Classification of both MDMA and psilocybin – more commonly known as magic mushrooms – changed in July to permit specifically authorised psychiatrists to prescribe the drugs for treatment of certain mental health conditions.

Those suffering from post-traumatic stress disorder (PTSD) can receive MDMA in conjunction with psychotherapy, while psilocybin is siloed for treatment-resistant depression. Australia was the first country in the world to take this step.

But at the time of writing, there’s not one authorised psychiatrist in South Australia able to prescribe the medication. Doctors need to be approved under the Authorised Prescriber Scheme by the Therapeutic Goods Administration following approval from a human research ethics committee, and none have managed to pass through these hoops yet.

These standards are necessary, the TGA says, to ensure prescriptions are granted under strict controls that ensure the safety of patients.

The sessions are also expected to be expensive, requiring two psychiatrists and pre- and post-therapy sessions, not to mention the cost of the drugs themselves.

Jörg Strobel is one South Australian psychiatrist who is hoping to prescribe the psychedelics and said that though the drugs have been proven to assist those suffering from the most severe treatment-resistant mental illnesses, they can be harmful if administered incorrectly.

“Patients are in very vulnerable and malleable mental states,” said Strobel, who has more than 30 years of experience in psychiatry.

Administration of the drugs would likely involve two therapists who would monitor the patient for up to eight hours and conduct the psychotherapy session.

“That’s a costly process – two professionals for 16 hours in total – and then in addition you have preparatory sessions and sessions afterwards.

“$20,000 per treatment is being bandied around.”

Strobel says that even once psychiatrists are approved to prescribe the medication by the TGA, many potential patients will be unable to afford the treatment without government support.

“It’s expensive, and at the moment Medicare doesn’t have any sort of schedule numbers for this service provision, and the private insurance industry is also at the beginning of getting their head around how to fund this,” he said.

“Between the rescheduling of the drugs and having readily accessible clinics there is still a big gap because of these practical things.

“As an early adopter, I would be quite happy to do a few sessions on a pro bono basis, but it requires more than me and you cannot scale that model.”

Psychedelic therapy hope for desperate patients

Mind Medicine Australia was behind the push to have the two psychedelics reclassified, and co-founder Tania de Jong stressed to InDaily that those desperate for the treatments should not lose hope despite the current barriers to access.

Her Melbourne-based organisation – a registered charity – has been training hundreds of psychiatrists through its Certificate in Psychedelic-Assisted Therapies since 2021.

The course teaches therapists how to work with patients in altered states and the provision of psychedelic-assisted therapy under the TGA’s new rules.

“One of the really transformational aspects of the treatments is that they do take patients into altered states, and in those states the patients’ brains and minds can become more flexible,” de Jong told InDaily.

“They can experience what’s called a neurogenesis of the brain, and that makes it much easier for a trained therapist to work with a patient to get much more rapid healing and transformations.”

She added that cost estimates of the sessions – while expensive at first glance – were probably on par to years of traditional treatment that might not work for certain people.

“If you think about how many psychiatric medications and how much psychotherapy a patient might do who’s not getting well over the course of years the costs actually shoot out to far greater,” she said.

“The length of these illnesses can be a lifetime unfortunately, and we’re starting to see a lot of interest emerging from governments and health insurance in this space.

“We’ve also started a patient support fund to encourage people to make donations to help subsidise patients who otherwise couldn’t afford to have the treatment.”

Companies are also making good progress in terms of readying the infrastructure required to treat patients. Just this week, Melbourne-based Incannex Healthcare announced its subsidiary Clarion Clinics Group was accepting registrations of interest for MDMA/psilocybin-assisted therapy.

The first clinic in Abbotsford, Melbourne, is nearing fit-out completion, and the company will commence treatments following final approval from the TGA.

“This is the first step in the process towards receiving treatment and we anticipate that there will be a high level of interest in our leading-edge treatments,” Clarion director Peter Widdows said.

But back in Adelaide, Strobel said there were some missing pieces that needed to be placed before local treatment could kick off.

“I don’t experience any particular pushback from any level of government or institutions to have to set things up, but my question is to what extent are they internally driving the development of the missing pieces?” he said.

“The government certainly has the option to be helpful in a very active way, but I’m not sure where they are up to in their internal thinking.

“The communication publicly needs to be that ‘good things take time’ so we don’t raise unrealistic expectations and add to the frustrations and suffering of people who feel their hopes are being dashed.”