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The future of medical psychedelics in Canada

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Bruce Tobin became interested in psilocybin, the psychoactive compound in magic mushrooms, 10 years ago when he was approached by a woman who had been diagnosed with terminal cancer.

She was suffering from intense depression, anxiety and hopelessness and the prospect of imminent death.

Fortunately, good treatment sent her cancer into remission. Yet she continued to experience these agonizing psychological symptoms, and conventional medical options proved ineffective in curbing them.

“The cancer was behind her, but there was this constant fear that it was going to return,” said Tobin, a psychotherapist based in Victoria, B.C., who has been practising for 35 years.

 

 

After exhausting other options, the woman tried psilocybin mushrooms. In a short period of time, her perspective drastically improved.

 

“She reported great gains in optimism, spiritual well-being, quality of life and an increased sense of acceptance of her death, whenever that happens,” Tobin said.

Her experience is in line with recent studies that have shown how psilocybin can help terminal cancer patients cope with anxiety stemming from their diagnosis. Other emerging research is showing the potential of psychedelics, some of which have been granted “breakthrough therapy” status by the U.S. Food and Drug Administration, to possibly treat and cure a range of medical concerns from Alzheimer’s to depression to addiction.

Since his patients’ positive mushroom experience, Tobin has devoted himself to fighting for patient access to psilocybin and is willing to take his battle to the courts, similar to the way cannabis patients and advocates fought for access.

 

Tobin is part of a growing number of health-care providers and researchers around the world who are championing the possibilities of mushrooms and other psychedelics that have been banned in Canada and the U.S. since the 1970s, but are now in the midst of a renaissance.

This fall, the University of Toronto launched the Centre for Psychedelic Studies, which will host the world’s first clinical trials on microdosing psilocybin. It joins a number of other prominent institutions devoting resources to psychedelics research, including other research centres at Johns Hopkins University and Imperial College London.

And in the year since cannabis became legal for recreational use in Canada, the world of psychedelics has also been attracting a number of cannabis executives who see it as the next frontier for therapeutic innovation.

Meanwhile, there are competing forces emerging across the country, differentiated by those who are willing to break the law to provide access to psychedelics and those who see legal channels as the best way forward.

 

In 2017, Tobin submitted an application to Health Canada requesting a special exemption to the current drug laws that would allow him to procure synthetic psilocybin and provide it to a group of terminal cancer patients who are experiencing end-of-life distress for which other treatments haven’t worked.

“They become depressed, demoralized, and life seems to lose its meaning. There’s no sense of future,” Tobin said.

Including his group of patients, Tobin estimates there are nearly 3,000 people in Canada for whom medical psilocybin could be beneficial.

He’s revised his application to Health Canada a number of times over the years, obtaining letters of support from members of psilocybin research teams across the United States, including from Johns Hopkins University.

But he says it’s been months since he’s heard from the federal health agency. If he gets rejected or doesn’t receive a response, Tobin says he plans to take the matter to court sometime next year.

 

“We’re talking about several thousands of Canadians that are suffering every day that treatment continues to be withheld from them,” Tobin said. “Treatment delayed is treatment denied.”

Health Canada would not comment on the specifics of the exemption applications that it receives, citing privacy reasons, but said it has received two applications regarding psilocybin, including one from 2017.

 

Tobin’s arguments in favour of providing psilocybin are similar to those of the medical cannabis advocates whose successful court battles eventually forced Health Canada to create special regimes to allow patients to obtain licences to use and grow cannabis.

Tobin sees these precedents as laying the groundwork for his own case. However, he said he’s not in favour of psychedelics being decriminalized, as was done earlier this year in Denver, Colorado.

I am not supporting the liberalization of psilocybin for spiritual or recreational purposes. I am confining my message to the medical use of psilocybin,” he said.

While Tobin is fighting for access for psilocybin on behalf of his patients, he’s clear that he’s not an “underground therapist.” The patients are responsible for obtaining the substance themselves.

