tag:theconversation.com,2011:/ca/topics/mdma-5855/articlesMDMA – The Conversation2023-12-12T19:53:39Ztag:theconversation.com,2011:article/2187842023-12-12T19:53:39Z2023-12-12T19:53:39ZCanada owes its veterans new mental health tools: Access to psychedelic therapies is overdue<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/canada-owes-its-veterans-new-mental-health-tools-access-to-psychedelic-therapies-is-overdue" width="100%" height="400"></iframe>
<p>The Canadian Senate Subcommittee on Veterans Affairs recently released a striking report entitled <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/"><em>The Time is Now: Granting Equitable Access to Psychedelic Therapies</em></a>. </p>
<p>To address high rates of suicide and post-traumatic stress disorder (PTSD) among veterans, the report calls on Veterans Affairs Canada (VAC) to immediately implement “a robust research program funded by VAC and the Department of National Defence (DND) in partnership with Health Canada, the Canadian Institutes of Health Research, and all other relevant partners.”</p>
<p>With psychedelic research, Veterans Affairs Canada has a real chance to live up to its mandate “to provide exemplary, client-centred services and benefits that respond to the needs of veterans, our other clients and their families.” </p>
<p>As a psychedelics researcher with an interest in veteran health, I couldn’t be happier, especially with the Senate focus on timeliness, equity and access. </p>
<p>Not only is <a href="https://www.researchgate.net/publication/372244882_Knowledge_Synthesis_in_the_Science_of_Psilocybin_Scoping_Reviews_of_Clinical_and_Preclinical_Research">my PhD on the therapeutic application of psilocybin</a>, but my father was a veteran of the Canadian Forces, as is my brother and two uncles and both of my grandfathers. I grew up on Canadian Forces bases.</p>
<h2>Canada’s veterans</h2>
<p>Lt. Col. (ret’d) Jack Shore, my father, graduate of the <a href="https://www.btb.termiumplus.gc.ca/tpv2alpha/alpha-eng.html?lang=eng&srchtxt=APPRENTICE%20SOLDIER">Soldier Apprentice Program</a> and a United Nations Peacekeeper in the <a href="https://peacekeeping.un.org/sites/default/files/past/onucB.htm">Congo mission</a> of the early 1960s, passed away as I was working as a guest co-editor of a special edition of the <a href="https://jmvfh.utpjournals.press/toc/jmvfh/current"><em>Journal of Military, Veteran and Family Health</em></a>. The theme of the edition is “Therapeutic use of psychedelics, entheogens, entactogens, cannabinoids and dissociative anesthetics for military members and veterans.” </p>
<p>While my Dad rarely talked about his time in the Congo, he experienced what we would now recognize as moral injury, and most likely PTSD. These conditions directly shaped our family life and upbringing. That was before Sudan, Rwanda, the Yugoslav wars and Afghanistan.</p>
<p>My childhood on bases occurred in time of relative peace, but Canada has now had a few generations of soldiers experience active combat. </p>
<p>The <a href="https://patientsmedicalhome.ca/resources/best-advice-guides/best-advice-guide-caring-for-veterans/">629,000 veterans living in Canada have rates of depression, anxiety and substance use disorder that are higher than the civilian population</a>. <a href="https://doi.org/10.1002/jts.21956">One in seven is living with PTSD</a>. Veterans are <a href="https://www.mcgill.ca/maxbellschool/files/maxbellschool/ofha_veteran_homelessness_policy_brief_-_2023.pdf">two to three times more likely</a> to experience homelessness compared to the general population. </p>
<h2>Duty of care</h2>
<p>To veterans of the Canadian Forces and to their families, we owe a duty of care, and not just to provide services and access to novel treatments. We also have a duty to care enough to do the science well and to tackle the public policy challenges (including regulatory drug reform) necessary to provide Canadian veterans with effective care.</p>
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<p>“It is the Government of Canada’s duty to assure veterans that it is doing everything in its power, immediately, to respect its solemn commitment to support, at any cost, those who chose to defend us with honour.” — <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/">The Subcommittee on Veterans Affairs, Senate of Canada</a> </p>
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<p>The role of the VAC includes paying for the cost of health-care benefits and other services for veterans through the <a href="https://www.canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/health-care-plan.html">Public Service Health Care Plan</a> and supplemental treatment benefits. While this single-payer provider model has advantages, it relies heavily on VAC staff and managers to assess and approve plans of care. </p>
<p>Developing a psychedelics research program for veterans should be seen as a public health priority. It will most likely require an independent panel of experts and stakeholders, including veterans, to help shape the agenda in a timely manner for the VAC. </p>
<h2>Psychedelic therapies</h2>
<p><a href="https://cimvhr.ca/">The Canadian Institute for Military and Veteran Health Research</a> (CIMVHR), founded in 2010, is well positioned as the Canadian hub for military, veteran and family health research to provide the infrastructure to foster collaboration, ensure stakeholder engagement and work on the knowledge translation so necessary to rapidly developing the capacity and expertise of Canadian researchers.</p>
<p>We can build on the work of the U.S. Department of Veterans Affairs, which is <a href="https://clinicaltrials.gov/study/NCT05876481?term=Veteran&intr=Psilocybin&rank=1">currently conducting several psilocybin trials</a>, and the long-standing work of <a href="https://maps.org/">MAPS (Multi-disciplinary Association of Psychedelic Studies)</a> in advancing MDMA-assisted therapy for PTSD towards regulatory approval. We can also listen to the experts, such as Canada Health Research Chair in Mental Health Disparities Monnica Williams, who are calling for <a href="https://doi.org/10.1007/s11469-023-01160-5">greater equity and improved inclusion of BIPOC veterans and researchers</a>. </p>
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<p>“When we have tried everything in our toolbox but still cannot help our patients, it is truly time for some new tools.” —<a href="https://jmvfh.utpjournals.press/toc/jmvfh/9/5">Monnica Williams</a>, Canada Health Research Chair in Mental Health Disparities </p>
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Read more:
<a href="https://theconversation.com/the-potential-of-psychedelics-to-heal-our-racial-traumas-218233">The potential of psychedelics to heal our racial traumas</a>
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<p>Psychedelic ketamine appears to have <a href="https://doi.org/10.1192%2Fbjo.2021.1061">positive but short-lived outcomes</a> in the treatment of mood disorders, and ketamine clinics require evaluation given recent <a href="https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine">FDA warnings</a> about risks of commercialized mental health telemedicine and take-home doses.</p>
<p>Ultimately, the Canadian public may want to reconsider the policy framework that still severely limits access to these promising compounds for researchers, clinicians and those in need. </p>
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Read more:
<a href="https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061">Alberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?</a>
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<p>Veterans have taken it upon themselves to support each other and to advocate for change. <a href="https://heroicheartsproject.org/">The Heroic Hearts Project</a> helps veterans access psychedelic therapies and has long championed the potential benefits of plant medicine ceremony.</p>
<p><a href="https://www.heroicheartsproject.ca/">Heroic Hearts Canada</a>, which aims to provide Canadian veterans with equitable access to safe, effective and affordable psychedelic therapies, has recently partnered with University of Calgary for some <a href="https://www.ucalgary.ca/research/participate/study/16168/are-you-veteran-canadian-armed-forces-have-you-investigated-working-psychedelics-legally">important observational research</a>.</p>
<h2>Faster progress to medical use</h2>
<p>The time lag from drug discovery to patient care is often decades, prompting the expression “<a href="https://doi.org/10.1186/s41231-019-0050-7">valley of death</a>” to refer to the gap between bench science and bedside care. </p>
<p>Given the real mental health needs of Canadian veterans, and the known limits on effectiveness for current standards of care, we must aim for quicker progress towards medical use, <a href="https://www.unodc.org/res/WDR-2023/WDR23_B3_CH2_psychedelics.pdf">as both the United States and Australia have done</a>. However, this progress must not be at the expense of safety and quality, and definitely not simply for commercialization. </p>
<p>Thought needs to be given to the development, evaluation and quality assurance of accessible programs for veteran-centred care, with Veterans’ voices at the table. It is time for more emphasis on psychedelics-related <a href="https://doi.org/10.1016/j.psychres.2019.04.025">implementation science</a>, the study of methods to promote the uptake (and identify barriers) of research findings into routine clinical use in order to improve effectiveness of health services.</p>
<p>There is <a href="https://healthsci.queensu.ca/source/Psychedelics%2520Research/Psychedelic%2520Medicine%2520Report%2520-%2520Final.pdf">robust and mounting evidence to support regulatory approval for MDMA and psilocybin-assisted therapies</a>. Their availability and uptake by clinicians and the public is only a matter of time. </p>
<h2>The need for more diverse research</h2>
<p>Research funds now are best allocated towards large Phase 3 trials that treat wider cross-sections of the veteran community, to begin to assess the safety and efficacy of interventions such as the naturally ocurring and culturally significant psychedelic compounds <a href="https://doi.org/10.1080/00952990.2023.2220874">ibogaine and 5-MeO-DMT</a> <a href="https://www.proquest.com/openview/2d897baa8a8203979eaf5ee7deb9037e/1?pq-origsite=gscholar&cbl=18750&diss=y">and ayahuasca</a>, and to invest in knowledge translation, program evaluation and training researchers and clinicians. </p>
<p>Apart from new biomedical research, it is time we recognized the widespread personal use of psychedelics, including among veterans, and develop safer use guidelines for psychedelics like those in place <a href="https://www.canada.ca/en/health-canada/services/substance-use/alcohol/low-risk-alcohol-drinking-guidelines.html">for alcohol</a> and <a href="https://doi.org/10.1007/BF03404169">cannabis</a>.</p>
<p>While the Senate report does not mention cannabis, it is worth noting that veterans in Canada have been <a href="https://dimensionsretreats.com/dimensions-retreats-algonquin-elevate-veterans-only/#:%7E:text=The%2520program%2520does%2520not%2520include,mind%252Dbody%2520practices%2520in%2520nature.">approved for treatment with cannabis-assisted therapy</a>. </p>
<p>This includes the use of <a href="https://doi.org/10.1177/0269881121997099">cannabis as a psychedelic</a> and mimics the <a href="https://doi.org/10.1007/s40429-021-00401-8">preparation-session-integration protocols</a> of psychedelic therapies. This intervention is also worth rapid evaluation and possible expansion. </p>
<p>Given the pressing needs of Canadian veterans and the limitations of our current tools, the need for research on psychedelic therapies, as well as for timely and equitable access, is urgent.</p><img src="https://counter.theconversation.com/content/218784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ron Shore worked for, and consulted to Dimensions Health Centres in 2021 and 2022; he continues to own shares in the company.</span></em></p>One in seven Canadian veterans is living with PTSD. Developing a psychedelics research program for veterans should be a public health priority.Ron Shore, Research Scientist, Queen's Health Sciences and Assistant Professor, Department of Psychiatry, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2195992023-12-12T03:46:44Z2023-12-12T03:46:44ZPlanning to use drugs at a festival on a scorching summer day? Here’s why extreme heat might make MDMA riskier<figure><img src="https://images.theconversation.com/files/565079/original/file-20231212-29-chp7fb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/crowds-enjoying-themselves-outdoor-music-festival-184911032">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Sydney and other parts of Australia have just experienced <a href="https://news.sky.com/story/australia-temperatures-in-sydney-climb-to-nearly-40c-as-authorities-issue-bushfire-warnings-13027266">a significant heatwave</a>, with temperatures reaching highs of well over 40°C. In Sydney in particular, the extreme heat has coincided with a bustling schedule of <a href="https://www.canberratimes.com.au/story/8453863/crowds-bake-at-sydney-concerts-as-mercury-soars/">live music events</a>, attracting large crowds despite the sweltering conditions.</p>
<p>Drug experts <a href="https://www.abc.net.au/news/2023-12-09/nsw-heat-drug-overdose-festival-deaths/103205522">raised concerns</a> ahead of the sold-out Epik festival which took place at Sydney Olympic Park on Saturday, cautioning revellers against the dangers of taking illicit drugs in extreme heat.</p>
<p>Reports have since emerged that <a href="https://www.abc.net.au/news/2023-12-10/nsw-sydney-epik-music-dance-festival-drug-hospitalisations/103211208">four festival patrons</a> were taken to hospital for reasons relating to drugs. </p>
<p>While illicit drug use is dangerous no matter the circumstances, extremely hot weather may make it even more risky.</p>
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Read more:
<a href="https://theconversation.com/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">5 reasons why climate change may see more of us turn to alcohol and other drugs</a>
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<h2>Drug use at festivals</h2>
<p>We know the use of recreational drugs is common at live music events such as festivals. Studies have shown people who frequently <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0205-7">attend music festivals</a> and dance events tend to have <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-6-18">more experience with illegal substances</a> than their counterparts who don’t attend these events. </p>
<p>Wastewater analyses <a href="https://www.sciencedirect.com/science/article/pii/S0048969718351490?casa_token=ZMgSdR0MnjYAAAAA:iseXbDHWCT8i4O4FqGUUrooAUleX9TXqSce89xbPVDjONBubOHB-rrpsCkHUl-if5m3DYgFW6Eg">have confirmed</a> the prevalence of drug use at music festivals.</p>
<p>In Australia and overseas, several live music events have been marred by tragedies linked to drug use. As recently as October, two men, aged 21 and 26, died following <a href="https://cityhub.com.au/two-men-die-from-suspected-drug-overdose-after-attending-sydney-music-festival/">suspected drug overdoses</a> at the Knockout music festival in Sydney. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1708729898116808711"}"></div></p>
<p>At these sorts of events, MDMA (or ecstasy) is among the <a href="https://www.tandfonline.com/doi/full/10.1080/15563650.2017.1360496?casa_token=qppYTfu_IBcAAAAA%3ANwXWLwMFiKcBWE0e8DIGu-97pJNnqynSjjiwYhg-gNDbOEcqhNI2MOccCvzszG4QCRewZhiDTPH_MQ">most commonly used substances</a>. And when taken during extreme heat, the risks could be much greater.</p>
<h2>MDMA and hot weather</h2>
<p>MDMA triggers the release of substances that interfere with our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/">temperature regulation</a>, leading the body to generate more heat than usual. This effect is known as hyperthermia (as opposed to hypothermia, when the body gets too cold). </p>
<p>This elevation in body temperature happens even if the person using drugs is not exerting themselves and not in a hot environment. In this context, the effect can still <a href="https://sunrisehouse.com/ecstasy-abuse/effects/">cause dehydration</a>.</p>
<p>However, the effects may be greater if a person is exerting themselves in hot, crowded settings. Studies have shown that on average, for a person who takes MDMA somewhere like a dance club, their body temperature can increase by <a href="https://www.sciencedirect.com/science/article/abs/pii/S0376871611003577">more than 1°C</a>.</p>
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Read more:
<a href="https://theconversation.com/taylor-swifts-brazil-concert-was-hammered-by-extreme-heat-how-to-protect-crowds-at-the-next-sweltering-gig-218341">Taylor Swift's Brazil concert was hammered by extreme heat. How to protect crowds at the next sweltering gig</a>
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<p>In extreme cases, a sharp increase in body temperature <a href="https://www.nih.gov/news-events/news-releases/mdma-can-be-fatal-warm-environments">can lead to</a> organ failure and even death. </p>
<p>Extreme heat may compound the hyperthermia induced by taking the drug. A <a href="https://www.jneurosci.org/content/34/23/7754.short">study in rats</a> showed a moderate dose of MDMA that is typically non-fatal in cool, quiet environments can be fatal in rats exposed to conditions that mimic the hot, crowded settings where people often use the drug.</p>
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<img alt="One person passing a small packet of pills to another person." src="https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Taking MDMA interferes with the body’s temperature regulation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drug-dealer-selling-ecstasy-pills-addict-1331364980">Impact Photography/Shutterstock</a></span>
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<h2>What now?</h2>
<p>Illicit drugs pose significant dangers to people who use them at music festivals and elsewhere. </p>
<p>Meanwhile, with climate change, we are set to face <a href="https://www.climatechange.environment.nsw.gov.au/impacts-climate-change/weather-and-oceans/heatwaves">more frequent and intense</a> heatwaves in the future. So it’s important to better understand how the weather might intensify the risks of drug use. </p>
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Read more:
<a href="https://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">Testing festival goers' pills isn't the only way to reduce overdoses. Here's what else works</a>
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<p>The principles of harm reduction recognise that, despite our best efforts to educate people about the risks associated with substance use, some people will continue to experiment with drugs at music festivals. So it becomes essential to minimise potential harms through evidence-based strategies, such as <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0205-7">pill testing</a>.</p>
<p>Harm reduction messages play a vital role in educating music festival attendees about the dangers of drug use, especially in hot conditions. These messages must encourage seeking medical help without fear of repercussions, staying hydrated, taking regular breaks, and wearing appropriate clothing for sun protection. Public officials, event organisers, families and friends can all contribute to spreading these messages, though attendees also need to exercise personal responsibility.</p>
<p>Messaging should also stress the importance of patrons looking out for their friends, highlighting everyone has a role in maintaining a safe environment at these events.</p>
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Read more:
<a href="https://theconversation.com/its-extremely-hot-and-im-feeling-weak-and-dizzy-could-i-have-heat-stroke-215084">It's extremely hot and I'm feeling weak and dizzy. Could I have heat stroke?</a>
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<img src="https://counter.theconversation.com/content/219599/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Milad Haghani receives funding from the Australian Research Council (Grant No. DE210100440). </span></em></p><p class="fine-print"><em><span>Dr Pegah Varamini has received funding from the National Breast Cancer Foundation, Therapeutic Innovation Australia (TIA), Pipeline Accelerator Grant, SPARK Oceania, Tour de Cure, Sydney Catalyst, Controlled Release Society, and Australian Pain Society. She is a lecturer and the head of Breast Cancer Targeting & Drug Delivery laboratory at the University of Sydney Pharmacy School. Pegah is affiliated with the World Health Organisation as a scientific advisor within the Global Breast Cancer Initiative and is the Co-Chair of NanoPharma cluster within NanoHealth Initiative at the Sydney Nano Institute.</span></em></p>Taking MDMA can raise our body temperature higher than it should be. Extreme heat may compound this effect.Milad Haghani, Senior Lecturer of Public Safety & Disaster Risk, UNSW SydneyPegah Varamini, Senior Lecturer in Pharmacy and Pharmacology, Head of Breast Cancer Targeting and Drug Delivery Laboratory, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2182332023-11-23T16:32:58Z2023-11-23T16:32:58ZThe potential of psychedelics to heal our racial traumas<iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/f2e5423c-d81f-41aa-a3c8-e7a6bb396a7b?dark=true"></iframe>
<p><em>Clinical psychologist and professor Monnica Williams is on a mission to bring psychedelics to therapists’ offices to help people heal from their racial traumas. To do this, she’s jumping over some big hurdles.</em></p>
<p>Judging from the colourful signs advertising mushrooms that we are seeing on our streets and the presence of psychedelics in pop culture, we are in the middle of a psychedelic renaissance. For example, in the TV program <em>Transplant</em>, a Syrian Canadian doctor experiencing trauma is treated by his psychiatrist with psilocybin therapy. </p>
<p>On a more official front, this month, the <a href="https://globalnews.ca/news/10079020/psychedelics-veteran-ptsd/">Canadian Senate recommended the federal government fast-track a research program</a> into how psychedelics can help veterans suffering from Post Traumatic Stress Disorder (PTSD). PTSD covers a range of issues, including racial trauma. </p>
<p><a href="https://dont-call-me-resilient.simplecast.com/episodes/the-potential-of-psychedelics-to-heal-our-racial-traumas">On this week’s episode of <em>Don’t Call Me Resilient</em></a>, we explore how psychedelics — including psilocybin (“magic mushrooms”) and MDMA — can help heal racial trauma. Racial trauma, Williams explains, is not necessarily something that happens through one event. It’s usually ongoing experiences of stress, including “daily insults to your person.” </p>
<p>With racial trauma, therapists are also looking at events beyond an individual’s lifetime. “We’re looking at historical trauma, that may have happened decades or even centuries ago, that is still associated with the person’s cultural group. These could be catastrophes that happened to a whole group of people, like ethnic cleansing or genocide, the Holocaust, or it could be a natural disaster.”</p>
<p>Intergenerational trauma is something Williams has experienced personally. Her parents grew up in the Deep South in the United States during the Jim Crow era. As African Americans, they were subject to segregation and extreme oppression. She says that affected the whole African American community.</p>
<p>People with racial trauma can have symptoms like depression or anxiety or may be despondent or angry. </p>
<h2>Research studies show results for psychedelics</h2>
<p>Once Williams saw the research studies coming out of <a href="https://maps.org/about-maps/">MAPS, a multidisciplinary association for psychedelic studies</a>, she was convinced that psychedelics can work: “The medicine does its thing and the brain starts to heal itself.”</p>
<p>But there are some big hurdles before we get there, including the fact that many mental health professionals don’t have any “training or knowledge in working with people across race, ethnicity and culture,” according to Williams. </p>
<p>And we don’t exactly have a great track record when it comes to communities of colour and drugs. There is a long and ugly history of institutions using Black, Indigenous and racialized bodies without consent for medical experimentation, including drug testing. We also can’t forget the racial roots of the <a href="https://apnews.com/article/war-on-drugs-75e61c224de3a394235df80de7d70b70">war on drugs</a> and the devastating impact it had — and continues to have — on Black and other racialized communities. </p>
<p>All this begs the question: As psychedelics appear to be entering the mainstream, how can we open up their healing properties to people in need in an inclusive way? </p>
<p>To find out more, listen to this week’s podcast with Monnica Williams, clinical psychologist and professor in the School of Psychology at the University of Ottawa, where she is the Canada Research Chair in Mental Health Disparities. She is also the Clinical Director of the Behavioral Wellness Clinic in Connecticut.</p>
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<p>People heal through connecting with other people. That’s how we get through traumas. Our society suffers from a mental illness called racism, and we as a society need to heal from this disease where you have one part of the body attacking another part of the body. It’s like an autoimmune disorder, right? Doesn’t make any sense: makes the whole body sick. And we’re on a planet that we all share and we’re all human beings, we’re all connected, even in ways we don’t realize or understand. We could think of it as a single organism and we all need to heal so that we can all function in a way that’s in the best interest of the whole entity.
- Monnica T. Williams</p>
</blockquote>
<h2>Read more in The Conversation</h2>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-real-promise-of-lsd-mdma-and-mushrooms-for-medical-science-100579">The real promise of LSD, MDMA and mushrooms for medical science</a>
</strong>
</em>
</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061">Alberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?</a>
</strong>
</em>
</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mdma-assisted-couples-therapy-how-a-psychedelic-is-enhancing-intimacy-and-healing-ptsd-127609">MDMA-assisted couples therapy: How a psychedelic is enhancing intimacy and healing PTSD</a>
</strong>
</em>
</p>
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<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/psychedelic-medicine-is-on-its-way-but-its-not-doing-shrooms-with-your-shrink-heres-what-you-need-to-know-208568">Psychedelic medicine is on its way. But it's not 'doing shrooms with your shrink'. Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>Resources</h2>
<p><a href="https://link.springer.com/article/10.1007/s11469-023-01160-5?sv1=affiliate&sv_campaign_id=922583&awc=26429_1700596296_e8eeb80cdaec76f40d0015d156200eef&utm_medium=affiliate&utm_source=awin&utm_campaign=CONR_BOOKS_ECOM_DE_PHSS_ALWYS_DEEPLINK&utm_content=textlink&utm_term=922583">“Psychedelics and Racial Justice”</a> by Monnica T. Williams</p>
<p><em><a href="https://podcasts.apple.com/ca/podcast/truth-be-told/id1462216572">Truth be Told</a></em> Season 5 (American Public Media/Tonya Mosley)</p>
<p><a href="https://www.nytimes.com/2023/10/23/us/oregon-psychedelic-mushrooms.html">“A New Era of Psychedelics in Oregon”</a> by Mike Baker</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811257/">“The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision”</a> by Darron T. Smith, Sonya C. Faber, NiCole T. Buchanan, Dale Foster and Lilith Green</p>
<p><a href="https://www.penguinrandomhouse.ca/books/529343/how-to-change-your-mind-by-michael-pollan/9780735224155"><em>How to Change Your Mind: The New Science of Psychedelics</em> by Michael Pollan
</a></p>
<p><a href="http://doi.org/10.1037/0022-006X.76.2.208">“Anger and Posttraumatic Stress Disorder symptoms in Crime Victims: A Longitudinal Analysis”</a>. <em>Journal of Consulting and Clinical Psychology</em>. by Orth, U., Cahill, S.P., Foa, E.B., & Maercker, A.</p>
<h2>Listen and follow</h2>
<p>You can listen to or follow <em>Don’t Call Me Resilient</em> on <a href="https://podcasts.apple.com/ca/podcast/dont-call-me-resilient/id1549798876">Apple Podcasts</a>, <a href="https://open.spotify.com/show/37tK4zmjWvq2Sh6jLIpzp7">Spotify</a>, <a href="https://www.youtube.com/playlist?list=PL_mJBLBznANz6ID9rBCUk7gv_ZRC4Og9-">YouTube</a> or wherever you listen to your favourite podcasts. </p>
<p><a href="mailto:DCMR@theconversation.com">We’d love to hear from you</a>, including any ideas for future episodes. Join The Conversation on <a href="https://twitter.com/ConversationCA">Twitter</a>, <a href="https://www.instagram.com/dontcallmeresilientpodcast/">Instagram</a> and <a href="https://www.tiktok.com/@theconversation">TikTok</a> and use #DontCallMeResilient.</p>
<p><iframe id="tc-infographic-572" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/572/661898416fdc21fc4fdef6a5379efd7cac19d9d5/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p><img src="https://counter.theconversation.com/content/218233/count.gif" alt="The Conversation" width="1" height="1" />
Clinical psychologist and professor Monnica Williams is on a mission to bring psychedelics to therapists’ offices to help people heal from their racial traumas. To do this, she’s jumping over some big hurdles.Vinita Srivastava, Host + Producer, Don't Call Me ResilientLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085682023-06-29T06:54:42Z2023-06-29T06:54:42ZPsychedelic medicine is on its way. But it’s not ‘doing shrooms with your shrink’. Here’s what you need to know<figure><img src="https://images.theconversation.com/files/534483/original/file-20230628-7269-u63go1.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/focus-on-female-psychiatrist-writing-information-2160876067">Shutterstock</a></span></figcaption></figure><p>Many people in Australia, including psychiatrists, were <a href="https://theconversation.com/the-tga-has-approved-certain-psychedelic-treatments-the-response-from-experts-is-mixed-199290">surprised</a> when earlier this year the medicines regulator <a href="https://www.tga.gov.au/news/blog/understanding-changes-mdma-and-psilocybin-access">down-scheduled</a> MDMA, known colloquially as ecstasy, and psilocybin, from magic mushrooms.</p>
<p>This means that under certain circumstances from July 1, <a href="https://www.tga.gov.au/sites/default/files/2023-03/change-classification-mdma-psilocybin-enable-prescribing-authorised-psychiatrists_.pdf">authorised psychiatrists</a> will be able to prescribe MDMA to treat post-traumatic stress disorder and psilocybin to treat depression that has not responded to other treatments. Patients must also undergo psychotherapy (talking therapy). </p>
<p>It all sounds very certain but it’s not really.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-post-traumatic-stress-disorder-11135">Explainer: what is post-traumatic stress disorder?</a>
</strong>
</em>
</p>
<hr>
<h2>Beware the hype</h2>
<p>The Therapeutic Goods Administration decision has left a lot of <a href="https://theconversation.com/the-tga-has-approved-certain-psychedelic-treatments-the-response-from-experts-is-mixed-199290">questions unanswered</a> about how the new scheme will be implemented and operated, both effectively and safely.</p>
<p>There are a small number of countries where psychedelic-assisted therapies are used outside clinical trials – in a very limited manner. However, this is the first time a national government has altered the way these substances are formally classified.</p>
<p>So the world is watching closely how “psychedelic-assisted therapy”, as it’s officially called, is rolled out in Australia.</p>
<p>It’s a hot topic, with much <a href="https://www.abc.net.au/radio/programs/pm/australia-to-allow-psychiatric-treatment-with-psychedelics/102526508">public interest</a>. But for researchers, there are concerns the hype is getting way ahead of the research.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-tga-has-approved-certain-psychedelic-treatments-the-response-from-experts-is-mixed-199290">The TGA has approved certain psychedelic treatments: the response from experts is mixed</a>
</strong>
</em>
</p>
<hr>
<h2>The first steps</h2>
<p>The Royal Australian and New Zealand College of Psychiatrists this week <a href="https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/therapeutic-use-of-mdma-for-ptsd-and-psilocybin-for-treatment-resistant-depression">released guidance</a> to their members about how this would work in practice.</p>
<p>As researchers in this field, we helped develop these guidelines. They cover topics such as patients’ suitability for this therapy, and how to administer and monitor it.</p>
<p>The guidelines also stress the importance of patient safety and appropriate training for prescribers, and advocates for continued research.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1673359318408650753"}"></div></p>
<h2>What does this mean for patients?</h2>
<p>This has several implications for potential patients: </p>
<ul>
<li><p>their existing psychiatrist may not be authorised to prescribe these psychedelics. So patients will have to ask their psychiatrist or GP for a referral to one who is</p></li>
