Harriet Newcombe explores Australia's decision to legalise psychedelic and MDMA treatment for individuals as a treatment of mental health conditions.
Photo by: Rick Barrett
According to the Australian Bureau of Statistics, over 40% of its citizens aged 16-85 have experienced some mental health disorder at some time in their life. Faced with a rising epidemic of mental health concerns, in July 2023 Australia became the first country in the world to legalise psychedelics and MDMA for treatment of mental health conditions.
This decision was not unanimous. Whilst some scientists and mental health experts thought it could be a gamechanger in treating patients, there were serious concerns over the lack of research and guidance in place. Now, over a year on from this major policy change, Australia has begun opening psychedelic treatment centres and psychiatrists are now prescribing these drugs to their patients, but whether these treatments will cause more harm than good is yet to be seen.
Controversy Over Legalisation
The controversy around this policy stems from the argument that this decision was driven by lobby groups as opposed to medical advice. Though there have been promising trials in the US and Canada over the use of psychedelics and MDMA in mental health treatment, the research was lacking in Australia and many of the clinical trials were not completed at the time of legalisation. Therefore, the main body for psychiatrists for Australia and New Zealand, and PRISM, the research body into psychedelic treatment, advised against the drugs being rescheduled and consequently legalised for treatment.
However, following the rescheduling of MDMA—commonly known as ecstasy, and psilocybin, found in magic mushrooms, from Prohibited Substance (Schedule 9) to Controlled Drug (Schedule 8) via the Therapeutic Goods Administration (TGA)—the treatment was legalised. The group Mind Medicine Australia applied for this rescheduling to occur which was approved.
Though not led by medical professionals they have long advocated for the use of psychedelics in treatment for mental health concerns. As a result, it was a surprise to the medical community that Mind Medicine Australia’s lobbying had been successful when the scientific results of the trials and research was not yet in place and the medical community was not consulted on the decision.
Did you know? 60% of cases involving severe depression do not respond adequately to standard antidepressants due to 'treatment resistant' depression, which calls for new forms of treatment.
The Treatment
The legalisation and usage of these psychedelics is highly controlled. Only specialist psychiatrists may prescribe either treatment and may only prescribe MDMA for treatment of post-traumatic stress disorder and psilocybin for the treatment of treatment-resistant depression. The drugs can only be administered in a controlled setting under supervision. , These are the only psychedelics that have been approved and any other usage of these drugs is still illegal
This control is essential for the safety of the patients, especially as the general lack of research and data has generated concerns around the potential harm to patients. Professor Susan Rossell, a lead researcher on a trial of psilocybin's effectiveness for treatment-resistant depression, has stated that about 10-20% of patients experience a so-called ‘bad trip’: “It could actually leave them with a post-traumatic stress disorder, which they didn’t have in the first place."
Due to this lack of research, Australia’s Pharmaceutical Benefits Scheme, which subsidises prescription medication, will not support psychedelic assisted therapies. As a result, the first psychedelic treatment centre opened in Australia costs patients $24,000 for nine months of treatment. This will price out many of those patients who potentially need the treatment the most.
Cautious Optimism
Despite these concerns, many mental health professionals see the potential in this line of treatment. Around 60% of depression cases develop into treatment-resistant depression, in which standard antidepressants have no effect. For these patients, this move by Australia to legalise psychedelics for treatment could provide them with hope of recovery that other means of treatment can’t give them.
It is also true that, though the number of published trials regarding psychedelic treatment is small, they are promising: “There have been a growing number of studies indicating that these psychedelic compounds—specifically MDMA for PTSD and psilocybin for MDD—may help patients who have severe symptoms and may not have previously responded to traditional treatments." said Dr Adrian Jacques H. Ambrose, senior medical director of the Department of Psychiatry at the Columbia University Irving Medical Center.
"Most people come out with much less depression than when they went in. Even in the people with severe depression who failed on ten different medications, you can still get substantial improvements for weeks or months [with the use of psychedelics in comparison to current forms of medication]." - Professor Nutt, neuropsychopharmacologist, ABC News
Besides the use of psychedelics, over the last 50 years there have been very few advancements in mental health treatment. Using psychedelics in this way could revolutionise mental health treatments and could start a wider movement to explore beyond the standard treatment for mental health.
This attitude shift can already be seen in the US—Colorado decriminalised the use of psilocybin in 2022, and Oregon became the first state to approve the adult use of it. Additionally, the US Food and Drug Administration designated psilocybin as a breakthrough therapy in 2018.
Conclusion
This world-leading change in psychedelic treatment is a distinct departure from Australia’s traditionally conservative approach to policy changes. Now the decision has been made, it could provide the opportunity to transform mental health treatments. However, the lack of research and data could equally put patients at risk.
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Researcher: Robyn Donovan | Editor: Fiona Patterson | Online Editor: Elena Silvestri Cecinelli
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