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Will Australia take a lead in psychedelic therapy?

Papercut head

By Kevin Ke

On September 30th 2021, the Therapeutic Goods Administration (TGA) of Australia published an eagerly awaited report on the use of psychedelics in treating mental health conditions. It is an independent review of the evidence surrounding two particular substances: MDMA and psilocybin, commissioned by the regulatory agency in order to inform its decision making process towards these substances. Currently, these substances are placed in ‘Schedule 9’ of the ‘Poisons Standard’ – the most restrictive classification which includes other substances like heroin. The TGA is in the midst of evaluating a proposal to move them into ‘Schedule 8’, a less restrictive category. Schedule 9 substances are considered ‘Prohibited substances with high potential for abuse and misuse’, and are only accessible for purposes of medical research, in order to severely limit access. Although we are in a time of increasing awareness and interest in psychedelic substances, the history of psychedelic research in the modern era is complex. The current restrictions on psychedelic use for recreational and medical purposes are closely intertwined with US government anxieties about counterculture movements in the Vietnam War era.

The proposal to reschedule is led by an Australian nonprofit, Mind Medicine Australia (MMA), and has the support of world leading experts in psychedelic research. If successful, it will lead to a situation where Australian patients suffering from mental illness can access psychedelic substances for use in therapy. There are no proposed changes to the status of recreational use of psychedelics, which will remain in Schedule 9. A range of safeguards will be in place – for example, prescription will be restricted to being prescribed by psychiatrist or specialist addiction physician. MMA has been training cohorts of qualified psychotherapists specifically in psychedelic-assisted therapy in anticipation of future demand. Access is envisioned to occur in a medically controlled environment with the patient never taking the substances home. As unregistered medicines, prescribers will still require approval on a per patient basis from both the TGA (under Special Access Scheme B) and the State or Territory Government where the treatment is to occur. Mental health conditions like post-traumatic stress disorder (PTSD) and depression are frustratingly difficult to treat, with debilitating impacts on patient’s lives and those around them – and it is envisioned that these patients stand to benefit from a psychedelic experience given in a controlled and supervised setting.

 

What’s the evidence for psychedelic-assisted therapy?

In recent years, psychedelic research has reached an inflection point, with accelerating recognition worldwide of its therapeutic value in a range of mental health conditions. A landmark phase 3 trial evaluating MDMA for the treatment of PTSD read out earlier this year, sponsored by the pioneering US based nonprofit MAPS. A total of 91 patients with severe PTSD were randomised to two groups, with the average patient having carried the diagnosis for 14 years. A large majority (92%) of patients had experienced suicidal ideation during their lifetime, and 1 in 3 had attempted suicide in the past.

Both groups received a structured program of therapy over 18 weeks, but only one group received MDMA across three sessions, with the other receiving an inactive placebo in its place. The group that had received MDMA-assisted therapy responded considerably better than the group without – with 67% (28/42) of patients no longer meeting the criteria for PTSD diagnosis, compared to 32% (12/37) in the therapy-only group, as measured 18 weeks after initiation of treatment. In a patient group with such severe and intractable disease, these results are remarkable – clearly demonstrating the potential of psychedelic assisted therapy to heal patients who may otherwise never respond to conventional treatment regimes.

 

How does psychedelic assisted therapy work?

The experience of increased empathy and connection appear to be central to the way that MDMA seems to produce these results. Pharmacologically, the drug increases levels of serotonin in the brain, also acting to increase noradrenaline and dopamine to lesser degrees. Modulation of serotonin neurotransmission is the primary proposed mechanism by which both MDMA and psilocybin are able exert psychological effects. On one hand, an increased level of serotonin binding to the 5HT-1A receptor is thought to lower anxiety, while action on the 5HT-2A receptor increases neuroplasticity and the capacity for learning. In this state of lowered barriers and heightened flexibility of thinking, the individual is able to confront and reprocess their trauma with the assistance of their therapist. Unlike MDMA, psilocybin is a ‘classic psychedelic’ as it predominantly acts on the 5HT-2A receptor like LSD, DMT and mescaline. Experiences of psilocybin have been demonstrated to be effective for conditions like depression, even when the patients are resistant to other therapies. When 5HT-2A receptor activation increases, patients enter into a state of cognitive flexibility and creative thinking where enduring patterns of thought are able to be rewired. Individuals often rank it as among the most challenging and meaningful experiences of their lives – undergoing intense emotional realisations which persist long after the therapy has ended. In this way, psychedelics represent a different approach to treating conditions characterised by fixed mindsets and beliefs like depression and anxiety. Treatment is considerably shorter in duration (a few sessions), and may have more durable results than other treatment modalities. This is quite significant because conventional antidepressants and psychotherapy are known to take several weeks to months to achieve effect, requiring considerable resources. Psychedelics therefore represent a novel modality with distinct therapeutic benefits.

According to proponents of psychedelic assisted therapy, the therapy itself is a crucial part of healing. Also, it is emphasised that the substances are medical grade, produced to purity and stability specification – reducing risks of contamination and adulteration. Theoretical risks that arise from overdose or drug interactions can further be mitigated when given in a supervised setting. While the history of psychedelic research is intricately linked to diverse fields including psychoanalysis, consciousness, religion, and anthropology, the current movement is seeking first to focus on the medical applications, and this stands to reason. It has been reported that the growing acceptance of recreational cannabis use stems largely from its recent medicalisation, with cannabis being explored for a range of diverse applications ranging from anxiety and stress to autism and seizures. In medical cannabis, the TGA also has an important precedent for psychedelic regulation. In February this year, low doses of cannabidiol (the non psychoactive component of cannabis), were rescheduled to Schedule 3, the category for over the counter sale. In practice, it will be some time before pharmaceutical companies achieve registration of their medicines – requiring demonstration of efficacy and safety through clinical trials, a process that can take years. Nonetheless, similar arguments can be drawn between ‘psychedelics’ and medical cannabis, and the shifting tide of public opinion towards this group of substances is also self-reinforcing.

