This sounds great on paper, but there's a devil lurking in the detail:
> The regulator says there are currently no approved products that contain MDMA or psilocybin. However the reclassification means psychiatrists will be able to access and legally supply certain medicines that contain them, even if they have not been evaluated for safety or effectiveness.
How exactly is this supposed to work then? Are psychiatrists supposed to order MDMA/psilocybin directly from the companies that produce the two for research use, which presumably involves fearsome bureaucracy and markups?
It sounds like this would make the law effectively a dead letter until a regular pharma company goes through the Australian approval process and gets the drugs into pharmacies. Medical marijuana in Australia has suffered from similar issues, with an onerous approval process in many states making it very difficult to get a prescription.
Mdma is tricky, but psilocybin is easy. Psilocybe cubensis can be grown easily at significant scale outside its natural ecosystem, due to work by the late Terence Mckenna and his brother Dennis.
Treatment centers could grow them on site pretty easily needing only basic cleanliness to avoid contamination.
>Are psychiatrists supposed to order MDMA/psilocybin directly from the companies that produce the two for research use,
As I understand it, yes.
Legalisation hasn't meant it has gone mainstream.
It is still going to be administered in very selective cases where the current range of medication and therapy has not been effective.
It may only be tens or low hundreds of people who receive these treatments in the first year.
The efficacy of the treatment will be monitored and the hope is that these patients outcomes are positive, which will add to the body of work supporting MDMA/psilocybin as an antidepressant.
It's the first step. When cannabis was legalised for medicinal purposes the doctors prescribing it had to import it from overseas suppliers.
Yes I imagine the next step is a local supplier company goes through the valid approval process and gets their product approved.
>Medical marijuana in Australia has suffered from similar issues, with an onerous approval process in many states making it very difficult to get a prescription.
I live in NSW so maybe I am a bit naive but it is possible to see a doctor over the internet that works for a dispensary in another state and have them issue you a prescription if you fit the criteria for medicinal cannabis.
I was cynical about the idea of these dispensaries having their own in house doctors but upon further thinking it makes sense since some doctors still don't acknowledge the medicinal benefit of cannabis.
Accessing medical cannabis is weird - each state has different access requirements and you must apply in the state(s) you practice in for permission (which isn’t hard) and then to the TGA for approval to prescribe.
The industry/clinic space is really bizzare.
I have been bombarded with requests to work as a telehealth prescriber. Because of the restricted product supply, ‘clinics’ are popping up to offer telehealth consults and then push their products.
There are multiple issues with this:
- the doctors doing the prescribing are often junior doctors, not GPs or pain specialists
- they have a limited supply of stock and no real understanding of ‘what is right when’
- pretty much all the stoners I know have now switched to medical marijuana (which is fine but for the next point)
- the TGA will at some point come down on doctors who are doing shitty consults and just writing the prescription with a cursory ‘whatever’ - because the TGA and medical board in this country are not as toothless as in the US
So basically anyone can get a prescription, and the clinics are pushing their own (or their own imported) product so they get fat margins, and there’s some médico-légal risk.
Over time (and even now) there are increasing numbers of GPs who can prescribe and there are websites that can point you to them which is what I’d recommend if you or a loved one actually has a medical condition, as opposed to just wanting to get stoned.
It’s still a fantastic step in the right direction, giving medical practitioners the flexibility to explore new medicines for treatment. I know my perception of these substances changed after reading How to Change your mind by Michael Pollan: https://michaelpollan.com/books/how-to-change-your-mind/
I believe the parents point is that Australia is lagging behind other countries in regards to legalisation of marijuana. So it’s surprising to see Australia leading the charge with psychedelics.
Is it? Legislation for entertainment and for medical use can be very independent. Different groups would push for either, with not necessarily that much overlap of interest. (And different level of requirements/restrictions)
Yes, and people who want to get high have the choice between purchasing non-medical marijuana illegally or medical marijuana illegally. Because 'I want to get high' isn't a legitimate reason for prescription, so instead people lie to a Doctor to gain access to a controlled substance. I'm not sure which is legally considered the worse crime.