“I’ve always had the sense that if I go to court and I’ve been engaged in illegal activities, that could come back to bite me,” Tobin said. “So I’ve played the squeaky clean role here. But I’m not going to go away.”

Dana Larsen is taking the opposite approach.

The longtime cannabis rights advocate from Vancouver is known for protesting against drug laws by flagrantly violating them, and he has now set his sights on psychedelic mushrooms. While he shares Tobin’s goal of ensuring medical access to psilocybin, he eventually would like to see it fully legalized or decriminalized.

This summer, he opened an illegal mail-order website, The Medicinal Mushroom Dispensary, and plans to open a physical space next year where people can consume psychedelics with supervision.

“Expanding into psychedelics is a really natural progression. The time is right,” Larsen said.

His is one of a number of illicit online mushroom stores in Canada, but Larsen appears to be the only operator who’s open about his operation.

Other dispensaries have been ordered by Health Canada to cease operations altogether. In July, the health agency sent a letter to Mungus.ca stating that its operations violated Canada’s drug laws.

 

“You are required to immediately suspend all activities in relation to psilocybin mushroom and to remove any content from your website related to the sale of a controlled substance,” states the letter, posted on the Mungus.ca site.

Health Canada confirmed in an email that the Mungus letter is authentic and that it is one of a total of 6 such letters it has sent to websites offering psilocybin.

For Larsen, who has faced numerous cannabis charges, his mushroom dispensary is part of a broader push to normalize psychedelics and eventually get them legalized.

“The civil disobedience movement was not the only reason cannabis was legalized in Canada, but I don’t think it would have happened without it,” Larsen said. “And I think we’re going to see similar things with mushrooms and psychedelics.”

Larsen’s online venture offers its members a microdosing “regimen,” which, in this case, is a low dose of mushrooms meant to be taken a couple times a week. This is different from taking a dose large enough to induce a trip, which can last several hours.

Like many illegal or so-called “grey market” dispensaries that operated before cannabis legalization, Larsen says he will only sell to people located in Canada who provide proof of a diagnosis or a recommendation for psilocybin from a health-care practitioner.

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This includes providing the substance to minors “if the parents consent in certain circumstances.”

Larsen says the mushroom dispensary’s membership has swelled to more than 1,000 people in the six months since he launched the site.

“It’s growing faster than when I was doing cannabis stuff, starting dispensaries and other projects 10 years ago,” he said. “But cannabis itself was easier to access to regular people, but mushrooms, especially microdoses, you have to know somebody.”

 

 

Former cannabis executives and researchers who are delving into psychedelics say that rigorous science and regulations must be pursued first to do justice to the burgeoning industry.

“My argument always has been that cannabis exists everywhere. Ignoring it helps illegal operators. It’s the exact same thing with psychedelics,” said Bruce Linton, formerly the co-CEO of cannabis giant Canopy Growth, who recently joined Toronto-based medical psychedelic firm Mind Medicine Inc.

“The job of the government is not to ignore. In this space, they should regulate, educate and monetize,” Linton, who still has one foot in the cannabis realm, said from a cannabis conference in Las Vegas. “Anybody who is opening illicit activities simply gives a stronger, compelling argument to the government to just smarten up.”

 

Canopy Growth Corp.’s former co-CEO Bruce Linton welcomes media to a new visitor centre at Canopy Growth’s Tweed facility in Smiths Falls, Ont., Thursday, Aug. 23, 2018. THE CANADIAN PRESS/Sean Kilpatrick

Linton’s company, also known as “Mindmed,” announced in September that it had invested in a molecule based on ibogaine, another psychedelic, to pursue its potential as a form of treatment for opioid addiction.

The company raised more than $6 million in new investment earlier this year, and it’s planning to go public in Canada in 2020.

Though Linton says the current scientific research around psychedelics is exciting and is in many ways more advanced than the science around cannabis, he doubts there will be a flood of cannabis execs like him entering the sector. To him, it requires harder work and more complicated ideas.

