The Royal College of Psychiatrists (RANZCP) says people may be getting the wrong impression about the availability of some psychedelic drugs, following an historic 2023 decision to take them off the prohibited drug list.
“There’s a definite risk of patients having significantly elevated expectations,” says the chair of RANZCP’s Psychedelic Steering Group, Professor Richard Harvey.
“Some of the marketing, what we see on the web … is suggestions that these are treatments or substances that everybody should use, that all psychiatrists should be prescribing — there’s absolutely not, by any means, the evidence that is the situation.”
The Therapeutic Goods Administration (TGA) decided last year to allow therapeutic use of both MDMA (also known as ecstasy) and psilocybin (the active ingredient in magic mushrooms) for specific mental health illnesses under strict conditions.
Previously, these drugs could only be used in research trials.
RANZCP recommended against the change and has since issued its own psychedelic guidelines.
Professor Harvey says he is concerned about recent publicity surrounding the first therapeutic prescription of MDMA to treat a patient with post-traumatic stress disorder.
The Monarch Mental Health Group in Sydney posted the prescription online saying it was “the first ever normal script for MDMA a psychedelic medicine in the world.”
Professor Harvey says this could send the wrong message.
“The concern that I would have is that seeing that, patients would be misled that a doctor, who has a script pad, could just write a prescription for these medications,” he said.
“I think it’s important for people to understand that it’s not legal to do that.”
The drugs are only available for therapeutic use in conjunction with intensive therapy carried out by authorised practitioners.
The psychiatrist who wrote the prescription and the post, Dr Ted Cassidy, denies his post is creating unreal expectations.
“I think the expectation in the community was out there anyway,” Dr Cassidy told 7.30.
7.30 can only confirm two cases of psychedelic drug prescriptions since the TGA’s decision came into effect in July last year.
Dr Cassidy says the process was complicated and expensive.
“[In terms of] cost and manpower and being able to get it to treat lots of people, it’s probably not such a good thing,” he told 730.
“But at this particular stage in the cycle it’s probably where we need to be at.
“I think the pace at which we’re doing things is probably about right, because there aren’t a lot of people with hands-on experience.”
‘A powerful tool’
The Australian Multidisciplinary Association for Psychedelic Practitioners (AMAPP) says there’s been an increase in people asking about the therapy.
“People [are] just desperate, saying, ‘Oh it’s legal now, sign me up, where do I get it?'” says AMAPP chair Dr Anthony Bloch.
But Dr Bloch said he basically agreed with the TGA’s cautious approach, although the AMAPP continues to ask for some clarification.
“The main concern was not to get the medicine to as many people as possible – but how to get the medicine safely rolled out,” he said.
“A lot of people who feel this is the answer for them – it probably isn’t. But for a lot of people this can be a very powerful tool.”
How to best use this tool for treating depression is the subject of a number of psilocybin trials rolling out across Australia this year.
Professor Susan Rossell from Swinburne University of Technology says there’s a trend across published psilocybin studies.
“About a third seem to have some very positive effects, a third nothing really, and a third do have some negative long-term consequences about the so-called bad trip,” she said.
Professor Rossell’s team is trying to find out what are the predictors of success.
“We know this intervention is going to be really expensive, it involves a lot of therapy.
“So if we can make some predictions as to who it’s going to benefit the most, wouldn’t that be the best way forward?”
Dr Leon Warne, from Reset Mind Sciences, which is involved in a separate psilocybin trial in Western Australia, agrees.
“We need to really be able to establish safety, we really need to establish how this therapy is going to be rolled out in the real world,” he said.
‘Intense’ but inconclusive
Tamara — who asked we don’t use her surname — has struggled with depression for 30 years and took part in one of Swinburne’s pilot research trials last year.
She found it inconclusive.
“It was very intense — I certainly didn’t have any epiphany or life-changing moments,” she said.
“I was hoping on one level it might shift something — and certainly from some reports you read it does have a dramatic effect for some people.”
But she said the psychedelic therapy did have some effect.
“I’ve never remembered my dreams ever, or felt that I’ve ever dreamt and I’m certainly dreaming a lot now, which is quite strange.”
She said ultimately though she is glad she went through the experience.
“Would I do it again? I don’t know.”
A spokesman from the TGA said since the decision on psychedelics was implemented some good progress had been made in establishing the framework of controls.
“As is the case with all new therapies, especially those outside of the medicine registration and approval framework, uptake is expected to be gradual,” he said.
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