 

An independent expert review

The original TGA submission from MMA dates back to July 2020, and from there, the original decision of the regulatory agency was to retain the status quo and to not reschedule. Some groups have a different perspective of the benefits and risks of this psychedelic assisted therapy. Medical bodies like the Australian Medical Association and the Royal Australian and New Zealand College of Psychiatrists emphasised a need for clinical trial processes, including careful assessment of efficacy and safety, under strict protocols and ethical oversight. For these groups, psychedelic research is still in its infancy, with ‘limited but emerging evidence that psychedelic therapies may have therapeutic benefit’, and emphasis is placed on their status as illicit substances. The initial decision was challenged by MMA, prompting an independent review of the evidence, bringing us to the recent report.

The expert panel was tasked with reviewing the available evidence on MDMA and psilocybin for the treatment of mental health conditions. Benefits and risks, therapeutic value, and applicability to the Australian healthcare system, were all aspects that were considered. For MDMA, a total of 8 randomised controlled studies were found to be relevant and pooled together, and their results analysed. The rationale is that looking at the results in totality may provide us with better estimates than looking at these studies individually. Results are collated and compared using the statistical quantity ‘standardised mean difference’, or ‘effect size’ – calculated by taking the difference in mean severity scores between groups relative to the standard deviation in these scores. This can be helpful when a range of different severity scores are used between trials, as ‘effect size’ allows for comparisons between different disease scoring systems. However, comparing interventions indirectly through looking only at ‘effect size’ can also be misleading, as different trials inevitably recruit patient populations which are heterogenous or homogenous in their own ways. Trials involving more homogenous patient populations will inevitably have higher effect sizes, while the converse is also true, with all else being equal. With that said, in our report, MDMA assisted therapy was found to have an effect size of -0.86 compared against the control arms, considered generally as a large effect size (almost one standard deviation). This is a promising result considering that the controls also received placebo medication, and the same course of intensive psychotherapy. In other words, patients will experience a large benefit from this treatment, beyond what you might expect from psychotherapy alone. The importance of these results are highlighted when we consider that the only two FDA-approved drugs for PTSD are the SSRI drugs sertraline and paroxetine, which both have modest efficacy, being 2-3 times less effective than MDMA, when compared using absolute change in the CAPS-2 score (and effect size). For psilocybin, six studies were identified by the panel as relevant to their evaluation. Their main findings were that psilocybin was better than placebo for treatment resistant depression, and that it showed efficacy for treatment of anxiety. It was also compared to escitalopram, a common antidepressant – and no ‘statistically significant’ differences were observed, although there is a good argument to be made that this is due to limited statistical power. A closer, critical read of an important recent trial comparing psilocybin with escitalopram would be worthwhile for any interested reader, as the data itself is promising (additional data is in the article appendix).  The authors of our TGA report conclude: “MDMA and psilocybin may show potential as therapeutic agents in highly selected populations when administered in closely supervised settings and with intensive support. Evidence appears strongest for MDMA.”

The case for psychedelic assisted therapy is strong, and the high quality evidence which has been generated to date cannot be ignored for long. The recent independent review highlights the clinical efficacy of this treatment, and the TGA is well placed to enact regulatory changes that will encourage the development of the field. In the midst of our current mental health crisis, patients with intractable conditions stand to benefit considerably from a rescheduling of these medicines.

It’s Time To Give Our Military The Medicine They Need

Military

Following the American decision to bring their troops home from Afghanistan after some 20 years in that troublesome country, Australia will also soon do the same. After losing 41 Australian lives, 261 wounded in action, facing war crimes allegations and billions of dollars of expense, thousands of our country’s bravest men and women will soon be coming home. Sadly, many of the more than 39,000 soldiers who served in Afghanistan will have varying degrees of post-traumatic stress disorder. This is nothing unique to the ADF. All soldiers everywhere suffer from PTSD. It’s just a question of degree; whether they know it or not.

Imagine the trauma then, when they come to learn that upon their arrival back in the lucky country, how unlucky they are that they still cannot access medicine with an incredibly successful track record in treating PTSD, that is cheap, plentiful and, most importantly, that works.

More than 150 recent empirical studies have shown the remarkable success that the therapeutic use of either psilocybin (the naturally occurring active ingredient in what are colloquially known as ‘magic mushrooms’) and MDMA (known more commonly as ecstasy) can have with people suffering from PTSD. These medicines can assist them in dealing effectively and permanently with the traumas of war. Yet when they return home, our soldiers will not have legal access to these medicines.

Both psilocybin and MDMA remain illegal in Australia and cannot legally be prescribed by doctors for patients, even though more and more people realise that such substances can be of great benefit in dealing with a range of mental disorders including PTSD. They cannot be grown or manufactured in Australia, cannot be imported and cannot be medically prescribed for patients in need, including returning military personnel. Yet they are available through Expanded and Compassionate Access pathways in many of our closest allies, including the United States, Israel, Switzerland and Canada.

