Longitudinal experiences of Canadians receiving compassionate access to psilocybin-assisted psychotherapy.

Recent clinical trials have found that the serotonergic psychedelic psilocybin effectively alleviates anxiodepressive symptoms in patients with life-threatening illnesses when given in a supportive environment. These outcomes prompted Canada to establish legal pathways for therapeutic access to psilocybin, coupled with psychological support. Despite over one-hundred Canadians receiving compassionate access since 2020, there has been little examination of these real-world patients. We conducted a prospective longitudinal survey which focused on Canadians who were granted Section 56 exemptions for legal psilocybin-assisted psychotherapy. Surveys assessing various symptom dimensions were conducted at baseline, two weeks following the session (endpoint), and optionally one day post-session. Participant characteristics were examined using descriptive statistics, and paired sample t-tests were used to quantify changes from baseline to the two-week post-treatment endpoint. Eight participants with Section 56 exemptions (four females, Mage = 52.3 years), all with cancer diagnoses, fully completed baseline and endpoint surveys. Significant improvements in anxiety and depression symptoms, pain, fear of COVID-19, quality of life, and spiritual well-being were observed. Attitudes towards death, medical assistance in dying, and desire for hastened death remained unchanged. While most participants found the psilocybin sessions highly meaningful, if challenging, one reported a substantial decrease in well-being due to the experience. These preliminary data are amongst the first to suggest that psilocybin-assisted psychotherapy can produce psychiatric benefits in real-world patients akin to those observed in clinical trials. Limited enrollment and individual reports of negative experiences indicate the need for formal real-world evaluation programs to surveil the ongoing expansion of legal access to psychedelics

Imprinting: expanding the extra-pharmacological model of psychedelic drug action to incorporate delayed influences of sets and settings

BackgroundPsychedelic drug experiences are shaped by current-moment contextual factors, commonly categorized as internal (set) and external (setting). Potential influences of past environments, however, have received little attention.AimsTo investigate how previous environmental stimuli shaped the experiences of patients receiving ketamine for treatment-resistant depression (TRD), and develop the concept of “imprinting” to account for such time-lagged effects across diverse hallucinogenic drugs.MethodsRecordings of treatment sessions and phenomenological interviews from 26 participants of a clinical trial investigating serial intravenous ketamine infusions for TRD, conducted from January 2021 to August 2022, were retrospectively reviewed. A broad literature search was undertaken to identify potentially underrecognized examples of imprinting with both serotonergic and atypical psychedelics, as well as analogous cognitive processes and neural mechanisms.ResultsIn naturalistic single-subject experiments of a 28-year-old female and a 34-year-old male, subjective ketamine experiences were significantly altered by varying exposures to particular forms of digital media in the days preceding treatments. Higher levels of media exposure reduced the mystical/emotional qualities of subsequent psychedelic ketamine experiences, overpowering standard intention-setting practices and altering therapeutic outcomes. Qualitative data from 24 additional patients yielded eight further spontaneous reports of past environmental exposures manifesting as visual hallucinations during ketamine experiences. We identified similar examples of imprinting with diverse psychoactive drugs in past publications, including in the first-ever report of ketamine in human subjects, as well as analogous processes known to underly dreaming.Conclusions/interpretationPast environmental exposures can significantly influence the phenomenology and therapeutic outcomes of psychedelic experiences, yet are underrecognized and understudied. To facilitate future research, we propose expanding the contextual model of psychedelic drug actions to incorporate imprinting, a novel concept that may aid clinicians, patients, and researchers to better understand psychedelic drug effects.Clinical trial registrationClinicalTrials.gov, identifier NCT04701866

The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression

BackgroundSubanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine’s mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties.MethodsThis article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives’ strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model’s various components, which are presented in detail.ResultsThe Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support.DiscussionOur integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model’s effectiveness and hypothesized psychological mechanisms

