Evidence “not there yet” for therapeutic use of psychedelics, say key players

The evidence to support the widespread use of psychedelics in the treatment of mental health conditions is lacking, say representatives of key stakeholder groups interviewed for a research paper published today.  

The paper’s publication in the latest issue of Public Health Research & Practice, a peer-reviewed journal of the Sax Institute, follows the Therapeutic Goods Administration’s controversial decision to allow approved psychiatrists to prescribe MDMA (ecstasy) to those suffering post-traumatic stress disorder and psilocybin (magic mushrooms) for some types of depression from 1 July this year.

The study investigators from Monash University in Melbourne conducted in-depth interviews with representatives from a range of key Australian stakeholder organisations involved in psychedelic drug law reform, clinical use or regulation. They included state and federal politicians, along with senior members of peak bodies representing clinicians impacted by the introduction of psychedelics, a mental health consumer body and a union representing workers in mental health services. Participants were interviewed just ahead of the surprise TGA decision to approve clinical use of the drugs, and were asked to comment on the position of their organisation or political party, rather than their own personal views, to identify issues that could impede use of psychedelics in clinical practice.

While participants were “cautiously optimistic” about using psychedelics to treat mental health conditions, they were hesitant to support their widespread clinical implementation due to the perception of poor quality of evidence and negative stigma around their use.

In particular, they noted the immature research base on the use of psychedelics in mental health, as well as their methodological flaws such as small sample sizes, short durations and the use of participants who were not representative of the general population.

“We don’t want to run before we walk. We want to make sure there’s a really good evidence base behind this,” was how one participant representing a clinical peak body put it.

Many interviewees (who can’t be identified due to study ethics requirements) wanted to see more research into the cost-effectiveness of psychedelics and the feasibility of their use in Australia, in terms of the type of clinicians needed to prescribe them, service cost and ways to ensure equity.

“No studies yet exist for cost-effectiveness in an Australian context,” the study authors note.

Where pharmaceutical-grade psychedelics will be obtained, how they will be regulated, and the costs and potential subsidies for medicines and associated therapies are among the many unknowns around psychedelic use as therapy, the authors add.

Another theme that emerged from the interviews was the need for clear and consistent messaging about treatment to combat negative stigma and gain support among the general public.

“These findings suggest significant effort may be required to convince those charged with designing legislation and supporting clinicians about the role of psychedelic assisted options in treating mental health conditions,” the authors write.

Another paper in this issue of the journal looks at loneliness and social isolation as global health challenges. Leading international researchers in the field of loneliness, including authors from the University of Sydney, identify three priority areas to reduce the impact on health: strengthening the evidence base; adopting a whole-of-systems approach; and developing support for governments worldwide to take action on loneliness.

Other papers look at:

In an editorial for this issue, PHRP Editor-in-Chief Professor Don Nutbeam looks at the desire to  “move on” from the COVID-19 pandemic, and suggests it may not be as simple as we would wish for.

Although the extraordinary breakthroughs in vaccines and COVID treatments have provided protection and mitigation from many of the serious health consequences, “the challenge to protect the most vulnerable from infection remains,” Professor Nutbeam writes.

Please acknowledge Public Health Research & Practice as the source for any stories on our papers. The link to the paper on the therapeutic use of psychedelics is https://doi.org/10.17061/phrp3332321.