Is the NHS ready to embrace psychedelics as medicine?


Awakn Life Sciences recently signed a memorandum of understanding with Devon Partnership NHS Trust and the University of Exeter, to assess the NHS’s readiness to adopt ketamine-assisted therapies.

The creation of the partnership indicates that the NHS is willing to explore and embrace psychedelic-assisted therapies, which could expedite their regulatory approval in the UK.

To learn more about the agreement and its implications for the nation’s psychedelic healthcare industry, PSYCH sat down with Professor Celia Morgan, head of ketamine-assisted psychotherapy for addiction at Awakn Life Sciences.

PSYCH asked Morgan to outline the partnership and whether reducing the cost of ketamine treatments was central to their adoption.

‘The memorandum of understanding with the Devon Partnership NHS Trust, which specialises in mental health services, and the University of Exeter was created to investigate the accessibility of ketamine-assisted therapy on the NHS,’ explained Morgan.

‘We’ve previously run a Phase II trial to treat alcohol use disorder with ketamine-assisted therapy alongside the Devon Partnership Trust, so we want to take that study forward and explore options for Phase III trials. We also want to examine how this type of therapy might be implemented in the NHS, and the challenges encountered when moved beyond the private healthcare space.

‘I don’t think it’s focusing around cost necessarily, but what would work best in an NHS setting. We’ve got to work with commissioners to look at different treatment services and the best way to implement them, then we can think about building these services out. The NHS incurs high costs from people not recovering from alcohol use disorder, about £3.5 billion a year, so any effective treatment represents a substantial cost saving. 

‘In the US, the uptake of Janssen’s drug esketamine has been slow, partly because the infrastructure delivered through wasn’t being properly implemented. We want to work with the NHS to find how we can best implement these treatments from the outset.’ 

To identify investment opportunities, PSYCH pressed Morgan on the challenges faced in the adoption of psychedelic medicines in the UK.

‘We have some insights into the foreseen challenges, but not all, which is why the partnership has been established. The main challenge is that the treatment model is just so different. You come in and spend a long time with a therapist, then you have this treatment, before coming back in for integration sessions.

‘It’s an intense treatment model for a short duration of time, and we don’t really have anything like that currently. We have inpatient detox and community-at-home detox, and then the group therapies offered by the majority of substance misuse services. 

‘A lot of alcohol misuse services are currently combined with opiate misuse services. For opioid addiction, methadone is given to reduce withdrawal symptoms, but patients have to take it every day. 

‘Some people have been on methadone for 25 years, so the model is ingrained with not only service users, but also service providers at every level of the organisation. It will take a real shake-up to embrace a model where you’re coming in and taking a drug to work through underlying issues and experiences, but one that would be welcomed. 

‘Therapists are hard to come by in the NHS’s current framework, so we’re working on improving their accessibility. We need to look at the resources we have in hand and those we need to secure, with a cost-benefit evaluation done on the effectiveness of these treatments in the long term. Ketamine-assisted therapy seems to be more effective over a longer period than existing treatments for alcohol use disorder, which is a real positive.

‘If we have to build different models to deliver these treatments, then we need to start thinking about that. It’s huge that the NHS has identified the need and wants to be involved from the outset, which is excellent, and we’re really enthusiastic to partner with them. They are also enthused by the evidence from the psychedelic space, and all partners in this MoU are fully bought into the idea of broadening access to these medicines and, hopefully, that means we can achieve a lot through this partnership. 

‘Treatment providers across the UK are desperate for new treatments to offer their patients, and it is a privilege to be able to do this work to try and get more patients access to a revolutionary treatment. There are not a lot of clinical trials taking place to discover alternative treatments, so it’s really exciting for both clinicians and patients that we’ll be able to offer something new.’

As the ketamine partnership is the first study on the NHS’s readiness to adopt psychedelic medicine, PSYCH asked if insights from it could be applied to MDMA and psilocybin.

‘The work with the Devon Partnership Trust will focus on our ketamine treatment, as it’s been through Phase II clinical trials and is about to enter Phase III. The treatment models we’re implementing in the NHS, however, would be able to fit around other psychedelic medicines like MDMA and psilocybin.

‘The data around these two compounds in particular suggest that these treatments are really effective, so it would be a shame if patients missed out on them because of our sometimes slow and unwieldy state-funded healthcare and commissioning systems. 

‘We have already started doing some of the work and expect the results to be published through NHS reports sometime next year. We have a number of work packages planned within the partnership, so it will be an ongoing project. At the University of Exeter we have a research clinic that delivers psychological therapies to patients referred by the NHS. We’ve previously looked at experimental treatments, mindfulness, and novel treatments for bipolar disorder, so I wanted to expand that model to include psychedelic-assisted therapies too – to improve access wherever we can.’

Morgan has extensive experience treating addiction and substance misuse disorders. PSYCH asked the professor how effective psychedelic medicines are in comparison to conventional treatments.

‘Psychedelic medicines are pretty unique. They don’t work for everyone, but when they do work the effects are often really transformative. The benefit of them, to my mind over existing treatments, is that they have relatively short treatment times with long-lasting effects.

‘There were patients in our trials who have tried different ways of getting off alcohol for 20 years, and now they’re still sober 3 years later after just 4 weeks of treatment. Some people do drop off and need to come back in, but that some maintain sobriety after a really short course means that the treatment is pretty incredible in that respect.

‘These treatments also empower patients, as the drugs are catalysts for the work they do with a therapist to unmask their problems. This puts the locus of control back on the patient, as opposed to patients on daily relapse-prevention medication who feel they’re taking medication to stay sober, so the medication has all the power.

‘If the clinical evidence supports its efficacy, the hope is to make ketamine treatments accessible to all patients on the NHS with buy-in at every level of the organisation. We have limited treatment options for people with addiction and mental health disorders, so enhancing the adoption of effective therapies is of crucial importance.’

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