« A drug that doesn’t discriminate » : les opioïdes dans les médias canadiens

Le présent article s’appuie sur le concept de « récit » pour analyser les principaux cadres médiatisés qui investissent des significations de la crise des opioïdes au Canada. Un échantillon de 400 articles publiés entre 2015 et 2018 a été soumis à une analyse de la rhétorique des cadres. Ce faisant, quatre cadres médiatisés furent soulevés : prohibitif, médicalisé, structurel et sanitaire. Si chacun d’entre eux donne un sens particulier à l’enjeu, une tendance transversale relève du changement de statut des consommateurs d’opioïdes, qui passent de « criminels » à « victimes-citoyens ». Notre analyse montre que cette transformation émerge au gré de discours de généralisation du risque et de stratégies discursives favorisant l’identification à l’usager et à sa famille. Ceci « dés-altérise » le consommateur, ce qui a comme double retombée de susciter la sympathie chez le public et de légitimer les demandes de soins auprès des décideurs. Émerge ainsi la figure de l’« entrepreneur de compassion », soit l’individu qui encourage la régulation des usages de drogues par des logiques de soins plutôt que punitives. Cette figure plaide plus précisément en faveur de l’implantation de « soins en réduction des méfaits », un concept employé de façon polysémique dans l’ensemble des cadres. Enfin, ces dynamiques de victimisation de l’usager légitiment le cadrage de cette crise comme un « enjeu d’approvisionnement toxique en drogues » et surlignent, aux niveaux provincial et fédéral, les méfaits des politiques prohibitionnistes qui affectaient les populations marginalisées depuis longtemps. En somme, nous émettons l’hypothèse que cette conceptualisation de la crise des opioïdes s’associe à la fin d’un paradigme et ouvre de nouvelles possibilités, notamment en permettant aux idées de décriminalisation et d’approvisionnement sécuritaire en opioïdes d’intégrer le discours public.This article relies on the concept of “narrative” to analyze the main mediatized frames that invested meaning in Canada’s opioid crisis. A sample of 400 articles published between 2015 and 2018 was subjected to a rhetorical frame analysis. This led to the identification of four frames transmitted in media articles: prohibitive, medicalized, structural, and sanitary. While each of them encourages a specific understanding of the issue, a transversal dynamic is the change of status of the opioid consumers, who evolved from “criminals” to “victim-citizens”. Our analysis shows that this transformation emerges through discourse that generalize the risk of overdose and addiction and through discursive strategies favoring the identification with the user and his family. This “de-othering” of drug users has a twofold effect: first, it heightens public sympathy and second, it legitimizes decision-makers’ requests for practices of care. It is in this discursive context that the figure of the “compassionate entrepreneur”, the individual who encourages the regulation of drug use by principles of care rather than punitive logics, emerges. More specifically, this figure argues in favor of implementing “harm reduction care”, a concept used in polysemous ways in all frames. Finally, these dynamics of victimization of the user legitimize the framing of this crisis as a “toxic drug supply issue” and highlight, at the provincial and federal levels, the harmful effects of prohibitionist policies which have been affecting marginalized populations for a long time. In sum, we hypothesize that this conceptualization of the opioid crisis is associated with the end of a paradigm and opens new possibilities, namely by allowing ideas of decriminalization and safe supply of opioids to integrate the public discourse.El presente artículo se apoya en el concepto de “relato » para analizar los principales marcos mediatizados que invierten significados de la crisis de los opioides en Canadá. Una muestra de 400 artículos publicados entre 2015 y 2018 se sometió a un análisis de la retórica de los marcos. De esta manera se definieron cuatro marcos mediatizados: el prohibitivo, el medicalizado, el estructural y el sanitario. Si bien cada uno de ellos da un sentido particular a la cuestión, una tendencia transversal depende del cambio de estatuto de los consumidores de opioides, que pasan de ser “criminales” a “ciudadanos víctimas”. Nuestro análisis muestra que esta transformación emerge del discurso de generalización del riesgo y de las estrategias discursivas que favorecen la identificación con el usuario y su familia. Esto « des-alteriza » al consumidor, lo que tiene un doble resultado de suscitar la simpatía en el público y de legitimar las demandas de atención entre quienes toman las decisiones políticas. Emerge así la figura del « empresario de compasión », es decir, la persona que alienta la reglamentación del uso de las drogas mediante lógicas de atención de la salud más bien que punitivas. Esta figura aboga más precisamente en favor de la implantación de “cuidados para la reducción de los daños”, un concepto empleado de manera polisémica en el conjunto de los marcos. Finalmente, estas dinámicas de victimización del usuario legitiman el enmarcamiento de esta crisis dentro de una “cuestión de aprovisionamiento tóxico en drogas” y subrayan, tanto a nivel provincial como federal, los daños de las políticas prohibicionistas que afectaban a las poblaciones marginalizadas desde hace mucho tiempo. En resumen, emitimos la hipótesis de que esta conceptualización de la crisis de los opioides se asocia con el fin de un paradigma y abre nuevas posibilidades, principalmente al permitir que las ideas de descriminalización y de aprovisionamiento seguro en opioides integren el discurso público