<li><p>the psychiatrist authorised to prescribe these psychedelics will need to assess whether the therapy is suitable for each individual patient. This involves a detailed and comprehensive assessment. If the treatment is suitable, several sessions of further assessment and therapy are required before the actual dosing session</p></li>
<li><p>patients will be informed of what to expect before, during and after treatment, and need to give consent to proceed. We also recommend psychiatrists tell patients this therapy is not guaranteed to work, and provide patients with a clear account of the risks and possible negative side effects of psychedelic medications.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/psychedelics-how-they-act-on-the-brain-to-relieve-depression-183320">Psychedelics: how they act on the brain to relieve depression</a>
</strong>
</em>
</p>
<hr>
<h2>Expectations are high, but clear evidence is lacking</h2>
<p>Despite a growing <a href="https://www.ranzcp.org/getmedia/0cf57ea2-0bd7-4883-9155-d2ba1958df86/cm-therapeutic-use-of-mdma-for-ptsd-and-psilocybin-for-treatment-resistant-depression.pdf">body of evidence</a>, psychedelic-assisted therapies are in their infancy.</p>
<p>In a time when demand for mental health services <a href="https://theconversation.com/a-bigger-budget-for-mental-health-services-wont-necessarily-improve-australias-mental-health-160767">far outstrips supply</a>, exaggerated promises about the effectiveness of these drugs, before the research results are in, has many researchers worried. Patient expectations remain high but good clear evidence is still lacking.</p>
<p>Australian research is just getting under way and so far most psychedelic research has been done overseas. Yes, early findings have been <a href="https://www.ranzcp.org/getmedia/0cf57ea2-0bd7-4883-9155-d2ba1958df86/cm-therapeutic-use-of-mdma-for-ptsd-and-psilocybin-for-treatment-resistant-depression.pdf">quite promising</a>, but numbers are small, long-term follow-ups sparse, and potential risks and dangers still need to be explored.</p>
<p>Destigmatising these drugs has allowed us to begin our research, but sensationalising their effectiveness has the potential to disappoint and even harm patients because we really don’t know enough about how they work and who is suitable for this treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older man, sitting on sofa, palms together, with therapist taking notes" src="https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534487/original/file-20230628-19-xd13tl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We still don’t know who is suitable for this treatment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/psychology-depression-elderly-asian-adult-man-2100727735">Shutterstock</a></span>
</figcaption>
</figure>
<p>Psychedelic-assisted therapy is no miracle cure. Espousing the benefits without a thorough examination of the risks and limitations is not only a misrepresentation of the science, it is arguably unethical.</p>
<p>Very few psychiatrists have had much experience in this fascinating but challenging field. We still have a lot to learn about the use of psychedelic medicines to treat psychiatric illness.</p>
<p>Undue haste in translating psychedelic-assisted therapy conducted in clinical trials to community clinics could affect how well these treatments work and their safety. Outside clinical trials, patients will also need to shoulder the <a href="https://theconversation.com/the-tricky-economics-of-subsidising-psychedelics-for-mental-health-therapy-201462">cost</a> of this therapy, raising equity issues.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-tricky-economics-of-subsidising-psychedelics-for-mental-health-therapy-201462">The tricky economics of subsidising psychedelics for mental health therapy</a>
</strong>
</em>
</p>
<hr>
<h2>There’s potential for harm</h2>
<p>Psychedelic-assisted therapy is not simply “doing shrooms with your shrink”.</p>
<p>There is potential for psychedelic substances to cause fear, panic or cause psychological damage if given to susceptible and vulnerable people who have been inadequately screened or assessed.</p>
<p>Paranoia, traumatisation, worsening depression, and even suicidal behaviour, among other <a href="https://pubmed.ncbi.nlm.nih.gov/36988924/">serious</a> <a href="https://pubmed.ncbi.nlm.nih.gov/36453037/">side-effects</a>, <a href="https://journals.sagepub.com/doi/full/10.1177/02698811211069100">have been observed</a> in some cases.</p>
<p>So we need ongoing monitoring of outcomes, including adverse events.</p>
<p>We also know psychedelic substances render patients particularly vulnerable. Boundary issues and safeguards are vital considerations for patient safety, particularly when patients are under the influence of the psychedelic drug. For instance, it is important to discuss and agree with patients beforehand about the nature and timing of any touch during treatment sessions, so any touch is appropriate and done with full informed consent.</p>
<h2>An exciting prospect</h2>
<p>Despite the potential harms, we remain excited at the prospect of psychedelic-assisted therapy becoming an established treatment to help a select group of patients.</p>
<p>But we want to do this in a safe, controlled and sustainable manner.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/208568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nigel Strauss is a psychiatrist and senior consultant with St Vincent’s Hospital Melbourne, an investigator on several psychedelic clinical trials, is on the scientific advisory board of the European Mind Foundation, and is the medical director of the Millswyn Clinic in Melbourne, a private psychiatric clinic. He has made his own philanthropic donation to Monash University for a trial of MDMA assisted psychotherapy for PTSD. The trials he's involved in have not personally received any funding.</span></em></p><p class="fine-print"><em><span>Colleen Loo receives research grant funding from the Australian NHMRC and MRFF. </span></em></p><p class="fine-print"><em><span>David Jonathan Castle has received grant monies for research from Servier, Boehringer Ingelheim; travel support and honoraria for talks and consultancy from Servier, Seqirus, Lundbeck, Mindcafe, Psychscene, Inside Practice. He is a founder of the Optimal Health Program (OHP) and holds 50% of the IP for OHP; and is part owner (5%) of Clarity Healthcare. He is an unpaid Chair of an Advisory Board of Psychae, an Australian not-for-profit institute specialising in psychedelic medicines research. He is a member of the Royal Australian and New Zealand College of Psychiatrists Psychedelic Assisted Therapy Working Group. He does not knowingly have stocks or shares in any pharmaceutical company.</span></em></p><p class="fine-print"><em><span>Steve Kisely was the first author of the report commissioned by the Therapeutic Goods Administration on the possible clinical benefits of MDMA and psilocybin. </span></em></p>From July 1, authorised psychiatrists will be able to prescribe MDMA and psilocybin in some circumstances. Here’s what we’re excited and concerned about.Nigel Strauss, Psychiatrist and Clinical Associate at The Centre of Mental Health, Swinburne University of TechnologyColleen Loo, Professor of Psychiatry, UNSW & Black Dog Institute, UNSW SydneyDavid Jonathan Castle, Chair of Psychiatry, The University of MelbourneSteve Kisely, Professor, School of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2014622023-04-30T20:02:33Z2023-04-30T20:02:33ZThe tricky economics of subsidising psychedelics for mental health therapy<figure><img src="https://images.theconversation.com/files/522258/original/file-20230421-14-irzqf9.jpg?ixlib=rb-1.1.0&rect=0%2C270%2C4200%2C2087&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Australia is the world’s first country to legalise the medical use of psychedelics. But not everyone is sure the timing is right. There are still major issues to work out for this move to benefit those most in need. </p>
<p>In particular, there is the question of whether psychedelic medicines will be publicly subsidised, given the lack of data about their cost-effectiveness compared with other treatments. </p>
<p>From <a href="https://www.tga.gov.au/news/media-releases/change-classification-psilocybin-and-mdma-enable-prescribing-authorised-psychiatrists">July 1 2023</a>, authorised psychiatrists will be able to prescribe psilocybin and MDMA for post-traumatic stress disorder and psilocybin for treatment-resistant depression, to be used in conjunction with psychotherapy.</p>
<p>The Therapeutic Goods Administration (TGA), which regulates medicines and medical devices in Australia, made this decision in February, reclassifying psilocybin and MDMA from “Schedule 9” (prohibited substances, only legally available for use in research) to “Schedule 8” (controlled substances). </p>
<p>Many in the field were surprised. Advocacy group <a href="https://mindmedicineaustralia.org.au/psychedelic-assisted-therapies-in-australia-and-faqs/">Mind Medicine Australia</a>, which lobbied hard for the decision, was delighted. But mental health experts such as former <a href="https://australianoftheyear.org.au/recipients/professor-patrick-mcgorry-ao">Australian of the Year</a> Patrick McGorry <a href="https://www.smh.com.au/national/not-so-fast-controversial-mdma-drug-ruling-jumping-the-gun-20230206-p5cido.html">questioned</a> the sufficiency of evidence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-tga-has-approved-certain-psychedelic-treatments-the-response-from-experts-is-mixed-199290">The TGA has approved certain psychedelic treatments: the response from experts is mixed</a>
</strong>
</em>
</p>
<hr>
<p>The TGA considered the effectiveness and safety of psilocybin and MDMA, as the regulator is supposed to do, but not their cost-effectiveness. This is not a requirement of TGA approval processes, but it is for the regulatory bodies that must approve these treatments for a public subsidy. </p>
<p>The paucity of such evidence is going to be a high hurdle. </p>
<h2>Will they be subsidised?</h2>
<p>How much will such therapy cost? One estimate is <a href="https://www.abc.net.au/news/2023-03-18/psychedelic-charity-accused-lobbying-tga-mdma-psilocybin/102103782">$20,000 to $30,000</a>, comprising the cost of the medication and therapists’ time for sessions. </p>
<p>The pharmaceutical-grade psilocybin and MDMA used in Australian clinical studies has largely been supplied free by US-based not-for-profit organisations such as the <a href="https://www.usonainstitute.org/">Usona Institute</a> and <a href="https://maps.org/">Multidisciplinary Association for Psychedelic Studies</a>. The bureaucratic requirements to import these medications include a permit from the TGA and an import licence and permit from the Office of Drug Control.</p>
<figure class="align-center ">
<img alt="Australian clinical trials with psilocybin and MDMA have relied on imports provided free by not-for-profit research groups such as the Multidisciplinary Association for Psychedelic Studies in California." src="https://images.theconversation.com/files/514375/original/file-20230309-18-9i5qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514375/original/file-20230309-18-9i5qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514375/original/file-20230309-18-9i5qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514375/original/file-20230309-18-9i5qvu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514375/original/file-20230309-18-9i5qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514375/original/file-20230309-18-9i5qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514375/original/file-20230309-18-9i5qvu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australian clinical trials with psilocybin and MDMA have relied on imports provided free by not-for-profit research groups such as the Multidisciplinary Association for Psychedelic Studies in California.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Increasing supply will require streamlining these import controls. There is also work to be done on the potential for local production. But for now the major determinant of costs for patients will be if the medicines and therapy are subsidised, as many psychological treatments and most psychiatric medications are now.</p>
<p>A subsidy for the psilocybin/MDMA component will require approval by the Pharmaceutical Benefits Advisory Committee, the independent body of medical experts that advises the federal health minister on which drugs should be listed on the Pharmaceutical Benefits Scheme.</p>
<p>This will require a detailed submission (usually from the pharmaceutical supplier) explaining how the medicine will be prescribed, its effectiveness, safety and cost-effectiveness compared with alternatives. Submissions must also include budget impact analysis – that is, how much it will cost if the medicine is listed on the PBS. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-is-the-price-of-medicine-decided-in-australia-83633">Explainer: how is the price of medicine decided in Australia?</a>
</strong>
</em>
</p>
<hr>
<p>A subsidy for the psychotherapy component will require listing on the Medicare Benefits Schedule, which funds services such as blood tests, diagnostics and allied health services. This will need endorsement from the <a href="http://www.msac.gov.au/internet/msac/publishing.nsf/Content/about-msac">Medicare Services Advisory Committee</a> (MSAC), which is not a statutory committee like the Pharmaceutical Benefits Advisory Committee but has <a href="https://www.valuehealthregionalissues.com/article/S2212-1099(20)30666-X/fulltext">a similar function</a>.</p>
<h2>Are they cost-effective?</h2>
<p>To date there are no published studies on psilocybin’s cost-effectiveness, and only three on MDMA – all on its use in treating PTSD. </p>
<p>The first of these studies was <a href="https://doi.org/10.1371/journal.pone.0239997">published in 2020</a>, the second <a href="https://doi.org/10.1371/journal.pone.0263252">in February 2022</a> and the third <a href="https://doi.org/10.1007/s40261-022-01122-0">in March 2022</a>. All three used economic modelling to to simulate long-term benefits and costs of MDMA-assisted psychotherapy compared with standard health care, extrapolated from the results of clinical trials (involving a few hundred people).</p>
<figure class="align-center ">
<img alt="alt text here" src="https://images.theconversation.com/files/523357/original/file-20230428-20-17qtn6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523357/original/file-20230428-20-17qtn6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523357/original/file-20230428-20-17qtn6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523357/original/file-20230428-20-17qtn6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523357/original/file-20230428-20-17qtn6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523357/original/file-20230428-20-17qtn6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523357/original/file-20230428-20-17qtn6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Phase 3 clinical trials show therapy with MDMA and psychotherapy substantially reduces PTSD symptoms compared to psychotherapy and placebo.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>All three conclude MDMA-assisted therapy is a potentially cost-effective treatment for people with chronic and severe PTSD. However, the modelling assumes the effects of MDMA-assisted psychotherapy taken from clinical trials of relatively short durations (with maximum follow up of 18 weeks) will extend over 10 to 30 years. This may be overly optimistic. They were also based on the treatment patterns and costs from the US that differ to those in Australia.</p>
<p>PBAC and MSAC will likely need to carefully weigh this type of evidence to make an assessment about cost-effectiveness.</p>
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Read more:
<a href="https://theconversation.com/psychedelics-researchers-balance-trippyness-with-scientific-rigor-after-history-of-legal-and-cultural-controversy-podcast-191502">Psychedelics researchers balance trippyness with scientific rigor after history of legal and cultural controversy – podcast</a>
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<h2>Estimating ‘off-label’ use</h2>
<p>Another issue to be carefully considered is how many people will likely use these medicines in routine practice. Such estimates are complicated by the risk of off-label use – psychiatrists prescribing psilocybin and MDMA for purposes not listed by the TGA. </p>
<p>An estimated 40–75% of anti-psychotic medicine use is “<a href="https://www1.racgp.org.au/ajgp/2021/may/off-label-medicine-use">off-label</a>”. For example, the anti-psychotic medicine quetiapine is registered for treating schizophrenia and bipolar disorder, but is <a href="https://www.nps.org.au/australian-prescriber/articles/concerns-about-quetiapine-1">often used off-label</a> for conditions such as anxiety or insomnia. This is despite the rules for prescribing quetiapine (the prescriber must state why they are prescribing it). </p>