“You’re more likely to see researchers come out of the woodwork if there’s a proper way they can present themselves and not have the concern of access to capital or career,” Linton said.

Over the last 40 to 50 years, he said, much of the research has been “done in the shadows.”

“Now you have to be smart and pick jurisdictions where you can get work done and not be out of sight. What you don’t want to say is, ‘I’m going to change the rules in Canada and then do the work.’ No, go do the work and use the work to change the rules.”

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Permanent residents in limbo waiting to immigrate to Canada – CBC.ca

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Aashray Kovi refreshes his email several times a day hoping for good news from Canadian immigration officials.

The 28-year-old computer programmer who lives in Bangalore, India, is one of about 23,000 aspiring immigrants with expired or soon-to-be expired documents waiting to enter Canada.

“It’s really depressing for all of us,” said Kovi, who plans to settle in Ottawa but can’t travel because his confirmation of permanent residency (COPR) document expired in early June, prior to travel restrictions being lifted.  

Late last month, the federal government lifted some COVID-19 restrictions, allowing anyone with a valid COPR to enter Canada, but that didn’t help Kovi’s case.

Despite having started the immigration process in 2018, Kovi says he’s never struggled to get clear answers from the government until this point. He says he’s been emailing and calling for weeks, waiting for the documents to be reissued, but has had no luck getting an answer on when he can expect to arrive in Ottawa.

WATCH | Waiting to enter Canada:

Sophie and Carlos Ballesteros got ready to make a move to Canada months ago, lining up jobs and bank accounts in Halifax. But border closures prevented the couple from moving and their confirmation documents expired in June. 1:14

“I know it is not simple, there is COVID, the only issue with all of this is a lack of communication,” said Kovi.

“If provided with better communication, I could wait till 2022, but this is putting my life in limbo.” 

Sameer Masih, his wife and son are similarly stuck in a mostly empty apartment in New Delhi, seven months after they got their initial approvals and started selling their belongings. 

“I am actually surviving on a bare minimum setup,” said Masih. He says the wait cost him a job at his employer’s Toronto office.

‘It’s hard for my family’

Sophie Ballesteros, from Barcelona, had a job lined up in Halifax and her husband, Carlos, quit his in January to ready himself for the move to Canada. The delay has been devastating for the couple, who started their immigration process in November 2019.

Carlos says he left his job because the permanent residency invitation told him to get his affairs in order, and he felt he had just a certain amount of time to immigrate or else he’d lose out on his dream of moving to Canada.

Aashray Kovi, a 28-year old from Bangalore, is stuck in India until his permanent residence documents get renewed. (Submitted by Aashray Kovi)

Their COPR documents also expired in June and there’s been no word yet on when they’ll be renewed.

The only communication they’ve received from the government was in March, when a generic email advised them that a previous communication of theirs had been received and that they would need to continue waiting.

“This is the first time in my life that I am unemployed,” said Carlos. “I don’t sleep at night.”

Sophie says she is struggling to immerse in her new digital marketing job in Canada while staying physically in Barcelona, and also trying to find a preschool for her four-year-old daughter.

“I have to work within the time zone of Canada and sometimes there are some clients that are from Vancouver,” she said. “It’s hard for my family.”

A spokesperson for Immigration Minister Marco Mendicino acknowledged that global migration has been a nuisance for many people and that officials are working to help permanent residency holders into the country.

“We know that these disruptions have had a significant impact on many people hoping to start a new life in Canada, and we thank them for their patience at this difficult moment,” Alexander Cohen said in a statement.

Sophie and Carlos Ballesteros hope to resettle in Halifax, but the Spanish couple doesn’t know when their expired permanent residence documents will be renewed. (Supplied by Carlos Ballesteros)

Holding pattern

Immigration lawyer Kyle Hyndman, in Vancouver, estimates more than half of those holding expired COPR documents are skilled workers who were chosen “to contribute to the Canadian labour market.”

