How psychedelics shock the system

In February 2023, the Therapeutic Goods Administration reclassified psilocybin (the active ingredient in magic mushrooms) and MDMA (the active ingredient in ecstasy) from ‘prohibited substances’ to ‘controlled drugs’. This landmark decision to prescribe these drugs by authorised psychiatrists, was justified due to the lack of options for patients suffering certain types of depression and PTSD.

But this world-first decision has wider implications for the politicians, organisations, and individuals who are affected by it. How will this be supported in a society with decades of negative stigma surrounding the use of psychedelic drugs? What is the evidence of benefits - given trials are still underway? How can we establish equitable access to a potentially game-changing new treatment?

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Shifting stigma and changing behaviours

Community attitudes are constantly changing on a range of health issues. Smoking, not wearing seatbelts, drink driving and getting a suntan (sometimes with the help of cooking oil) were once accepted social norms. Mental health was not discussed openly, and was clouded in stigma and ignorance. It wasn’t that long ago that treatments such as isolation in asylums, high doses of sedatives, and crude surgical interventions were considered legitimate and even scientific.

Now, a shift in community attitudes (along with a broad concerted effort by the health sector) means talking about mental health issues is becoming more normalised. Mental health disorders affect almost 1 billion people globally at any time, and while some stigma remains, events such as RUOK Day have prompted conversations in our daily lives that would have been considered private and taboo only a generation ago.

The use of medicinal cannabis has not only been legitimised as therapeutic for cancer treatments, cannabis use has been legalised in some US states, Canada, and decriminalised in the ACT in Australia. We can all agree, the things society accepts and rejects is in constant flux.

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Cautious optimism

Over recent years, clinical trials into the effects of controlled doses of psilocybin and MDMA to treat depression and PTSD (both in conjunction with psychotherapy) have shown promising results. However, the success of any innovation requires the support of those who might be impacted by it, including those who manage, deliver and use the medication.  

The study, published in Public Health Research & Practice and led by Monash’s BehaviourWorks Australia and the Neuromedicines Discovery Centre within the Monash Institute of Pharmaceutical Sciences, involved conducting in-depth interviews with a range of people involved in psychedelic drug law reform, clinical use or regulation.  The theme of the paper could be summed up as cautious optimism - caution that there is a perceived lack of evidence that consequently limits confidence in the efficacy, safety and feasibility of psychedelics, and optimism at the prospect of new treatments for depression and PTSD finally offering hope after decades without innovation. The prospect of improving treatments for mental health conditions in Australia is exciting, but supporting the integration of psychedelic therapies into Australian clinical practice requires more than excitement.

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Attitudes, access and equity

Research into attitudes towards, support for, or concerns about these changes needs to be accurately understood, especially when it comes to those expected to fund, regulate and deliver new mental health regimes.  Their support is critical for making these schemes work.

There are many possible outcomes and players affected by this decision - state and federal politicians, members of mental health peak bodies, clinicians and unions representing mental health workers, and of course, those living with mental health conditions.

Access and equity is also a critical issue.  A single course of psilocybin treatment costs around $25,000, so we need to ensure that these new treatments are accessible to those who really need them, and not only those who can afford them.

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A strong evidence base

These kinds of deep dives bring to the fore stakeholders concerns and reveal what may be driving them, such as lack of effective messaging from trusted sources about the benefits and controls put in place around these innovative health treatments. Without this research, decision makers are relying on guesswork and their own beliefs and assumptions about important health issues.

Implementing any health strategy relies on the best available evidence, and at BehaviourWorks Australia, that’s what we do; good-quality, rigorous data that can present insights into a given challenge to achieve the best outcomes.  The results may be surprising and even controversial, but they reflect and reveal truths about those involved that may otherwise be missed.

What is your opinion on the prescribed use of psilocybin and MDMA for certain types of depression and MDMA?