Legalising Illicit Therapies: Why Psychedelics Could Be The Most Important Mental Health Breakthrough Of The 21st Century
Many years ago, I was interviewing Aussie musician Ben Lee about a new album when our chat fell into the topic of ayahuasca — a plant-based psychedelic that has been used for centuries by the First Nations people of several South American countries. Lee had attended an ayahuasca retreat, at the time increasingly popular for Western spiritualists seeking a mind-altering experience. He told me it had been transformative, but back then, it had seemed to me such a wild, inaccessible notion; flying to a far-flung corner of the Amazonian forest, drinking psychedelics that had been known to kill people with a local shaman, and discovering the meaning of life for as little as $800 USD (£580).
Flash forward almost a decade later, and psychedelics are seeing a renaissance beyond the dark corners of the Amazon as a mind-altering substance that promises to heal several different mental health issues in just a single session — in fact, they’ve become so mainstream, even Gwenyth Paltrow’s Netflix series The Goop Lab sent their staff to try it out alongside the best diets for anti-ageing, and how to work out if you’re secretly psychic.
Yet despite the penchant for placing psychedelic therapy into the woo-woo wellness box, a torrent of clinical and scientific studies all seem to point towards psychedelics having the potential to deliver one of the biggest mental health revolutions of the 21st century. The only problem is, they’re illegal.
What can psychedelics offer us?
Although the use of psychedelics stretches back many hundreds of years in human history, their use as a modern mental health therapy started to gain steam in the late 1950s. Hallucinogens like LSD were showing immense promise in research-based treatments for alcoholism and a litany of mental health disorders, but due to their connection to ‘hippy’ culture, politics stepped in to all but halt the research in its tracks.
It wasn’t until the '90s that interest in psychedelics as a form of therapy popped up again in neurobiological research — this time, broadening to include ketamine and MDMA. Since then, hundreds of reports have been released following psychedelic therapy trials, supporting the use of psychedelics in mental health treatment — and showing huge potential for incredible and life-changing results.
More importantly, however, recent trials are showing that psychedelics are proving not only successful but also incredibly effective when stacked up against traditional forms of treatment, with one recent trial reporting that they are up to four times more effective than antidepressants. For those with conditions that have proven to be treatment-resistant for depression over many years, a 2016 study found that two-thirds of all participants were in remission after a mere week of psilocybin (magic mushroom) therapy.
Dr. Prash Puspanathan, a doctor with a background in psychiatry who has spent many years embedded in psychedelic therapy research, tells me these results aren’t unique. “The results from studies have been incredibly dramatic in terms of the improvements of mental health outcomes,” he says. “The principle point of difference that I would point out is that firstly the side effect profile and the physiological after-effects of psychedelics as opposed to even something that is so commonplace as anti-depressants, it’s quite dramatically different.”
“Most psychiatric drugs and medication come with a ridiculously long list of side effects, from something as simple as weight gain to mood instability — I could go on listing these. Psychedelics seem to have none of that.”
“Even if you’re not talking about medication — and medication often tends to be months, years, if not lifelong — then the psychotherapy, or talk therapy, is a very long term process. There’s often years of learning that needs to be unlearned. Psychedelic therapy tends to be almost surgical in its action. It’s often one, two or three sessions, which seem to produce dramatic long term effects.”
“The intensity of the learning that can happen in one session, compared to 6-12 months of psychotherapy, quite a dramatic difference.”
“The key difference that is often forgotten is that there’s a huge difference between recreational use and clinical use”
It’s something that 28-year-old Makayla Herdman, owner of the holistic skin clinic House of Maxx in Melbourne, has found during her personal experiences with microdosing. Herdman openly shares the journey and effects of her own psilocybin self-treatments with her followers on her Instagram.
“Like most people, I had this stigma around psychedelics, that it was somewhat of a party drug for hippy festival-goers that didn't mind risking being trapped in a bad trip,” she tells me. “So I didn't actually experience mushrooms until May 2020.”