He says communication from the federal government has been messy. He says sending documents that would expire to incoming residents, with directions to get their affairs in order, created a sense of working against the clock.

“These people are kind of in a holding pattern … you do a bunch of things to get ready to move that are kind of hard to undo,” Hyndman said.

Cohen says the pandemic has significantly impacted immigration processing times, and that the government will be contacting individuals with expired papers in the “weeks and months to come.” 

Canada permitted 184,000 immigrants last year — the fewest since 1998 — compared to 341,000 in 2019. The government is aiming to jump-start immigration with 400,000 new residents per year for the next three years.

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India flights to Canada: When will they be allowed? – Canada Immigration News

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Published on July 24th, 2021 at 01:00am EDT

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Earlier this week Canada extended its ban on flights from India until at least August 21.

The extension of the ban comes amid Canada continuing to ease its coronavirus travel restrictions for the rest of the world.

Denying flights from India is extremely disruptive to both Indians and Canadians alike. India is one of Canada’s most important allies and by far the largest source of new immigrants and international students. Some 20 per cent of Canada’s new permanent residents come from India. Indians comprise 30 per cent of Canada’s new international students. In Canada’s 2016 Census, nearly 1.4 million respondents identified themselves as being of Indian heritage.

Hence, it goes without saying that the flight ban is currently a major challenge for Indians, Indian-Canadians, families, and the Canadian economy.

The Canadian government first introduced the travel ban on India on April 22 due to its concerns about COVID-19 variants which public health officials said showed higher rates of transmissibility.

While health is the main reason Canada introduced the ban, the decision to lift it will likely be influenced by other factors as well.

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Health factors

When making its COVID-19 travel policies, the Canadian government looks at factors such as domestic case counts, the rate of vaccination, as well as case counts and vaccination rates in other countries. It also evaluates variants, their transmissibility, and whether existing vaccines are proven to protect against variants.

In a written statement to CIC News on July 22, the Canadian government explained “While progress is being made, the situation in India is still very serious. This extension of the travel ban is based on scientific evidence and has been put in place to protect Canadians from an increased introduction of the Delta variant, which is prevalent in India.”

While health is the main consideration, an argument can be made that the Canadian government is also influenced by other factors, namely the impact of restrictions on its economy. Canada has stated it will begin to welcome fully-vaccinated tourists from the United States beginning on August 9. This decision comes amid rising COVID cases in the U.S. and that country’s vaccination rate stagnating.

On the other hand, the U.S. has extended its ban on Canadian tourists driving across the border. This means that it was not political pressure from the U.S. that caused Canada to decide to welcome American tourists again, but rather a combination of health and economic considerations.

As mentioned, the rising case count in the U.S. is cause for concern and has resulted in some Canadian media commentators questioning the decision to lift restrictions on American tourists. Conversely, the decision is being celebrated by those with an economic interest at stake, namely the Canadian tourism industry. Prior to the pandemic Canada welcomed 15 million American tourists per year and tourism supported about 10 per cent of Canadian jobs. Given the pandemic has decimated the tourism industry, the Canadian government likely felt significant pressure to reopen its border to U.S. tourists even if there were compelling reasons to keep it closed.

This should give us reason to believe that non-health reasons will play a role in Canada’s decision on India flights.

The pressure will be on from Designated Learning Institutions (DLIs)

Canada does not have any strong special interest groups that lobby on behalf of immigrants. This explains why groups such as Confirmation of Permanent Residence (COPR) holders have faced significant challenges throughout the pandemic. Temporary foreign workers, however, are backed by the Canadian business community while Canadian designated learning institutions (DLIs) advocate on behalf of international students.

International students are a major source of revenue for Canada’s colleges and universities. DLIs played a crucial role in getting Canada to lift its travel restrictions on international students last October. Given that Indians are by far the number one source of new international students, DLIs will remain vocal as they seek to obtain concessions from the Canadian government by August 21, ahead of the start of the academic year when the fast majority of new study permit holders arrive to Canada.

