This is the first occasion that the Minister for Crime, Policing and Fire, my right hon. Friend the Member for Croydon South (Chris Philp) and I have had to debate an element of his new portfolio in public, a subject to which I have devoted much of my time over the past five years. I want to put him at his ease. I of all people know he has one of the toughest jobs in Government—I suspect his willingness to go out and bat for the Government on the most difficult of wickets is one reason he was chosen for these responsibilities—and I do not want to draw him on to ground where he has to defend the indefensible. Instead, I will use most of this brief debate to make the case as best I can for his positive intervention in a narrow but profoundly important and potentially positive part of his responsibilities.
I do not want or expect an answer this evening; these matters demand careful consideration. There will shortly be an application to the Backbench Business Committee, supported by more than a score of colleagues from across the House, for time for a fuller consideration. I hope by the time that debate is secured we can enjoy the news that this Minister is taking the available opportunities of his very tough policy inheritance.
Since the United States—directed by the FBI of Harry Anslinger under J. Edgar Hoover—corralled the world into agreeing a 1961 UN convention on comprehensive narcotic prohibition, global drug policy has a decent claim to being the greatest public policy failure since 1945. The casualties and costs, certainly, are cumulatively much greater than those of any conflict of the period.
In the future, historians will look back on the policy in stunned wonderment that the US, having had a decade and a half of prohibition of alcohol in its own country, thought it sensible, less than 30 years later, to press the rest of the world to prohibit everything but alcohol and tobacco, and expect a different outcome. This time, the scale was truly epic, affecting the entire world and everything that humans had come to use to make themselves feel better, driven by the same moral certainty that underpinned the temperance movement decades earlier. The scale of the cost and the toll of the casualties should have been entirely predictable. So great have been the investment in that policy around the world, the moral high ground of the political class, and the blood price paid by state security forces around the world, that it seems that only retired leaders engage properly in this first-order debate, and, based on their experience, now challenge the assumptions upon which they governed.
Today’s leaders face the particular problem of explaining to their electorates why the certainties on which self-evidently failing policies are based are in fact a mirage. The black-and-white simplicities that lend themselves to ease of political communication do not exist. They must also begin to put in place an alternative and more effective answer to reduce the harm done to humanity by narcotics than the simplicity of blanket prohibition. That will be complex and difficult, and will require communication skills and moral courage of an exceptional order. That global reordering will be for the future. The sooner we get there, the sooner the carnage can stop and the cost and benefits of our policy can be measured properly with a degree of disinterested academic rigour so absent over the past half century.
I thank the hon. Gentleman for securing this important debate. Does he have any estimate of the number of people living with treatment-resistant depression in the UK and what the cost could be to the economy of not rescheduling psilocybin as he proposes?
The cost is enormous if one considers that there are 1.2 million people suffering with depression and the number of those people who go on to commit suicide who could be treated. Approximately one third of armed servicemen who have come back from active service in Afghanistan and Iraq are beyond treatment for the trauma they have sustained. Of all people, to whom does the state owe a debt? The cost of this issue is enormous.
How did we get into this position? There was 20 years of documented medical research prior to the scientific blackout that followed the stringent terms of the Misuse of Drugs Act 1971. How did this awareness of the therapeutic potential of psychedelics not weigh in the balance to avoid the situation we are in today, where they are so tightly controlled that even researchers at world-class UK universities struggle to access them for research purposes? It is an unhappy accident of history that Government regulation of controlled drugs in the 1970s has impacted the public in ways that were completely unforeseen.
These extremely safe drugs are in the most stringently controlled class and schedule, based not on any historical or contemporary assessment of their toxicity or dangers, but simply because there were no submissions made to British or American regulators of medical products containing psilocybin before the instatement of the UN single convention through the UK’s Misuse of Drugs Act 1971. They were therefore assumed to be worthless for medicine. The historical use of cocaine and heroin in medicine prior to 1971 accounts for why those drugs, with far higher dangers and awful potential for abuse, reside in a lower schedule than the much more benign psilocybin and its fellow psychedelics.