I am not the GP but for me it is when therapists strike at the same weaknesses you're still trying to get over, and aren't tolerant of the ensuing negativity or wounds that are reopened. From my understanding the person in therapy has to be at their most vulnerable to receive the most effective care, and if you happen to pick a therapist that disagrees with your state of mind at your most vulnerable moments, then that only validates your existing fears. "You should see a therapist" has been said to me (and I'm sure countless others) without any indication that therapy is only a tool that works on some and not others. It also doesn't encapsulate that you have to have a strategy in place for how you use therapy, you have to do the majority of the work yourself, and if you choose a therapist that doesn't accept your worldview, however flawed it is at the time, you could validate your deepest fears all over again. I thought I at least understood those parts but I wasn't prepared for the rest, namely that therapists (for the time being) are human, and by nature of being human will always be infallible
One of my (many) issues was fear of expressing my own feelings. (For reasons that will become clear it still is) I wasn't in complete denial of this at the time and in fact wrote a fairly long document "outing" myself, my past history and my behavioral tendencies so my therapist wouldn't be fooled by the unconscious things I said or did. It was because therapy has to be based on self-reporting because the therapist can't read your mind, so what you say to them will influence the advice they give. I had unconsciously trained myself to speak in such a way that whatever help they would give would be irrelevant to my actual situation by way of omitting details or blowing up issues out of proportion and I could eternally vent to them without getting over any of my problems. I understand this is wrong. It wasn't productive at all; it was a defense mechanism I put up to avoid talking about my feelings under the guise of being "gifted" like I had been labeled in my early years. This was what I wanted to unroot with my last therapist and though a part of me hated how I was trying to "test" them I was going to have these tendencies anyway so I thought it was better if I tried to be vulnerable about them upfront
In response to that long document of self-reflection my therapist at the time raised his voice at me and the one thing I can remember him saying was that he "was only human." I interpreted this to mean only a super-human was capable of dealing with me; that he was frustrated by something he couldn't understand. I brought this up with him but it seemed to just glance off. In fact, I realized that the entirety of my document where I had for the umpteenth time exposed my darkest feelings to a stranger had been glanced over. And indeed this exact fear of vulnerability was one of the problems I was wanting to work over with him, and now that fear had become a lot more justified in my mind. I hadn't even gotten to talking about that fear because there was still so much about myself that I hadn't written about yet and I was still planning to. Or rather, had yet to expose unjustifiably (at least how I felt in the moment). Certainly I wasn't going to write about myself anymore. I realized my latest therapist was just another person in a long line of people throughout my life, supposed friends and relatives included, for whom trying to be vulnerable only resulted in more harm to my psyche than good. And over the course of my life up to this point, that was a consistent pattern with other therapists, whether or not I was paying the person to listen. It felt like I was preventing my actual voice from being heard, and any attempt at metacognition to point at myself and say "this is the real problem, not any of the gobbledygook I was spouting earlier" was for some reason always stamped out,...
That's true. But we already have millions of people globally taking long term SSRI medication for depression - many are prescribed it with barely a thought, and little more diagnostic vigour than "oh, they said they're depressed, so here, take these pills for a year".
And in my deep experience of that area, no recreational drug I ever took (which includes quite a few!), had even a shadow of the lasting, foundational changes and effects that SSRIs have. Permanent mood alteration and permanent sexual dysfunction are just two of the common outcomes.
No so-called recreational trip (or series of trips) I ever had, resulted in that kind of monumental systemic effect.
This is true. And it's really not talked about enough.
And when you do talk about it, little beetles crawl out of the woodwork to tell you that ackshully, lots of people get help from SSRIs and you need to stop shaming them and scaring them.
So let's never mention the suicidal ideation, the tardive dyskinesia, the massive weight gain and metabolic destruction; because the psychiatrists "believe" in the SSRIs (though we don't even have a great theory how they work, or strong data that they do).
But oh, those scary mushrooms - don't you know you might have a bad trip and see stuff that isn't there; like in a dream or at a movie - oooh, spoooky.
I understand there's a rhetorical thing going on here where you're inverting the meaning while keeping the same structure, but what are you actually arguing? People should be taking shrooms instead of going to therapy?
I'd put them both, and their combination, on an equal footing.
Therapists are not infallible and like all people vary in skills and competence. Not everyone is going to benefit from therapy and for some people it will be harmful. Ditto for shrooms.
Given the expense and lack of access to therapists, for many people trying mushrooms first is probably a good option. You could have a bad time but it's very much dose dependent. Most people will just laugh a lot. Taking a massive dose and not being prepared for the things lurking in your subconscious is most definitely not recommended.
