The interest in psilocybin as a therapeutic approach has grown exponentially in recent years. Despite increasing access, there remains a lack of practical guidance on the topic for health care professionals. This is particularly concerning given the medical complexity and vulnerable nature of patients for whom psilocybin-assisted psychotherapy may be considered. This article aims to provide health care professionals with an overview of practical considerations for psilocybin therapy, rooted in a patient safety focus. Within this piece we will review basic psilocybin pharmacology and pharmacokinetics, indications, practical therapeutic strategies (e.g., dosing, administration, monitoring) and safety considerations (e.g., contraindications, adverse events, and drug interactions). With this information, our goal is to increase the knowledge and comfort of health care professionals to discuss and counsel their patients on psilocybin therapy, ultimately improving patient care and safety.

Background: One in five individuals live with chronic pain globally, which often co-occurs with sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed with cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, and appropriate use of CBM for therapeutic purposes. Aims: We present these clinical practice guidelines to help clinicians and patients navigate appropriate CBM use in the management of chronic pain and co-occurring conditions. Materials and Methods: We conducted a systematic review of studies investigating the use of CBM for the treatment of chronic pain. Articles were dually reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical recommendations were developed based on available evidence from the review. Values and preferences and practical tips have also been provided to support clinical application. The GRADE system was used to rate the strength of recommendations and quality of evidence. Results: From our literature search, 70 articles met inclusion criteria and were utilized in guideline development, including 19 systematic reviews and 51 original research studies. Research typically demonstrates moderate benefit of CBM in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis. Conclusions: All patients considering CBM should be educated on risks and adverse events. Patients and clinicians should work collaboratively to identify appropriate dosing, titration, and administration routes for each individual. Systematic Review Registration: PROSPERO no. 135886.

Background: The World Health Organization (WHO) defines wellness as the optimal state of health of individuals and groups. No study to date has identified the impact of psychedelic medicines for optimizing wellness using a dimensional approach. Treatment effects can be measured more broadly using a composite score of participants global perceptions of change for pain, function, and mood scores. Given the precedence in previous work for retrospective study of participants self-medicating with these substances, the nature of this study design allows for a safe way to develop further evidence in this area of care, with wellness as the broad indication. Methods: 65 civilian or military veterans between the ages of 18-99 self-identifying as having used psychedelic medicines for non-recreational therapeutic purposes in the last 3 years were recruited for this study. Participants completed various standardized questionnaires that will be analyzed in a separate study, while this study analyzed the qualitative experiences described in relation to the medicines used and coded them according to themes developed from review of previous literature. Results: A total of 93 comments were analyzed. Participant comments were classified into these categories: mysticism and spirituality, functional improvement and self awareness, social connection and cultural impact, impact on medical and mental health conditions, neutral impressions, sensations or difficult experiences. Participants described impacts in these categories related to spiritual, physiological, psychological, and social improvements, as well as difficulties and complex emotions regarding the experience of using psychedelic medicines. Discussion: Wellness of individuals or groups is not simply an absence of disease, symptoms, or impairments. Rather, it reflects the outcome of numerous personal characteristics, psychophysiology, and choices, expressed throughout one's lifespan, unfolding in dynamic interaction with a complicated socio-cultural and physical environment. Participants that used psychedelic medicines described improvement of medical and mental health conditions, social interaction, spirituality, and overall function. In general, quality of life and wellness consequently improved after the use of these medicines based on established multidimensional factors. Conclusion: The use of various psychedelic medicines appears to be associated with a broad range of qualitative experiences that could help clarify the mechanism of how they impact wellness in the future.