Among other critics of the status quo, Dr Simon Longstaff AO, Executive Director of The Ethics Centre says that it is unethical and inhumane to withhold these treatments from those who are suffering. Existing treatments for PTSD lead to remissions in only 5% of patients compared to remissions for 60–80% of those receiving 2–3 medicinal doses of MDMA or psilocybin combined with a short course of psychotherapy.

In a recent trial supervised by the U.S. Food and Drug Administration (FDA), 105 participants (many of whom were veterans and first responders) had been suffering from treatment-resistant PTSD for an average of 18 years. Just three medicinal doses of MDMA with a short course of psychotherapy led to remission in 52% of cases immediately and in 68% of cases at the 12 month follow up.

Brigadier General Sutton, New York City’s Commissioner of Veteran Services said: “If this is something that could really save lives, we need to run and not walk toward it. We need to follow the data.” This same approach should be taken in Australia and inform the recently announced Royal Commission into Veteran Suicide.

Former Defence Force Chief, Admiral Chris Barrie has repeatedly confirmed that psychedelics offer the “only possibility of a cure for post-traumatic stress disorder”.

The Icahn School of Medicine at Mount Sinai in New York has launched a new Centre for Psychedelic Psychotherapy and Trauma Research (one of 6 similar Centres recently launched in the UK and USA), to discover novel and more efficacious therapies for PTSD, depression, anxiety, addiction and other stress-related conditions in the veteran and civilian population. The Centre will focus on studying MDMA, psilocybin and other psychedelic compounds.

Think of the immense suffering, mental illness and suicides that could be prevented if our veterans could finally get well through having access to all medicines that could potentially help them. Wouldn’t it be wonderful if they could lead meaningful and healthy lives contributing their skills and courage to our community?

Our health care system and the services it provides is in many respects the envy of the world. Medicare and private health services provide immediate access to both care and medicine for everyone in need. No one falls through the cracks in this country and no one has to show up in an Emergency Department just to access a doctor, as is the case in one of our closest allies, in particular. We should be justifiably proud of this, but also open to how this remarkable system could be improved.

After all, international laws, including those that have been ratified by Australia clearly recognise the right of everyone to “the enjoyment of the highest attainable standard of physical and mental health”. This must mean that everyone needing effective medical treatment should have access to all medicines that work, including psilocybin and MDMA which are proven to be safer and more effective than existing treatments, particularly when given under professional medical supervision.

The Therapeutic Goods Administration is currently considering rescheduling these medicines, which if successful, will mean that this medicine could then be prescribed by professionally trained doctors for patients that they feel will benefit from its use. It does not mean that these substances will be legal in a recreational sense. However, they will be part of the full medicinal arsenal available to all trained doctors to provide to all people in need, including our soldiers. With mounting pressure, the TGA recently announced an Independent Review on rescheduling both psilocybin and MDMA. A final decision is expected within months, and there is a large and growing chorus of voices who are calling on the TGA to provide medical access to these treatments to prevent further avoidable suicides and suffering.

Mind Medicine Australia and a rapidly growing global network will soon be releasing a short and, what we hope will be widely applied, Declaration on the Right to Universal Access to All Forms of Safe and Effective Medicine which calls upon governments everywhere to make available, to all persons, every reasonably accessible form of safe and effective medicine — regulated only for reasons of safety and efficacy, and then only to the extent strictly necessary.

Many people, and especially our soldiers, simply cannot afford to wait any longer.


Scott Leckie is an international human rights lawyer. Tania de Jong AM is a social entrepreneur and the Executive Director and co-Founder of the charity, Mind Medicine Australia.

This article was originally published by The Spectator on 6th May 2021.

Scott Leckie

Scott A. Leckie is an international Human Rights lawyer, Law Professor and Director and Founder of Displacement Solutions, an NGO dedicated to resolving cases of forced displacement throughout the world, in particular displacement caused by climate change. He also founded and directs Oneness World Foundation (www.onenessworld.org), a think tank exploring questions of world-centric political evolution and new forms of global governance.

He hosts Jointly Venturing, a podcast dedicated to the question of world citizenship, and manages the One House, One Family initiative, an ongoing project in Bangladesh building homes for climate displaced families. He regularly advises a number of United Nations agencies and conceived of and was the driving force behind more than 100 international human rights legal and other normative standards, including UN resolutions – most recently the Peninsula Principles on Climate Displacement Within States. He has written 22 books and over 250 major articles and reports.

Tania de Jong AM

LL.B (Hons), GradDipMus

Tania de Jong AM is a trail-blazing Australian soprano, award-winning social entrepreneur, creative innovation catalyst, spiritual journey woman, storyteller and global speaker. Tania is one of Australia’s most successful female entrepreneurs and innovators developing 5 businesses and 3 charities including Creative Universe, Creativity Australia and With One Voice, Creative Innovation Global, Mind Medicine Australia, Dimension5, MTA Entertainment & Events, Pot-Pourri and The Song Room.

She works across the public, private, creative and community sectors and is passionate about mental health, innovation, diversity and inclusion.  Tania speaks and sings around the world as a soloist and with her group Pot-Pourri releasing twelve albums. She is Founder and Executive Producer of future-shaping events series, Creative Innovation Global.