It's the usual story: if they were legal you'd have much more control over strength, variety and usage. Less people would be harmed and more people would benefit.
My original point was that the warning from the experts sounds pretty hollow and pointless. I don’t know why they even bothered to print such an empty statement.
If antidepressants are known for anything, it’s the side effects. It seems people must still go through these before psychedelics, what a shame. Hopefully this will change over time. We need more data, but I have a feeling there will be fewer side effects compared to current treatments.
> MDMA - also known as the party drug ecstasy - is a synthetic drug that acts as a hallucinogen.
This is misleading. It's 3,4-Methylenedioxymethamphetamine, an amphetamine and a stimulant. It has minor psychedelic effects and no one in their right mind would consider it a hallucinogen.
It does sound kind of misleading, but the nomenclature is correct. It's being used in the broad sense of hallucinogen (ie the drug is a dissociative, deliriant, or psychedelic). MDMA definitely has psychedelic effects, though less pronounced than eg MDA and much less pronounced than eg LSD.
Does it though? In my (and friend's) experience it intensifies emotions and senses but doesn't produce anything new, nor is it so intense as to be a "deliriant". I can't help but think people are labeling this drug over broadly without controlled research, because of its illegal status.
Are you sure it was (reasonably) pure MDMA though? It tends to have a ceiling, besides the usual effects of having too much speed such as grinding teeth, rapid heartbeat and the like.
It's a question of definition, from pharmacological it is since it affects similar receptors as mescaline, but the effect is so mild that from users perspective it's not very mind altering.
Yes, in higher doses (or lower depending on varying personal sensitivities) one can experience psychedelic visual effects. These are much more pronounced when combined with cannabis.
A "deliriant" is an entirely different class of drugs to psychedelics. Very different indeed, with far more discrete hallucinations, indistinguishable from reality, like a waking dream.
calling MDMA an amphetamine is technically (i.e. structurally) correct but also misleading. it's structurally an amphetamine, but so are DOB, Sudafed and Wellbutrin. it's stimulating, but in a different way from regular amphetamines, because it doesn't release dopamine.
the psychedelic effects are lesser than e.g. DOB, but if you look at its cousin MDA you can see it's on the spectrum of psychedelia. a better category for MDMA is "empathogen/entactogen."
> calling MDMA an amphetamine is technically (i.e. structurally) correct but also misleading. it's structurally an amphetamine, but so are DOB, Sudafed and Wellbutrin. it's stimulating, but in a different way from regular amphetamines, because it doesn't release dopamine.
MDMA is more selective for serotonin, but it does release dopamine as well.
Comparing it to Wellbutrin, a nonstimulant, is far more misleading. MDMA is an amphetamine, and it acts similarly (but not identically) to other amphetamines that people are familiar with.
The requirement that, for the entire (up to 8-10 hour) duration of the trip, a suitably qualified therapist be on hand, must dictate that each non-trivial dosage under this regime will have a ticket price of several thousand dollars per-time.
It's one of the catch-22s in medicine. That a poor person on the street can have the same experience for $50 as a rich person has for $5000, with the difference in cost being the literal $4950 more of specialists and testers and monitors and side experts that the rich person is paying for. For reasons, yes, but that doesn't change the numbers, the fact that for every one of the latter there are 10 of the former.
> poor person on the street can have the same experience for $50 as a rich person has for $5000
Not the same. You mentioned the ongoing support through the whole trip already. Then there's guidance for the purpose of the experience rather than possibly just getting lost in the feeling/escape. Then there's validated source/safety of the drugs. Finally, if anything goes wrong, you have a person hopefully trained in how to respond immediately.
That is basically the qualification I included in my later statements within the same post:
"..the difference in cost being the literal $4950 more of specialists and testers and monitors and side experts that the rich person is paying for. For reasons, yes..."
The PBS won't cover the drug portion of the treatment at least until there's good quality stage 3 clinical trials that support it's use. Even then, given the need for a long therapy session next to the drug, they'll likely have to create a special access scheme to cover both.
I'd say it's very unlikely that these treatments will ever be government subsidied for anything except very treatment resistant depression/PTSD (for psilocybin/MDMA respectively).
51 comments
[ 4.7 ms ] story [ 132 ms ] thread> The regulator says there are currently no approved products that contain MDMA or psilocybin. However the reclassification means psychiatrists will be able to access and legally supply certain medicines that contain them, even if they have not been evaluated for safety or effectiveness.