Background Since 2001, Canadians have been able to obtain cannabis for medical purposes, initially through the Access to Cannabis for Medical Purposes Regulations (ACMPR). The Cannabis Act (Bill C-45) came into force on October 17, 2018, replacing the ACMPR. The Cannabis Act enables Canadians to possess cannabis purchased from a licensed retailer without authorization for either medical or nonmedical purposes. The Cannabis Act is currently the guiding legislation which governs both medical and nonmedical access. The Cannabis Act contains some improvements for patients but is essentially the same as its previous legislation. Beginning in October 2022, the federal government is conducting a review of the Cannabis Act and is questioning whether a distinct medical cannabis stream is still required, given the ease of access to cannabis and cannabis products. Although there is overlap in the reasons for medical and recreational cannabis use, the distinct legislation of medical versus recreational use of cannabis in Canada may be under threat. Main body A large segment of the medical, academic, research, and lay communities agree that there is a need for distinct medical and recreational cannabis streams. Perhaps most importantly, separation of these streams is necessary to ensure that both medical cannabis patients and healthcare providers receive the required support needed to optimize benefits while minimizing risks associated with medical cannabis use. Preservation of distinct medical and recreational streams can help to ensure that needs of different stakeholders are met. For example, patients require guidance in the form of assessing the appropriateness of cannabis use, selection of appropriate products and dosage forms, dosing titration, screening for drug interactions, and safety monitoring. Healthcare providers require access to undergraduate and continuing health education as well as support from their professional organizations to ensure medical cannabis is appropriately prescribed. Although there are challenges in conducing research, as motives for cannabis use frequently straddle boundaries between medical versus recreational cannabis use, maintenance of a distinct medical stream is also necessary to ensure adequate supply of cannabis products appropriate for medical use, to reduce stigma associated with cannabis in both patients and providers, to help enable reimbursement for patients, to facilitate removal of taxation on cannabis used for medical purposes, and to promote research on all aspects of medical cannabis. Conclusion Cannabis products for medical and recreational purposes have different objectives and needs, requiring different methods of distribution, access, and monitoring. HCPs, patients, and the commercial cannabis industry would serve Canadians well to continue to advocate to policy makers to ensure the continued existence of two distinct streams and must strive to make ongoing improvements to the current programs.

Background: The World Health Organization (WHO) defines wellness as the optimal state of health of individuals and groups. No study to date has identified the impact of psychedelic medicines on optimizing wellness using a dimensional approach. Using this approach, treatment effects can be measured more broadly using a composite score of participants global perceptions of change for pain, function, and mood scores. Given the precedence in previous work for retrospective studies of participants self-medicating with these substances, the nature of this study design allows for a safe way to develop further evidence in this area of care, with wellness as the broad indication. Methods: 65 civilian or military veterans above the age of 18, self-identifying as having used psychedelic medicines for non-recreational purposes in the last 3 years were recruited. Participants completed the following standardized questionnaires: Patient Global Impression of Change (PGIC) scale, Pain, Enjoyment of Life and General Activity (PEG) scale, Anxiety and Depression scale (ADS), and Disability Index (DI) scale. The analysis focused on reported PGIC outcomes and correlations between subscales. Given the nature of the study, a comparison to the baseline could not be made. Results: On average, participants reported improvement in all domains (pain, mental health, function, and overall quality of life), regardless of the medicine. Perceived improvement was highest in mental health and overall quality of life, and lowest in pain. Kendall correlation showed a highly significant association between the perceived changes in all domains. Correlation coefficients were highest between the perceived change in function, quality of life, and mental health. Discussion: The use of various psychedelic medicines may be associated with a broad range of changes that could help clarify the mechanism of how they impact wellness in the future. Pain, mental health, function, and overall quality of life accordingly improved after the use of these medicines. Minor differences between the drugs were not found as significant, indicating that the perceived benefits seemed to be specific to the psychedelic class. Numerous limitations exist to this type of study which was relatively small in size, retrospective and anonymous in nature. Conclusion: The wellness of individuals or groups is not simply an absence of disease, symptoms, or impairments. Instead, it is an outcome that is shaped by a myriad of personal characteristics, psychophysiology, and choices, expressed throughout ones lifespan, unfolding in dynamic interaction with a complicated sociocultural and physical environment. Keywords: Psychedelics, Participant reported outcomes, Wellness, Dimensional measure, Retrospective, Quantitative data