“It took me maybe 2 or 3 more tries until I had a 'breakthrough' experience… The best way to describe the experience, and something you will hear from regular users, is an 'ego death'. I had the epiphany that I am a tiny cog in this massive wheel of life... This carried on for weeks after the trip, and I felt like I had been taken completely out of the scramble within my head and placed back in my body.”
“[Microdosing] is like waking up on the right side of the bed, in a productive mood after your morning coffee. You're positive and just get shit done! Overall my trips have been positive and gentle. Think 'lightbulb moments'.”
Crystal Fong, a 36-year-old Creative Director based in Melbourne, has also found success in self-treatment with psychedelics, having experimented with varying doses of DMT, ayahuasca, psilocybin, LSD and ketamine.
“Psychedelics turn my hard-to-reach layers into liquid,” she explains. “I'm a complex person, and they give me the power to read my mind… Trauma is an intricate beast, and it's amazing what we — as humans — do to avoid and bury it. We develop coping mechanisms that we're often blind to. Psychedelics, in the right dose and with the right care, can help us unpack trauma and dissect all the sticky layers.”
However much Fong is an advocate of the healing power of psychedelics, she is also quick to caution that such substances can also be dangerous if not applied in the correct setting, with the correct substance, and at the correct doses — something that Dr. Puspanathan echoed during our chat.
“The key difference that is often forgotten is that there’s a huge difference between recreational use and clinical use,” he tells me. “It is as different as trying to draw a comparison between morphine that your doctor gives you in hospital and street heroin that you’ve bought on the side street in Richmond. They are that different.”
“Particularly with MDMA – the purity of street MDMA in Australia is probably about 20-30%, and that’s being generous… If you’re drawing data or anecdotal evidence based on what you feel is an understanding of the risks that you associate with recreational MDMA use, you might as well be talking about a completely different substance.”
"The risk, when they’re not being utilised by practitioners who have the adequate level of training or in the appropriate settings, is far greater than any benefit than they can do"
So what exactly is it that these substances do to our brains that create such dramatic changes in our minds?
Dr. Puspanathan tells me the short answer is, we don’t really know yet. He tells me that it mostly affects our ‘default mode network’ — basically the paths that many of our subconscious thoughts travel through most commonly in our brain. These ‘paths’ deepen over time, encouraging us to make connections in the same way over and over again, like skiers following marked runs on the ski slopes.
He explains that psychedelics are like triggering an avalanche, wiping out those frequently trodden paths. “All of a sudden, a myriad of new routes are available to you, going down the slopes. Perspectives change, and paradigms shift, and new ways of seeing old things appear.”
“Most of our problems are that we get stuck into these patterns — behavioural patterns and cognitive loops — and we can’t break out of them because they’re so deeply ingrained. And so an opportunity to kind of ‘avalanche them away’ can be quite revolutionary.”
And when you’re talking avalanches in reference to the entire way you see the world, you can start to see why most advocates of these therapies — including Puspanathan — believe that legalisation in a clinical sense does not mean they support the general legalisation of these substances in a recreational setting.
“These are powerful substances, and they’re not to be bandied about with,” says Puspanathan. “The risk, when they’re not being utilised by practitioners who have the adequate level of training or in the appropriate settings, is far greater than any benefit than they can do. Therefore caution, and a measured process of injecting these into the mainstream — and one that is principally being guided and advised by researchers and clinicians, not by commercial interests or non-scientific advocacy groups — is paramount.”
So, where does Australia sit compared to the rest of the world in legalising the use of such treatments?
Although these treatments are currently not legal outside of a research setting, some encouraging work by experienced advocates of psychedelics for mental health treatment is seeing small movements toward overturning public and government sentiment.
Earlier this year, the Australian government announced a $15 million fund to inject money into psychedelic research for mental health, and despite Australia’s medical regulator, the TGA, rejecting an application earlier this year to move the substances from schedule 9, currently rating them a ‘prohibited substance’, to a schedule 8 ‘controlled medicine’.
Opioids sit in schedule 8, for example, because although it’s illegal to use heroin for recreational use, morphine is used in hospitals for anaesthetic.