She was appointed a Member of the Order of Australia in June 2008. Tania was named in the 100 Women of Influence, the 100 Australian Most Influential Entrepreneurs and named as one of the 100 most influential people in psychedelics globally in 2021. Tania’s TED Talk ‘How Singing Together Changes The Brain’ has sparked international interest. Tania’s mission is to change the world, one voice at a time!

A Mother’s Prayer To The TGA

Woman on boat

I am writing this as a mother, in the hope that my words may open the closed minds of our politicians, the TGA and the RANZCP, who we rely upon to ensure every Australian has access to the latest medical therapies.

Our 26-year-old daughter suffers from treatment resistant PTSD and severe depression as a result of a trauma when she was only 11.  Rape at any age is devasting, but for a child the impact is profound. We live with the daily fact that with the current treatment of anti- depressants and anti- psychotic drugs available to her in Australia, there is only a 5% chance of her getting well. We also live with the fear that we could lose her. We have journeyed with her for the past 15 years and have seen her suffering as she has tried every treatment available to her. We have all been profoundly impacted by her illness. Our current mental health system has failed our daughter. We need answers. We need treatment. And, we need it now. Tomorrow our daughter may not be here.

Unless you have lived with the fear of your child taking their own life, you will never truly know how it feels. Thousands of mothers, live with that fear every day. Our journey has taken us to countless specialists and across the world. We have watched the work with treatment resistant PTSD using Medicinal MDMA, which is often confused with the recreational drug Ecstasy, Ecstasy is frequently adulterated with more dangerous substances and taken in unsafe environments. We learnt about the outstanding remission rates from Medicinal Psilocybin (which in its natural form comes from certain mushrooms) for treatment of depression. We are confident that these medicines offer real hope. We know that no treatment, even the current ones advocated by our government, is without risks and that the answers are not simple. But we deserve hope.

Clinical trials with medicinal MDMA conducted overseas demonstrate remission rates between 60-80% for treatment resistant PTSD. We were confident Australia would embrace this research in an applied way. Surely, we would act when potentially one of the greatest shifts in psychiatric medicine is knocking on the door? You can imagine our dismay when the TGA refused to reschedule MDMA in its recent Interim Decision. The news was heartbreaking.

The irony is that the TGA is already authorising individual requests from psychiatrists to use these medicines with therapy under its Special Access Scheme, but their listing as prohibited substances in Schedule 9 of the Poisons Standard means that there is no ability to get State and Territory Government approval which is also required so that patients can be treated and have a chance to finally get well.  All this will change if they become Schedule 8 Controlled Medicines.  What a cruel system we have. Providing hope with one hand and taking it away with the other.

I contacted the TGA for answers and found their response deeply disturbing. Their justifications were not based on data or science, but rather demonstrated deep bias and misrepresentation (for example, calling these medicines ‘illicit substances’ when they would, in fact, be used only in clinical medical environments). Their responses were offensive to sufferers and their families.

I contacted the RANZCP in the hope that they would show the capacity to lead us out of this crisis. It was clear that they cannot accept the facts which are undeniable and globally supported by leading experts, that these treatments are a viable and safe treatment option.

These bodies MUST begin to rely upon the validated data generated by the wider medical community. Do they suggest the outstanding research done at the leading Universities around the world is not valid or sufficient? Do they believe that countries that have enabled psychiatrists to use these therapies under Expanded Access Schemes have done so without high levels of regard?  These therapies have been granted Breakthrough Therapy Designation by the USA regulator and my daughter should be given the chance to access these therapies in Australia. Sadly, the Australian community is losing trust in the ability of our institutions to lead us forward. They risk becoming irrelevant as more and more Australians seek treatments conducted illegally by underground therapists.

I contacted every Australian Senator and the common response I have received was “we are sorry for your suffering but it is in the hands of the TGA and RANZCP”. These responses reveal that the TGA and RANZCP have too much power; beyond that of even my elected representatives. I elected my politicians to speak for me and lead us forward, and, as yet, few seem willing to ask if these bodies are advising them correctly and acting in the best interests of Australians. Who will challenge them on my behalf? Has my government forgotten they are here to serve my daughter?

This is so much bigger than my daughter. I speak also for those who don’t have a voice. For the lives already lost and for the families too enmeshed in simply surviving to speak out. Our nation is in a mental health crisis where 1 in 5 Australians have a chronic mental health condition and at least 1 in 8 are on antidepressants including 1 in 4 older adults and 1 in 30 young children.

Anxious adult

Australia should be leading the world in treatment, but instead our system is on its knees, bogged down by regressive thinking that places us as one of the poorest performing countries. We need innovation and leadership from our politicians and our medical establishment.  We can make Australia a leader in this field.  I imagine a day when the world looks to us. A day when no Australian suffers unnecessarily or dies from a treatable mental health illness.

I have NO doubt that the tide is turning and we will see these medicines rescheduled. The push from Australians like myself, WILL bring about this change. I believe the government knows this too.  They know they WILL lose the battle but don’t seem to care about those that will die in the final days of this “war”.

So, it’s time. Enough procrastination, posturing and politics. Our representatives MUST do the job that we have a right to expect of them.

I am praying that the TGA’s announcement this week, that it will be seeking further advice before making the final rescheduling decisions for MDMA and psilocybin will at last mean that the data and facts will come to the surface and block out the bias and stigma. Then finally, change will happen. The TGA has promised an Independent Expert Review into the therapeutic value, risks and benefits to public health outcomes for these medicines. My daughter and so many other sufferers need this so urgently, but I am not holding my breath.

