Intoxicants as medicine: Between high and healing

Ecstasy and magic mushrooms are common drugs – components of which are now also effective medicines. Australia will become the first country in the world to allow MDMA and psilocybin for psychiatric treatment in July.

Michael Raymond worked as an engineer for the Australian Air Force for 16 years. He retired early due to severe depression and post-traumatic stress disorder. He made several suicide attempts.

Therapy with drugs saved his life, he says: “It really helped me to overcome a lot of barriers that I had in therapy. Taking these drugs made a deeper change possible. My quality of life is better today.”

He now speaks for Mind Medicine Australia, which has lobbied heavily for the approval of MDMA and psilocybin in Australia.

“controlled” instead of “forbidden”

Australia is the first country in the world to approve such substances for psychiatric treatment. Instead of Category 9 (Prohibited Substances), MDMA and psilocybin will be listed in Category 8 (Controlled Drugs) from July 1st.

Psilocybin is a component of so-called “magic mushrooms”, i.e. hallucinogenic mushrooms. MDMA is a component of ecstasy.

Not all experts agree

Neuropsychologist Susan Rossell of Swinburne University in Melbourne was shocked when Australia’s therapeutic products regulator announced its decision in February. Rossell directs the largest study on psilocybin in Australia and is otherwise regularly consulted by the agency.

Science in Australia is still at the beginning of its research, especially with MDMA, criticizes Rossell. There are no long-term studies. Therefore, she and other researchers believe the approval is too early.

But she also says: The use of MDMA and psilocybin in therapies can help many people. “People with mental illness are stuck. Their thoughts are always going in the same direction. What we can do when the brain opens up is we can reprogram it. So get rid of some of the thought patterns that are very negative or very compulsive. “

The permit only applies to a small circle

The drugs are initially only approved for people with certain mental illnesses: MDMA for post-traumatic stress disorders and psilocybin for previously untreatable depression.

The psychologist Stephen Bright makes it clear that the medical use of the drugs is very different from the illegal use as a party drug. “MDMA is typically associated with raves, festivals and ‘duff-duff’ music where people are having fun. People under the influence of MDMA in this treatment are not having fun.”

A matter of many hours

A therapy session lasts around eight hours, plus extensive preparation and follow-up work. During the session, two therapists work through the patient’s inner problems.

When taking MDMA, there is a lot of talking because patients open up more, explains neuropsychologist Susan Rossell. Psilocybin causes more intense physical reactions: “The perception of the patients changes, they have hallucinations, they are in a kind of waking dream.”

Sometimes a “bad trip” follows

A third of the patients feel significantly better after the therapy. Studies in the USA even speak of around 70 percent of patients. But for some, the drugs work differently – instead of a high, they get anxiety attacks, says Rossell: “They have a ‘bad trip’ and it’s pretty horrible. We’ve had people who have completely collapsed and curled up in the fetal position all day , sobbing and crying. It’s scary for them.”

In her experience, one in ten study participants feel this way. Research is not yet ready to say who is affected by the therapy and who is not. In general, the effects of MDMA are better researched than psilocybin.

The health insurance companies are still holding back

The costs and availability are also still unclear. Estimates are based on the equivalent of around 15,000 euros per treatment. So far, only one health insurance company in Australia has announced that it will consider covering the costs.

Psychologist Stephen Bright worries that only the wealthy will have access to the treatments. “The people who need them most probably don’t have the money to get them.” In addition, there are only a handful of psychiatrists and therapists in Australia who are trained and certified to provide treatment.

Many sick people are waiting for treatment

The scientists agree that there is definitely a great need for new treatment options for depression and other mental illnesses. The number of people affected has doubled in Australia during the corona pandemic. Surveys show that one in two Australians will experience mental health problems at some point in their life.

Research on psychedelic substances therefore continues – also for diseases such as anorexia, alcohol addiction or anxiety, for example in people with terminal cancer.