Formerly prohibited drugs have been approved as psychedelic medicines to treat mental health conditions. How can we boost support for this world first?
From July 1, 2023, MDMA and psilocybin will move from ‘prohibited substances’ to ‘controlled drugs’ for treating post-traumatic stress disorder (PTSD) and treatment-resistant depression.
Australia will be the first in the world to allow the prescribing of these medicines by approved psychiatrists. This is building on the highly promising outcomes in large-scale clinical trials overseas.
The Therapeutic Goods Administration (TGA) in February 2023 approved the use of 3,4-methylenedioxymethamphetamine, or MDMA (the active ingredient in ecstasy) and psilocybin (the active ingredient in magic mushrooms) for the treatment of post-traumatic stress disorder (PTSD) and treatment-resistant depression.
There is a mental health crisis in Australia. 43.7% of Australians have experienced a mental health condition during their lifetime. One in five Australians reported a mental health condition in the past 12 months but this doubled to 39.6% for young people aged 16-24 years. Rates of mental health conditions are higher in some groups including veterans, first responders, victim-survivors, and First Nations people.
The risk of developing PTSD is higher among Indigenous peoples, veterans, and first responders. Suicide rates have also increased in the last 20 years. Some professional groups are at greater risk of suicide including agriculture and construction. Veterans are also overrepresented in deaths by suicide, a topic currently under a Royal Commission investigation. Measures of psychological distress also increased significantly throughout the COVID-19 pandemic and have not returned to pre-pandemic levels. Demand for mental health services continues to exceed availability and people face long waiting lists.
The mental health crisis has a significant negative impact on sufferers, families and carers. It also impacts businesses and the economy. Something drastic needs to change to address this.
Clinical guidelines for PTSD consistently recommend both psychological (i.e. talking) therapies and pharmacological (e.g. selective serotonin reuptake inhibitor [SSRIs]) antidepressants as first-line treatments. However, SSRIs have been reported to have only small effect sizes. In contrast, a 2021 randomised, double-blind, placebo-controlled phase 3 trial that found MDMA-assisted therapy significantly improved PTSD symptoms for those with severe PTSD further complicated by comorbidities such as childhood trauma.
Key stakeholders in the space of mental illness (such as professional healthcare bodies and politicians, as well as the general community) are cautiously optimistic about the use of psychedelic medicines to treat mental health conditions, although many believe more research is needed before supporting the move. Since the TGA has just approved the controlled use of psychedelics based on existing evidence, we use findings from our own research to suggest three ways to get key stakeholders on board and set up the scheme for success.
Community members generally have a poor understanding of psychedelic-assisted therapies, thus communications should emphasise how treatments work, that treatments are medically supervised, and that treatments and associated research are strictly regulated.
Messages should be delivered using plain language that most can understand, and use personal stories, that evoke empathy. For example, the story of Cooper Wallace who has intractable epilepsy and found improvements in using cannabis oil was pivotal in changing political opinion that facilitated the push for cannabis decriminalisation.
Those with prior experience of mental health conditions (personally or as a carer), young adults, and more highly educated adults tend to be favourable toward the use of psychedelic medicines to treat mental health conditions. In order to increase support from groups who might be less supportive, such as older adults and those without experience with mental health condition, it is important to have them engage with materials and information about psychedelic drugs that appeals to their values, potentially shifting their attitudes from undecided or negative to at least neutral or even positive.
Al Gore’s ‘An Inconvenient Truth’ was a documentary outlining the threat of climate change as has been attributed to changing community attitudes and behaviours towards climate change (e.g. empowering people to fight climate change). In this example, Al Gore, the former US Vice President, could be seen as using his credibility as a leader to persuade people to trust his message.
Doctors and scientists are among the most trusted professions. Therefore, communications materials designed to persuade and convince people about the benefits of psychedelic medicines to treat mental health conditions must be delivered by these trusted entities. Collaboration between doctors, scientists, and the media could improve the quality of information being produced, while direct engagement of doctors and scientists with online platforms, including social media, could further leverage source credibility.
However, the message delivered by doctors and scientists must also be trustworthy to convince people to believe them. The message must also be honest and outline the strengths and weaknesses of the existing evidence base, including therapeutic benefits and longer-term effects, but also any concerns regarding adverse events.
The honesty used by the Victorian Chief Health Officer, Professor Brett Sutton, as well as his relatability saw him emerge as a key influencer during the COVID-19 pandemic, reportedly making news of new restrictions easier to accept.
We have needed a new pharmaceutical approach to managing severe mental health conditions for some time. Now the TGA has provided greater access to promising medicines, it is important that we get the roll out right to ensure those suffering have access to, what could be, an important ingredient to solving the mental health crisis.
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