Ronnie Cowan (Inverclyde) (SNP)
Does the hon. Gentleman agree that we are in danger of taking psilocybin into the same arena as medical cannabis, where the medical profession blames politicians and politicians blame the medical profession, and rather than all looking for obstacles, we should be looking for constructive solutions?
I have learned so much with the hon. Gentleman over the last five years, as well as with the hon. Member for Warrington North (Charlotte Nichols), who has joined this debate with personal testimony and the most enormous strength; I know that she has had conversations with the Minister, and I thank him for making time for these conversations and for learning.
It is the Minister to whom, inevitably, we now look for positive leadership in this space. That is why I do not want to push him this evening. I could have spoken for five minutes and then left him swinging on the hook, where we could beat him all around the Chamber trying to defend the indefensible of how we got into this position, but I do not want to do that. I want this debate to be a positive contribution, to lay out the challenge of why we are having to respond in this way and to give the Minister the room for manoeuvre to come forward with positive answers about all the opportunities of this policy.
The hon. Gentleman and I may have some differences of opinion on this. The Minister responsible in the previous Administration was the person who enabled my constituent, young Sophia Gibson, to get medicinal cannabis, which helped to stop the fits that that wee girl had. Today, her and her family have a better standard of life. While I understand that steps sometimes have to be taken, I would caution that we do not move forward until we are absolutely sure that there will be no side effects. In Sophia’s case, it worked, but it will not work in every case.
I listened with care to the hon. Gentleman and thank him for attending this debate and for championing the cause of his constituent. It is part of a piece. Behind the consideration of psychedelics sits consideration of cannabis as a medicine and, indeed, a wellness treatment. There is a huge economic as well as a health opportunity. They are not completely unrelated. His points are well made, but we do not want to get ourselves into a place where we have so much anxiety about risk where risk does not really exist in reality that we create blocks to progress.
This is where we need to come back to the historical context that led to the irrationality of the position we are in, which of course was the thalidomide crisis. That crisis led to the tightening of a number of regulations concerning the testing of investigational drugs. The commendable intent of those regulations was to ensure that drugs came to the market safe and effective. Double-blind, randomised, placebo-controlled trials became the gold standard for testing emerging medicines, but because psychedelic-assisted psychotherapy is ultimately a form of psychotherapy, rather than a drug treatment in the traditional sense, strict adherence to those standards proved close to impossible to meet. The story of psychedelics is thus one of an extremely promising treatment modality that was lost in discussion over how to understand and evaluate therapeutic treatment effectiveness.
The primitive design of psychedelic trials in the 1950s and 1960s, as well as a lack of flexibility in how regulators evaluated more traditional pharmaceutical interventions, ultimately led to psychedelic-assisted therapies falling below the cut-off for approval as market-authorised medicines. Those drugs were completely novel to researchers and regulators. They troubled the distinction between biological psychiatry, with its pharmacological interventions, and the psychological arm of psychiatry and its psychotherapies. Given the novelty of the way in which these treatments work and the virtual impossibility of designing placebo controls for psychedelic-assisted psychotherapy, it is no wonder that the trials of those drugs did not meet the standards of regulators remaining faithful to the standards used to test pharmaceutical interventions on their own. These treatments are fundamentally forms of psychotherapy, and need to be tested as such.
In the short time that I have available, I thank my hon. Friend the Member for Reigate (Crispin Blunt) for securing the debate and for the thoughtful, knowledgeable and carefully considered manner in which he delivered his speech. I also recognise the hon. Member for Warrington North (Charlotte Nichols), who is in her place. I know that she has a deep personal interest in the topic, about which we had a detailed meeting a few days ago, so I am delighted to see her in the Chamber.
Of course, the Department of Health and Social Care leads on questions concerning the availability of medicines and prescribing, because medicines are licensed and regulated by the MHRA. The Home Office, however, is responsible for controlled drugs legislation and our controlled drugs licensing regime to support research and clinical trials in the UK, which is why I am responding rather than a Health Minister.
