Research studies demonstrate great promise for psychedelic medicines in treating depression, PTSD, substance abuse disorders and generalized anxiety. MDMA for treating PTSD is in the last stage of clinical trials in the USA. Psilocybin is about a year or two behind in trials. Meanwhile, MDMA and psilocybin have become legal forms of treatment in Australia. As with all things in life, the proof of things is in the details. As Australia is putting psychedelic therapy into practice we will learn how effective these medicines are in real world situations and what sorts of problems emerge.
Psychedelic Therapy Is Not Doing Ecstasy or Shrooms With Your Therapist
A point made in reporting about psychedelic medicine therapy in Australia is that it will not consist of doing shrooms or ecstasy with your therapist. The governmental authority that OK’d psilocybin and MDMA for therapeutic use has restricted their use to approved psychiatrists. Virtually all research into these medicines has involved using the drugs as adjunctive agents along with coaching or psychotherapy. However, the folks who OK’d these medicines are not in the business of prescribing therapeutic routines. That is left to the professional medical and psychiatric associations in Australia. The medicines are OK for use in treating depression that has resisted standard therapies and PTSD. The medicines are to be used along with psychotherapy although how this will work was not specific when the medicines were OKed.
In preparation for the rollout of MDMA and psilocybin as treatments for depression and PTSD the Royal Australian and New Zealand College of Psychiatrists published guidance for their members for how to proceed. This involves amounts, frequency, and timing of administration as well as methods for monitoring progress and potential side effects. This guidance includes suggestions as to necessary training. All of this has specific implications for those individuals with PTSD and depression who seek psychedelic therapy.
Can Your Doctor Provide Psychedelic Therapy?
A family physician, internist, surgeon or other physician who is not a psychiatrist will not be able to prescribe psychedelic therapy for their patients. They will need to refer their patients to an appropriate psychiatrist. The psychiatrist will need to have been specifically approved for providing this treatment. Once a patient comes under the care of an approved psychiatrist they will have to assess whether or not psychedelic therapy is the right treatment for each patient in question. Assessment may take several sessions with the psychiatrist. When treatment is deemed appropriate the patient may need several more sessions before psychedelics are administered.
Patients will be informed of all this and will have to give written consent before starting out. The Royal Australian and New Zealand College of Psychiatrists in their guidance advise psychiatrists to tell patients that psychedelic therapy is not a guaranteed cure and that there may be risks involved from psychedelic medicines.
The Risk of High Expectations With Psychedelic Medicines
In Australia as in most parts of the world the need and demand for psychiatric services exceeds the supply. Psychiatric practitioners in Australia who have worked with psychedelics are optimistic that these medicines will be useful. They are also concerned that the amount of hype that precedes their use “in the field” is huge. Many will expect miracles. Many who are not appropriate candidates for psychedelic therapy may be severely disappointed that they are not approved for treatment.
The Risk of Inappropriate Use of Psychedelic Medicines
Despite precautions put in place in Australia to make certain that only competent professionals use psychedelic treatments there is always the risk of overreach. Psychiatrists who are convinced that psychedelics are a cure-all may treat patients who are not appropriate for these medicines. For example, individuals with psychoses such as schizophrenia are at greater risk of having persistent hallucinatory flashbacks after using psychedelics like psilocybin or MDMA. As much as one might want to help such patients, psychedelics are likely to carry risk in excess of potential benefits.
Even Psychiatrists Will Have a Learning Curve When Using Psychedelics
It is one thing to know the science and it is another thing to put it into practice treating real live patients. How much time will it take to treat a patient with psychedelics? How long does the psychiatrist need to be personally available when a patient is undergoing treatment. What precautions need to be in place in case of adverse reactions? All of this will be sorted out as Australia rolls out therapy with psychedelic medicines.