If our government and health agencies continue to fail us, we will be forced to re-mortgage our house and attempt go overseas for treatment. To countries that lead the world in the treatment of mental health. To countries that care in actions, not just words. I will then shout from the roof tops, that my government has failed me and I am deeply ashamed of the country we have become.

Annie Mason

Annie Mason is an educator with a wide range of experiences including classroom teaching K-12, Special Education and Student Wellbeing. She was a Principal for over 15 years and has a special interest in Gender Equity, Social Justice and Women in Leadership. She is a strong advocate for the legal and ethical rights of those with mental health issues.

Healing A Troubled Mind: A Personal Perspective On Victoria’s Stagnant Mental Health System

Person standing near lake

The Royal Commission’s report on the Victorian mental health system sent shockwaves throughout the State, one of which landed squarely on a patient of mine. They noted that Victoria’s mental health system is “not geared for…change”. Just to ensure we got the message, and despite a Federal Government TGA approval, my request to treat my traumatized patient with MDMA-assisted therapy was declined by our state’s regulatory authority.

To be clear, my disappointment lies not with the state government regulators, nor with the medical opinions suggesting MDMA-assisted therapy should not be used for treatment of traumatized patients (despite excellent emerging evidence that it works with little risk). I understand these opinions, though I certainly do not agree with them.

My issue is a more troublesome one. Underlying these opinions is a problem with how we practice psychiatry, which in turn reflects the alienated community in which we live. Mental health paradigms are always a reflection of the society which supports them. You see, us Australians are alienated both intra-personally (from our own emotional worlds) and inter-personally.

Our current paradigms tend to view mental illnesses in a biologically reductive way. In other words, mental illnesses are both understood and treated primarily as biological diseases (which they are not). The posters at your doctor’s rooms will teach you – depression is just like any other medical disease, such as heart-failure or emphysema. In this paradigm, entities such as addictions and depression are seen as distinct phenomena. They are treated in our current system as totally different diagnoses by entirely different teams. The alienated individual who suffers from depression and addiction is labeled with the alienating and erroneous term ‘dual-diagnosis’, which enshrines the division. Furthermore, if addictions are understood (as they are) as inherited conditions (which they are not), and primarily as brain diseases based in dysfunctional dopamine rewards circuits, they will be primarily treated as inherited brain diseases, by doctors with medications.

But what if we have got it all wrong (which we do). You see, addictions are heritable but not inherited (there is a big difference, I recommend looking it up), and the chemical dopamine in no-way explains addictions. Rather, it is the human experience of dopamine (along with numerous other chemicals) which explains addictions, suggesting that addictions are rooted in difficulties with the human experience of life, rather than the neural correlates of those experiences.

The events which lie at the root of illnesses such as addictions and depression are those which overwhelm the mind’s ability to process and integrate. We know that the presence of adverse childhood experiences is present in the majority of (if not all) people with addictions and chronic depression. But rather than seeing these conditions as consequences of trauma (which they are) and treating the underlying emotional issues (which would help), our society mistakes the symptoms (depression and anxiety) for the disease itself. We treat depression as depression and addiction as addiction and all the while we are missing the forest for the trees. The real disease is the high prevalence of trauma, alienation, and neglect in our society. After all, it is these conditions which twist and distort the mind into the contortions which fill the latest catalogues of mental illnesses.

Which brings me back to my patient. Traumatized when young, she has suffered from every diagnosis a psychiatrist’s finger can point at. She has had every treatment a medical guideline can fathom. Yet her trauma remains in place, because no-one has been able to reach it. Suddenly, on the horizon, a change is coming. Treatments like MDMA-assisted therapy appear to touch the root of the trauma, allowing individuals to process the unintegrated parts of their minds, and offer the chance of real healing. But we don’t change. Our outlooks have ossified, our diagnoses have desiccated. And all the while we suffer in our own blindness. People continue to kill themselves, and my patient will continue to suffer in silence until the Victorian Government allows me to access a new treatment which may finally bring peace to a troubled mind.

Dr Eli Kotler

MBBS MPM FRANZCP Cert. Old Age Psych. AFRACMA

Eli is a consultant psychiatrist, holds an academic position at Monash University through the Alfred Psychiatry Research Centre, and is the medical director of Malvern Private Hospital, the first addiction hospital in Australia. He is a member of the Australasian Professional Society on Alcohol and other Drugs (APSAD). Clinically, Eli is interested in the deep connections between trauma and addiction and works within a neuro-psychoanalytic framework. Eli has overseen the development of a clinical program for addictions focused on trauma, particularly developmental trauma. This has led to an interest in medication-assisted trauma therapy. Eli worked for many years researching neurodegenerative diseases and was the principle investigator on numerous trials for novel therapeutics. He is founding member of the Melbourne Neuropsychoanalytic Group and welcomes new members. Through involvement with Monash University, Eli oversees the addiction rotation for medical students.

Eli graduated from the first intake of the Certificate in Psychedelic-Assisted Therapies (CPAT) in June 2021. He has also been recently appointed as the Principal Investigator to lead Emyria’s upcoming MDMA trial.

Utilizing Eye Movement Desensitization and Reprocessing Therapy to Help Process Challenging Experiences with Psychedelics

EMDR

The last twenty years has arguably led to a renaissance of scientific investigation into the therapeutic benefits and risk of a range of psychedelics. LSD, ecstasy, psilocybin and ayahuasca that are increasing in popularity as alternative therapies used to address a host of mental health challenges [1] [2] [3]. These include anxiety, depression, trauma, addiction [4] [5], existential fear, relationship issues, addiction, obsessive compulsive disorder, and post-traumatic stress disorder [6] [7].

