Drugs Can Help

Medicine’s Double-Edged Sword Just Got Even Sharper

A. J. Li

WHAT DO YOU FIRST THINK OF WHEN YOU HEAR THE WORD “DRUGS?” There is no doubt that the word “drugs” has acquired quite a negative connotation in the modern vernacular. But now, these same drugs so often associated with shady dealings and illegal activities are now being used as a legitimate medical treatment in Australia – for the first time anywhere in the world.

Specifically, MDMA, known by recreational users as ecstasy, as well as psilocybin, the drug found in magic mushrooms, were legalised for prescription in their pure forms in July last year by the Therapeutic Goods Administration (TGA). They were approved on the basis of their conjectured efficacy in acting as an assistant therapy for those suffering from complex post-traumatic stress disorder (PTSD), and treatment-resistant depression. Despite being legalised mid-last year, the first dosages were only administered in late January in Melbourne. With new clinics opening up and advertising this new treatment, the debate has only grown fiercer over whether or not the TGA is truly looking out for the welfare of patients and whether the decision to legalise such drugs is grounded in empirical evidence or political pressure.

It is important to note that the new treatment is not a general treatment. It is not a new standard for treating patients suffering from emotional trauma. Only a subset of particularly affected patients suffering from PTSD and treatment-resistant depression whose current therapies are making minimal progress in their rehabilitation can qualify for MDMA or psilocybin treatment. According to Ted Cassidy, a Sydney psychiatrist whose patient was one of the few who underwent the new MDMA treatment in Melbourne, the drug can help highly traumatised patients who are too anxious to think about their past, let alone discuss it with a therapist, leaving traditional therapeutic methods ineffective. MDMA relaxes such patients and “reduces the fear centres” to allow for better communication and addressing of their trauma. The use of MDMA in a controlled medical environment is also vastly different to its well-known use at parties and other such activities. In a controlled setting, the drug is non-addictive and does not cause any other adverse effects, which are usually caused by substance abuse and mixing at parties. So far, the patients who have undergone the treatment are responding well. They are more calm and more willing to talk, which are crucial steps in addressing such trauma and improving their rehabilitation. 

In light of the TGA’s approval, specialty clinics are also opening up to solely facilitate psychotherapies involving the approved MDMA and psilocybin drugs. For example, Clarion Clinics, a dedicated facility for such treatments, received over 250 expressions of interest from patients in its first week. Due to the specialty nature of the treatment, the screening process is also aptly rigorous. Prospective patients must first meet the clinical diagnosis for PTSD or treatment-resistant depression and have already tried an approved pre-existing treatment without success. They must then complete an online medical screening and personally meet with psychiatrists from the clinic to undergo further psychiatric and physical assessments. Only then are they enrolled in the program if deemed eligible. The treatment process itself involves taking the medication and spending several hours with therapists. Further meetings are then carried out with therapists without the drug being administered to discuss the previous existence and make rehabilitative progress. The whole programme’s dosage comes to around one dose per month.

But although the drugs are there only to help and facilitate the therapy (i.e. the drugs are not the cure), there is still a lot of scepticism and fear that the treatment has too many unknowns and is simply not ready for widespread clinical use. Some members of The Royal Australian and New Zealand College of Psychiatrists believe not enough research from clinical trials was gathered to justify the TGA’s decision to approve the drugs. Data such as length of efficacy, which patients will respond to the treatment, and further use of the drugs in conjunction with other treatments is lacking. Although some patients, such as Cassidy’s, may respond well to the novice treatment, it is important to note that this is in no way guaranteed for all people who end up using the drug. Thus, further research and data are needed to improve the screening process to make sure that only people who are completely eligible for the treatment receive it, and not individuals who may be vulnerable to it. These concerns are further exacerbated by fears that the TGA only approved this treatment in the first place due to intense pressure from lobby-groups instead of health experts and empirical evidence. “It seems the TGA has yielded to pressure from the public and lobby groups to increase access to these experimental treatments, outside of clinical trials,” said writers, led by Professor Susan Rossell, a cognitive neuropsychologist at Swinburne’s Centre for Mental Health. This has also led to ethical debate surrounding the price tag of MDMA prescriptions and treatment. For Clarion Clinics, the full package costs up to $24,000, where the psychotherapy component accounts for around 85% of the total cost. Could pro-psychedelic lobby groups be jeopardising the wellbeing of emotionally weak and distressed patients for profits? It is a hardly palatable idea, but with such a steep price for treatment and the research not being 100% solid yet, there is definitely some suspicion and exasperation from mental health experts about the true intentions of many pro-psychedelic clinics, which could lead to serious adverse effects in patients if the process is faulty.

With all the buzz surrounding MDMA as a new treatment for extreme PTSD, it is important to remember that mental health problems are extremely common and that the treatment involving such drugs is being used as a quasi-last resort; it is in no way a mainstream treatment. For many, the best way to start and continue the process of internal healing is simply to talk to someone about it.