Patients in Australia will soon have legal access to the psychedelic drugs psilocybin and MDMA under a plan announced by regulators last month. But with no approved source of the drug available to therapists, patients will likely face bills in the tens of thousands of dollars to obtain the promising treatment.
Last month, the Therapeutic Goods Administration (TGA), the Australian government’s medicine and therapeutic regulatory agency, announced that qualified psychiatrists will be able to prescribe the psychedelic drugs psilocybin and MDMA for the treatment of certain mental health conditions beginning later this year. But the agency has not approved any products containing the promising psychedelic drugs, leaving mental health professionals to source the drugs themselves. Without a government subsidy to help cover the cost of the medications, psychiatrists estimate that patients will have to pay as much as AU$25,000 (nearly $17,000) and more out of pocket for psychedelic-assisted therapy.
“For the actual patient, it might be $25,000, $30,000 for a treatment,” said Dr. Stephen Bright, a senior lecturer at Edith Cowan University and director of the charity Psychedelic Research In Science & Medicine.
“I honestly don’t think, for the next 12 to 18 months post July 1, that these treatments will be very widely available at all,” he added. “The tight controls of therapy mean there are very few psychologists who put their hand up. There will be a few clinics that open up, but I don’t think we’re going to see the floodgates open.”
Dr. Paul Liknaitzky, the head of the Clinical Psychedelic Lab at Monash University, revealed last month that he and other mental health professionals will be partnering with investors to open a psychedelic-assisted therapy clinic in Melbourne. But training requirements for therapists and detailed guidelines for such therapy have yet to be issued by government regulators.
“There is a lack of detailed clarity from the TGA to help us understand how it’s going to roll out. We are concerned but cautiously optimistic,” he said.
Liknaitzky said that he and his colleagues will help establish protocols that set high standards for ethical and effective psychedelic-assisted therapy. But he warned that the high cost of treatment might make the treatment inaccessible to most Australians.
“Sensible and safe treatment approaches, based on decades of best-practice development, will include considerable screening, psychotherapy and other support. A typical course of treatment, spanning a few months, may be in the order of $25,000, plus or minus $10,000,” he said. “If it turns out to be cost-effective, it will be in the government’s interest to fund it.”
Ongoing research has shown that psilocybin, the primary psychoactive compound in magic mushrooms, has the potential to be an effective treatment for several serious mental health conditions, including PTSD, major depressive disorder, anxiety and substance misuse disorders. A study published in 2020 in the peer-reviewed journal JAMA Psychiatry found that psilocybin-assisted psychotherapy was a quick-acting and effective treatment for a group of 24 participants with major depressive disorder.
Separate research published in 2016 determined that psilocybin treatment produced substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer. And in 2021, a study published in the journal NatureMedicine determined that MDMA, commonly known as ecstasy, is a highly efficacious and safe treatment for individuals with severe PTSD.
But Professor Chris Langmead of the Monash Institute of Pharmaceutical Sciences says that it is unlikely that public health agencies will cover the cost of such treatment until further research including a cost-benefit analysis has been completed.
“We’re trying to get a groundswell of research and funding so we can do the research, clinical studies and practice rollout [to ensure] that this is not purely a market-led solution where the most disadvantaged populations are missing out,” he said. “The TGA has put Australia at the forefront of the world and we really need to take the opportunity and make the most of it.”
University of Melbourne associate professor Gillinder Bedi said that a shortage of clinical staff trained in psychedelic-assisted therapy will also make the treatment difficult for patients to obtain.
“The infrastructure will get set up. There will be clinics. But the problem is we don’t have staff. People can’t even see psychiatrists under normal conditions,” she said. “If you put two clinical psychologists in a room for eight hours, at a [Medicare] billing rate of $120 an hour – which is not what people charge, they charge $200 to $300 – you have an enormously expensive treatment. I think it could get higher [than $25,000].
“No matter which way you look at it, it will take time away from other treatments and cost a whole bunch of money. It’s unclear who will foot the bill, some organizations are trying to set up philanthropic funding,” Bedi added. “But it’s going to be for people with money, in the initial stages at least.”
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