Psychedelics can cause profound shifts in consciousness, personal belief structures, relationships and alter the trajectory of one’s life [8]. Although psychedelics may provide you with 10 years of psychotherapy in one night this does not necessarily equate to 10 years of practical insights that can be translated and integrated easily into one’s daily life. Many people require psychological support and a range of integration practices to process these profound states of consciousness [9].

High quality psychedelic integration can help facilitate deep exploration and processing of the bio-psycho-social-cultural-spiritual and political domains of the individual. Examples of these can be found across multimodal and complementary therapies such as somatic experiencing, movement, music, nature, exercise, nutrition, acupuncture, massage, yoga, breathwork, art and creative forms of expression, rituals, prayer, meditation and psychotherapies [9] [10].

 

What is EMDR and how can it help people integrate their psychedelic experience?

The writer is the National Practice Manager at Mind Medicine Australia Psychological Support Services. One of the writer’s psychedelic integration tools in her tool kit is Eye Movement Desensitization and Reprocessing (EMDR) therapy. EMDR can be used to support psychedelic assisted psychotherapy as an integration tool. Clients safely confront material that arose during the psychedelic experience and continue to process meaning, body sensations, emotions, blocked and challenging content.

EMDR was originally designed to reduce the distress associated with traumatic memories [11]. There have been more than 30 controlled outcome studies with positive results conducted on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. It is now recognized as an effective form of treatment for trauma by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense and Australian Medicare system.

For a detailed outline of the EMDR phases and results of clinical trials refer to www.emdr.com/frequent-questions.

EMDR had expanded beyond trauma and is often used to help clients access new perspectives, improve self-esteem and to shift and expand rigid belief systems [12]. The writer has utilized bilateral stimulation, which is a left and right repetitive eye movement technique with clients requesting psychedelic integration. The client follows the therapist’s fingers and is assisted to concentrate on a distressing memory, emotion and/or challenging and dynamic psychedelic content whilst moving their eyes rapidly back and forth [13].

People naturally do bilateral stimulation every night in during REM sleep. The left to right eye movement is believed to be storing our memories from the day [14]. Retrieving a traumatic memory and following eye movements requires more working memory capacity than is available and subsequently the clients working memory is taxed. Consequently, the client is able to experience the distressing content with fewer associations with fear, anger or sadness.

As the process unfolds, the client often taps into somatic experiencing (e.g., crying, shaking, sensations in their gut, throat etc.) and one’s natural ability to locate helpful beliefs, perspectives and anchors to process and integrate the challenging experience emerge. Clients often report a sense of experiencing new insights and downloads (e.g., information, shifts in core beliefs, a new way to interpret and experience the psychedelic content). Furthermore, clients can process any left-over tensions, emotions and energetic blocks from the previous psychedelic experience; this often results in clients feeling more relaxed, grounded and a sense of ease with the psychedelic material.

Bilateral movements also happen when we walk, run, write, read, cook, play music, and when we are making art. Therefore exercise, hobbies, creative arts, and expressive arts are effective ways to help people with trauma healing and integrating challenging psychedelic experiences.

 

Can EMDR be used to support Hallucinogen-Persisting Perception Disorder?

HPPD is a very rare condition which causes a person to keep reliving the visual element of an experience caused by psychedelics. Little is known about why HPPD occurs and the specific mechanisms behind the experience. However, it should be noted that HPPD does not cause people to have full delusions [15]. HPPD flashes are typically characterized by seeing bright lights, circles, blurry patterns and various size and shape distortions [15]. Due to the persistent nature of these flashbacks and the persons inability to stop them from occurring randomly people can experience agitation, fear and anxiety [15].

 

There are two types of HPPD

Type 1: This is where people experience HPPD in the form of random, brief flashbacks.
Type 2: People with this kind of HPPD experience ongoing changes to their vision, which may come and go.

[16].

The writer has also utilised EMDR to help people who are experiencing HPPD to confront the distressing visual content, and the associated emotions and physical responses. Throughout the session the client visualizes the hallucination and what this image means for them in regard to associated negative beliefs, fear and anger. Clients can organically construct a more meaningful narrative (whilst releasing somatic movements, sounds and sensations) and often reported seeing the visual/hallucination in a new light. In so doing, clients often make the commitment to have a different relationship with the imagery post sessions (e.g., as a reminder to ground, a teacher, a cue to slow down etc.) thus integrating the psychedelic experience and overcoming anxious and fear-based states.

To date there is little research regarding the efficacy of EMDR, psychedelic integration, and/or treatment of HPPD. Future research could explore how the mechanisms of bilateral stimulation (left and right repetitive eye movement technique) and strong therapeutic rapport can support these clinical experiences.

If you would like to know more about psychedelic integration and EMDR please email alana@mindmedicineaustralia.org

 

References

[1] J. Daniel and M. Haberman, “Clinical potential of psilocybin as a treatment for mental health conditions”, Mental Health Clinician, vol. 7, no. 1, pp. 24–28, January, 2017. doi:10.9740/mhc.2017.01.024

[2] Curtis, R, Roberts, L, Graves, E, Rainey, HT, Wynn, D, Krantz, D & Wieloch, V 2020, “The Role of Psychedelics and Counseling in Mental Health Treatment”, Journal of Mental Health Counseling, vol. 42, no. 4, pp. 323–338, October, 2020. doi:10.17744/mehc.42.4.03.

