictions were not in place.”
A controlled drugs licence costs approximately £3,000 and is renewable every 12 months, with a renewal fee of approx. £325, or £1,370 if an inspection is required.
Separate Schedule 1 licenses are required at every stage of the supply chain, from the manufacture of the active substance, to the manufacture and preparation of the finished product, through to dispensing and administration.
Prof Joanna Neill notes that her team “had to wait one year to obtain our [Schedule 1] controlled drugs licence”.
Long delays related to Schedule 1 regulations are reported by research staff to occur at multiple stages in the research process, typically related to licensing, ethical approval and other administrative requirements, as well as contracting specialist pharmacy services, increased daily work involved with the added regulations on the storage, record-keeping and movement of Schedule 1 drugs at research sites etc.
One researcher pointed out that “Schedule 1 research is considered high-risk, politically sensitive, and that creates a lot more bureaucracy”.
The stigma of Schedule 1 status perpetuates cultural biases against this category of controlled drugs and increases the difficulty of academic collaborations, obtaining ethics approval, and achieving institutional funding through research.
Further details and examples can be found on pages 50 to 59 of the CDPRG report Medicinal Use of Psilocybin: Reducing Restrictions to Research and Treatment, these specific pages attached below for ease of access. Quotes can be found in Annex A.
Words: Timmy Davis, Psilocybin Rescheduling Project Mananger
Bibliography
Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A., Wilcox, C. E., Barbosa, P. C. R., & Strassman, R. J. (2015). Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study. Journal of Psychopharmacology (Oxford, England), 29(3), 289–299. https://doi.org/10.1177/0269881114565144
Brown, T. K. (2013). Ibogaine in the Treatment of Substance Dependence. Current Drug Abuse Reviews, 6(1), 3–16.
Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term Follow-up of Psilocybin-facilitated Smoking Cessation. The American Journal of Drug and Alcohol Abuse, 43(1), 55–60. https://doi.org/10.3109/00952990.2016.1170135
Johnson, S., & Black, Q. C. (2020). Classic Psychedelics as a Psychotherapeutic Aid in the Treatment of Stimulant Use Disorder: A Case Report. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-020-00398-7
Krebs, T., & Johansen, P.-Ø. (2012). Lysergic Acid Diethylamide (LSD) for Alcoholism: Meta-Analysis of Randomized Controlled Trials. Journal of Psychopharmacology (Oxford, England), 26, 994–1002. https://doi.org/10.1177/0269881112439253
Rodger, J. (2018). Understanding the Healing Potential of Ibogaine through a Comparative and Interpretive Phenomenology of the Visionary Experience. Anthropology of Consciousness, 29(1), 77–119. https://doi.org/10.1111/anoc.12088
Savage, C., & Mccabe, L. (1973). Residential Psychedelic (LSD) Therapy for the Narcotic Addict. Archives of General Psychiatry, 28, 808–814. https://doi.org/10.1001/archpsyc.1973.01750360040005
Schenberg, E. E., de Castro Comis, M. A., Chaves, B. R., & da Silveira, D. X. (2014). Treating drug dependence with the aid of ibogaine: A retrospective study. Journal of Psychopharmacology, 28(11), 993–1000. https://doi.org/10.1177/0269881114552713
Sessa, B., Higbed, L., O’Brien, S., Durant, C., Sakal, C., Titheradge, D., Williams, T. M., Rose-Morris, A., Brew-Girard, E., Burrows, S., Wiseman, C., Wilson, S., Rickard, J., & Nutt, D. J. (2021). First study of safety and tolerability of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder. Journal of Psychopharmacology (Oxford, England), 269881121991792. https://doi.org/10.1177/0269881121991792
Annex A
“In our first study of psilocybin in the treatment of resistant depression, I calculated that because of the extra costs incurred by the Schedule 1 status of psilocybin, each dose cost around £1,500 – more than ten times the amount if the restrictions were not in place. This money is taken from research grants and so undermines their financial viability and reduces their extent. It also took us over 2 years to get the permissions to conduct the research, which represents a huge lost opportunity cost.”
Professor David Nutt, Imperial College London
“We had to wait one year to obtain our [Schedule 1] controlled drugs (CD) licence to investigate effects of cannabinoids in rats. This is an enormous delay. We cannot move the drugs outside of our building. This means that a colleague working on the same project in another building could not work under the permission of our CD licence. To have one licence for each building within an institution is very restrictive, expensive and time-consuming (for us and the Home Office) and does not enable academic collaboration which is essential for the success of research.”
Professor Joanna Neill, University of Manchester
“There are several different people in a range of departments who all have to agree in order for Schedule 1 research to happen. Many of them have anxiety about engaging in research with a Schedule 1 drug because they are considered to be “high risk”. This starts a bureaucratic process of oversight and audit, which does not happen for research with other drugs that are considered low-risk. Schedule 1 research is considered high-risk, politically sensitive, and that creates a lot more bureaucracy; different departments around the university that may not otherwise want to know about what is going on, suddenly want to know about the research.”
Clinical trial example, University of Manchester analysis
Sources
https://www.addictionhelper.com/addiction/addiction-statistics/
https://www.therecoveryvillage.com/alcohol-abuse/related-topics/alcohol-relapse-statistics/
https://www.centreforsocialjustice.org.uk/wp-content/uploads/2018/03/addict.pdf