Psychedelic therapy is making waves worldwide as a groundbreaking mental health treatment. Now, a surprising announcement is set to change Australia’s perspective on psychedelic drugs.
In 2023, the Therapeutic Goods Administration (TGA) will open new avenues for psychedelic therapy in Australia. It’s a change that brings hope to many Aussies living with mental health conditions.
For decades, the ‘war on drugs’ has swept the medical potential of MDMA and psilocybin under the rug. However, clinical trials across the globe have gathered momentum over the past decade, and the results are in: psychedelic therapy has life-changing potential.
We know that 1 in 5 Australians suffer from mental illness, including anxiety and depression – but what happens when conventional treatments like medication, therapy, and even exercise for depression fail? Could psychedelics be the answer?
To find out, I spoke to Dr Paul Liknaitzky, Head of Clinical Psychedelic Research at Monash University. He’s also Chief Principal Investigator for psychedelic clinical trials at Monash.
This article will explore what psychedelic-assisted therapy is, what it’s used for, and what these changes mean for healthcare in Australia.
Read on to learn more!
Psychedelic Therapy in Australia: 2023 Changes Explained
What’s the big change? The Therapeutic Goods Administration (TGA) has reclassified MDMA and psilocybin for therapeutic use in Australia from July 1st 2023. PTSD and treatment-resistant depression are the two conditions currently eligible for psychedelic treatment in Australia.
While still a Schedule 9 prohibited drug in most cases, this legal shift allows authorised psychiatrists to prescribe these psychedelics as a Schedule 8 controlled drug for certain uses. This classification is similar to medicinal cannabis, opioids and many ADHD medications.
However, these treatments won’t be available immediately outside of clinical trials. February’s TGA ruling poses immediate challenges for pharmaceutical and insurance companies that need to coordinate supply and funding for these medications.
With speciality training and authorisation needed for psychiatrists to deliver PAT, it will take some time for psychedelic therapy to gather momentum.
Eager to learn more about this groundbreaking treatment? Keep reading below as I unpack all the details about psychedelic-assisted therapy.
What is Psychedelic Assisted Therapy?
Psychedelic-assisted therapy (PAT) is a mental health treatment combining the benefits of psychedelic drugs with psychotherapy. Most modern studies focus on one of two psychedelic substances: MDMA (the active ingredient in ‘ecstasy’) and psilocybin (‘magic mushrooms’).
“It’s a little bit like psychotherapy on rocket fuel”, explains Dr Liknaitzky. The mind-altering effects of a psychedelic ‘trip’ enable patients to work through difficult emotions, thoughts, and behaviours. Treatment aims to help patients explore the root causes of mental illness, reframe traumatic experiences, improve mood and reduce distress.
Unlike other medication-based treatments, psychedelics are administered under supervision to facilitate intensive therapy. One of the biggest misconceptions about psychedelic therapy, Dr Liknaitzky says, is seeing it as a medication-based treatment like antidepressants. “We say psilocybin rather than psilocybin assisted therapy because it’s less of a mouthful,” he explains, but the therapy component is absolutely essential.
How Does Psychedelic Assisted Therapy Work?
The specific therapeutic mechanisms of psychedelic treatment are unique to the patient themselves. “We’re providing a situation in which people can have far greater contact with the sources of distress in their life,” explains Dr Liknaitzky.
“Now, that may look like pulling apart rigid beliefs and patterns. It may be about opening up their hearts to something, feeling feelings that they’ve avoided, or identifying in ways that they haven’t identified. People might have just a radical form of empathy that they haven’t had before, and that can be quite healing.”
The unique nature of the psychedelic experience is what makes it different to all other mental health treatments. It’s also what makes PAT effective for such a broad range of conditions.
In fact, the breakthroughs made during psychedelic therapy may be unexpected for both patients and therapists. This may be the x-factor that makes psychedelics so effective where other treatments have failed.
What Conditions Are Treated with Psychedelics?
The two conditions currently eligible for psychedelic-assisted therapy in Australia are PTSD and treatment-resistant depression.