[3] J. Sarris et al. “Ayahuasca use and reported effects on depression and anxiety symptoms: An international cross-sectional study of 11,912 consumers”, Journal of Affective Disorders Reports, vol. 4, 100098, pp. 1–8, 2021. doi:https://doi.org/10.1016/j.jadr.2021.100098

[4] M. Winkelman, “Psychedelics as medicines for substance abuse rehabilitation: evaluating treatments with LSD, Peyote, Ibogaine and Ayahuasca”, Current drug abuse reviews, vol. 7, no. 2, pp. 101–116, 2014. doi:10.2174/1874473708666150107120011

[5] A. Loizaga-Velder and R. Verres, “Therapeutic Effects of Ritual Ayahuasca Use in the Treatment of Substance Dependence — Qualitative Results”, Journal of Psychoactive Drugs, vol. 46, no. 1, 63–72, doi:10.1080/02791072.2013.873157

[6] M. Ot’alora et al. “3,4-Methylenedioxymethamphetamine- assisted psychotherapy for treatment of chronic posttraumatic stress disorder: A randomized phase 2 controlled trial”, Journal of Psychopharmacology, vol. 32, no. 12, pp. 1295–1307, 2018. doi:10.1177/0269881118806297

[7] M. Mithoefer et al. “Durability of improvement in posttraumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3, 4-methylenedioxymethamphetamine- assisted psychotherapy: A prospective long-term follow-up study”, Journal of Psychopharmacology, vol. 27, pp. 28–39, 2013. doi:10.1177/0269881112456611

[8] R.R Griffiths et al. “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial”, Journal of Psychopharmacology, vol. 30, no. 12, pp. 1181–1197, 2016. doi:10.1177/0269881116675513

[9] A. Garcia-Romeu and W.A. Richards, “Current Perspectives on Psychedelic Therapy: Use of Serotonergic Hallucinogens in Clinical Interventions.” International Review of Psychiatry, vol. 30, no. 4, pp. 291–316, 2018. doi:10.1080/09540261.2018.1486289.

[10] J. Guss, R. Krauseand and J. Sloshower, “The Yale Manual for Psilocybin-Assisted Therapy of Depression (using Acceptance and Commitment Therapy as a Therapeutic frame)”, 13th August 2020, [Online], Available: https://psyarxiv.com/u6v9y/

[11] F. Shapiro, (1989). Eye Movement Desensitization: A New Treatment for Post-Traumatic Stress Disorder. Journal of Behavior Therapy and Experimental Psychiatry [Online]. 20(3), pp. 211–217. Available: https://www.sciencedirect.com/sdfe/reader/pii/0005791689900256/pdf

[12] Griffioen, B.T. Van Der Vegt, A.A. De Groot, I.W and De Jongh, A, “The effect of EMDR and CBT on low self-esteem in a general psychiatric population: A randomized controlled trial” Frontiers in Psychology, vol. 8, 1910, pp. 1–12, November, 2017. doi:10.3389/fpsyg.2017.01910

[13] F. Shapiro, “Efficacy of the Eye Movement Desensitization Procedure in the Treatment of Traumatic Memories” Journal of Traumatic Stress, vol. 2, no. 2, pp. 199–223, 1989. doi:10.1002/jts.2490020207

[14] F. Shapiro, Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford Press, 2001.

[15] J. Halpern and H. Pope “Hallucinogen persisting perception disorder: what do we know after 50 years?”, Drug and Alcohol Dependence, vol. 69, no. 2, pp. 109–119, 2003. doi:10.1016/S0376–8716(02)00306-X

[16] L. Orsolini et al. “The ‘Endless Trip’ among the NPS Users: Psychopathology
and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review”, Frontiers in Psychiatry, vol. 8, pp. 1–10, November, 2017, doi:10.3389/fpsyt.2017.00240

Dr Alana Roy

Ph. D Psychology, B. A Social Work (MHSW)

Dr Alana Roy is a psychologist, social worker and therapist and has spent the last 13 years working in mental health, suicide prevention, trauma, sexual abuse, family violence and the disability sector. Alana has worked with borderline personality and dissociative identity disorder in various roles in the community such as: Rape Crisis Centres with victims of ritual abuse, childhood and adult sexual assault, supporting women in the sex industry, survivors of human trafficking and now as a psychedelic integration specialist.

Alana focuses on harm reduction, community and connection. She is dedicated to psychedelic-assisted psychotherapy and plant medicines. She has engaged with, and provides integration therapeutic support services for communities across Australia. Alana works at several universities as a Research Fellow and supervisor of students on placement. Alana passionately advocates for public policy, community education and legislative changes so that these treatments are regulated and supported by a strong, connected and skilled sector.

Learn more about Alana’s experiences in: Psychedelic Medicines: How My Journey Into The Jungle Changed My Life

Psychedelic Healing Stories: Michael Raymond

Abstract

 

My name is Michael Raymond. I served in the Airforce for 16 and a half years, serving initially as an Avionics Technician, working on Fighter Jets such as the F-111 and F/A18F Super Hornet. 10 years into my career I commissioned to become an Electrical Engineer Officer and worked on a number of projects, as well as what many refer to as the Australian version of the Pentagon near Canberra. As a side job I also became a Motorcycle Instructor and by the end of my Defence career was regularly coaching the fastest rider group at the Sydney Motorsport Park racetrack. My other passion was martial arts: training and fighting in Boxing, MMA, Shaolin Kung Fu and Brazilian Jiu Jitsu.

