Much of our focus has continued to be on cluster headaches, one of the most excruciating conditions known to medicine, and on trying to change government regulations so that patients can legally obtain medical psilocybin, one of the most effective means of preventing cluster headache episodes from occurring. (I briefly explain the issue in this interview.) When we released our policy paper late last year, we started collaborating with the UK-based Conservative Drug Policy Reform Group, which is advocating for psilocybin to be rescheduled in the UK, and established an official partnership early this year with TheraPsil, a Canadian organisation supporting patients with a range of conditions in their efforts to obtain medical psilocybin. Our close collaboration with the Finnish Horton Association continues. Notable events and developments:

• We co-organised webinars with the UK-based Psychedelic Society and with TheraPsil, in which expert panelists, including neurologist Dr. Brian McGeeney, patients and advocates, provided insight into cluster headaches and the pressing need to change regulations to allow effective treatment.
• We have been working with TheraPsil to lobby the Canadian Minister of Health to provide legal exemptions for medical use of psilocybin by cluster headache patients, and to change regulations so that doctors can prescribe it to their patients without government approval on a case-by-case basis. The exemption approval process, which had ground to a halt, has started up again, and we are cautiously optimistic that soon the first Canadian cluster headache patient will obtain a legal exemption to use psilocybin for medical use. This would be a milestone in the recognition of the potential of this substance for the treatment of cluster headaches, and help lead to its general acceptance as a standard medical option.
• In September I addressed a Finnish Parliamentary working group on migraines as part of a session on cluster headaches. The interest led to a new meeting specifically on cluster headaches with MPs from across the political spectrum – including one MP who suffers from cluster headaches himself. There is now reason to hope that further progress will take place and that new regulations may be implemented.

Our collaboration with Hospice Burkina and the national conference we co-organised two years ago continue to bear fruit. This post from August 2021 by our partner Dr. Martin Lankoandé and colleagues attests to the progress made, which has since continued. The new Minister of Health supports the initiative taken by his predecessor, and the World Health Organisation has now become actively involved in the program to provide palliative care and access to liquid morphine in the country.

Drug policy
In January 2021, OPIS became a member of the International Drug Policy Consortium (IDPC), a global network of 192 NGOs that promotes objective and open debate on the effectiveness, direction and content of drug policies at the national and international level, and supports evidence-based policies that are effective at reducing drug-related harm. I also co-signed a paper in the American Journal of Bioethics calling for an end to the war on drugs, which causes so much suffering and also deprives patients of substances with therapeutic benefits.

There is a separate issue, which is the notion that people have the right to explore different states of consciousness. Although this issue is less directly about intense suffering than about bodily autonomy and personal liberty, if this right were respected, the potential prosecution of those seeking therapeutic benefits from such substances would cease to be an obstacle to self-treatment. This is an example of unjustified policies having pernicious downstream consequences.

Ethics
On a relevant personal note, I have also been working on finishing my new book, The Tango of Ethics, which should be published next year. The book makes the case why preventing extreme/unbearable suffering has such intrinsic importance, while recognising that as humans we have other drives that are strongly intuitive, especially the desire to exist and to thrive, and that need to be taken into account in a holistic approach to ethics.

Next steps for OPIS and compassionate governance
Our vision since the start has been, not only to call attention to solutions to specific sources of intense suffering, but to strive for a world where the highest priority in decision-making is to prevent extreme and unbearable suffering from happening, whatever the cause – physical or mental, in humans or non-humans. Our world is now going through great turmoil, with the perpetual uncertainty around COVID and governmental responses to it, and with the dark clouds of climate change drifting closer, to name two of the most pressing concerns. And our governments seem incapable of explaining their reasoning clearly and transparently in a way that also fosters trust, and of explicitly referring to ethical principles grounded in compassion. Clearly there is a fundamental problem with the way most governments function.

While the timing and extent of potential societal collapse in the next decades is unclear, the possibility seems very real – in some ways, it feels as if it has already started. In a webinar on the ethics of collapse that I co-organised this past summer with Jem Bendell, who initiated the Deep Adaptation movement, and in an accompanying briefing paper, I called attention to some of the consequences of collapse for human and animal suffering, and why this perspective matters so much.

All this to say: there is urgency to spread compassionate ethics in the most effective ways possible, and to encourage a culture of respectful, empathetic listening, where needs can be heard and addressed. These include the needs of those who often are not given a voice or seat at the table, such as the sick, elderly or underaged, and non-human animals. This is the path towards a less polarised, less violent, more caring and happier society. Success in this endeavour will also ensure that those suffering the most are treated with the utmost urgency and compassion.

Our next projects will therefore focus both on detailing some of the concrete ways that we might get closer to this vision, and on communicating a compassionate perspective and actionable ideas through powerful videos, films and creative campaigning. By scaling up our efforts, we hope to have impact in spreading a more empathetic, compassionate culture, and in changing how we allow ourselves to be governed. We also hope to inspire others to start their own initiatives based on these ideas.

These efforts are already underway, including a case clinic we held earlier this year to get feedback on some of the ideas, and many discussions with experts and activists towards optimising our strategy. If you have insights, expertise or suggestions you would like to contribute, we would be happy to hear from you.

We welcome and appreciate donations of all sizes. If you agree that these ideas and projects are worth being given the best chance at succeeding, and you are considering providing more substantial financial support, or have suggestions on potential funders, please do contact us!

Thank you for your support and interest, and wishing you a very happy holiday season!

Best wishes,
Jonathan