Australia Has Legalised Psychedelic-Assisted Therapy – Should The Rest Of The World Follow Suit?
“You can look at all the clinical data you want, but meeting people and hearing about their lives has convinced me. War veterans who didn’t want to sleep because they could see, hear and smell the trauma all over again. You can’t hear stories like that and not want this to be available.” Jo Neill, professor of psychopharmacology at the University of Manchester, is talking about psychedelic-assisted therapy. Specifically, why she welcomes the fact Australia has just become the first country in the world to classify psychedelics as medicines. In July this year, the law changed to mean that specialist approved psychiatrists can prescribe MDMA for post-traumatic stress disorder (PTSD) and psilocybin (magic mushrooms) for treatment-resistant depression.
British army veteran Keith J Abraham has benefited from psychedelic-assisted therapy and is calling for its introduction in the UK. Seeing friends killed on the battlefield in Iraq and Afghanistan left him severely traumatised. Alongside distress, frustration, resentment and anger, he experienced debilitating physical symptoms: “I started sweating all the time – my palms, my back, my chest, my face, my feet – everything. I wasn’t being triggered, I was just constantly in this state.” These hyperarousal symptoms are a core feature of PTSD. Abraham tried therapy and antidepressants, but “they just numbed me”. When friends told him about ayahuasca, a psychoactive brew used in healing ceremonies in the Amazon, he booked a trip to Peru. “I spent 10 days in the jungle, had two ayahuasca ceremonies and when I walked out, I absolutely knew I had been healed,” he says.
It’s powerful testament, but many critics still see Australia’s decision as rushed and potentially dangerous. Dr Arash Javanbakht, a psychiatrist and director of the Stress, Trauma, and Anxiety Research Clinic at Wayne State University in Michigan says, “Although reports sound promising, I’m sceptical of breakthrough medical pronouncements. Throughout the history of psychiatry, we’ve had hype about promising cures like psychoanalysis, ketamine, cannabinoids, propranolol, opioids and memory-enhancing agents, which faded over time or showed minimal efficacy in the long run. There is no magic bullet.”
While supporters argue that there have been close to 300 clinical trials into the efficacy of psychedelics, concerns over their use include the quality of the evidence, potential side effects (which have been found to include psychosis), long-term effectiveness, risk of relapse and the cost of treatments (one round could cost as much as AUS $25,000).
Dr Javanbakht adds, “There isn’t sufficient data on use in the community, including who it works for and who it does not, what severity of illness this works for, what types of trauma, or comorbidities. Many patients with PTSD use drugs and alcohol – is it OK for them to use psychedelics?”
On cost, Neill points out that antidepressants, taken daily, are anything but cheap over the long term – particularly given a quarter of people stay on them for a decade or more. “With psychedelics, you have one, two or three high doses, a load of therapy and may not need any further treatment. That’s a paradigm shift. It will be cost-effective in the long-term.” And she argues that as long as treatment is tightly regulated, as it is in Australia, where only psychiatrists approved by both the Human Research Ethics Committee and the medical regulator (TGA) are allowed to deliver psychedelic-assisted therapy, then it can be as safe as it has been found to be in clinical trials. “The number of people I’ve met with PTSD or severe depression who have tried to kill themselves is heartbreaking,” she says. “Nothing has worked and we know [psychedelic-assisted therapy] can help.”
According to the World Health Organisation, one in every eight people globally lives with a mental disorder and one person dies by suicide every 40 seconds. The very fact treatment-resistant depression exists suggests a need for new options. For the most commonly prescribed antidepressants, selective serotonin reuptake inhibitors (SSRIs), “only a third of people go onto remission”, says Neill. “For severe depression, psychedelics will reset the brain, reframe how you see the past experiences that have led to your depression and allow you to move on.” They may even have further uses. “Certain psychedelics have powerful anti-inflammatory effects”, says Neill. “That means they could treat a huge number of diseases and conditions.” Research is ongoing in everything from pain to OCD, eating disorders to Alzheimer’s.
Everyone agrees that correct use, clear psychotherapy protocols and careful support and integration from licensed therapists is key because, as Dr Javanbakht points out, “When trauma memories are recalled, they are vulnerable to reconsolidation, which means they, or parts of them, or their emotional aspects can be rewritten. This is good in correct therapy but could be bad in the wrong hands.”
Motivated by his own experience, Abraham set up the UK arm of Heroic Hearts, a charity which helps military and emergency services veterans with PTSD. While psychedelics are illegal in the UK, the charity connects people with programmes in places where these drugs are available. Abraham believes the drugs are a way to reach the unreachable. “In the summer of 2018, there were two suicides every week for eight weeks in [the military veteran] community,” he says. “The shockwaves that go through a community when you get a spate of suicides like that is heartbreaking. Those people could have been saved if they had access to these drugs.”
Laura Potter is a freelance editor and writer whose work has appeared in The Observer Magazine, The Guardian’s Saturday magazine, The Times Magazine and Women’s Health