How exactly is this supposed to work then? Are psychiatrists supposed to order MDMA/psilocybin directly from the companies that produce the two for research use, which presumably involves fearsome bureaucracy and markups?
It sounds like this would make the law effectively a dead letter until a regular pharma company goes through the Australian approval process and gets the drugs into pharmacies. Medical marijuana in Australia has suffered from similar issues, with an onerous approval process in many states making it very difficult to get a prescription.
Treatment centers could grow them on site pretty easily needing only basic cleanliness to avoid contamination.
As I understand it, yes.
Legalisation hasn't meant it has gone mainstream.
It is still going to be administered in very selective cases where the current range of medication and therapy has not been effective.
It may only be tens or low hundreds of people who receive these treatments in the first year.
The efficacy of the treatment will be monitored and the hope is that these patients outcomes are positive, which will add to the body of work supporting MDMA/psilocybin as an antidepressant.
Yes I imagine the next step is a local supplier company goes through the valid approval process and gets their product approved.
>Medical marijuana in Australia has suffered from similar issues, with an onerous approval process in many states making it very difficult to get a prescription.
I live in NSW so maybe I am a bit naive but it is possible to see a doctor over the internet that works for a dispensary in another state and have them issue you a prescription if you fit the criteria for medicinal cannabis.
I was cynical about the idea of these dispensaries having their own in house doctors but upon further thinking it makes sense since some doctors still don't acknowledge the medicinal benefit of cannabis.
The industry/clinic space is really bizzare. I have been bombarded with requests to work as a telehealth prescriber. Because of the restricted product supply, ‘clinics’ are popping up to offer telehealth consults and then push their products.
There are multiple issues with this:
- the doctors doing the prescribing are often junior doctors, not GPs or pain specialists
- they have a limited supply of stock and no real understanding of ‘what is right when’
- pretty much all the stoners I know have now switched to medical marijuana (which is fine but for the next point)
- the TGA will at some point come down on doctors who are doing shitty consults and just writing the prescription with a cursory ‘whatever’ - because the TGA and medical board in this country are not as toothless as in the US
So basically anyone can get a prescription, and the clinics are pushing their own (or their own imported) product so they get fat margins, and there’s some médico-légal risk.
Over time (and even now) there are increasing numbers of GPs who can prescribe and there are websites that can point you to them which is what I’d recommend if you or a loved one actually has a medical condition, as opposed to just wanting to get stoned.
So young people who want to get high have to go to drug dealers who also offer meth and other drugs.
Thanks, conservative Australian politicians.
All psychiatric treatments have a risk of a bad experience, including talk therapy.
Don't ask me how I know this.
Don't ask me how I know this.
One of my (many) issues was fear of expressing my own feelings. (For reasons that will become clear it still is) I wasn't in complete denial of this at the time and in fact wrote a fairly long document "outing" myself, my past history and my behavioral tendencies so my therapist wouldn't be fooled by the unconscious things I said or did. It was because therapy has to be based on self-reporting because the therapist can't read your mind, so what you say to them will influence the advice they give. I had unconsciously trained myself to speak in such a way that whatever help they would give would be irrelevant to my actual situation by way of omitting details or blowing up issues out of proportion and I could eternally vent to them without getting over any of my problems. I understand this is wrong. It wasn't productive at all; it was a defense mechanism I put up to avoid talking about my feelings under the guise of being "gifted" like I had been labeled in my early years. This was what I wanted to unroot with my last therapist and though a part of me hated how I was trying to "test" them I was going to have these tendencies anyway so I thought it was better if I tried to be vulnerable about them upfront
In response to that long document of self-reflection my therapist at the time raised his voice at me and the one thing I can remember him saying was that he "was only human." I interpreted this to mean only a super-human was capable of dealing with me; that he was frustrated by something he couldn't understand. I brought this up with him but it seemed to just glance off. In fact, I realized that the entirety of my document where I had for the umpteenth time exposed my darkest feelings to a stranger had been glanced over. And indeed this exact fear of vulnerability was one of the problems I was wanting to work over with him, and now that fear had become a lot more justified in my mind. I hadn't even gotten to talking about that fear because there was still so much about myself that I hadn't written about yet and I was still planning to. Or rather, had yet to expose unjustifiably (at least how I felt in the moment). Certainly I wasn't going to write about myself anymore. I realized my latest therapist was just another person in a long line of people throughout my life, supposed friends and relatives included, for whom trying to be vulnerable only resulted in more harm to my psyche than good. And over the course of my life up to this point, that was a consistent pattern with other therapists, whether or not I was paying the person to listen. It felt like I was preventing my actual voice from being heard, and any attempt at metacognition to point at myself and say "this is the real problem, not any of the gobbledygook I was spouting earlier" was for some reason always stamped out,...