L’intervention en contexte de sport auprès des jeunes : La place du rite de passage dans le programme DesÉquilibres

Cet article est issu d’une étude portant sur l’analyse d’un rite de passage vécu au sein du programme d’intervention par le sport de l’organisme montréalais DesÉquilibres. Il vise à explorer les conditions nécessaires à l’obtention de résultats positifs à l’intérieur d’interventions psychosociales en contexte de sport. Plus spécifiquement, la recherche vise à comprendre comment les interventions sportives peuvent être vécues comme un rite de passage. Pour ce faire, une analyse de données secondaires a été réalisée auprès de 14 jeunes inscrits en secondaire 3, âgés de 14 à 18 ans et ayant participé au programme DesÉquilibres. L’analyse du discours des participants a permis de relever cinq éléments essentiels pour que les interventions sportives puissent être vécues avec succès comme un rite de passage : l’existence d’une épreuve physique et mentale, la mise en oeuvre d’une symbolique commune de l’épreuve, la reconnaissance sociale des participants, le présence d’un passeur et la mise en valeur du rôle et de la place de chacun au sein du groupe. Enfin, l’analyse permet de souligner comment cette intervention sportive « ritualisée » contribue au devenir adulte des participants.This article is the result of a study on the analysis of a rite of passage experienced within the sports intervention program of the Montreal organization DesÉquilibres. It aims to explore the conditions necessary to achieve positive outcomes through sports-based interventions. More specifically, the research aims to understand how sports interventions can be experienced as a rite of passage. To do this, a secondary data analysis was conducted with 14 students aged 14 to 18, who were in their third year of high school, and who participated in the DesÉquilibres program. The analysis of the participants’ discourse revealed five essential elements for sports interventions to be successfully lived as a rite of passage: the existence of a physical and mental test, the implementation of a common symbolism of the event, the social recognition of the participants, the presence of a “validation agent” and the enhancement of each person’s role and place within the group. Finally, the analysis highlights how this “ritualized” sports intervention contributes to the participants’ coming of age into adulthood

Table_1_Imprinting: expanding the extra-pharmacological model of psychedelic drug action to incorporate delayed influences of sets and settings.DOCX

BackgroundPsychedelic drug experiences are shaped by current-moment contextual factors, commonly categorized as internal (set) and external (setting). Potential influences of past environments, however, have received little attention.AimsTo investigate how previous environmental stimuli shaped the experiences of patients receiving ketamine for treatment-resistant depression (TRD), and develop the concept of “imprinting” to account for such time-lagged effects across diverse hallucinogenic drugs.MethodsRecordings of treatment sessions and phenomenological interviews from 26 participants of a clinical trial investigating serial intravenous ketamine infusions for TRD, conducted from January 2021 to August 2022, were retrospectively reviewed. A broad literature search was undertaken to identify potentially underrecognized examples of imprinting with both serotonergic and atypical psychedelics, as well as analogous cognitive processes and neural mechanisms.ResultsIn naturalistic single-subject experiments of a 28-year-old female and a 34-year-old male, subjective ketamine experiences were significantly altered by varying exposures to particular forms of digital media in the days preceding treatments. Higher levels of media exposure reduced the mystical/emotional qualities of subsequent psychedelic ketamine experiences, overpowering standard intention-setting practices and altering therapeutic outcomes. Qualitative data from 24 additional patients yielded eight further spontaneous reports of past environmental exposures manifesting as visual hallucinations during ketamine experiences. We identified similar examples of imprinting with diverse psychoactive drugs in past publications, including in the first-ever report of ketamine in human subjects, as well as analogous processes known to underly dreaming.Conclusions/interpretationPast environmental exposures can significantly influence the phenomenology and therapeutic outcomes of psychedelic experiences, yet are underrecognized and understudied. To facilitate future research, we propose expanding the contextual model of psychedelic drug actions to incorporate imprinting, a novel concept that may aid clinicians, patients, and researchers to better understand psychedelic drug effects.Clinical trial registrationClinicalTrials.gov, identifier NCT04701866.</p