Question Period Note: EMERGING MENTAL HEALTH TREATMENTS FOR VETERANS

• The health, safety and well-being of Veterans and their families is a priority for our Department.

• Veterans Affairs Canada provides coverage, based on eligibility, for health care benefits and services where supported by scientific evidence.

• The Department monitors emerging treatments, and once there is sufficient scientific evidence available demonstrating it as safe and effective, may add it to its list of approved treatments.

• Mental health care is an ever-evolving field. As emerging treatments are brought to our attention, the Department reviews the scientific evidence to ensure that these are safe and effective for Veterans and adjusts its benefit grids or formulary accordingly.

BACKGROUND — MENTAL HEALTH TREATMENTS FOR VETERANS

Mental Health care is an ever-evolving field greatly influenced by research and
innovations. While there are always new and emerging treatments, in an effort to ensure Veterans are receiving safe and effective care, Veterans Affairs Canada provides coverage for health care benefits and/or services that is evidence-based; that is where the value and safety of the benefit and/or service is supported by scientific research findings.

Psychedelic-assisted psychotherapy is an emerging mental health treatment which includes the ingestion of substances such as lysergic acid diethylamide (LSD), Psilocybin, 3-4 methylenedioxymethamphetamine (MDMA, i.e., ecstasy, molly), Ketamine or lbogaine, to induce a psychedelic state prior or at the beginning of a psychotherapy session. The hypothesis or belief is that the psychedelic drug can bring meaningful insight for the patient in regard to their condition, as well as diminishing their fear and arousal responses, thereby augmenting the psychotherapeutic process. As this therapy is emerging and there is not sufficient scientific literature available to date to support the effectiveness and safety of this approach, it has not been recognized as a Veterans Affairs Canada-approved treatment.

The use of Ketamine as a pharmacologic treatment is however approved as a non-formulary product administered orally, by infusion, nasal spray or compounded cream, to treat treatment-resistant major depression disease or chronic pain. Criteria has been established for these uses only.

The use of Ketamine to induce a psychedelic state as required for psychedelic-assisted psychotherapy, is not currently approved by Veterans Affairs Canada.

Veteran Affairs Canada monitors emerging treatments for Veterans, and once there is sufficient scientific evidence available to support a safe and effective treatment, it may adjust its benefit grids and formulary accordingly.

WHEN PRESSED:

Q1– What is the quality of the current scientific research on psychedelic-assisted psychotherapy? How long will it take to get solid findings?

Response

• The research on psychedelic-assisted psychotherapy is fairly new.
• Further research is needed to assess efficacy, safety and effectiveness.
• Much of the neuroscience with regard to the therapeutic effects of psychedelics remains unknown.
• Studies to date have had relatively short follow-ups and there has been considerable heterogeneity between studies
• No relevant treatment guidelines have yet to be developed.
• More research required on long-term benefits and side effects.
• Insufficient data on safety for persons with psychotic disorders, disorders with risk of psychosis, dissociative disorders, suicidal risk, or family history of these conditions or risk factors.

Q2 – What is VAC doing to build the necessary evidence on psychedelic-assisted psychotherapy? Is VAC funding research in psychedelic-assisted psychotherapy and if not, why not?

Response

• The Department has been in discussion with the Canadian Institute for Health Research who are taking the lead, in the federal government, in regard to the funding of research specifically on the subject of psychedelic-assisted psychotherapy.

Q3. Can you comment on the position of the Director of the Emory Healthcare (U.S.) Veterans Program, psychiatrist Dr. Barbara Rothbaum, on the subject of psychedelics? She appears to be favorable to the possibility of using psychedelic-assisted psychotherapy to treat PTSD.

Response
• Our understanding is that Dr. Rothbaum is also of the opinion that traditional evidence-based interventions should be delivered before attempting a newer therapy. She recommends a stepped approach, starting with traditional treatments, virtual reality treatments, and then possibly psychedelic-assisted psychotherapy. VAC disagrees on the latter point given the insufficient scientific evidence available on efficacy and to ensure Veteran safety.
Q4 – Clinics already exist where psychedelic-assisted psychotherapy is administered by fully licensed, regulated, and qualified health professionals. If these health professionals can freely administer these treatments, why can this not be an acceptable treatment for VAC to fund in a context of ill Veterans with PTSD?

Response
Psychedelics are illicit drugs in Canada with the exception of Ketamine. VAC does provide funding for Ketamine as a mental health treatment for treatment resistant depression and for chronic pain, as per the existing evidence as to it effectiveness and safety. VAC does not fund Ketamine-assisted psychotherapy given the lack of sufficient evidence as to its effectiveness and safety.
Veterans Affairs Canada covers the use of Ketamine when prescribed as a pharmacological treatment, when administered orally, by infusion, nasal spray or compounded cream, to treat treatment-resistant major depression disease or chronic pain.

Q5 – What are the alternative mental health treatments available to Canadian Veterans with PTSD given that psychedelic-assisted psychotherapy is not yet approved for funding?

Response
Veterans have a variety of evidence-based PTSD psychological and psychiatric treatments available to them. Psychological treatments that are recognized as first-line evidence-based treatments include cognitive processing therapy, exposure therapy, and EMDR.