I am keen to encourage research into the use of drugs in the UK as far as we can. We have an internationally well-regarded research sector in universities and, of course, in commercial pharmaceutical companies. It can be a great source of national competitive advantage to make their research projects as straightforward as possible.
Drugs scheduled in schedule 1 can be used for research purposes, but with a licence. As I discussed with the hon. Member for Warrington North a few days ago, I know that some people feel that the process to obtain such a licence can be onerous, particularly for universities and NHS trusts. Clearly, for drugs scheduled in schedule 2 and higher, those restrictions do not apply in the same way. I am very aware of the point about research.
I am also aware that, to consider whether there are medical benefits that would support the rescheduling of drugs from schedule 1 to schedule 2 or higher, which might enable them to be prescribed to patients for medical purposes, there needs to be a research base. I accept that there is an element of chicken and egg or Catch-22 about the situation, because we need to do the research before there is an evidence base to justify the rescheduling that might be merited.
I think you are indicating that we are almost out of time, Mr Deputy Speaker, but I am sure my hon. Friend and I can speak briefly afterwards, and on that point, I will rest.
Question put and agreed to.
7:31 pm
House adjourned.
What policymakers can do immediately is to address the most obvious and damaging consequences of prohibition: access to medicine being lost and denied. Forgone medical treatment is just one element of the cost of blanket narcotic prohibition, but it is very great once we understand the treatments that we have denied ourselves amid the moral panic underpinning prohibition. For no class of drugs is that urgent repair more needed than for the psychedelics.
First, the opportunity for a major step change in mental health treatment is real. We are not talking here about simply improving the treatment of symptoms of mental ill health. We have the opportunity, with the psychedelic class of compounds, to make a step change in mental health treatment and, with a proper regard for the actual risks involved, drive access to medicines while facilitating the collection of data for their efficacy in the real world.
As Ministers around the world are now becoming aware, psychedelics, including psilocybin, are being investigated and found to have promising application as facilitators of psychotherapy for the treatment of the most debilitating and devastating mental health conditions suffered by people around the world. Unlike the treatment options that are currently available to patients, psilocybin-assisted psychotherapy does not foster dependence. It treats the underlying causes of mental ill health rather than simply covering the symptoms through emotional blunting, unlike selective serotonin reuptake inhibitors—antidepressants—on which patients can come to rely for decades, and to which they currently have no real alternative.
My hon. Friend the Member for Devizes (Danny Kruger) is properly concerned about freeing people from the overuse and dependence on those treatments. When I sought his support for my application to the Backbench Business Committee, he cautioned me to stay my enthusiasm until we had solved that problem as the first priority. But that misses the point that assisted psychotherapy can give patients back their lives, allowing them to escape antidepressants in the first place by helping them to form and enjoy satisfying relationships with other people; to return to and thrive at work or study; to contribute fully to society; or even better, to help them to confront their fear of death and cope with end of life. It really is revolutionary and has the potential to dramatically improve the lives of millions of our fellow citizens. We must do both.
Addressing the missed opportunity of treatment over half a century will help address the miserable dependence of too many on SSRIs. It would be untenable for the Government to keep barriers to cancer research, for example. That should also be the case for psychedelics given their promise for mental health.
A flexible and intelligent capacity to measure the efficacy of a drug that facilitated psychotherapy was simply not yet present in the culture of the regulators of the time. With the stigma surrounding those drugs fuelling the tabloid appetite for excitable exaggeration, misinformation abounded about these mysterious, mind-altering substances. They appeared to belong to indigenous communities in remote jungles—surely there was nothing to learn there. I think that, in the decades since, we have learned a great deal about learning from experiences elsewhere in the world. In reality, death and injury rates, both physical and psychological, from unadulterated psychedelics are extremely low. Teams of researchers from the United States, the UK, the EU and Australia have consistently found psychedelics to be of the lowest possible harm potential of all the controlled drugs to both user and society. Those studies considered the physiological toxicity of these drugs, as well as other risks.