There may also be political pressure

It appears likely that prime minister Justin Trudeau will call a new federal election in the coming months as he seeks to obtain a majority government.

The stakes for the India flight ban may be higher than usual going into the election given the significant influence of Indian-Canadians, who tend to live in the country’s most vote-rich cities. Courting their votes will be key to Trudeau’s electoral ambitions, and he may feel it is worthwhile lifting flight restrictions on India to further encourage them to vote for him.

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Canada could avoid the worst of a 4th wave — but we're not out of the woods yet – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


Canada will likely face a fourth wave of the pandemic as the highly contagious delta variant continues to spread ahead of borders and schools reopening, but there’s growing optimism another surge won’t bring the country back to a crisis point.

Canadian immunologists, virologists and infectious disease specialists say we could fare better than in previous waves, with a lower rate of serious infections, due to the effectiveness of COVID-19 vaccines and the willingness of Canadians to get vaccinated. 

But our rollout is plateauing and there are still huge swaths of the population that are unvaccinated — either by choice or due to a lack of access or eligibility — including millions of Canadian kids who are heading back to school in just over a month.

“We’re going to see rises in case counts at some point again,” said Matthew Miller, an associate professor of infectious diseases and immunology at McMaster University in Hamilton.  

“Probably similar to last year, as we head into the fall and the cold weather arrives. But those bumps are hopefully just that — tiny hills, and not mountains like the earlier waves.”

People walk in downtown Montreal on June 3 after the city lifted public health restrictions. (Jean-Claude Taliana/CBC/Radio-Canada)

How bad will Canada’s 4th wave be?

The severity of Canada’s fourth wave will largely be determined by levels of COVID-19 immunity in the population from vaccines or prior infection, which can prevent community transmission from rising and stop severe cases from overwhelming hospitals.

Canada has had more than 1.4 million cases of COVID-19 so far, yet only 2.6 per cent of Canadians were found to have antibodies due to prior coronavirus infection in early 2021.

“The question is — is there sufficient population immunity? No,” said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa. 

“And the reason for that is because we measure population immunity by recovered cases and vaccinations.”

More than 80 per cent of eligible Canadians aged 12 and up have received at least one shot, and more than 60 per cent have had two. But that number drops to about 70 per cent with one dose and just over 50 per cent fully vaccinated when you consider the country’s entire population.

Although Canada has “nowhere near enough” immunity yet, Deonandan says we can “artificially create” adequate protection by using interventions like masking indoors to help with “building walls” around unvaccinated Canadians as COVID-19 becomes more seasonal

“We’re seeing the arrival of the endemic phase of this disease in places around the world,” he said. “Because mostly they don’t have enough people vaccinated — it comes down to that.”

Maria Rey, 27, gets her first dose of the Pfizer-BioNTech COVID-19 vaccine at an overnight clinic at the International Centre in Mississauga, Ont., on May 16. (Evan Mitsui/CBC)

Delta threatens to drive COVID-19 surge

Another key factor in Canada’s ability to fend off a severe fourth wave is the spread of the more contagious, potentially more deadly delta variant, which is driving COVID-19 levels back up in countries around the world.

“We know from watching the U.K., for example, that delta is very, very capable of tearing through unvaccinated people very quickly,” said Dr. Dominik Mertz, an infectious diseases physician and associate professor of medicine at McMaster University.

“Any percentage of unvaccinated people in the population are leaving themselves at very, very high risk.”

The United Kingdom has seen a rise in COVID-19 levels in recent weeks, putting pressure on the health-care system. Israel has reinstated mask mandates in response to new outbreaks. And the U.S. has seen a surge in undervaccinated states driven by delta.

A new study in the New England Journal of Medicine (NEJM) this week found two doses of the Pfizer-BioNTech vaccine were 88 per cent effective against the delta variant, while two shots of the AstraZeneca-Oxford vaccine were 67 per cent effective.