“Probably the most compelling evidence we have to date Is for MDMA-assisted therapy in the treatment of post-traumatic stress disorder,” Dr Liknaitzky says.
A Johns Hopkins study into psilocybin for depression also showed a 58% remission rate after 12 months, and three-quarters of participants had some improvement. This is particularly promising for treatment-resistant depression, affecting up to 30% of patients.
Clinical trials have also shown promising results in treating addiction (including alcohol use disorder and nicotine addiction), generalised anxiety disorder, obsessive-compulsive disorder, eating disorders, cluster headaches, functional neurological disorder, and end-of-life anxiety.
A clinical trial recently concluded at St Vincent’s Hospital in Melbourne explored psilocybin-aided therapy for patients with terminal illnesses. Rather than treating the life-limiting condition, psychedelic treatment aimed to alleviate associated anxiety and depression.
Results are pending formal publication in late 2023, but patients report “transformative” changes to their end-of-life journey.
What Does Psychedelic Assisted Therapy Involve?
Psychedelic-assisted therapy is a combined drug and psychotherapy treatment protocol over several months. In addition to supervised psychedelic sessions, patients receive specialised therapy sessions before and after each dose.
Typically, PAT involves between one and three full-day dosing sessions between three and six weeks apart. The drug is always administered in a safe, highly supervised environment with trained therapists and medical staff on hand. This is critical since high-dose psychedelics like MDMA or psilocybin produce a dramatic mind-altering effect.
Dr Liknaitzky explains that the clinical benefits are closely linked with the quality and nature of the patient’s psychedelic experience. Hitting that goal means pulling together a range of ingredients: the right drug, the right dosage, the right environment, and the therapeutic support to process it all.
Dosing sessions are conducted in a comfortable, quiet environment. Often, music is played during the session, and the patient wears an eyeshade. Earlier psychedelic trials used more stimulus during doses, but research has shown that a ‘patient-led’ approach is most effective.
Therapy sessions before and after psychedelic sessions are critical to successful treatment outcomes. Patient experiences are unique, and the therapists help contextualise and frame the patient’s insights as part of their recovery. These ‘integration sessions’ are essential to maximise treatment benefits and minimise adverse outcomes.
“Sometimes they come out with this very clear lesson or a set of really deep embodied or emotional lessons that make a lot of sense, and there’s a lot of clarity,” explains Dr Liknaitzky. “In other cases, it can be just confusing: a lot of chaos, a lot of imagery, a lot of what seem like messages but don’t make sense. So it can be about working through that material to find the gems.”
Dr Liknaitzky notes that this treatment protocol is far from set in stone, and we can expect more innovation as the science of psychedelics matures. Some trials combine the basic PAT protocol with other evidence-based therapy or behaviour change processes.
What Are the Risks of Psychedelic Therapy?
Psychedelic-assisted therapy can be life-changing, but like other medications, there are still risks and side effects. Drugs like MDMA and psilocybin produce an intense experience for the patient, including strong emotional reactions.
“Psychedelic experiences can be very challenging, confronting, bewildering; they can seem chaotic to people,” explains Dr Liknaitzky. That’s why psychedelic-assisted therapy is carried out in a controlled, safe environment with specially trained staff. Careful screening also ensures patients are suitable candidates for PAT to minimise risks.
Common side effects of psychedelics include:
- Perceptual disturbances
If these feelings become too intense, trained professionals are on hand to assist, including administering other medications if required.
Therapy to set patient expectations and contextualise experiences also help minimise some of the risks. For example, Dr Liknaitzky identifies false memories as one potential outcome of psychedelic treatment – and one which requires a tactful approach in post-session therapy.
Careful screening is also important for the medical use of psychedelic drugs. Psychedelics can trigger a bad reaction in patients with some conditions, including a history of psychosis.
Dr Liknaitzky emphasises that current treatment criteria err on the side of caution. Since psychedelic therapy is still an experimental treatment, plenty of unknowns exist, including whether these drugs are safe with certain medical conditions or predispositions.
As research continues to unfold, the next five years will see our understanding deepen and a potential expansion of PAT eligibility criteria.
