As the COVID-19 pandemic evolves, experts warn it is triggering a national mental health crisis. Some say it could cause up to 75,000 U.S. deaths by suicide and drug overdose. Millions may experience lasting grief from losing loved ones, depression due to unemployment, and post-traumatic stress disorder (PTSD) from working on the frontlines as healthcare providers and other essential workers.
Traditional medications for mental illness, such as the antidepressants fluoxetine and paroxetine, are ineffective in about half of those who try them. Consequently, there is an urgent need for innovative treatments for mental illness, and unless we act soon, many will be left untreated during the COVID-19 mental health crisis. Fortunately, there is an untapped resource.
The experimental drug psilocybin can reduce symptoms of depression and anxiety disorders. It appears to be safe when administered in controlled settings, it acts quickly, and its effects are long lasting. Psilocybin is one of the psychedelics, a class of drugs that alters mood, perception, and cognition. Indigenous cultures have used them for centuries, and scientists studied their therapeutic properties in the 1950s. However, in the 1960s, psychedelics became synonymous with cultural rebellion, and they were ensnared in the U.S. war on drugs.
In 1970, Congress passed the Controlled Substances Act, which placed psilocybin and other psychedelics in Schedule 1, the most heavily restricted category, effectively banning their study and use. A few years later, President Nixon established the U.S. Drug Enforcement Agency (DEA), which continues to claim that psilocybin is highly addictive and without legitimate medical applications. However, the lack of widely effective psychiatric drugs has prompted a resurgence of interest in psilocybin research.
In 2016, a team at Johns Hopkins showed that a single dose of psilocybin reduced depression and anxiety in people with life-threatening cancer. In 2017, researchers at Imperial College London showed that two doses of psilocybin decreased symptoms of treatment-resistant depression. In 2018, I published an article titled Psychedelic Medicine for Mental Illness and Substance Use Disorders: Overcoming Social and Legal Obstacles in the NYU Journal of Legislation and Public Policy. It argued for rescheduling psychedelics, expanding access for researchers, and implementing state-level regulation or decriminalization.
Since then, several cities have decriminalized psilocybin and other naturally-occurring psychedelics. Last May, Denver became the first, and Oakland quickly followed suit. In 2020, Santa Cruz became the third. Similar measures are under consideration in Chicago and Washington, D.C. In Oregon, advocates hope to legalize psilocybin-assisted therapy statewide.
In light of increasing understanding of psilocybin’s safety and efficacy, and the urgent need for new psychiatric drugs, the DEA should remove psilocybin from Schedule 1. Rescheduling the drug could improve access for researchers and make psilocybin available to mitigate the COVID-19 mental health crisis. Meanwhile, the Food and Drug Administration (FDA) should issue an emergency use authorization for psilocybin-assisted psychotherapy. In March, it issued an emergency authorization for the controversial drug hydroxychloroquine. In May, it issued a similar authorization for remdesivir. I discuss these issues further in Drug Regulation for the COVID-19 Mental Health Crisis,which is forthcoming in the Administrative Law Review.
Long before COVID-19, the U.S. faced rising rates of depression, suicide, and substance use disorders. The pandemic is exacerbating these problems. Unless we act quickly to provide a solution, the mental health crisis will damage our healthcare system, the economy, and our communities.
Mason Marks, MD, JD is an Assistant Professor of Law at Gonzaga University, the 2020-21 Edmond J. Safra/Petrie-Flom Center Joint Fellow-in-Residence at Harvard University, and an affiliated fellow at Yale Law School’s Information Society Project.