<p>Allowing only authorised prescribers of psilocybin and MDMA may reduce the risk but not eliminate it. It could mean the cost of the medicines to the health budget ends up being a lot higher than estimated.</p>
<p>The upshot of all this means, in practice, Australia is still a way off from offering a public subsidy for these psychedelic treatments. Which means, come July 1, the number of Australians able to afford these treatments will be small.</p><img src="https://counter.theconversation.com/content/201462/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cathy Mihalopoulos was a member of the Economics Sub-Committee of the Pharmaceutical Benefits Advisory Committee from 2012 to 2022. She receives funding from organisations including National Health and Medical Research Council, Medical Research Future Fund, Department of Health, the Butterfly Foundation. She is an investigator on a clinical trial evaluating psilocybin-assisted psychotherapy for treatment resistant depression with Swinburne University and Woke Pharmaceuticals.</span></em></p><p class="fine-print"><em><span>Christopher Langmead receives funding from the National Health and Medical Research Council, Medical Research Future Fund, Therapeutic Innovation Australia, and Servier Australia. He is co-founder and chief executive of Phrenix Therapeutics Pty Ltd, a biotechnology company developing new medicines for mental health disorders. </span></em></p><p class="fine-print"><em><span>Mary Lou Chatterton receives funding from multiple organisations including National Health and Medical Research Council, Medical Research Future Fund, Department of Health, and the Butterfly Foundation. She is an investigator on a clinical trial evaluating psilocybin-assisted psychotherapy for treatment resistant depression with Swinburne University and Woke Pharmaceuticals. She is also an investigator on a trial of MDMA-assisted therapy for alcohol use disorder and post-traumatic stress disorder funded through the Medical Research Future Fund. </span></em></p>Australia is the first country in the world to legalise the medical use of psychedelics. But without a public subsidy, few Australians will be able to afford them.Cathy Mihalopoulos, Professor, Monash UniversityChris Langmead, Professor, Monash UniversityMary Lou Chatterton, Senior research fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2019372023-04-17T12:42:31Z2023-04-17T12:42:31ZPsychedelics may better treat depression and anxiety symptoms than prescription antidepressants for patients with advanced cancer<figure><img src="https://images.theconversation.com/files/521074/original/file-20230414-28-z0dpc7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psilocybin and other psychedelics could help patients process the challenges of a cancer diagnosis.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/magic-mushrooms-illustration-royalty-free-illustration/1390280399">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p>In people with advanced cancer, psychedelic drugs like psilocybin, LSD and MDMA may significantly <a href="https://doi.org/10.1097/coc.0000000000000998">reduce the severity of depression and anxiety</a> symptoms.</p>
<p>Roughly 10% of <a href="https://doi.org/10.1016/S1470-2045(11)70002-X">patients with cancer</a> experience anxiety, while 20% report depression. However, current research suggests that available prescription antidepressants <a href="https://doi.org/10.1002%2F14651858.CD011006.pub2">do not significantly decrease depressive symptoms</a> in cancer patients compared with a placebo. </p>
<p><a href="https://scholar.google.com/citations?user=lWAD9d8AAAAJ&hl=en">My team and I</a> recently completed a <a href="https://doi.org/10.1097/coc.0000000000000998">meta-analysis of five clinical trials</a> examining anxiety and depression symptoms in patients with advanced forms of cancer and other life-threatening diseases. We found that taking psychedelic medication alone – specifically LSD, psilocybin or MDMA – reduced depression scores as measured by the <a href="https://instruct.uwo.ca/kinesiology/9641/Assessments/Psychological/BDI.html">Beck’s Depression Inventory</a> by six points, where a score below 10 indicates minimal to no depression and above 30 indicates major depression. The average scores at baseline were between 15 and 18 for most studies, though one trial had a baseline of <a href="https://doi.org/10.1038/s41598-020-75706-1">approximately 30</a>. Psychedelics also reduced anxiety scores as measured by the <a href="https://doi.org/10.1159/000478993">State-Trait Anxiety Inventory</a> by seven to eight points, where a score of 20 to 37 indicates no or minimal anxiety and a score of 45 to 80 indicates high anxiety. The average scores were between 40 and 55 but <a href="https://doi.org/10.1038/s41598-020-75706-1">approximately 60 in one trial</a>.</p>
<p>In one trial of 51 cancer patients, 60% of those who received a single high-dose psilocybin session <a href="https://doi.org/10.1177/0269881116675513">achieved clinical remission</a> for depression, and 52% did for anxiety. In comparison, 16% of those who received a placebo achieved remission for depression and 12% for anxiety. These effects were still maintained six months later.</p>
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<figcaption><span class="caption">Researchers are studying the use of psychedelics to treat a number of mental health conditions.</span></figcaption>
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<h2>Psychedelics and trauma</h2>
<p>Why would one to two psychedelic therapy sessions be more effective than taking daily prescription medications like fluoxetine (Prozac) and paroxetine (Paxil)?</p>
<p>Receiving a cancer diagnosis and experiencing adverse effects from treatments can be traumatic. In severe cases, patients can develop <a href="https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq">cancer-related post-traumatic stress disorder</a>. </p>
<p>People who develop PTSD from military service or physical or sexual violence <a href="https://doi.org/10.1002%2Fda.22881">commonly experience depression and anxiety</a>. Research on <a href="https://doi.org/10.1002/jcph.1995">MDMA-facilitated psychotherapy</a>, in which psychotherapists incorporate psychedelic sessions with traditional counseling, has shown that this treatment approach can effectively reduce PTSD symptoms by allowing patients to be willing and able to share traumatic memories to help process them. These reductions were larger than those seen in studies on prescription antidepressants alone.</p>
<p>Based on this research, my team and I hypothesize that psychedelic sessions might have an advantage over traditional prescription antidepressants for patients with cancer-related depression or anxiety because it may help them deal with their underlying trauma. </p>
<p>Some of the trials in our review noted what patients perceived as the <a href="https://doi.org/10.1177/10600280221144055">reasons for the reduced anxiety and depression symptoms</a> they experienced. Patients stated that the psychedelic sessions helped them process the intense feelings they were repressing without being overwhelmed. While the catharsis was emotional and difficult, it helped them achieve acceptance of those emotions, lessening their feelings of isolation and inner withdrawal.</p>
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<a href="https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patient in hospital gown with IV sitting on bed, looking out window" src="https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Cancer can be a traumatic experience.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/patient-woman-in-hospital-room-royalty-free-image/1468190611">aquaArts studio/E+ via Getty Images</a></span>
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<h2>Unknowns in psychedelic therapy</h2>
<p>While these results are promising, there are limitations to the available research that could bias the results. A <a href="https://doi.org/10.1097/coc.0000000000000998">number of the advanced cancer studies</a> we examined included people with a history of psychedelic use. People with prior positive recreational psychedelic experiences may be more likely to participate in these studies than those who experienced a “bad trip” or were opposed to recreational drugs altogether. Additionally, even though the placebo was made to look identical, it is unlikely that patients or caregivers were fooled if it did not elicit a psychedelic effect.</p>
<p>While past studies have found lackluster benefits from traditional antidepressant medications compared with placebos <a href="https://doi.org/10.1002/jcph.1995">in PTSD</a> and <a href="https://doi.org/10.1002%2F14651858.CD011006.pub3">cancer-induced anxiety and depression</a>, there have not been any clinical trials directly comparing the effectiveness of traditional antidepressants with psychedelics for PTSD or cancer patients. However, one completed early-phase trial that compared psilocybin with the traditional antidepressant escitalopram (Lexapro) in <a href="https://doi.org/10.1056/NEJMoa2032994">patients with major depression</a> found that 57% of people receiving psilocybin achieved clinical remission, compared with only 28% receiving escitalopram.</p>
<p>Finally, psychedelic sessions caused large <a href="https://doi.org/10.1097/coc.0000000000000998">increases in blood pressure</a>. This might not be the best treatment for patients with poorly controlled hypertension or with heart disease. </p>
<h2>Next steps for psychedelics</h2>
<p>More research is needed on effectiveness of psychedelics to treat anxiety and depression in cancer patients. Exploring psychedelic treatments for patients with other life-threatening diseases that cause trauma, anxiety or depression could clarify their potential therapeutic benefits.</p>
<p>Were the Food and Drug Administration to approve psychedelics for this kind of use, the agency would need to figure out how these psychedelics can be used legally. As <a href="https://www.ecfr.gov/current/title-21/chapter-II/part-1308#p-1308.11(d)">Schedule 1 drugs</a>, they are currently banned from any medical use in the U.S. Researchers must <a href="https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-057)(EO-DEA217)_Researchers_Manual_Final_signed.pdf">register with the U.S. Drug Enforcement Agency</a> to study controlled substances. However, the FDA has already set a precedent with its June 2018 approval of <a href="https://doi.org/10.1002/jcph.1387">cannabadiol (Epidiolex)</a> for the treatment of rare childhood seizure disorders, even though this cannabis derivative remains banned by the Drug Enforcement Administration.</p><img src="https://counter.theconversation.com/content/201937/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Receiving a cancer diagnosis and undergoing cancer treatment can be a traumatizing experience. Psychedelics like LSD, psilocybin and MDMA could help alleviate symptoms from cancer-related PTSD.C. Michael White, Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1993842023-02-10T13:52:21Z2023-02-10T13:52:21ZUse of psychedelics to treat PTSD, OCD, depression and chronic pain – a researcher discusses recent trials, possible risks<figure><img src="https://images.theconversation.com/files/508513/original/file-20230206-29-xiko4j.jpg?ixlib=rb-1.1.0&rect=89%2C0%2C7336%2C3540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are some possible health issues with the drugs, including cardiovascular risks.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/creative-background-royalty-free-image/1352156068?phrase=PSYCHEDELICS&adppopup=true">wildpixel/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>New research is exploring whether psychedelic drugs, taken under strict medical supervision, might help in treating post-traumatic stress disorder, chronic pain, depression and obsessive-compulsive disorder. SciLine interviewed <a href="https://profiles.ucsf.edu/jennifer.mitchell">Dr. Jennifer Mitchell</a> – a professor in the Departments of Neurology and Psychiatry & Behavioral Science in the School of Medicine at the University of California, San Francisco – to discuss what scientists have found so far about the effectiveness of these drugs in treating these disorders and how they might safely be administered.</em></p>
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<figcaption><span class="caption">Dr. Jennifer Mitchell discusses psychedelic medicine.</span></figcaption>
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<p><em>The Conversation has collaborated with SciLine to bring you highlights from the discussion, which have been edited for brevity and clarity.</em></p>
<p><strong>What are psychedelic drugs and how do they work?</strong></p>
<p><strong>Jennifer Mitchell:</strong> Psychedelic <a href="https://www.verywellmind.com/types-of-psychedelic-drug-22073">basically means “mind manifesting</a>,” suggesting that the compound assists one in uncovering subject matter that perhaps is otherwise deeply hidden from the conscious mind. </p>
<p>It’s a slightly different term from hallucinogen, which you see used almost interchangeably at times with the term psychedelic. </p>
<p>A hallucinogen by definition is something that makes you see, hear, smell something that isn’t otherwise there, so you can imagine there’s a lot of overlap between psychedelics and hallucinogens. </p>
<p><strong>Which types of psychedelic drugs are being studied by researchers for potential therapeutic use?</strong></p>
<p><strong>Jennifer Mitchell:</strong> The two most well studied drugs at this point are MDMA and psilocybin. </p>
<p><a href="https://nida.nih.gov/publications/drugfacts/mdma-ecstasymolly">MDMA</a> is being evaluated mainly for treatment of post-traumatic stress disorder treatments, and <a href="https://adf.org.au/drug-facts/psilocybin/">psilocybin</a> mainly for treatment of resistant depression and major depressive disorder. </p>
<p>MDMA is the furthest along because there’s phase 3 data (data from late-stage research) and the possibility that a new drug application would be submitted to the FDA sometime later this year. </p>
<p><a href="https://www.dea.gov/factsheets/lsd">LSD</a> is also being evaluated for a number of different indications, most notably obsessive-compulsive disorder. </p>
<p>And then a couple of sort of heavier hitters are now being tested in primarily healthy control populations, including drugs like <a href="https://clinicaltrials.gov/ct2/results?cond=&term=mescaline&cntry=&state=&city=&dist=">mescaline</a> and <a href="https://clinicaltrials.gov/ct2/results?cond=&term=ayahuasca&cntry=&state=&city=&dist=">ayahuasca</a>.</p>
<p><strong>What have scientists discovered about whether these drugs are effective in treating health problems like PTSD or chronic pain?</strong></p>
<p><strong>Jennifer Mitchell:</strong> The drugs so far <a href="https://doi.org/10.1038/s41591-021-01336-3">appear to be quite effective</a>. I think one key, though, is that they’re typically being administered in conjunction with some form of psychotherapy. </p>
<p>So it’s important to keep that in mind when we look at the <a href="https://doi.org/10.1016/j.eclinm.2022.101809">results from some of these recent trials</a> that these are not drugs that are being administered in isolation. You are not taking home a bottle of pills and taking those twice a day as you would, say, an antidepressant. These are administered in a very particular way.</p>
<p><strong>What is involved in therapeutic treatment using these drugs?</strong></p>
<p><strong>Jennifer Mitchell:</strong> Typically, prior to taking the drug at all, subjects participate in a number of preparatory sessions so that they understand a little bit about what is going to happen on an experimental session day. </p>
<p>And then subjects come into a room that looks very much like a comfortable living room, and they spend all day there. The drug is administered typically in the morning. For psilocybin, you’re looking at a six-hour dosing session, and for MDMA, an eight-hour dosing session. </p>
<p>You are in the company of a group of trained providers: therapists, psychedelic facilitators, psychiatrists and clinical research coordinators.</p>
<p><strong>What are the potential risks of using psychedelic drugs for therapeutic purposes?</strong></p>
<p><strong>Jennifer Mitchell:</strong> One concern we’ve had is cardiovascular risk, and so we are taking great care in some of the clinical trials at present <a href="https://doi.org/10.1002/cpdd.796">to evaluate cardiovascular burden</a>, including heart attack risk, during and after the experiment. This evaluation includes tracking the heart rate and blood pressure of the participants.</p>