How Can I Access Psychedelic Therapy in Australia?
While psychedelics will be rescheduled in Australia from 1st July 2023, these treatments are expected to become available sometime in 2024. There are still hurdles, as PAT will only be available from a select number of approved psychiatrists in a highly controlled therapeutic setting.
In order to prescribe MDMA or psilocybin, psychiatrists must be specially authorised by the TGA and pass human ethics committee approval.
Similar to Australia’s requirements for prescribing medicinal cannabis, this means psychedelic-assisted therapy won’t be a first-line treatment. Instead, psychedelic-assisted therapy aims to help patients with treatment-resistant conditions, meaning typical medications and therapies haven’t helped.
Cost is also a major barrier: the cost for a full PAT protocol – including psychotherapy before and after psychedelic sessions – is predicted to be around $20,000. Insurance companies say they’re ‘monitoring the space’, but criteria are likely to be strict. This puts psychedelic therapy well out of reach for most Australians with mental illness unless they can get involved in a clinical trial.
We can expect the accessibility and affordability of PAT to expand over the next decade or so. However, it can be challenging for those suffering to wait for access.
“I have a lot of sympathy for the folk who don’t feel like they can hang in there and wait,” Dr Liknaitzky says, encouraging those interested to contact Monash’s psychedelic research group.
Learn more about joining a psychedelic clinical trial below!
Can I Try Psychedelic Therapy On My Own?
It’s important not to underestimate the risks of illicit psychedelics. This includes the hazards of taking an uncontrolled drug and the psychological risks that come with ‘intense altered state experiences’.
“One avenue is fully legal, evidence-based and research-backed, and the other is fully illicit and fraught, with all the challenges and dangers involved,” says Dr Liknaitzky.
Illicit psychedelic drugs carry a much higher risk of adverse effects, like hallucinogen-persisting perception disorder (‘flashbacks’). There’s also far more uncertainty about the purity of the drug and the dose you’re receiving.
Most importantly, administering your own dose of a psychedelic drug is a very different experience from proper psychedelic-assisted treatment. The psychotherapy component and professional supervision are critical to the outcomes seen in clinical trials.
Similarly, seeking out psychedelic-assisted therapy overseas can be dangerous. While the legal status of psychedelics is more relaxed in some countries, the standard of care and supervision may not be equivalent to Australian standards.
Can I Join a Psychedelic Clinical Trial in Australia?
There are a number of clinical trials in progress in Australia. If you’re interested in joining a clinical research study at Monash, you can sign up for their notification list by emailing firstname.lastname@example.org. You can also find details about current and upcoming research studies on the official Australian Clinical Trials website.
What’s Next for Psychedelics in Australia?
Psychedelics for medical use may sound groundbreaking enough – but during my chat with Dr Liknaitzky, he confirmed there’s still plenty of innovation to come.
“I’m always mindful of what it takes to deliver the treatment well and support people well through this, and it’s really not trivial,” says Dr Liknaitzky. However, for those living with mental health challenges, hope is on the horizon.
Personally, I find breakthrough treatments like psychedelics so fascinating. I work with many mums struggling with mental illness, sometimes for many years, so it’s something close to my heart. Many of us have deep-seated traumas which undermine our sense of self-worth, and those continue to hold us back if they go unaddressed.
One current study in Australia is even exploring psychedelics for post-partum depression, which affects 1 in 8 women. This is an especially vulnerable time, as new mums deal with the challenges of a newborn as well as the effect of hormones on energy levels and mood.
As a nutritionist and exercise scientist, I love to talk about regular exercise, stress management and mood-boosting foods. After all, there’s a close link between physical, mental and emotional health.
However, when it comes to mental health conditions like depression, anxiety and PTSD, the current treatment options fall short for many. Up to 30% of patients don’t respond to antidepressants, and the side effects of these medications can also be debilitating.
These changes also make it easier for trials and research to be conducted in Australia, so we can learn more about how these treatments work.
I’m excited to see how psychedelic medicine evolves over the next few years!
For more, listen to my full interview with Dr Paul Liknaitzky on the Healthy Her podcast.