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Psychiatrist hopes 'magic mushroom' treatment will be more widely available
The drug which is used for the treatment of depression costs tens of thousands of dollars.
Photo:
supplied / Imperial College London / Thomas Angus
The country's first psychiatrist granted approval to prescribe the Class A drug psilocybin hopes the milestone will be the first step to making the promising therapy available to more people.
The drug which is used for the treatment of depression costs tens of thousands of dollars.
On Wednesday, Associate Minister of Health David Seymour announced the first approval to prescribe
psilocybin - the hallucinogenic compound found in magic mushrooms
- outside of clinical trials in New Zealand.
Psilocybin will remain an unapproved medicine, but "a highly experienced psychiatrist has been granted authority to prescribe it to patients with treatment-resistant depression", Seymour said.
That psychiatrist, Ōtautahi -based Dr Cameron Lacey, who was also behind the first clinical trials of psilocybin, said it had taken "a long time, a lot of energy and perseverance" to get to the approval stage, which had taken around four years.
Lacey did not put a price on the resource intensive therapy - which involves months of psychotherapy and one or two eight-hour psilocybin sessions accompanied by two clinical professionals - but thought it could be done for "significantly less" than overseas costs.
"In Oregon, it's about USD$10,000 (NZ$16,500), in the European Union it's about €10,000 (NZ$19,000), in Australia, it's looking to be about $30,000 (NZ$32,000) to $40,000 from the information I've received - I think it can be delivered here for significantly less than that."
The Medsafe approval would not in itself bring down the cost, Lacey said, but was "an important first step".
"We need to be pushing so that it is a treatment that's going to be accessible to all. I think insurance companies ... will become very interested in this as a potential treatment. And I'm hopeful we can work with Health New Zealand to create a funding pathway for those who have failed to respond to current standard treatments and endure significant symptoms to be able to get access to this treatment."
Lacey stressed the research pointed to the importance of using the hallucinogen in conjunction with intensive psychotherapy.
"All of our evidence to date demonstrates the combination of good quality psychotherapy combined with the psilocybin experience, followed up with further psychotherapy, has been required in order to get the response rate."
While the dosing happened under strict clinical supervision, and in a clinical setting, the experience was no small undertaking and still had all the hallmarks of a psychedelic trip.
"Those who take psilocybin can experience mystical, spiritual and a whole range of very challenging experiences. It's certainly not microdosing. It's a very significant experience and people who go through it often rate it as one of the most important and significant events in their lives."
For some, just one treatment can be sufficient.
"Most of the studies have involved one or two doses integrated with a course of psychotherapy. For those that do respond and have an improvement in their depression, their depression seems to remain improved for up to two years within the longest studies that have been followed to date," Lacey said.
Thirty to forty percent of patients diagnosed with depression are treatment-resistant - or don't respond to two different anti-depressant medications - according to Auckland University research. The NZ Health Survey puts that at around 283,000 people.
There's a range of theories to explain how people improve from the use of psychedelics, "from the biological, involving neurotransmitters and default mode networks, but the one I tend to favour is that it's the psychological insights gained through the experience about reimagining themselves and their sense of connectedness to the world, to others and beyond, that provides them with new insights that can then be leveraged in the psychotherapy to create meaningful and enduring change", Lacey said.
There had been very promising results from a number of studies for people who would normally have low response rates for existing options for treatment-resistant depression, Lacey said.
But he noted there were limitations to the research, because it was difficult to control for placebo responses, given those receiving psychedelics could "easily predict" if they had received the active ingredients or not.
Initially, Lacey would be sourcing the psilocybin off-shore, but indigenous fungi containing psilocybin was imminent, after biotechnology company Rua Bioscience, working with Rangiwaho Marae and in collaboration with rongoā Māori practitioners, ESR (Institute of Environmental Science and Research), University of Auckland, University of Waikato, Manaaki Whenua Landcare Research, Mātai Medical Research Institute, an iwi health provider and other community stakeholders
were granted a cultivation licence in 2023
.
"There is a group based in Gisborne at Rangiwaho marae who have a research project
which has been funded and authorised to develop New Zealand grown psilocybin
, but that will take some time in order to be able to deliver quality controlled product. In the meantime we are importing it from overseas, and there are a number of suppliers who are providing quality controlled, guaranteed dosing."
Associate Health Minister David Seymour
Photo:
RNZ / Cole Eastham-Farrelly
Seymour said the announcement brought New Zealand in line with Australia, where MDMA (ecstasy) and psilopsycbin have been able to be prescribed since 2023, when it became the first country to classify psychedelics as medicines at a national level.
"This is huge for people with depression who've tried everything else and are still suffering. If a doctor believes psilocybin can help, they should have the tools to try," Seymour said.
The latest data from the New Zealand Drug Foundation shows the use of psychedelics - which includes substances such as LSD, psilocybin and ketamine - has doubled in the past six years.
After cannabis and MDMA, psychedelics were the third most commonly used illicit drug in New Zealand.
"Many of our most popular illicit substances have well-documented medicinal uses and are being actively studied for their potential to treat a range of health conditions, so it's likely at least some of the use in this report is self-medication," NZDF executive director Sarah Helm said.
All three rank at the lower end of potential for harm, she said.
"We think it's time to enable more medical access to the likes of psychedelics and MDMA and stop prosecuting people who use them," she said.
Auckland University senior research fellow Dr Tehseen Noohrani is the co-lead of Community Strategising about Psychedelic Therapy in Aotearoa - a philanthropically funded 18-month project looking at what psychedelic therapy "could and should look like in Aotearoa, and pursuing answers in line with Tino Rangatiratanga and harm reduction principles".
He said the increased use and burgeoning body of research around psychedelics
is part of a global trend
.
"There is a growing movement internationally of different stakeholders interested in psychedelic therapy, and what a responsible path forward might be for increased access pathways - whether for different patient populations, for Indigenous populations who have ancestral uses of these plant medicines and fungi, or for non-therapeutic uses altogether.
"Different countries around the world are changing their legislation and policies at different rates, driven by different concerns and incentives."
He said accessibility was a "real issue", especially given how costly treatment can be, prompting ongoing work on ways to bring those costs down, such as group treatments.
Criminalisation and prohibition were also preventing people from accessing psychedelics, "whether they're understood as medicines, drugs or as sacred taonga."
"There are a lot of different issues in play. Medicalisation is one of the driving forces here but there's a whole raft of issues, which are in a way treaty-based issues that might be related, for example, the long histories and legacies of colonialism and the Taonga Suppression Act and so on, the rightful ability of Maori to use endemic species of psilocybin-containing mushrooms as taonga, harm reduction principles in relation to the quote unquote 'underground use' of psychedelics in 'recreational ways' that are also really healing."
Noohrani said some people experience "profound" healing from psychedelics.
"The kind of healing that one sees through clinical trials with psychedelics and through testimonials from various contexts as psychedelic use for healing are extraordinary. Really, really profound forms of healing that have led to hypotheses and thinking about psychedelic healing in terms of really something different, potentially getting at root problems rather than just treating symptoms.
"So that's all really exciting. But at the same time, hype has been part of the machinery of psychedelic science from the beginning, and that's related to the fact that psychedelics are these very colourful substances that bring their own histories with them."
He said there were multiple considerations and challenges in "trying to figure out what a system of access and availability would look like, particularly one that's consistent with values of Tino Rangatiratanga and harm reduction".
"But in terms of the making psychedelics available for health treatments, one thing that is really important is doing it in a way that we can systematically gather data to better understand these substances - regardless of whether they're understood as substances or as sacred medicines or as drugs or as chemicals or as psychological adjuncts."