In late 2018, I was medically retired after battling with mental and physical illness, including, Major Depression, Anxiety Disorders and Post Traumatic Stress Disorder. I had been in a state of suppression following some near-death experiences both in and out of service, one including an engine explosion during a flight with the US Airforce, narrowly avoiding impact with the ground and involving an evacuation of Waikiki beach, Hawaii. I managed all my struggles by working myself harder, training harder, pushing my limits more on the motorcycle and drinking on the weekends to blow off the steam. I was also prescribed antidepressants and sleeping medication, some of which I later found out was above the recommended maximum dosage.

Prior to my personal research and experiences with Psychedelic Therapies, I held many negative assumptions and judgements regarding the use of psychedelics which deterred me from any consideration of their healing qualities. I believed they were for party goers or drug abusers who had little interest in being a productive member of society or successful within the professional workspaces. I also had a preconceived notion that they were dangerous, addictive, or may even cause a mental breakdown. It is funny to look back on now.

I also had little understanding of my own sub-conscious behaviours and beliefs, which prevented me from exploring potential avenues for healing, self-love, self-growth and acceptance. I was able to keep everyone at an arm’s length, avoid truly dealing with my deepest fears, traumas, lack of self-worth and unknowingly perpetuate a decline into depression and anxiety, to the point of feeling like suicide was my only reprieve. It was in that darkness and in a failing relationship, my partner at the time convinced me to investigate psychedelic plant medicines and their success with helping people recover from severe depression, as well as other mental illnesses. I was intrigued enough to max out the credit cards and book my flights to South America the next month.

My first introduction to Psychedelic Plant Medicines was Ayahuasca and San Pedro at a healing retreat. We had to follow a regimented routine of preparation both mentally and dietary in order to prepare for the ceremonies with the traditional South American Shaman. This included stopping my anti-depressant medication which had terrible side effects, and I was severely dependent on them for mental and emotional stability. I was very sceptical from the start and held little hope for anything significant to change.

Taking Ayahuasca was life changing for me. I was humbled and vulnerable in the ceremony. The medicine seemed to have a mothering energy, disciplining me with cold hard and undeniable truths but also holding me and supporting me through the emotions which inevitably followed when having them highlighted. I had always struggled to cry and could not understand why a man would show what I perceived as weakness. In these moments of nausea and confronting truths, I let go of my grip of control and had a much-needed release of deep sadness I had been holding for far too long.

The next day I felt renewed. I found my sense of humour which my friends and partner had missed. I was laughing and felt joy and peace with the world for the first time in years. It felt like the weight of the world was no longer on my shoulders. The following ceremonies offered me healing beyond what I could have imagined, they all felt like I was conversing with the wisest parts of myself or some spiritual teacher such as Eckhart Tolle or Alan Watts. It was truly life-changing, and my depression seemed to evaporate. I could see the beauty in living and my self-worth no longer felt conditional. Someone had pressed the reset button on my brain. I was more present and felt this peace within me, the type I only ever glimpsed after riding motorbikes on the racetrack at full speed. My ADHD mind was silenced! It was as if I had defragmented my mind and it was now running beautifully again.

Like any healing modality there is no magic pill to instantly resolve chronic and complex traumas; rather, the healing process is often in layers. On my return from South America this proved true as I faced new and emerging layers of my trauma. Thankfully, I was free from my dependence on anti-depressants after 10 years on them and had shifted the stigma around psychedelic plant medicines. I also now knew I had a way to shift my perspective when my internal program of pessimism, lack of hope and/or purpose had run me into a dead negative dead-end once again. Journeying with plant medicines had revealed my intrinsic worth purely from my existence, and that life is worth living.

After my initial experiences I started to understand that taking the psychedelic plant medicines was only one aspect of the healing. The integration, support, intention and understanding of the medicine all contributed to the success of my recovery from cannabis dependence and mental illness in the long term. When combined with exercise, purpose, community engagement, diet and other healthy lifestyle choices, the results were drastically improved, and I was astonished at how powerfully healing these journeys were.

Having experienced both the Western medicine (anti-depressants, talk therapy psychotherapy) and Psychedelic Plant Medicine approach to my mental health, I reflected on the results. I cannot speak for everyone of course, but for me the difference was significant to the point of wanting to share my story.

If we were to imagine myself as a sick tree, the anti-depressants solution would be in line with building a greenhouse around the tree. It is an externally dependent relationship that did not improve my resilience and only sheltered me from feeling the full brunt of life’s weather patterns. The Psychedelic Therapies approach, however, felt like diving deep into the soil to uncover the origin of what may be causing the sickness; then finding that fundamental issue and taking action to improve the soil and health of the roots system. In doing so improving its resilience. I felt exactly this, more resilience and self-empowerment to take on what life throws at me.

With my community of friends and three of my bothers having served in the military, I am aware there will be many barriers to shifting the stigma around Psychedelic Therapies. I do, however, believe that therapeutic use of Psylocibin and MDMA are a godsend for Veterans who may be dealing with complex traumas, such as PTSD and other mental health issues. If rescheduled, I have no doubt about the positive effects organisations such as Mind Medicine Australia will have on the mental health of so many of those who are suffering within the veteran and wider community. So that they are no longer just surviving life, they are thriving.

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