However, these drugs are best administered within supportive psychotherapeutic environments; doing so reduces the risks yet further. The medical research shows that, when administered in such settings, psychedelics are associated with very positive psychotherapeutic outcomes. For example, research by Robin Carhart-Harris and others in 2016 showed a significant decrease in depressive symptoms for up to six months—that in a cohort already suffering from treatment-resistant depression. Research by Ross and others in 2016 showed significant decreases in anxiety and depression, and research by Johnson and others in 2014 showed that 80% of the cohort were abstinent from smoking following treatment with psilocybin. Mental health harm is estimated to cost the UK economy more than £110 billion a year annually, a staggering 5% of our gross domestic product. Smoking alone costs the economy £14.7 billion per year, £2.5 billion of which falls to the national health service. Even if psychedelics were to play a small role in improving outcomes in those areas, the impact would be huge, given the impact of those areas on society and the economy.
The safety of these drugs has been firmly demonstrated, too. Phase 3 trials are now under way, meaning that their safety is well enough established in healthy and clinical populations that regulators are allowing research into their effectiveness in clinical treatment. Psilocybin and the other psychedelics have been well enough established as safe—that is all but unquestioned within the scientific and medical literature—and when administered under the supervision of trained professionals in suitably controlled environments, we move from a risk range of “minimal” to one of “very significant benefit”. The method of achieving the maximum benefit for patients and its extent is yet to be established, but there is every indication that it will be remarkable compared with psychotherapy unassisted by pharmacology or today’s pharmacological assistance of antidepressants, from which a depressing number of patients—please excuse the pun, Mr Deputy Speaker—now need withdrawal services, something that my hon. Friend the Member for Devizes is campaigning to address.
Research methods have matured since prohibition, so the best and easiest way to obtain information on how effective psychedelic-assisted psychotherapies will be in the real world is to establish research and access to prescribing physicians and researchers, but we are already falling behind. The potential has been identified across the world. To our embarrassment as a nation committed to science, entrepreneurship and sustaining one of the world’s great financial sectors, not only has $7 billion been raised on the markets of North America to invest in this emerging bioscience technology—as compared with very little raised here—but our scientists, having largely owned this knowledge within the United Kingdom, are now following that investment.
The market for psychedelic substances is projected to grow from $2 billion in 2020 to $10.7 billion by 2027. Facilitating the investigation of these drugs in that way would have allowed the United Kingdom to become the leading country in the study of the therapeutic potential of the psychedelic class of drugs and simultaneously facilitate access for patients. Hopefully, it is not too late, but unless this science is noisily supported and championed in the UK, it will be too late for the United Kingdom to make its proper contribution in this area.
The use of psilocybin and other psychedelics in psychiatry is of even greater medical and scientific importance than simply their commercial promise, yet the Government still want to evaluate the evidence regarding safety, scheduling and classification. To add insult to injury, it seems that they will only do so following a successful application for a medical formulation containing psilocybin to the Medicines and Healthcare products Regulatory Agency.
In practice, there appear to be three routes to the rescheduling of a substance within the Misuse of Drugs Regulations 2001, of which it seems the Home Office remains wedded to one: rescheduling being triggered following a market authorisation by the MHRA. The more evidence-based route—a self-commissioned review by the Advisory Council on the Misuse of Drugs—is effectively ruled out because of the AMCD’s lack of funding and capacity. The simple third route is for the Minister in the Home Office to take the initiative and commission such a review of evidence with a view to rescheduling by the ACMD.
The Minister, had I given him time, would no doubt have referred to his commissioning of the ACMD to investigate barriers to researching substances controlled under schedule 1, and especially psilocybin, which I welcome. Forgive me for offering him time to reflect further before responding to more colleagues than just me. In July 2017, the then Home Secretary commissioned a review of the barriers to research caused by drugs designated as schedule 1, only for the long-term recommendations of the ACMD to be rejected. The current review has already been ongoing since 2020. Is this delay without cost?