<p>In addition, researchers are worried about suicidality, in part because these are treatment-resistant populations that we’re starting off with, and so there’s a concern that perhaps, if they’re destabilized – either by the psychedelic, or just by tapering off their other meds in order to be part of a psychedelic trial – that we could run the risk of suicidality. </p>
<p>Lastly, I think the FDA has been concerned about the possibility that psychedelics are addictive, and so we’ve been following up with study participants to ensure that they aren’t engaging in drug seeking or drug taking outside of the study.</p>
<p><strong>What do we know about the safety of taking psychedelics outside the clinical context?</strong></p>
<p><strong>Jennifer Mitchell:</strong> I think we’ve all heard stories from the ‘60s and '70s of people taking psychedelics and <a href="https://www.verywellmind.com/what-is-a-bad-trip-22071">having very bad experiences</a>. What we know now is that the environment in which you take the psychedelic is of the utmost importance. It’s not appropriate at this point to try to take some of these substances or replicate some of these protocols on your own without oversight. </p>
<p><em>Watch the <a href="https://www.sciline.org/mental-health/psychedelic-medicine/">full interview</a> to hear more about psychedelic medicine.</em></p>
<p><em><a href="https://www.sciline.org/">SciLine</a> is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their news stories.</em></p><img src="https://counter.theconversation.com/content/199384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Mitchell has received funding from MAPS and currently serves on the Research Advisory Panel within the California Department of Justice.</span></em></p>The early research suggests the drugs might be effective for some conditions. But scientists have safety concerns.Jennifer Mitchell, Professor of Neurology, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992902023-02-07T19:04:23Z2023-02-07T19:04:23ZThe TGA has approved certain psychedelic treatments: the response from experts is mixed<figure><img src="https://images.theconversation.com/files/508558/original/file-20230207-15-pxckyl.jpg?ixlib=rb-1.1.0&rect=16%2C16%2C3730%2C2247&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Collaborative care teams will need to be established for safe treatment.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>A few days ago, the Australian drug regulator – the Therapeutic Goods Administration (TGA) – surprised experts around the world when it announced the approval of certain psychedelic treatments. </p>
<p>From July this year, the TGA will <a href="https://www.tga.gov.au/news/media-releases/change-classification-psilocybin-and-mdma-enable-prescribing-authorised-psychiatrists">permit</a> authorised psychiatrists to prescribe psilocybin (found in “magic mushrooms”) for treatment-resistant depression, and MDMA (found in “ecstasy”) for post-traumatic stress disorder.</p>
<p>I head up Australia’s first <a href="https://www.monash.edu/turner-institute/paul-liknaitzky-lab">clinical psychedelic lab</a>, where we develop psychedelic-assisted therapies for treating various mental illnesses, test their safety and effectiveness, explore how the treatments work, and train therapists. </p>
<p>I’ve witnessed, up close, the rapidly accelerating developments within the field and in positive public sentiment, over a few short years. But this surprising announcement may have devils – and angels – in the detail. </p>
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Read more:
<a href="https://theconversation.com/ai-maps-psychedelic-trip-experiences-to-regions-of-the-brain-opening-new-route-to-psychiatric-treatments-179263">AI maps psychedelic 'trip' experiences to regions of the brain – opening new route to psychiatric treatments</a>
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<h2>In from the wilderness</h2>
<p>Just a <a href="https://theconversation.com/shroom-to-grow-australias-missing-psychedelic-science-17344">few years ago</a>, Australia had no psychedelic research, almost no professional interest, and negligible public awareness of the clinical potential of these treatments. </p>
<p>The <a href="https://www.svhm.org.au/newsroom/news/australia-s-first-psychedelic-clinical-trial-commences-recruitment">first psychedelic trial</a> in Australia was approved in 2019. We established the country’s <a href="https://www.monash.edu/turner-institute/paul-liknaitzky-lab/research">first clinical psychedelic lab</a> in 2020. And by the end of 2023 there will be more than 15 active clinical psychedelic trials nationwide.</p>
<p>While the TGA’s announcement was hailed as groundbreaking, there are actually a handful of places where psychedelic-assisted therapies have been approved for very limited clinical use outside of research trials (for example, compassionate or expanded access programs in the <a href="https://maps.org/news/media/press-release-fda-agrees-to-expanded-access-program-for-mdma-assisted-psychotherapy-for-ptsd/">United States</a>, <a href="https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/magic-mushrooms.html#a22">Canada</a>, and <a href="https://maps.org/2019/02/04/israel-approves-compassionate-use-of-mdma-assisted-psychotherapy-for-ptsd/">Israel</a>, and a version of authorised prescribers in <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2022.863552/full">Switzerland</a>). </p>
<p>But this is the first time a government has changed the way these drugs are formally classified (“scheduled”). This may turn out to be a distinction without difference, as only so-called “authorised prescribers” will be approved to use these drugs outside of trials; or instead, it may turn out to be be a watershed moment with dramatic effects on the field globally.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="mushrooms grown in red lit natural environment" src="https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508525/original/file-20230207-15-n2ozy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Only certain types of mushrooms produce psilocybin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mushrooms-containing-psilocybin-grow-fairy-forest-1847112112">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Emerging evidence</h2>
<p>Emerging evidence shows that, when used alongside psychotherapy, certain psychedelic drugs can be safe to administer and produce large, rapid and sustained benefits for a range of addiction and mental health conditions. These include <a href="https://www.nature.com/articles/s41591-021-01336-3">post-traumatic stress disorder</a>, <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772630">depression</a>, <a href="https://journals.sagepub.com/doi/10.1177/0269881116675513">end-of-life distress</a>, <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625">alcohol use disorder</a>, and <a href="https://www.tandfonline.com/doi/abs/10.3109/00952990.2016.1170135?journalCode=iada20">nicotine dependence</a>. </p>
<p>While there are some important research limitations associated with these studies, the results have been compelling. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061">Alberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?</a>
</strong>
</em>
</p>
<hr>
<h2>Cautious optimism</h2>
<p>Since the announcement, I’ve spoken with numerous clinicians and researchers working in psychedelic trials in Australia, and all have expressed mixed reactions to the TGA news.</p>
<p>There’s excitement: about drug policy progress; about potential access for more people in need; about the prospect of being able to offer patients more suitable and tailored treatment without the constraints imposed by clinical trials and rigid protocols. </p>
<p>And then there are concerns: that evidence remains inadequate, and moving to clinical service is premature; that incompetent or poorly equipped clinicians could flood the space; that treatment will be unaffordable for most; that formal oversight of training, treatment, and patient outcomes will be minimal or ill-informed. </p>
<p>Many professionals working at the coalface are concerned that soon-to-be prescribers, therapists, and decision-makers probably <em>don’t know that they don’t know</em> about some of the essential elements of safe and effective psychedelic therapy. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1621434935419576324"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/latest-trials-confirm-the-benefits-of-mdma-the-drug-in-ecstasy-for-treating-ptsd-173070">Latest trials confirm the benefits of MDMA – the drug in ecstasy – for treating PTSD</a>
</strong>
</em>
</p>
<hr>
<h2>Angels or devils</h2>
<p>The TGA announcement cites <a href="https://www.tga.gov.au/resources/publication/publications/independent-expert-panel-mdma-and-psilocybin">promising evidence</a> as the basis for its decision. However, its approach does not appear to account for factors that may be key to this evidence base, and leaves some critical questions unanswered. Here are a few things to watch:</p>
<p><strong>Who treats?</strong></p>
<p>The TGA decision permits only authorised psychiatrists to administer this treatment, and <a href="https://www.tga.gov.au/sites/default/files/2023-02/notice-of-final-decision-to-amend-or-not-amend-the-current-poisons-standard-june-2022-acms-38-psilocybine-and-mdma.pdf">states</a> “the product must not be supplied to other practitioners who prescribe or administer the product”. </p>
<p>While psychiatrists are an important part of a collaborative care model, they will need substantial psychedelic training to deliver this complex form of drug-augmented psychotherapy. What will constitute adequate psychedelic training is unlikely to be clarified, nor is there a requirement for practitioners to be supervised by psychedelic experts. </p>
<p>Psychedelic therapies are so dissimilar to general psychiatry that simply trusting that psychiatrists “<a href="https://www.tga.gov.au/sites/default/files/2023-02/notice-of-final-decision-to-amend-or-not-amend-the-current-poisons-standard-june-2022-acms-38-psilocybine-and-mdma.pdf">have the training and expertise […] to appropriately treat</a>” patients using psychedelics is ill-informed.</p>
<p>Moreover, any requirement to have psychiatrists attend all treatment sessions (dosing days typically last eight hours and a typical treatment model involves about <a href="https://maps.org/mdma/mdma-resources/treatment-manual-mdma-assisted-psychotherapy-for-ptsd/">40 hours of therapy</a>) will make this even less affordable. </p>
<p>Any prospective authorised prescriber will need extensive training and ongoing supervision from credible professionals who have experience delivering psychedelic therapy, and should establish collaborative care teams with qualified psychologists and psychotherapists.</p>
<p><strong>Who is treated?</strong></p>
<p>The evidence for safe and effective psychedelic treatments comes from trials with very strict eligibility criteria. Over 90% of applicants to these trials are typically excluded. </p>
<p>Trials are cautious, in part because we know these treatments can <a href="https://journals.sagepub.com/doi/abs/10.1177/0269881116662634?journalCode=jopa">destabilise people</a>, exacerbate certain symptoms, and increase suicidality. The excellent track record of safety across almost all modern psychedelic trials has been established in the context of extensive screening. </p>
<p>Authorised prescribing will open up the eligibility to a greater diversity of help-seekers. This is a good step, but should be well-informed, and taken with caution and transparency. </p>
<p><strong>What does treatment involve?</strong></p>
<p>Since 1999, clinical psychedelic trials have delivered psychotherapeutic support before, during, and after the drug administration, with one to three dosing sessions. The <a href="https://www.tga.gov.au/sites/default/files/2023-02/notice-of-final-decision-to-amend-or-not-amend-the-current-poisons-standard-june-2022-acms-38-psilocybine-and-mdma.pdf">TGA decision</a> does not mandate any of this, advising “there does not currently appear to be any established treatment protocols”. </p>
<p>This is a misunderstanding. While treatment protocols across trials are not all the same, they certainly exist, and there is considerable overlap in the therapeutic approaches used. Improved protocols will be developed over time, but a sensible approach is to start with an approximation of what has been done in trials that have shown safe and effective outcomes.</p>
<p><strong>Are patients informed before they consent?</strong></p>
<p>Practitioners need to make informed decisions about any departure from precedent, and be transparent about those details with patients. </p>
<p>For example, if a prescriber does not provide therapy, does not have psychedelic training or supervision, or offers more than three dosing sessions, patients need to know which aspects of their treatment sit outside the evidence base. </p>
<p>Wider prescribing will effectively entail a “community-based experiment”, and a basic right of all patients is that they are able to make informed decisions about their treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chemical molecule" src="https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508554/original/file-20230207-29-qmn8xb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">MDMA has been approved for treatment of PTSD.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/molecule-mdma-ball-stick-molecular-model-1964905126">Shutterstock</a></span>
</figcaption>
</figure>
<h2>A brave new world?</h2>
<p>There are many other questions worth grappling with over the next five months, including those regarding appropriate oversight and patient protection, affordability and reimbursement, and public expectations and awareness. </p>
<p>I feel cautiously optimistic that many more Australian patients may be able to access safe and effective psychedelic treatments, and that the Australian mental health care sector has an opportunity to learn how best to deliver them.</p>
<p>To those planning to work in this space in Australia, I urge you to start or continue climbing the steep learning curve with curiosity, to organise reputable training, support, and resources from those already doing the work, and to establish appropriate systems of governance, oversight, and transparency. </p>
<p>There’s so much potential here, plenty at stake, and work to be done. </p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/199290/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Liknaitzky has received research funding from Incannex Healthcare Ltd, Dr Nigel Strauss, and the Multidisciplinary Association for Psychedelic Studies. He is a member of the Medical Advisory Board of Incannex Healthcare Ltd.</span></em></p>From July this year, some psychiatrists will be able to prescribe psychedelics to some patients. Responses from experts working in the field are mixed.Paul Liknaitzky, Head of Clinical Psychedelic Research, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992392023-02-06T20:53:55Z2023-02-06T20:53:55ZWhy the drug poisoning crisis in B.C. won’t be addressed by the new decriminalization policy<p>On the same day that British Columbia began a new era in drug policy with the <a href="https://www2.gov.bc.ca/gov/content/overdose/decriminalization">decriminalization of simple possession of some drugs</a>, the province’s chief coroner provided a <a href="https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports">devastating update</a> about the number of lives lost to illicit drugs during the previous year. </p>
<p>On Jan. 31, 2023, B.C. began a <a href="https://www2.gov.bc.ca/assets/gov/overdose-awareness/decriminalization_factsheet.pdf">three-year pilot project</a> under which simple possession of some drugs (opioids, methamphetamine, cocaine and MDMA) can no longer lead to criminal prosecution or even seizure of the drugs by police. The policy applies to possession of up to 2.5 grams of substance for personal use.</p>
<p>While a major step in the right direction, decriminalization does nothing to tackle what is fuelling the drug-poisoning crisis: the makeup of a toxic and unregulated drug supply. </p>
<p>In fact, imposed carry restrictions of 2.5 grams could theoretically lead to unintended consequences as drugs become more potent to fit within legal limits. </p>
<p>The stated goal of the decriminalization policy change is to <a href="https://theconversation.com/decriminalizing-drug-use-is-a-necessary-step-but-it-wont-end-the-opioid-overdose-crisis-162497">remove the stigma associated with drug use</a> to encourage people to seek help when they need it. </p>
<p>While the effects that decriminalization may have on the stigma of drug use remain to be seen, what it won’t affect is the toxicity of the drug supply that is killing thousands of Canadians each year.</p>