But there are conflicting reports from the real world about vaccine effectiveness against delta, including new data from Israel’s health ministry that suggests the Pfizer shot is only 39 per cent effective against infections — but far better at preventing severe illness.

WATCH | Why the delta variant is different from others:

A respirologist breaks down what is known about the coronavirus delta variant, including what makes it different, how dangerous it is and whether vaccines protect against it. 4:26

Dr. Anthony Fauci, director of the U.S. National Institute for Allergy and Infectious Diseases, told CBC’s Power & Politics Friday that the U.S. still has a “substantial proportion” of the population that is unvaccinated and at highest risk from delta.

“That is absolutely something we need to correct, because when you are dealing with a variant like the delta variant that is so efficient in spreading from person to person, you are going to see a kind of surge in cases,” he said. 

“And for those who are vulnerable, like the elderly and people with underlying conditions, the chances of their getting hospitalized increases.”

A nurse tends to a patient suspected of having COVID-19 in the intensive care unit at North York General Hospital in Toronto in May 2020. (Evan Mitsui/CBC)

Reopening borders, schools leaves unvaccinated at risk

Canada could also be at increased risk of exposure to delta due to the reopening of the border to U.S. travellers next month and international travellers in September, along with the return of school, which could put unvaccinated Canadians at higher risk of COVID-19 exposure.

“It absolutely will. In addition, the greater travel that we’re doing inside the country is going to increase the risk of variants,” said Dr. Allison McGeer, a medical microbiologist and infectious diseases specialist at Toronto’s Mount Sinai Hospital. 

“We should not be surprised if the delta variant starts to increase quite substantially and we should not be surprised if we have to go back to some level of travel and other restrictions.” 

The single biggest cohort of unvaccinated Canadians are children under 12, who are not yet eligible for COVID-19 vaccines despite ongoing clinical trials. Experts say the reopening of schools in September could put them at higher risk.

“It’s important that we start reporting our percentage vaccinated, including kids, because that’s our actual number,” said Alyson Kelvin, an assistant professor at Dalhousie University and virologist at the Canadian Center for Vaccinology and the Vaccine and Infectious Disease Organization.

“Considering we want to have herd immunity be above 85 per cent, we’re not going to get there without kids.” 

Wearing masks to prevent the spread of COVID-19, elementary school students walk to classes in Godley, Texas, on Aug. 5, 2020. (LM Otero/Associated Press)

Until children under 12 are eligible for vaccination in Canada, Kelvin says those who have less effective immune responses from COVID-19 vaccines — including older Canadians and the immunocompromised — will continue to be vulnerable.

“Children can’t be vaccinated and variants such as delta are more highly transmissible — and there seems to be case reports of increased disease severity in kids when they do get infected,” she said. “That’s something that we need to be watching going forward.”

Future variants pose unknown threat

One unknown threat Canada faces is the possibility of more transmissible variants emerging in the weeks and months ahead that could be worse than delta, as COVID-19 continues to ravage undervaccinated countries around the world. 

Canada was hit hard by the alpha variant at a time when our vaccination campaign had not yet picked up steam, and new and more dangerous variants have repeatedly appeared in countries that continue to be hit hard with each passing wave. 

“Definitely we’ll see other variants. If they will be more severe or a variant of concern is another question,” said Kelvin. “But it is an interesting trend that … there seems to be an increase in transmissibility with each as time goes on and we see new variants.” 

That’s not typically something that is seen with other circulating viruses like influenza, said Kelvin, meaning the unpredictability of this virus leaves its future an open question.

Miller says COVID-19 will likely become endemic in Canada and around the world, returning each year like the flu, and our ability to control it is contingent on our ability to get more people vaccinated. 

“It’s going to keep evolving for decades, presumably. It’s not going anywhere. But we have astoundingly successful vaccines,” he said. “The truth is, there is light at the end of the tunnel. This will end as all things end.

“But if you’re not vaccinated, you’re definitely — at some point — going to get infected.”


This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

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