What are psychedelic assisted therapies?

You may have heard about psychedelic assisted therapies, which have received increasing attention in the media as potential mental health and substance use treatments. In these therapies, substances like MDMA and psilocybin are used in controlled therapeutic settings alongside other established therapies, such as talk therapy, to treat conditions including severe forms of depression, PTSD, and anxiety. The substances are highly regulated, and manufacturers, suppliers, and medical practitioners need to comply with strict requirements. The drugs can only be taken under the supervision of at least one medical professional in a clinical setting. The research is in early stages, but the findings so far suggest these substances, when used carefully, under supervision, and alongside therapy might offer unique benefits.

There have been recent changes to Australia’s regulation of psychedelic assisted therapies that you may have heard about:

• As of the 1^st of July 2023, MDMA and psilocybin are nationally recognised as medicines and can be prescribed in strictly controlled contexts and conditions. However, currently there are no approved MDMA or psilocybin containing products on the Australian Register of Therapeutic Goods (ARTG)
• Only registered and authorised psychiatrists can prescribe them
• MDMA can only be prescribed to treat PTSD
• Psilocybin can only be prescribed to treat treatment-resistant depression (when someone has tried at least 2 anti-depressants and shown no improvement)

More information can be found here: https://www.tga.gov.au/news/blog/understanding-changes-mdma-and-psilocybin-access

It is important to know that these drugs remain illegal for all other purposes. It is still illegal in most states and territories in Australia to possess these drugs. Even small amounts for recreational use can be met with criminal punishments and fines.

Psychedelic assisted treatment is only considered in very limited circumstances where other treatments have not worked. Psychedelic assisted treatment will only be offered if after a medical review, the treating psychiatrist considers that the potential benefits outweigh the risks to the patient.

It's crucial to highlight that psychedelic assisted therapies are not about the medicines alone. Rather, they are a combination of the psychedelic experience and skilled therapeutic support, all done in safe and highly controlled settings. When these drugs are taken outside controlled settings there are increased risks of adverse events happening. While these treatments may be promising, it doesn’t mean these substances are safe to use recreationally.

When used in treatment, the substance is strictly controlled to ensure appropriate purity and strength. The patient is also under strict medical supervision, which helps to decrease risks.

Illegal drugs lack quality control and are prone to contamination. This increases the risk of unpredictable and potentially dangerous health effects, including overdose, due to uncertainties in dose, potency, and purity.

Visit https://theknow.org.au/ for timely information on drug warnings. Read our ‘How to help someone who has taken a drug’ factsheet to learn more.

Psychedelics (or hallucinogens) are a group of drugs that can cause large changes in the chemicals in your brain. This can affect how you see and feel reality, causing things like hallucinations. Two psychedelics being used in therapy are MDMA (ecstasy) and psilocybin. Below we will explain these substances in more detail.

Psilocybin

Psilocybin is a natural psychedelic found in many mushroom species around the world. Psilocybin can bring about hallucinations such as seeing vivid colours, distorted shapes and seeing or hearing things that aren’t there. People who use Psilocybin report having reflective thoughts and feeling emotions differently during intoxication. These effects can vary widely among individuals and misuse can lead to anxiety, nausea, or a challenging experience known as a “bad trip”.

Follow the link to find out more about psilocybin and other psychedelics: https://positivechoices.org.au/teachers/hallucinogens-factsheet

Early research with small sample sizes suggests that psilocybin assisted therapy can be safe when delivered in a controlled environment. It also shows promise in reducing the severity of depression symptoms in patients with major depressive disorder (MDD), a severe form of depression, when compared to patients taking a placebo drug with therapy. In clinical trials, a placebo drug looks and tastes like the drug being tested but does not have any effects. Researchers compare the results from participants who took the placebo to results from participants who took the drug (i.e., psilocybin) to rigorously assess the effects of the drug. There is also early research for psilocybin therapy compared to placebo in reducing end of life anxiety symptoms in patients with life threatening cancer.

When used medically, psilocybin is given as part of a highly structured psychedelic assisted therapy program. It is thought that psilocybin assists treatment by helping the patient trust the therapist and make them more open to flexible thinking. This type of treatment is only approved for patients who have depression that is not improved by other treatments. There are several approaches to treating depression that are more widely available. For more information, visit https://www.healthdirect.gov.au/depression#treatment.

MDMA

MDMA or ecstasy causes the body’s central nervous system to speed up. Many users report a sense of euphoria, feeling more energised and emotionally open, and increased relatability to others. It's important to note that MDMA can also have risks, including nausea, dehydration and overheating. Other short-term effects can include anxiety and paranoia.

Follow the link to find out more about MDMA: https://positivechoices.org.au/teachers/ecstasy-and-mdma-factsheet

Recent research on MDMA assisted therapy found large reductions in PTSD symptoms when compared with a placebo drug and therapy among a diverse sample. Everyone who was given MDMA in this trial experienced negative side effects during treatment including muscle tightness, nausea, and decreased appetite.  When used medically, MDMA is delivered in a highly controlled environment to support structured therapy programs, rather than as a treatment by itself. Researchers think it may help improve the therapy process by increasing trust between the therapist and patient. Its activity in the brain could potentially help to reduce fear or negative emotions when revisiting traumatic events in patients with PTSD, which is useful for processing these events.

While psychedelic assisted therapy research is still in early stages, early evidence suggests that psychedelic-assisted therapies have the potential to be safe and effective tools in improving mental health care among targeted clinical population groups in a controlled setting, when other treatment options have not worked. Small sample sizes in controlled clinical settings makes it hard for researchers to be sure that the results would apply to larger, more diverse populations. As psychedelic assisted therapies are a relatively recent approach, more research is needed to determine whether the benefits of these treatments last over the longer term.