<h2>Inconsistent and unreliable drug supply</h2>
<p>Chemical analysis of drugs (such as from <a href="https://drugcheckingbc.ca/video/">drug checking</a> or police investigations) can tell us what is circulating in the supply, but <a href="https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug-type.pdf">toxicology results</a> from those who have died from overdoses tell us what is actually causing death. </p>
<p>These data sources describe how increases in adulteration of drugs with fentanyl analogues, <a href="https://theconversation.com/benzo-dope-may-be-replacing-fentanyl-dangerous-substance-turning-up-in-unregulated-opioids-164286">benzodiazepines</a> and animal tranquilizers like <a href="https://substance.uvic.ca/blog/xylazine/">xylazine</a> are driving the drug poisoning crisis. </p>
<p>Fentanyl has been the main opioid sold on the unregulated market for several years. It is typically sold mixed into other powders like caffeine or sugars to make a final product. </p>
<p>Drug supply monitoring has shown that fentanyl concentration in these powders sold on the street can range from zero to nearly 100 per cent, with a standard sample in B.C. being <a href="https://drugcheckingbc.ca/wp-content/uploads/sites/2/2023/01/Drug_Checking_BC_Nov_20224.pdf">around 10–15 per cent</a>. </p>
<p><a href="https://doi.org/10.1093/aje/kwab129">Research conducted in Vancouver</a> has described how fentanyl concentration in these samples was somewhat consistent between 2018 and early 2020, with variability between samples even decreasing over that period. What that may speak to is producers of fentanyl reaching a sort of “sweet spot” that satisfies their customers. People who sell drugs have described how they <a href="https://doi.org/10.1016/j.drugpo.2020.102845">listen to feedback</a> from their regulars and adjust the product to meet their customers’ needs. </p>
<p>However, following the start of the COVID-19 pandemic, <a href="https://epiresearch.org/wp-content/uploads/2022/06/2022-Abstract-Book.pdf#page=77">variation in potency between fentanyl samples rose dramatically</a>, leading to further unpredictability. These changes to the fentanyl supply around the spring of 2020 coincided with rates of drug poisonings previously not seen in the province. </p>
<p>Under B.C.’s decriminalization framework, possession for personal use caps at 2.5 grams of substance. While 2.5 grams may be more than enough MDMA for a night out, it may not be enough heroin to last a single day for someone who has a high opioid tolerance. People who use drugs say that to abide by these limits, they will be forced to make <a href="https://vancouver.citynews.ca/2022/05/31/bc-decriminalization-drugs/">more frequent, smaller purchases.</a> With the drug supply as volatile and unpredictable as it is, every new purchase puts someone at risk. </p>
<h2>Legal limit may affect potency</h2>
<p>Since we know that the drug supply is dynamic, it raises a question: Will the imposed legal carry limit of 2.5 grams result in increased potency of fentanyl to fit within the new 2.5-gram threshold? </p>
<p>Increases in average potency of fentanyl has been <a href="https://www.inhsu.org/resource/fentanyl-concentration-in-drug-checking-samples-and-risk-of-drug-related-mortality-during-an-illicit-drug-toxicity-crisis-in-vancouver-canada-a-time-series-analysis/">shown to be linked to increased drug poisonings</a> in the same geographic area. If the unregulated fentanyl market adjusts to fit more active ingredient into a smaller package, there will be downstream effects on people lives. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cropped image of a person holding a hand-lettered sign reading 'Every death is a drug policy failure'" src="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An advocate holds a sign at a demonstration in Victoria in April 2022. Decriminalization alone may have little effect on drug deaths without changes to the addiction treatment system.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>The provincial and federal governments have <a href="https://www.theglobeandmail.com/canada/british-columbia/article-federal-minister-promises-data-on-impact-of-decriminalization/">committed to a data-driven approach</a> to decriminalization. Ongoing drug supply monitoring will help public health professionals characterize what changes occur to the unregulated drug supply as a result of the policy change. Yet the act of decriminalizing drugs for personal use does not have any direct effect on the cause of the ongoing poisoning crisis. </p>
<p>The <a href="https://news.gov.bc.ca/releases/2023PSSG0008-000109">consensus among experts</a> has consistently pointed to unpredictable drugs from an unregulated supply and the absence of a functioning addiction treatment system. For those who want to seek treatment, the lack of available space leaves people waiting, once again left to rely on the toxic drug supply. </p>
<p>If B.C. is serious about confronting the leading cause of unnatural death in the province, it is going to take far more than decriminalizing simple drug possession. People who use drugs require an alternative to the toxic unregulated supply to not be risking their lives every time they use drugs. </p>
<p>Increasing access to a safer supply of drugs through a <a href="https://theconversation.com/safer-supply-of-opioids-saves-lives-providing-alternatives-to-toxic-street-drugs-177925">variety of formats</a> and providing meaningful funding for accessible treatment options are some examples of ways the province can take immediate steps to make an impact. </p>
<p>In the meantime, <a href="https://bc.ctvnews.ca/illicit-drug-death-toll-surpasses-2-000-in-b-c-for-a-2nd-consecutive-year-1.6253605">six more people will die today</a> from a drug poisoning in B.C. And another six will die tomorrow. How many more days can this go on?</p><img src="https://counter.theconversation.com/content/199239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Tobias does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As British Columbia begins a new era in drug policy, the drug poisoning crisis continues without an end in sight.Samuel Tobias, PhD Student, School of Population and Public Health, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1950612023-01-15T14:36:13Z2023-01-15T14:36:13ZAlberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?<figure><img src="https://images.theconversation.com/files/502616/original/file-20221223-30570-ki7ovk.jpg?ixlib=rb-1.1.0&rect=20%2C122%2C1901%2C1182&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psychedelics are being held up as a potential solution to the growing need for mental health treatment. But, magic mushrooms are not magic bullets.</span> <span class="attribution"><span class="source">(AP Photo/Peter Dejong)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/alberta-s-new-policy-on-psychedelic-drug-treatment-for-mental-illness--will-canada-lead-the-psychedelic-renaissance" width="100%" height="400"></iframe>
<p><a href="https://www.cbc.ca/news/canada/edmonton/psychedelics-alberta-regulations-united-conservative-party-government-ketamine-psilocybin-mdma-1.6622674">Patients in Alberta</a> will now be able to legally consider adding psychedelic-assisted therapy to the list of treatment options available for mental illnesses. </p>
<p>Alberta psychiatrists and policymakers suggest that they are getting ahead of the curve by creating regulations to ensure the safe use of these hallucinogenic substances in a therapeutically supported environment. As of Jan. 16, the option is available only through <a href="https://www.alberta.ca/psychedelic-drug-treatment-service-provider-licensing.aspx">registered and licensed</a> psychiatrists in the province. </p>
<p>Alberta’s new policy may set a precedent that moves Canadians one step closer to accepting psychedelics as medicinal substances, but historically these drugs were widely sought out for recreational and non-clinical purposes. And, if cannabis has taught us anything, medicalizing may simply be a short stop before decriminalizing and commercializing.</p>
<p><a href="https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/hallucinogens">Psychedelic drugs</a> — including LSD, psilocybin (magic mushrooms), MDMA (ecstasy) and DMT (ayahuasca) — are criminalized substances in most jurisdictions around the world, but some people are suggesting it is time to re-imagine them as medicines. A few places are even <a href="https://bc.ctvnews.ca/stigma-against-psychedelics-could-fade-with-b-c-decriminalization-experts-say-1.6035470">considering decriminalizing psychedelics</a> altogether, claiming that naturally occurring plants like mushrooms, even “magic” ones, should not be subject to legal restrictions. </p>
<p>In the wake of cannabis reforms, it appears that psychedelics may be the next target in the dismantling of the war on drugs. Canada made bold strides internationally with its widespread <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">cannabis decriminalization</a>, but are Canadians ready to lead the psychedelic renaissance?</p>
<h2>Early psychedelic research</h2>
<p>There is some precedent for taking the lead. In the 1950s and ‘60s, an earlier generation of researchers pioneered the first wave of psychedelic science, including Canadian-based psychiatrists who <a href="https://www.mqup.ca/psychedelic-prophets-products-9780773555068.php">coined the word psychedelic</a> and made headlines for dramatic breakthroughs using <a href="https://doi.org/10.1093/shm/hkl039">LSD to treat alcoholism</a>. </p>
<p>Vancouver-based therapists also used LSD and psilocybin mushrooms to treat <a href="https://www.anvilpress.com/books/the-acid-room-the-psychedelic-trials-and-tribulations-of-hollywood-hospital">depression and homosexuality</a>. While homosexuality was considered both illegal and a mental disorder until later in the 1970s, psychedelic therapists pushed back against these labels as patients treated for same-sex attraction more often experienced feelings of acceptance — reactions that aligned this particular approach in Vancouver with the gay rights movement.</p>
<p>Despite positive reports of clinical benefits, by the end of the 1960s psychedelics had earned a reputation for recreational use and clinical abuse. And, there was good reason to draw these connections, as psychedelic drugs had moved from pharmaceutical experimentation into mainstream culture, and some researchers had <a href="https://www.thecanadianencyclopedia.ca/en/article/mkultra">come under scrutiny for unethical practices</a>.</p>
<h2>Regulation and criminalization</h2>
<p>Most legal psychedelics ground to a halt in the 1970s with a set of regulatory prohibitions and cultural backlash. In public health reports since the 1970s, psychedelics have been described as objects of <a href="https://www.unodc.org/unodc/en/Resolutions/resolution_1968-05-23_6.html">unethical research, recreational abuse and personal risk</a> including injury and even death.</p>
<p>Underground chemists and consumers tried to combat this image, suggesting that psychedelics provided intellectual and spiritual insights and <a href="https://www.artsy.net/article/artsy-editorial-psychedelics-offer-artists-creative-boost">enhanced creativity</a>.</p>
<p>Most jurisdictions around the world criminalized psychedelics, whether for clinical research or personal experimentation. <a href="https://doi.org/10.2307/20067845">Indigenous and non-western uses</a> of hallucinogenic plants of course stretch back even further in history, and these too <a href="https://www.encyclopedia.com/history/united-states-and-canada/north-american-indigenous-peoples/native-american-church">came under legal scrutiny</a> through a combination of colonial pressures to assimilate and a looming war on drugs that did not distinguish between religious practices and drug-seeking behaviours.</p>
<h2>The return of psychedelics</h2>
<figure class="align-center ">
<img alt="Close-up view of long-stemmed mushrooms with reddish-brown caps" src="https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">At the moment, the next generation of scientific research on psychedelics still lags behind the popular enthusiasm that has catapulted these substances into the mainstream.</span>
<span class="attribution"><span class="source">(AP Photo/Peter Dejong)</span></span>
</figcaption>
</figure>
<p>In the last decade, regulations prohibiting psychedelics have started relaxing. The U.S. Food and Drug Administration has designated breakthrough therapy status to <a href="https://maps.org/news/media/press-release-fda-grants-breakthrough-therapy-designation-for-mdma-assisted-psychotherapy-for-ptsd-agrees-on-special-protocol-assessment-for-phase-3-trials/">MDMA</a> and <a href="https://www.livescience.com/psilocybin-depression-breakthrough-therapy.html">psilocybin</a>, based on their performance in clinical trials with post-traumatic stress disorder (PTSD) and treatment-resistant depression, respectively. </p>
<p>Health Canada has provided exemptions for the <a href="https://www.cbc.ca/news/canada/london/some-doctors-therapists-get-health-canada-permission-to-use-magic-mushrooms-1.5834485">use of psilocybin for patients with end-of-life anxiety</a>, and has started approving suppliers and therapists interested in working with psychedelic-assisted psychotherapy. <a href="https://michener.ca/ce_course/fpp/">Training programs</a> for psychedelic therapists are popping up across Canada, perhaps anticipating a change in regulation and the current <a href="https://www.ctvnews.ca/health/canadian-health-care-professionals-request-psilocybin-for-training-1.5801538">lack of trained professionals</a> ready to deliver psychedelic medicine.</p>
<p>At the moment, the next generation of scientific research on psychedelics still lags behind the popular enthusiasm that has catapulted these substances into the mainstream. <a href="https://www.smh.com.au/lifestyle/health-and-wellness/the-unparalleled-greatest-feeling-or-risky-drug-inside-the-celebrity-loved-psychedelic-20220331-p5a9oa.html">Celebrity testimonials</a> and compelling <a href="https://open-foundation.org/hear-about-psychedelic-clinical-studies-from-the-perspective-of-patients/">patient accounts</a> are competing for our attention. </p>
<p>Meanwhile, the growing burden of mental illness continues to <a href="https://www.ctvnews.ca/health/some-canadians-waiting-months-for-public-and-private-mental-health-services-1.6204350">overwhelm our health-care systems</a>. Psychedelics are being held up as a potential solution. But, magic mushrooms are not magic bullets.</p>
<h2>Beyond the medical marketplace</h2>
<p>Historically hallucinogenic substances have defied simple categorization as medicines, spiritual enhancers, toxins, sacred substances, rave drugs, etc. Whether or not Health Canada, or the province of Alberta, reclassifies psychedelics as a bona fide therapeutic option, these psychoactive substances will continue to attract consumers outside of clinical settings.</p>
<p>Canada has an opportunity to take the lead once more in this so-called psychedelic renaissance. But, it might be our chance to invest in more sustainable solutions to harm reduction and ways of including Indigenous perspectives, rather than racing to push psychedelics into the medical marketplace. </p>
<p><a href="https://www.culturalsurvival.org/publications/cultural-survival-quarterly/hallucinogenic-plants-and-their-use-traditional-societies">Indigenous approaches to sacred plants</a> are not only about consuming substances, but involve preparation, intention and integration, often structured in ritualistic settings that are as much about spiritual health as physical or mental health. </p>
<p>This cosmology and approach does not easily fit under the Canada Health Act, nor is it obvious who should be responsible for regulating or administering rituals that sit outside of our health-care system. These differences in how we might imagine the value of psychedelics is an opportunity to rethink the place of Indigenous knowledge in health systems. </p>
<p>We are well positioned to take a sober approach to the psychedelic hype, which has been driven in large part by financial interests, and consider what aspects of the psychedelic experience we want to preserve. </p>
<p>Now may be a good time to reinvest in our public institutions to ensure that psychedelics don’t simply become another pharmaceutical option that profits private investors. Instead, we have an opportunity with psychedelics to rethink how a war on drugs has harmed individuals and communities and how we might want to build a better relationship with pharmaceuticals.</p><img src="https://counter.theconversation.com/content/195061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erika Dyck receives funding from Social Sciences and Humanities Research Council.
