This article was originally published by Dr David Reiner here. Connect with David on LinkedIn here.
On January 19, 2024, the landscape of mental health care was changed forever. In an unprecedented move, MDMA was given to a patient not as part of a trial but as a prescribed treatment. This bold step came less than a year after the Therapeutic Goods Administration’s (TGA) decision to sanction MDMA for the treatment of PTSD.
As we acknowledge the weight of this moment, it is fitting, as many of us are, to be celebrating. The patient under the care of Ted Cassidy and Monica Schweickle, grappling with chronic treatment-resistant PTSD, reportedly experienced profound therapeutic gains. Writing on LinkedIn, Dr Cassidy said, “one day with MDMA-assisted therapy achieved more than is usually achieved in a year.”
This event should fuel our optimism for the future of psychiatric treatment. Yet, it also serves as the perfect point for us to pause and ponder the journey that has brought us here, and to balance our enthusiasm with the right amount of caution.
As we stand on the cusp of a new era in mental health intervention, one that could promise great leaps forward in healing, it’s vital we remember our commitment to patient safety and evidence-based practice.
The trajectory of medical science has been and continues to be a journey into the unknown. The strides forward that we now accept as conventional thought first required someone to view things unconventionally, sometimes at great risk to their personal and professional reputations.
Consider Dr Ignaz Semmelweis, the tragically marginalized pioneer of antiseptic procedures, who was branded a charlatan and met his end in a Viennese asylum. While it is the mavericks and iconoclasts who have propelled science forward, his story is a sobering reminder of the price paid for radical thought.
Overlooked or not, some of the greatest scientists in history started as outsiders and rebels. In medicine, the field of psychiatry perhaps best exemplifies this spirit of rebelliousness, with unconventional figures such as Freud littered along its annals of fame. It seems fitting, then, that psychedelics—long associated with counter-culture—have found a niche within this rebellious lineage.
Yet, in the pursuit of progress, we should anchor ourselves with a healthy level of scepticism – the vital counterbalance we use in science to ensure that our optimism does not outpace the evidence available.
It is our duty, as doctors within the psychedelic space, to rigorously scrutinize, research, and refine our methods. So, as we congratulate Ted Cassidy and Monica Schweickle for conducting the first MDMA dosing session beyond a research setting, let’s also commit to the meticulous study that this new frontier demands.
The initiation of MDMA in clinical therapy is a significant leap, yet our journey is far from complete. Continued research is essential to refine our treatment protocols and to validate the efficacy of our work with patients. Though the road ahead is promising, it will be long and filled with complexity and controversy, just as the road to this point has been.
The journey toward the TGA decision in 2023 to approve MDMA and psilocybin as medicines was a complex one. Just a year before the decision, a proposal to down-schedule these substances was rejected, with major professional bodies like the Royal Australian and New Zealand College of Psychiatrists and the Australian Psychological Society supporting this stance.
The eventual shift in policy seems to have been catalysed by advocacy from groups like Team Mind Medicine Australia and notable scientists such as Professor David Nutt, despite little new scientific evidence at the time. This pivot highlights the nuanced dynamics at play in the landscape of psychedelic medicine.
As a result, reactions to the TGA’s decision have been polarized, with some such as Professor Nutt embracing it as a beacon of hope for patients with few alternatives, while others voice apprehension. Prominent psychiatric professionals, including Orygen CEO Patrick McGorry , have voiced concerns about the potential implications of “intense private lobbying” on regulatory decisions.
Decisions in the medical field ought to be grounded in rigorous scientific evidence and to be made with the utmost integrity. As we continue to explore the therapeutic potential of psychedelics, we must maintain balance. However, there are patients out there suffering from chronic and treatment-resistant conditions. For them, waiting for new treatment options risks prolonged suffering and the pace of governments and bodies is overly risk-averse.
Psychedelic medicine is currently at a pivotal crossroads, experiencing a shift propelled by a diverse cohort including clinicians, researchers, and, notably, entities from the med-tech sector, venture capitalists, and investors. The entrance of for-profit interests into this sphere inevitably prompts scrutiny over the motivations steering the field.
Amidst this transformation, cultural contributions such as Michael Pollan’s “How To Change Your Mind: The New Science of Psychedelics,” now a successful Netflix series, have catalysed public curiosity and piqued demand for psychedelic-assisted therapies. The resultant surge in public interest has significantly outpaced the more measured approach traditionally taken by established medical bodies.
This disparity in pace has been highlighted by the actions of the Royal College of Psychiatrists, which has only recently begun to actively engage in establishing a dedicated working group on psychedelics and forming a committee to write clinical guidelines for psychedelic treatment.
The slow response from such established institutions has left a void, now being filled by non-traditional actors. Their readiness to step in reflects a broader trend where, in the face of pressing public demand and the potential for profound therapeutic benefits, the impetus for innovation emerges from outside the medical establishment.
We can hope that this pioneering first case of MDMA as a medicine in a clinical setting could catalyse a broader movement towards accessible and affordable mental health treatments. As evidence supporting psychedelic therapies grows, so too does the potential for government support and integration into healthcare systems
The broadening of the evidence base is a crucial factor that could pave the way for psychedelic treatments to be integrated into mainstream healthcare systems. If these therapies can continue to demonstrate efficacy and safety in clinical use, it stands to reason that they might soon be considered for inclusion in national healthcare schemes like the Pharmaceutical Benefits Scheme and Medicare.
The potential for reducing the financial burden on patients and increasing the availability of innovative therapies is a hopeful prospect, one that could transform the landscape of mental health treatment and offer new hope to those for whom traditional therapies have fallen short.
As we stand at the cusp of what could be a revolution in mental health care, our shared mission must be to proceed with informed enthusiasm and cautious optimism. Let us embrace the new dawn of MDMA-assisted therapy with diligence, ensuring that every step forward is taken with care for those we serve and respect for the science that guides us.
B.Med, F.A.N.Z.C.A, PG Dip Echo
Dr David Reiner graduated medical school in 2003 and completed his anaesthesia training at the Prince Of Wales Hospital in Sydney, Australia.
He has been working as a Anaesthesiologist at The Canberra Hospital (public) since 2011. He was the quality and safety officer for the Australian New Zealand College of Anaesthetists in the ACT for 3 consecutive years – during this time he activated the WEBAIRS platform in the ACT – the Adverse Incident Reporting System. He has administered anaesthesia to over 16,000 patients. The majority of his clinical practice involves anaesthesia for neurosurgery. Anaesthesiology by definition involves using mind altering drugs. Every medication has side effects/complications including the ones we are trialling – Dr David Reiner is skilled at managing drug disturbances to physiology. Having an anaesthesiologist during the clinical administration of novel drugs increases safety of that trial. Anaesthesiologists are capable of basic life support and advanced life support. Acute circulatory, neurological and respiratory disturbances due to drugs are part of Dr Reiner’s everyday practice. Like all anaesthesiologists he alters consciousness, blood pressure and breathing patterns of every single patient under his care.
