MDMA and magic mushrooms are not “miracle cures” for mental illnesses and Australia must approach them cautiously, the country’s training body for psychiatrists has warned ahead of the psychedelics being classified as medicines for certain purposes.
The Royal Australian and New Zealand College of Psychiatrists will publish its first guidelines for psychedelic-assisted therapy on Monday, taking a conservative approach to what it describes as a “developing” field for which evidence is either limited or emerging.
Magic mushrooms are seen in a grow room at the Procare farm in Hazerswoude, central Netherlands. Credit: AP
The Therapeutic Goods Administration shocked the health sector earlier this year when it announced that authorised psychiatrists would be able to prescribe MDMA to assist treatment of post-traumatic stress disorder, and psilocybin, the active ingredient in magic mushrooms, for treatment-resistant depression.
The change takes effect on July 1, but there are few qualified researchers in the space and treatment is initially expected to cost $25,000 or more out-of-pocket. It has been hailed by some researchers as an opportunity for Australia to lead the world in innovative mental health treatments, but others are worried that the ruling is premature.
A typical course of therapy varies but generally involves two psychologists supervising at least three eight-hour sessions when the drugs are administered, with additional therapy sessions in between.
Professor Richard Harvey, who chaired the college’s steering group to create the new guidelines, said they had prioritised patient safety in stipulating that an authorised psychiatrist should be responsible for the full treatment and therapeutic team.
He said patients should not be left alone during the dosing process, and there must be thorough follow-up measures. The gender of the therapist should also be agreed upon by the patient in advance, there must be a consent process around touch, and facilities should be appropriately designed so that they are quiet and avoid disturbances.
“It’s not like these are drugs that can be taken home and result in benefit to the patient. ... The availability has been made in the context of fairly intensive psychotherapy,” Harvey said.
“The difficulty we have ... is that the evidence for these treatments is extremely limited. There is a very subtle signal that these treatments might work.
“But there is a lot of lobbying and information being put out there to patients, not by the College of Psychiatrists but by other groups [that] are trying to push these treatments as some kind of miracle. We view them as being pretty much experimental.”
Harvey said that most psychedelic-assisted treatments had so far been conducted in clinical trials, meaning there were strict controls around who could partake.
“When this jumps into the real world, then you’re treating patients who are taking other medications and where it could be very much less predictable as to what will happen,” he said.
“Any new treatment that comes along, suggesting it’s a miracle and somehow is going to fix all of these [things], I think, needs to be very much taken with a pinch of salt. My advice to patients is you need to be working with your trusted psychiatrist.
“This is not the sort of treatment where you should be going hunting on the internet, looking for someone who might be able to do this for you.”
Dr Nigel Strauss, who was also on the working group, said Australia needed experienced people providing the treatment.
“The landscape will be pretty sparsely occupied until more of the research programs get under way and people get trained,” he said. “With time and more trials, there will be more people who will be able to successfully become authorised prescribers.
“If people are patient, the regulations could change over the next six to 12 months and become less conservative as we learn how this is going to roll out.”
But he said it was “a bit of a moving feast” and he wanted people to understand that safety was the primary issue.
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