Psilocybin remains prohibited in most jurisdictions, but Switzerland, Canada, and Australia have established tightly regulated clinical access pathways. In this developing landscape, prescribers are pivotal to safe access and must navigate conflicting guidance, uncertainty, and legal risk. Clarifying how current regulations define prescribers’ roles is therefore important for understanding how regulated clinical access pathways operate in practice. Our study thus aimed to map prescribers’ legal and professional practice contexts for psilocybin-assisted therapy in Switzerland, Canada, and Australia. We conducted a scoping review of Embase, Medline (Ovid), PsycINFO, CINAHL Complete (EBSCO), Web of Science and gray literature from 2000 to 30 April 2025, for documents focusing on required professional qualifications, training and experience, as well as prescription-, treatment- and staff-related responsibilities. Two reviewers independently screened documents, assessed full texts, and charted data, resolving disagreements by consensus. A total of 3641 documents were retrieved from databases and 3422 from gray literature. Twelve documents met the inclusion criteria (Switzerland: n = 2; Canada: n = 5; Australia: n = 5). In Canada, Australia, and Switzerland, prescribers are regulated health professionals authorized to prescribe controlled drugs, although the specific professional qualifications differ. Training requirements are specified in each country, but experience requirements are defined only in Australia. Prescription- and treatment-related responsibilities are clearly delineated and closely aligned across the three countries, whereas staff-related responsibilities are more heterogeneous. Overall, the practice for the prescription of psilocybin is similar across jurisdictions, with variations mainly reflecting legislative and administrative differences. Under current regulatory frameworks, prescribers play a central role in clinical decision-making and oversight within regulated access pathways for psilocybin-assisted therapy, but guidance on training and responsibilities remains uneven. Examining how regulatory requirements operate in practice will be important for informing the continued development of regulated clinical access pathways internationally.
Background Chronic pain and anxiety are two common conditions for which medicinal cannabis (MC) is prescribed in Australia. Project Twenty21 Australia was an observational study that investigated the effectiveness of MC for chronic pain, anxiety, post-traumatic stress disorder and multiple sclerosis, following patients for up to 12 months. The analysis reported in this paper is restricted to patients prescribed one specific full-spectrum high cannabidiol (CBD) oil, CannC CBD3000/5000, for chronic pain or anxiety at three-month follow-up. Methods CannC CBD3000/5000 are the same high CBD oil product (100 mg/ml CBD, 30 or 50 ml bottles) derived from two cannabis cultivars, Charlotte's Web and Charlotte's Angel. Changes in pain (severity, interference) and anxiety from baseline over 3 months were measured using the Brief Pain Inventory and the Generalised Anxiety Disorder-7 Questionnaire, respectively. Secondary outcome variables included mood/depression, quality of life, perceived general health and sleep quality. Results Three-month follow-up data (9 anxiety patients, 22 chronic pain patients prescribed only CannC CBD3000/5000) showed that, compared with baseline, for chronic pain patients there was a significant improvement in pain severity and mood/depression, whilst for anxiety patients, there were significant improvements in anxiety and mood/depression. When results were combined for the two cohorts, perceived overall health, mood and sleep were all significantly improved from baseline at 3 months. Conclusion CannC CBD3000/5000 may be useful in the treatment of chronic pain and anxiety. More research is needed in full-spectrum CBD products to investigate their potential efficacy in common conditions such as anxiety and chronic pain.