That is what I was getting at - if the therapy is bad, there is a chance you can get out before it gets too bad and "save yourself".
Once you take the shrooms, there is no antidote, and there is no going back. No damage mitigation.
Sorry either way...
And in my deep experience of that area, no recreational drug I ever took (which includes quite a few!), had even a shadow of the lasting, foundational changes and effects that SSRIs have. Permanent mood alteration and permanent sexual dysfunction are just two of the common outcomes.
No so-called recreational trip (or series of trips) I ever had, resulted in that kind of monumental systemic effect.
And when you do talk about it, little beetles crawl out of the woodwork to tell you that ackshully, lots of people get help from SSRIs and you need to stop shaming them and scaring them.
So let's never mention the suicidal ideation, the tardive dyskinesia, the massive weight gain and metabolic destruction; because the psychiatrists "believe" in the SSRIs (though we don't even have a great theory how they work, or strong data that they do).
But oh, those scary mushrooms - don't you know you might have a bad trip and see stuff that isn't there; like in a dream or at a movie - oooh, spoooky.
Therapists are not infallible and like all people vary in skills and competence. Not everyone is going to benefit from therapy and for some people it will be harmful. Ditto for shrooms.
Given the expense and lack of access to therapists, for many people trying mushrooms first is probably a good option. You could have a bad time but it's very much dose dependent. Most people will just laugh a lot. Taking a massive dose and not being prepared for the things lurking in your subconscious is most definitely not recommended.
It's the usual story: if they were legal you'd have much more control over strength, variety and usage. Less people would be harmed and more people would benefit.
If antidepressants are known for anything, it’s the side effects. It seems people must still go through these before psychedelics, what a shame. Hopefully this will change over time. We need more data, but I have a feeling there will be fewer side effects compared to current treatments.
This is misleading. It's 3,4-Methylenedioxymethamphetamine, an amphetamine and a stimulant. It has minor psychedelic effects and no one in their right mind would consider it a hallucinogen.
Does it though? In my (and friend's) experience it intensifies emotions and senses but doesn't produce anything new, nor is it so intense as to be a "deliriant". I can't help but think people are labeling this drug over broadly without controlled research, because of its illegal status.
The mechanism of action of mdma makes anything above normal somewhat redundant.
the psychedelic effects are lesser than e.g. DOB, but if you look at its cousin MDA you can see it's on the spectrum of psychedelia. a better category for MDMA is "empathogen/entactogen."
MDMA is more selective for serotonin, but it does release dopamine as well.
Comparing it to Wellbutrin, a nonstimulant, is far more misleading. MDMA is an amphetamine, and it acts similarly (but not identically) to other amphetamines that people are familiar with.
I'm also not sure you can claim that Wellbutrin isn't a stimulant, since it's a dopamine and norepinephrine reuptake inhibitor.
Also expensive.
The requirement that, for the entire (up to 8-10 hour) duration of the trip, a suitably qualified therapist be on hand, must dictate that each non-trivial dosage under this regime will have a ticket price of several thousand dollars per-time.
It's one of the catch-22s in medicine. That a poor person on the street can have the same experience for $50 as a rich person has for $5000, with the difference in cost being the literal $4950 more of specialists and testers and monitors and side experts that the rich person is paying for. For reasons, yes, but that doesn't change the numbers, the fact that for every one of the latter there are 10 of the former.
Not the same. You mentioned the ongoing support through the whole trip already. Then there's guidance for the purpose of the experience rather than possibly just getting lost in the feeling/escape. Then there's validated source/safety of the drugs. Finally, if anything goes wrong, you have a person hopefully trained in how to respond immediately.
"..the difference in cost being the literal $4950 more of specialists and testers and monitors and side experts that the rich person is paying for. For reasons, yes..."
I'd say it's very unlikely that these treatments will ever be government subsidied for anything except very treatment resistant depression/PTSD (for psilocybin/MDMA respectively).