She is a board member of the US not-for-profit Chacruna Institute for Psychedelic Plant Medicines.</span></em></p>Alberta’s new policy on psychedelic-assisted therapy for mental illness may set a precedent that moves Canadians one step closer to accepting psychedelics as medicinal substances.Erika Dyck, Professor and Canada Research Chair in the History of Health & Social Justice, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1849262022-06-19T12:50:48Z2022-06-19T12:50:48ZDecriminalizing hard drugs in B.C. follows decades of public health advocacy<figure><img src="https://images.theconversation.com/files/469560/original/file-20220617-14205-7slb7v.JPG?ixlib=rb-1.1.0&rect=0%2C467%2C5439%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">B.C. Minister of Mental Health and Addictions Sheila Malcolmson holds a copy of exemption documents that enable British Columbia to decriminalize possession of small amounts of 'hard' drugs for personal use. B.C.’s bold experiment will be closely watched as a comparator with other progressive jurisdictions.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/decriminalizing-hard-drugs-in-b-c--follows-decades-of-public-health-advocacy" width="100%" height="400"></iframe>
<p><a href="https://globalnews.ca/news/8882290/bc-overdose-crisis-decriminalize-possession/?utm_source=NewsletterNational&utm_medium=Email&utm_campaign=2022">British Columbia has become</a> the first province to be granted an exemption under the <a href="https://laws-lois.justice.gc.ca/eng/acts/c-38.8/">Controlled Drugs and Substances Act</a> to remove criminal penalties for possession of opioids, cocaine, methamphetamine and MDMA for personal use. </p>
<p>This means that police will no longer arrest, charge or seize drugs from adults found with 2.5 grams or less of these substances. Instead, people with drugs will be offered information on available health and social services and assistance with referrals to access treatment if they choose.</p>
<p>B.C.’s bold experiment to decriminalize “hard” drugs will be closely watched as a comparator with other progressive jurisdictions, such as <a href="https://www.pbs.org/newshour/politics/oregon-1st-state-to-decriminalize-possession-of-hard-drugs">Oregon</a> and <a href="https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it">Portugal</a>. Decriminalization in these places has been implemented differently, reflecting the distinctive circumstances and priorities that influence drug policy in different global contexts.</p>
<p>As a sociologist who has been studying drug policy development in Canada for nearly 30 years, it is plainly evident to me that decision-making is a political process that does not rest on facts alone. <a href="https://doi.org/10.1017/S0829320100006566">Drug policy</a> reflects <a href="https://doi.org/10.1080/0959523021000023270">ideological commitments</a> that are influenced by, and in turn influence, prevailing public understandings and opinions about drugs. <a href="https://doi.org/10.1080/09595230500404145">Exposure to the facts</a> — which are also contested — and <a href="https://doi.org/10.1016/S0955-3959(01)00085-8">constructive dialogue about social norms and values</a> is needed to facilitate more meaningful debate. </p>
<figure class="align-center ">
<img alt="Cropped image of a group of people, one of whom is holding a hand-lettered sign reading 'Every death is a drug policy failure'" src="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Advocates gather in Victoria to mark the anniversary of the declaration of a public health emergency in opioid-related overdoses in British Columbia on April 14.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Decriminalizing drug use is the <a href="https://www.oupcanada.com/catalog/9780199007882.html">realization of 50 years of policy discussions</a> advocating for removal of all penalties for small amounts of drugs. The called-for public health perspective is just beginning to materialize, despite extensive evidence that <a href="https://cannabiscoalition.ca/info/HarmReductionHeadway_Resistance_IJDPX2008.pdf">the war on drugs has failed</a>. The research evidence instead supports the view that prohibition of substance use has been ineffective, costly, inhumane and harmful to the user and society.</p>
<h2>Why so little progress for so long?</h2>
<p>Canada has long pursued half-measures by adopting a hybrid model recognizing public health considerations within a legal framework that enforces prohibition. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947221/pdf/canmedaj01573-0103.pdf">LeDain Commission of Inquiry</a> in 1972 proposed a gradual withdrawal from criminal penalties for illicit drug possession, phasing out incarceration in favour of medical treatment. </p>
<p>The LeDain report foreshadowed the emergence of drug policy with the goal of <a href="https://ontario.cmha.ca/harm-reduction/">harm reduction</a> and the need for more attention to the principles that underlie drug policy debates. What is meant by “harm” has been contentious when determining the proper role of law when the police and politicians define harm in ways that justify continued prohibition.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman at a podium in front of a row of flags, and two other women at opposite sides of stage, in front of background with the words 'A pathway to hope'" src="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Minister of Mental Health and Addictions Sheila Malcolmson discusses details about the province’s application for decriminalization at the provincial legislature in Victoria on Nov. 1, 2021, as provincial health officer Dr. Bonnie Henry and chief coroner Lisa Lapointe look on.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Ten years after the LeDain report, the enactment of the <a href="https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/">Charter of Rights and Freedoms</a> provided legal tools that complement more scientific evidence-based arguments for drug policy reform. The success of <a href="https://doi.org/10.1017/S0829320100006566">legal challenges on Charter grounds</a>, however, has been largely limited to striking down the most egregious policing practices and penalties for drug crimes.</p>
<p>Sweeping changes in the law might well have been expected with the launch of <a href="https://www.csc-scc.gc.ca/research/forum/e133/133a_e.pdf">Canada’s Drug Strategy</a> in 1987. The language change was monumental: it covered the full spectrum of non-medical drug use, including legal drugs like alcohol, prescription drugs and even solvents; and it signalled an intent to set out in a new direction that dramatically departed from the war-on-drugs approach. </p>
<p>The implementation of the strategy, however, was much less so. Police continued to command the lion’s share of funding, despite the promise of pursuing a “more balanced” and coherent public health approach to substance use. </p>
<p>Thirty-five years later, the situation has changed little. In 2018, after decades of debate, but little action indicating actual commitment to reform, <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">cannabis was legalized in Canada</a>, transforming its users from pariahs to responsible consumers. Users of more dangerous drugs continue to be treated differently, primarily because such use elicits more concern for crime control than protecting health. </p>
<h2>Lessons from other jurisdictions</h2>
<p>In Oregon, the lack of full commitment to a public health approach explains the <a href="https://abcnews.go.com/Health/wireStory/oregon-decriminalized-drugs-2020-hows-83846382">“mixed results.”</a> U.S.-style decriminalization there has been adopted as a social justice remedy to mitigate the impact of policing on marginalized communities.</p>
<p>In 2020, Oregon voters approved a <a href="https://www.oregonlegislature.gov/lpro/Publications/Background-Brief-Measure-110-(2020).pdf">ballot measure to decriminalize hard drugs</a> as a way to keep addicts out of prison and get them into treatment. Possession of controlled substances is now a “violation” carrying a maximum US$100 fine. The fine is waived if the offender calls a hotline for assessment, which may lead to them receiving treatment. </p>
<p>However, after the first year, just one per cent had used the hotline, and nearly half did not show up to court, prompting criticism that the system is too lenient.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A black wall with colourful handprints and names on it" src="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some of the handprints of people recovering from drug addiction are seen on a wall in the parking lot of an addiction recovery centre in McMinnville, Ore., on Dec. 9, 2021.</span>
<span class="attribution"><span class="source">(AP Photo/Andrew Selsky)</span></span>
</figcaption>
</figure>
<p>Portugal’s adoption of decriminalization measures has been <a href="https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight">implemented more successfully</a>, in part because its social safety net is far more comprehensive and better integrated with the criminal justice system. </p>
<p>Portugal’s approach is both more vigorous and nuanced, recognizing that most drug use is “low risk” and requires no intervention. The vast majority of cases referred by the police are deemed non-problematic and the charges are suspended. Those who have a pattern of repeated violations may be issued fines or offered counselling appointments. Substance use dependence and abuse in high-risk cases more often triggers a referral for non-mandatory treatment. </p>
<p>Portugal’s adoption of a graduated system of intervention demonstrates a view that is consistent with coherent harm reduction policy development. Drug use is treated as a health issue. And the proof is in the pudding. Since these measures were enacted in 2001, drug-related deaths and rates of drug use have remained below the European Union average. The rates of HIV infection from injection drug use, and incarceration for committing drug offences, have also been dramatically reduced. </p>
<p>Canada’s adoption of a public health perspective on substance use is hampered by its failure to address the inconsistencies inherent in its hybridized approach. Enacting harm reduction within a prohibition framework perversely criminalizes people recognized as needing help.</p>
<p>B.C.’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs. Much can be learned from other places in deciding the path forward, and the world is waiting for new lessons to be learned.</p><img src="https://counter.theconversation.com/content/184926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Hathaway does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>British Columbia’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs.Andrew Hathaway, Professor, Department of Sociology and Anthropology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1817782022-04-27T00:19:22Z2022-04-27T00:19:22ZPill testing really does reduce the risk of harm for drug users<figure><img src="https://images.theconversation.com/files/459915/original/file-20220426-24-munzl.jpg?ixlib=rb-1.1.0&rect=0%2C31%2C5184%2C3414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Days out from the event, festival goers for Canberra’s Groovin the Moo festival were told the event would <a href="https://www.abc.net.au/news/2022-04-20/pill-testing-cancelled-for-groovin-the-moo/101002974">no longer be offering a free drug checking service</a> after Pill Testing Australia, which provides the testing service, had public liability insurance withdrawn, without explanation from insurers. </p>
<p>Pill testing in the Australian Capital Territory was hard fought and won, and this represents a setback for an intervention that can reduce the harms of drug consumption.</p>
<h2>A history of pill testing in Australia</h2>
<p>In Australia, the ACT has been ahead of other states in applying innovative drug policies. In 2018, it gave permission for Australia’s first trial of pill testing at a music festival. Pill testing, or “drug checking” as it’s often called internationally, is a harm reduction intervention with clear benefits. </p>
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Read more:
<a href="https://theconversation.com/six-reasons-australia-should-pilot-pill-testing-party-drugs-34073">Six reasons Australia should pilot 'pill testing' party drugs</a>
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<p>Acknowledging a “drug-free” Australia is magical thinking, and that some people will always use drugs, pill testing provides consumers with information about the actual content of their chosen substance, so they might make better decisions about consumption. It also gives us access to an otherwise invisible group of “functional” drug consumers. </p>
<p>Advocates have been working to have pill testing made legal in Australia since the early 2000s. And while there was apprehension in the ACT in 2018, it was deemed a <a href="https://www.theguardian.com/australia-news/2019/apr/29/pill-testing-at-groovin-the-moo-festival-potentially-saves-seven-lives-organisers-say">huge success</a> at its first trial there.</p>
<p>Colleagues in other states have followed progress in the ACT with interest, but several proposals have stumbled as a consequence of political or ideological objections by conservative elements.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Girl on shoulders at a music festival" src="https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459916/original/file-20220426-16-wj486h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pill testing trials in Australia have been deemed a huge success.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Pill testing reduces drug harms</h2>
<p>Since 2002, <a href="http://www.bonger.nl/PDF/Overigen/kleinPill%20Testing%20-%20Ecstasy%20%20Prevention.pdf">several</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123557/">studies</a> have clearly shown pill testing has never been associated with increased drug use, or drug-related harm – no matter how much opponents of pill testing would have you believe. </p>
<p>Work conducted by colleagues from the ANU <a href="https://medicalschool.anu.edu.au/files/ACT%20Pill%20Testing%20Evaluation%20report.pdf">shows quite clearly</a> a deep trust by those using the service and in broader health services providing services to drug users. </p>
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Read more:
<a href="https://theconversation.com/heres-why-doctors-are-backing-pill-testing-at-music-festivals-across-australia-109430">Here's why doctors are backing pill testing at music festivals across Australia</a>
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<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.15734">Research increasingly confirms</a> pill testing does influence the behaviour of people who use drugs, especially when pill testing results show unexpected results, or drugs of concern. From our own work in Canberra, we have also found consumers spaced out doses, reduced doses, or even disposed of their drugs, following conversations with those providing the service. </p>
<p>These general findings have been corroborated by several <a href="https://coroners.nsw.gov.au/documents/findings/2019/Music_Festival_Redacted_findings_in_the_joint_inquest_into_deaths_arising_at_music_festivals_.pdf">coronial inquests</a> in Australia into music festival deaths and a <a href="https://www.dpc.nsw.gov.au/publications/special-commissions-of-inquiry/the-special-commission-of-inquiry-into-the-drug-ice/">special inquiry</a> commissioned by the New South Wales government.</p>
<p>Both recommended, independently, further trials of pill testing in those jurisdictions, as have subsequent <a href="https://www.theguardian.com/australia-news/2021/apr/07/victorian-coroner-backs-pill-testing-after-inquest-into-deaths-of-four-men-and-a-boy">coronial inquiries in Victoria</a>. The Australian Medical Association also <a href="https://www.ama.com.au/media/ama-formally-backs-supervised-pill-testing-trials#:%7E:text=%E2%80%9CThe%20AMA%20strongly%20backs%20pill,an%20overarching%20harm%20minimisation%20strategy.%E2%80%9D">officially supports</a> calls for medically supervised, ethically approved pill testing.</p>
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<strong>
Read more:
<a href="https://theconversation.com/while-law-makers-squabble-over-pill-testing-people-should-test-their-drugs-at-home-109421">While law makers squabble over pill testing, people should test their drugs at home</a>
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<p>Such has been the success of the festival-based testing in Canberra, a fixed site is now on the cusp of opening, ensuring a service that functioned only at music festivals, and for the demographic groups that attend them, can now be extended to benefit a broader group of consumers over a longer period of time.</p>
<p>There is no research comparing festivals that did or did not deploy pill testing – it would be quite the design challenge to try to conduct controlled experiments in the chaos of a music festival. But we can follow the behaviours of those who participate in the pill testing process, and when we do, most early indications suggest those who use drugs change their behaviour in such a way as to be less likely to result in harm.</p>
<h2>What has to happen to ensure pill testing goes ahead?</h2>
<p>In this recent instance, the issue was not with government, but with private insurers. We cannot say what made them pull out, but the fact a private entity determined the course of public health policy is a disappointment and should not be allowed to happen again. Given the manner and timing in which this was done, it suggests the prevention of pill testing was the intended outcome.</p>
<p>Governments could address this by requiring insurers to provide the actuarial basis for any decisions they make about insurance. They might also consider their insurance options when choosing insurance providers, selecting those prepared to support evidence-based health care.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/more-australians-back-legalising-cannabis-and-57-support-pill-testing-national-survey-shows-142720">More Australians back legalising cannabis and 57% support pill testing, national survey shows</a>
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<p>Pill testing, now established in the ACT, is not going away. It is only a matter of time before other jurisdictions find a way to introduce their own systems in their own way.</p>
<p>Insurers should be trying to win customers with ethical and evidence-based policies. Harm reduction <em>is</em> insurance, not just for people who use or who have used drugs, but also for people who love the people who use drugs. Between those two groups, that represents a lot of Australians – all of them who have choices as to where to source their insurance products.</p><img src="https://counter.theconversation.com/content/181778/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr David Caldicott is the clinical lead for Pill Testing Australia.</span></em></p>Pill testing has faced a setback in Australia with insurers withdrawing insurance from Groovin the Moo festival in Canberra.David Caldicott, Senior lecturer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1730702021-12-16T13:28:54Z2021-12-16T13:28:54ZLatest trials confirm the benefits of MDMA – the drug in ecstasy – for treating PTSD<figure><img src="https://images.theconversation.com/files/435683/original/file-20211204-25-1atx7vt.jpg?ixlib=rb-1.1.0&rect=18%2C0%2C6020%2C4019&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">MDMA has therapeutic potential for the treatment of PTSD.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-a-reflected-pill-on-a-reflective-royalty-free-image/1286653300?adppopup=true">Aitor Diago/Moment via Getty Images</a></span></figcaption></figure><p>For people with <a href="https://www.ptsd.va.gov/understand/common/common_adults.asp">post-traumatic stress disorder</a>, recalling memories of physical or sexual assault, combat or disaster-related events can induce intense anxiety or panic attacks as well as debilitating flashbacks.</p>