Members of Parliament from across the House have provided to me and others, including the Home Office, a proposal for the Minister to safely resolve the issue based on evidence and in a short space of time. Indeed, when cannabis-based products for medicinal use were rescheduled in 2018, it took a mere 12 weeks. When the evidence and need are so overwhelming, just as they were for cannabis-based products for medicinal use, for what reason can the Government wait to take decisive action? The letter of the laws that govern use in medicine and science of these controlled substances is designed to be flexible and permissive. As I understand it, nearly two years ago, when the then Prime Minister, my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson), endorsed advice from his policy unit to get this done, the Home Office dived for the weeds of process around an application for a medicine before contemplating changing scheduling or classification.
I have asked the Home Office on three occasions by written parliamentary question whether it has in its possession any evidence that supports the current scheduling of psilocybin. I am wholly certain the answer is none. The MHRA, the Food and Drugs Administration, the Australian Therapeutic Goods Administration and the UK science and research community all know there is not that evidence. Every day that we do not act to support and enable the efforts of UK researchers, we hinder the progress of science and put what were our globally renowned research institutions at a growing disadvantage.
Perhaps most scandalously of all, this delay in the science now will be delay in the medicine deployed and the therapeutics established on the basis of those medicines. Some 1.2 million people with depression in the UK will continue to provide the grim reaper with 18 suicides a day. Our untreatable soldiers, traumatised from their active service in Iraq and Afghanistan, will continue to self-medicate with alcohol and other unsupervised drugs to the misery of themselves and their families. Addiction will be treated less effectively. Anxiety will not be addressed as it could be. That pain, and the scale of the economic cost to our country, demanded “Action This Day” a long time ago.
All that I have heard reinforces my hope that the Minister will break the logjam, which would be in direct accord with the Government’s 10-year drugs plan that aims to put evidence at the heart of drug policy. Behind the issue of psychedelics—practically and intellectually the easiest part of the drug policy thicket—sits the possibility of a legal cannabis and hemp industry, with huge economic and environmental positives to secure. The chance to seize that low-hanging fruit and reap the rewards presents itself to the Minister, the Home Secretary and the Prime Minister.
The Prime Minister has begun the machinery of government changes that should enable many departmental Ministers, as yet unrepresented in the councils and committees that in effect control our nation’s drug policy, to make a reality of that opportunity. If we make a reality of policy based on evidence, we can finally start to right the wrongs of 60 years of policy failure. The Minister has a historic opportunity to radically improve the lives of millions of his fellow citizens while helping the United Kingdom to be a world leader in medical research. Current drug policy has produced far more victims than successes; he can begin to reverse that.
As my hon. Friend the Member for Reigate said, I received part 1 of the Advisory Council on the Misuse of Drugs’ advice on reducing barriers to research with controlled drugs, which focused on synthetic cannabinoids. In December last year, so just a few weeks ago, I formally commissioned it to conduct part 2 of its review, which is designed and intended to consider, and will consider, research with schedule 1 drugs more widely. That of course includes LSD and MDMA. In my letter to the ACMD commissioning that work, I specifically highlighted psilocybin. It would be open to the Government, depending on the ACMD’s advice, to change the research rules to say that all schedule 1 drugs might be capable of being used for research purposes without the onerous requirements that currently apply, in the same way as happens with schedule 2 drugs and higher, or some variation of that. There is obviously quite a lot of policy detail that one would have to consider, but were that move to be made, it would clearly address the barriers to research that my hon. Friend highlighted. Were those barriers to research to be removed, the evidence base could then be developed, which might provide a basis for the MHRA to make a case that such a drug should be moved to schedule 2 or higher, and that would facilitate doctors prescribing these drugs to the patients who need them.
My hon. Friend very kindly said that he would not press me too hard, given that I am relatively new in this position. I think the comments I have made do suggest that there is a path forward. I do strongly support making it as easy as possible for UK institutions—universities, hospitals and private companies—to conduct research using not just psilocybin, but all drugs, and there is clearly a commercial as well as an academic benefit. I am looking forward to receiving the ACMD advice as soon as possible, and I can certainly assure my hon. Friend, the hon. Member for Warrington North and others that, when that is received, it will receive my prompt and positive attention.