The schedule change is something that Tania de Jong, Executive Director at Mind Medicine Australia, is passionately advocating for.
The current tools that doctors and psychiatrists have just aren’t good enough – they’re not fit for purpose,” de Jong tells me. “There’s been no innovation in treatment for mental illness in 50 years… we speak to psychiatrists who are still alive today, who were treating patients in the 60s, and they remember that as the most exciting period in their careers – when they were getting people well, and out of the system.”
Mind Medicine, a registered charity launched in 2019 to build education and awareness of psychedelic treatments for mental health, is hoping for the TGA approval soon, as they ready medical and mental health professionals for the change with Australia’s first 4-month, part-time certificate course in psychedelic-assisted therapies.
“It’s to actually train people to work with patients and take them through from screening to building rapport, through to the medicinal sessions and integration sessions,” she tells me. “They administer the medicines, and they help the patient integrate their experience.”
“It really fast tracks the therapeutic process. Some patients describe it as 15 years of psychological therapy in one session. It’s quite amazing. Many people who go through these treatments describe it as one of the five most meaningful experiences in their life. Who says that about a medicine?”
"If psychedelics were legalised, we'd have more confidence in the quality of the medicine. Most importantly, we'd know what to do with the learnings from each trip"
Yet despite the overwhelming potential of these substances to do immense amounts of good during a time that our government is repeatedly referring to as a ‘mental health emergency’, it hasn’t been an easy run.
“In general, it’s been a shit fight, to use a technical term,” says Puspanathan. “One, to convince the mainstream, or even to convince scientists and clinicians. Even though all the evidence back up that these are one of the safest drugs you will prescribe.”
“Even though the evidence backs it up, the stigma is long-standing. And breaking down that stigma— even among scientists, who you would think would be able to fall back on the evidence — it’s quite difficult. People get stuck in this loop of ‘drugs are bad’. Well, why are they bad? ‘Because they’re illegal’. Why are they illegal? ‘Because they’re bad’.”
“This conflation of morality, and right and wrong, with the truth turns it into a really confusing space. There’s so much misinformation over the years so deeply steeped into the consciousness — it’s a hard barrier to overcome.”
Even casual, underground users like Crystal Fong are concerned with the unintended effects of having these substances classified as illegal. Often those seeking out these substances are subject to sourcing them via unregulated means, and taking them in environments without the support of a mental health professional to guide them through their potentially mind-altering discoveries.
“Revisiting trauma is dangerous and can damage us further if we're not in a safe environment,” says Fong. “Reintegration can be tough. Right now, reintegration comes down to self-education, journaling and having an open-minded therapist to talk to. If psychedelics were legalised, we'd have more confidence in the quality of the medicine. Most importantly, we'd know what to do with the learnings from each trip.”
Makayla Herdman disagrees, however.
“I personally don't feel like a western doctor could help me with psychedelics, as it is such a spiritual and personal journey of self-discovery.”
“I would love to see natural therapies become more mainstream and accessible. However, they require a lot more time and care with the client than the medical system currently gives, to understand the many moving parts. It would take a holistic and integrative approach to be successful - and after naturopathy has been taken off private health, I don't have much faith that it will be accessible anytime soon.”
Despite the legal hurdles ahead, psychedelics undoubtedly herald a new era in mental health treatment — underground or not. From regular self-administration and microdosing for an everyday mood lift, through to the compelling research suggesting that an effective treatment for devastating and life-threatening conditions like PTSD, addiction, suicide ideation, anxiety and depression is just beyond the horizon, the incredible potential of these substances cannot be ignored.
“It’s completely unethical to withhold these treatments any longer from those who are suffering,” de Jong says. “There have been over 160 recent and current trials taking place; the medicines are considered extremely safe, effective and non-addictive.”
“The elephant in the room is the lack of innovation in treatment. We can increase access gateways, train more therapists, provide more telehealth sessions, subsidise more sessions, all sorts of things. But if the practitioners don’t have the treatments to get their patients well, then really nothing is going to change.”