Trips out: regulator says no to ‘shrooms as treatment for mental illness

The Therapeutic Goods Administration (TGA) won’t allow magic mushrooms and MDMA to be used as treatments for mental illnesses in a decision that’s been criticised by advocates and psychiatrists as evidence of Australia’s deep-rooted conservatism around drug policy.

In an interim decision published last week, the regulator refused to reschedule psilocybin (the ingredient in magic mushrooms) and MDMA (aka ecstasy or pingers) as controlled medical substances, a classification which would allow doctors to more easily prescribe them for treatment.

The TGA will hand down its final decision in April, and by then Mind Medicine Australia (MMA), the group behind the push to get psychedelics rescheduled, hopes to have changed the regulator’s mind. While that might not be likely, the fact it’s being considered is a sign of slowly shifting attitudes to their use.

Can the drugs work?

In September Mind Medicine Australia applied to the TGA to get MDMA and psilocybin rescheduled. Too many Australians suffer with a chronic mental illness and for many of them conventional treatments like anti-depressants simply do not work.

In the past few years Australia’s first two major clinical trials into the use of psychedelics began. At St Vincent’s Hospital in Melbourne, palliative care patients have been administered doses of psilocybin to ease the anguish of imminent death. One researcher said patients had experienced a sense of inner peace so profound that they were moved to tears.

At Monash University two trials are investigating magic mushrooms as a treatment for anxiety disorders, and MDMA’s effectiveness in treating post-traumatic stress disorder.

But outside of a handful of trial participants, doctors will not be able to use these drugs if the TGA’s final ruling upholds last week’s decision. The regulator conceded there had been “promising” research but given the lack of training for doctors and potential risks of psychosis, there wasn’t enough evidence to reschedule the drugs.

However, in submissions received by the regulator, nearly 98% supported reclassifying psilocybin and MDMA. And with a chance to resubmit before the final submission, MMA hopes to correct the record.

“We believe that the reasons given by the secretary to justify his interim decisions contain a number of significant errors and omissions and we will be working hard over the next few weeks to draw these to his attention in our final submissions,” MMA chairman Peter Hunt said.

Stigma and conservatism

If the TGA had rescheduled the drugs, Australia would have been the first country to recognise them as legitimate medicines. But the decision and the comparative lack of research into psychedelics was a general sign of Australia’s conservatism when it comes to drugs, says The Ethics Centre’s executive director Simon Longstaff, who is also on the MMA’s board.

That conservatism is a product of historical and political factors, Longstaff says. In the 1970s, psychedelics were emerging as a promising sub-field of medical research. But the substances became demonised and thanks to the puritanism of the “war on drugs”, experimentation was relegated to raves and retreats.

Over the past decade psychedelics have been steadily pushing their way back to the mainstream of medical research, and are being investigated at some of the world’s most established institutions. Johns Hopkins University is looking at psilocybin’s potential to help people quit smoking and treat anorexia. Imperial College London launched the world’s first centre for psychedelic research in 2019.

“[But] Australia hasn’t been able to marshal enthusiasm and regulatory will,” Longstaff told Crikey.

“I think we are by many measures a quite conservative society. I think we’ve had conservative governments at a state and territory [level] who’ve tried to run very hard on law and order.”

In New South Wales, for example, the Berejiklian government adamantly refused drug law reforms arising from an inquiry into ice last year. It would rather kids overdose than consider pill-testing.

And while such reasoning doesn’t explain the TGA’s decision, Longstaff says such attitudes have framed the discussion around drugs in Australia.

That said, a regulatory rescheduling is very different from advancing research. And the divided response to last week’s ruling shows how fraught the issue is. Ahead of the decision, psychedelics researchers Stephen Bright and Martin Williams wrote in The Conversation that allowing these drugs to be used for treatment would be premature.

MMA’s proposal was opposed by the Australian Medical Association and the Royal Australian and New Zealand College of Psychiatrists. But the latter came under fire from its own members.

For Longstaff though, the biggest tragedy is that while we dither, real people, for whom nothing else works, continue to suffer.

“We’re not talking about unsupervised self-medication, we’re talking about carefully administered, well-regulated therapy,” he said.

“The burden of this conservatism falls on those who have to suffer needlessly.”