<p>In the U.S., about <a href="https://doi.org/10.1017/S0033291717000708">7% of people suffer from PTSD</a> and lose an average of about four working days each month as a result. Trauma-specific psychotherapy, like <a href="https://doi.apa.org/doiLanding?doi=10.1037%2F0022-006X.70.4.867">cognitive processing</a> or “talk” therapy, is the cornerstone of treatment for PTSD. But for approximately half of people, these traditional approaches are ineffective at fully addressing PTSD symptoms over the long term. <a href="https://doi.org/10.3389/fpsyt.2019.00650">Antidepressant drugs</a> are frequently used if psychotherapy fails, or in combination with it, but the effects are usually modest.</p>
<p>MDMA (3,4-methylenedioxymethamphetamine) is an active ingredient in the illicit street drug known as ecstasy or molly. People in dance clubs and <a href="https://doi.org/10.1002/jcph.266">raves use illicit MDMA</a> because it elevates mood and energy levels, induces a feeling of bonding with others and produces a surreal psychedelic effect. These same effects have been hypothesized to <a href="https://doi.org/10.1177/1060028014532236">support people with PTSD</a> during psychotherapy sessions, since they can make people more willing and able to share and explore their traumatic experiences. Our new <a href="https://doi.org/10.1002/jcph.1995">meta-analysis of clinical trials</a> confirms the benefits of MDMA-assisted psychotherapy in the treatment of PTSD.</p>
<p>We are a pharmacist and physician team who investigate the benefits and harms associated with substances of abuse like <a href="https://doi.org/10.1002/jcph.742">bath salts</a>, <a href="https://doi.org/10.1002/jcph.1922">phenibut</a>, <a href="https://doi.org/10.1001/jama.2015.6358">cannabis</a> and <a href="https://doi.org/10.1002/jcph.827">synthetic marijuana</a>. Through this work we have become intrigued about the therapeutic potential for some psychedelic drugs in the treatment of myriad psychiatric disorders, from PTSD to major depression, especially MDMA and psilocybin (hallucinogenic mushrooms). </p>
<p>It is important to state that using ecstasy or molly products from the street would not help PTSD symptoms because the MDMA needs be used along with carefully crafted psychotherapy in a safe, controlled environment. Ecstasy or molly products purchased illicitly never specify the exact amount of MDMA they contain, so it is impossible to dose it properly for PTSD. Taking too much MDMA or exercising while taking MDMA can cause <a href="https://doi.org/10.1002/jcph.266">heart attacks, strokes, seizures and arrhythmias</a> and can damage muscles and kidneys.</p>
<h2>What is MDMA-assisted psychotherapy?</h2>
<p>In an <a href="https://doi.org/10.1002/jcph.1995">MDMA-assisted psychotherapy session</a>, patients take MDMA as a pill upon entering a psychiatrist’s office and then work with a team of therapists who help them divulge traumatic events or discuss aspects of those events over the course of several hours. They usually have non-MDMA sessions before the first MDMA session so they know what to expect. And they have at least one non-MDMA session after each MDMA one to work through the traumatic memories that were revealed and to learn coping strategies. A standard treatment course includes two or three multihour MDMA-assisted psychotherapy sessions and several non-MDMA sessions. </p>
<p>The MDMA products used in these sessions are pharmaceutical grade. This means that, unlike illicitly obtained street products, they do not contain <a href="https://doi.org/10.1002/jcph.1860">other substances of abuse</a>, such as methamphetamine, or contaminants like heavy metals, bacteria or mold. People with hypertension or those at high risk of heart attacks, strokes or arrhythmias should not participate, because they can have unsafe elevations in blood pressure and heart rate. In addition, patients are not allowed to leave for eight hours, until the effects of MDMA have fully worn off. </p>
<h2>Assessing the effectiveness of MDMA-assisted psychotherapy</h2>
<p>In 2014, we reviewed the available animal data and the few preliminary human studies of <a href="https://doi.org/10.1177/1060028014532236">MDMA-assisted psychotherapy</a>, but at the time, higher-quality clinical trials had not yet been completed. But in the past few years, larger and higher-quality trials have been published, warranting an in-depth assessment. </p>
<p>So we recently reviewed the data comparing antidepressant use to placebos for patients with PTSD and <a href="https://doi.org/10.1002/jcph.1995">performed a meta-analysis study</a> of the six different clinical trials that assessed the usefulness of MDMA-assisted psychotherapy versus psychotherapy alone. All of the trials we analyzed included both men and women who had experienced a multitude of traumatic events that led to PTSD. The studies used the same <a href="https://www.ptsd.va.gov/professional/assessment/adult-int/caps.asp">points scale</a> to determine the effectiveness of therapy, making it easier to compare data across studies. Scores above approximately 50 points mean a patient has severe PTSD, and scores reduced by more than 10 points from baseline are clinically meaningful. </p>
<p>We found that daily antidepressant therapy reduced PTSD by <a href="https://doi.org/10.1002/jcph.1995">6 to 14 points compared with the placebo</a>, but a range of 27% to 47% of patients across the studies withdrew before the end of the trials. In contrast, MDMA-assisted psychotherapy reduced the scores by 22 points compared with those receiving psychotherapy with placebo, and <a href="https://doi.org/10.1002/jcph.1995">patients were twice as likely</a> to no longer meet the criteria for PTSD diagnosis by the end of the trials. In addition, only 8% of patients withdrew from MDMA-assisted psychotherapy trials. The main adverse effects included teeth grinding, jitteriness, headache and nausea. One of these MDMA trials found that participants’ <a href="https://doi.org/10.1038/s41591-021-01336-3">blood pressure and heart rate</a> were elevated in the course of MDMA therapy, but not to a concerning extent.</p>
<figure class="align-center ">
<img alt="A young woman sits on a couch facing another woman." src="https://images.theconversation.com/files/435974/original/file-20211206-141979-1dot1re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435974/original/file-20211206-141979-1dot1re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435974/original/file-20211206-141979-1dot1re.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435974/original/file-20211206-141979-1dot1re.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435974/original/file-20211206-141979-1dot1re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435974/original/file-20211206-141979-1dot1re.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435974/original/file-20211206-141979-1dot1re.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">One year after their last MDMA-assisted psychotherapy session, more than 80% of study participants reported improved feelings of well-being.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/problem-shared-is-a-problem-halved-royalty-free-image/1271550771">PeopleImages/E+ via Getty Images</a></span>
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<p>For several of the trials in our meta-analysis, investigators sent a <a href="https://doi.org/10.1007/s00213-020-05548-2">questionnaire to participants</a> 12 months after their last MDMA session to assess the long-term impact. Overall, 86% of participants said they received substantial benefits from the combined MDMA-assisted psychotherapy. Eighty-four percent of participants reported having improved feelings of well-being, 71% had fewer nightmares, 69% had less anxiety and 66% had improved sleep. The results from across all of the studies suggested that MDMA-assisted therapy was helping to alleviate the PTSD itself, not simply suppressing symptoms.</p>
<h2>Looking ahead</h2>
<p>The U.S. Drug Enforcement Administration identifies MDMA and psilocybin as <a href="https://medicalboard.iowa.gov/sites/default/files/documents/2018/04/controlled_substance_defs-20180301.pdf">Schedule I controlled substances</a>. According to the DEA, these substances have no currently accepted medical use in the U.S. and come with high abuse potential.</p>
<p>However, it’s worth noting an important exception. <a href="https://doi.org/10.1002/jcph.1387">Cannabadiol, or CBD,</a> a chemical that comes from the plant <em>Cannabis sativa</em>, is classified as a Schedule I drug. But the Food and Drug Administration approved its use in 2018 for the treatment of <a href="https://doi.org/10.1002/jcph.1387">two rare and severe childhood seizure disorders</a>. That doesn’t mean that the CBD in your <a href="https://theconversation.com/no-cbd-is-not-a-miracle-molecule-that-can-cure-coronavirus-just-as-it-wont-cure-many-other-maladies-its-proponents-claim-132492">lotion or seltzer</a> has proof of benefit for most of the ills people are using it for, but its full therapeutic potential is still being explored. Given the strong consistent beneficial effects and manageable adverse events in the newer trials designed with FDA input, we suspect that MDMA-assisted psychotherapy will become an FDA-approved option for PTSD by the end of 2023. Psilocybin – commonly known as hallucinogenic mushrooms – <a href="https://doi.org/10.1056/NEJMoa2032994">also shows promise</a> for treating major depression, but further research is needed. </p>
<p>The DEA’s stringent policies made it exceptionally hard for scientists to <a href="https://doi.org/10.1002/jcph.1995">conduct research</a> on Schedule I drugs for decades by <a href="https://sgp.fas.org/crs/misc/R45948.pdf">criminalizing the possession of the products</a>, even in research settings. But in 2018, the agency <a href="https://www.dea.gov/press-releases/2018/01/18/dea-speeds-application-process-research-schedule-i-drugs">streamlined the application process</a> for securing a waiver for research purposes. This made it easier for researchers to conduct trials into the pharmaceutical value of psychedelic drugs. Within the next decade, this shift will almost certainly accelerate the discovery of new treatments for patients suffering from mental illness.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/173070/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some psychedelic drugs – paired with therapy – hold great potential for helping sufferers of PTSD, depression and other mental health disorders.C. Michael White, Distinguished Professor and Head of the Department of Pharmacy Practice, University of ConnecticutAdrian V. Hernandez, Associate Professor of Comparative Effectiveness and Outcomes Research, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671002021-09-16T12:11:03Z2021-09-16T12:11:03ZOxyContin created the opioid crisis, but stigma and prohibition have fueled it<figure><img src="https://images.theconversation.com/files/421389/original/file-20210915-17-1lvjamv.jpg?ixlib=rb-1.1.0&rect=6%2C12%2C997%2C597&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People around the world mourned loved ones on International Overdose Awareness Day on Aug. 31, 2021.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/edmontonians-pose-wooden-crosses-with-roses-on-news-photo/1234986137?adppopup=true"> NurPhoto/Getty Images</a></span></figcaption></figure><p>The <a href="https://theconversation.com/how-the-purdue-opioid-settlement-could-help-the-public-understand-the-roots-of-the-drug-crisis-166701">highly contentious</a> <a href="https://www.npr.org/2021/09/01/1031053251/sackler-family-immunity-purdue-pharma-oxcyontin-opioid-epidemic">Purdue Pharma settlement</a> announced Sept. 1, 2021, comes at a pivotal time for the U.S. overdose crisis: 2020 was the worst year on record, with over <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm">93,000 Americans</a> losing their lives to fatal drug overdose. The drug overdose epidemic, now more than two decades long, has claimed the lives of <a href="https://www.cdc.gov/opioids/data/index.html">more than 840,000</a> people since 1999. Current estimates suggest that some <a href="https://www.rand.org/content/dam/rand/pubs/research_reports/RR3100/RR3140/RAND_RR3140.pdf">2.3 million people</a> in the U.S. use heroin and <a href="https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis">1.7 million people</a> use pharmaceutical opioids without a prescription. </p>
<p>Since 2016, I’ve <a href="https://gc-cuny.academia.edu/EmilyCampbell?from_navbar=true">studied the overdose crisis</a> with an eye to understanding its roots as well as its ramifications. As a <a href="https://www.holycross.edu/academics/programs/sociology-and-anthropology/faculty/emily_b_campbell">sociologist</a>, I came to this area of research in my own quest for meaning, as each year brought more funerals of former classmates and friends. What I found was an increasingly dangerous drug environment for people who use drugs, often exacerbated by policies not founded in research and by attitudes that harm those affected.</p>
<h2>How prohibition fuels dangerous markets</h2>
<p>Research shows that <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">the illicit drug market adapts</a> to both demand and drug enforcement efforts. </p>
<p>The first consequence of increased demand is that drugs become <a href="https://doi.org/10.1016/j.drugpo.2007.11.016">cheaper over time</a>. For example, the price of heroin and cocaine have been falling for decades. Political economists explain that demand, coupled with globalization, increases efficiency and competition. The result is that there are more drugs on the illicit market, which in turn lowers prices. </p>
<p>Second, as a response to drug prohibition, <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">drugs become more potent</a>. A stronger product in a smaller package is easier to transport and harder to detect. The American overdose crisis has become <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">a case study</a> in the devastating interplay of demand and prohibition. </p>
<p>OxyContin was released in 1996 and <a href="https://doi.org/10.2105/AJPH.2007.131714">mass-marketed as a revolutionary intervention</a> in the medical treatment of pain. Purdue Pharma, its maker, <a href="https://www.nytimes.com/2007/05/10/business/11drug-web.html?smid=url-share">knowingly downplayed</a> its addictive potential. As an opioid and central nervous depressant, <a href="https://doi.org/10.1300/J069v23n04_01">OxyContin has effects</a> similar to those of morphine or heroin. Not surprisingly, studies show that prescription patterns of opioids from 1999 to 2008 were <a href="https://pubmed.ncbi.nlm.nih.gov/22048730/">directly linked to a surge in overdose deaths</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pill bottle and pills of OxyContin prescription-only pain medication" src="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Oxycontin prescription-only pills were aggressively promoted to primary care physicians as a safe and effective pain control method for patients.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/oxycontin-pills-oxycodone-hydrochloride-prescription-only-news-photo/563590877?adppopup=true">Lawrence K. Ho/Los Angeles Times via Getty Images</a></span>
</figcaption>
</figure>
<p>As concern over opioid overdose grew, doctors’ prescribing practices <a href="https://doi.org/10.1007/s11013-016-9496-5">came under scrutiny</a>. In 2010, Purdue Pharma replaced the original OxyContin with an <a href="https://doi.org/10.1001/jamapsychiatry.2014.3043">“abuse deterrent” formulation</a> that was more difficult to crush and inhale. As a result, many people who were addicted to OxyContin turned to heroin, which was <a href="https://doi.org/10.1162/rest_a_00755">cheaper and easier to get</a>. This spurred a surge in heroin-related fatal overdoses, which is often termed the <a href="https://doi.org/10.1016/j.drugpo.2019.01.010">second wave of the overdose crisis</a>.</p>
<p>The growing market for heroin paved the way for the <a href="https://doi.org/10.1016/j.drugpo.2017.06.010">introduction of fentanyl</a> into the illicit U.S. drug market. Fentanyl, a drug used in medical settings for severe pain, is <a href="https://www.drugabuse.gov/publications/drugfacts/fentanyl">50 times more potent than heroin</a>. From the standpoint of efficiency for shipping and trafficking, fentanyl is easier to transport and sell than heroin. Fentanyl’s entry into the illicit drug market, in particular in combination with heroin, <a href="https://doi.org/10.1016/j.drugpo.2017.06.010">led to a doubling and tripling </a>of overdose deaths around 2012 to 2013. </p>
<p><a href="https://journals.lww.com/co-psychiatry/fulltext/2021/07000/the_rise_of_illicit_fentanyls,_stimulants_and_the.4.aspx">Since then, fentanyl</a> <a href="https://doi.org/10.1016/j.drugpo.2021.103353">has contaminated</a> the U.S. illicit drug supply: It is often found in not just heroin but cocaine, MDMA – commonly known as Ecstasy – methamphetamine and counterfeit prescription pills. The result is that most people <a href="https://doi.org/10.1016/j.drugpo.2019.07.008">do not know the potency or contents</a> of what they are using. </p>
<p>As the overdose crisis evolves, <a href="https://doi.org/10.1007/s40615-021-01007-6">communities of color</a> in particular have experienced a surge in fatal overdoses – deaths that are often preventable. And most recently, COVID-19 supply chain disruptions led people to use whatever was available, causing <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306256">a surge in overdoses</a> from drug mixing. </p>
<h2>Barriers to treatment</h2>
<p>Too often, people who use drugs are bombarded with messages that are not supported by research and that deepen the harm. </p>
<p>Public health officials and community leaders urge people to seek treatment and highlight that recovery is within reach. Yet, roughly 70% of people who seek treatment are <a href="https://www.rcorp-ta.org/sites/default/files/2020-06/Improving-Access-to-Evidence-Based-Medical-Treatment-for-OUD_FINAL.pdf">unable to access it</a>. <a href="https://doi.org/10.1080/10826084.2017.1363238">Barriers to treatment</a> include health care costs, lack of available treatment options and social stigma. Research also demonstrates that some people are not ready for treatment or <a href="https://doi.org/10.1080/10826084.2017.1310247">do not want to be sober</a>.</p>
<p>Sobriety is touted as the ultimate goal for people who use drugs. Yet research shows that addiction is a <a href="https://doi.org/10.1038/s41386-020-00950-y">recurring brain disease</a>, and relapse is highly likely. Most people who use drugs do so in a <a href="https://www.ucpress.edu/book/9780520293472/hurt">sporadic way</a> that features bouts of controlled and uncontrolled use as well as sobriety. It is also well documented that fear of arrest and shame encourages people to hide their drug use in ways that <a href="https://doi.org/10.1080/10826084.2020.1790008">increase their risk</a> of a fatal overdose. This is because when people use alone, there is no one there to call 911 or perform CPR should an overdose occur. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman holding up phone with image of brother and son who died after taking fentanyl-laced drugs" src="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=541&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=541&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=541&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Laurie Restivo’s brother, David Restivo, 47 (left on phone image), died from fentanyl-laced heroin, and her son, Jason Fisher Jr., 25 (right), died from fentanyl-laced cocaine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/fentanyl-overdose-restivo-johnson-laurie-restivo-displays-a-news-photo/1315873058?adppopup=true">Reading Eagle/MediaNews Group via Getty Images</a></span>
</figcaption>
</figure>
<p>In terms of effective treatment, <a href="https://doi.org/10.1176/appi.ps.201300256">medically assisted treatments</a> are considered the gold standard for opioid use disorder, yet they are still <a href="https://doi.org/10.1111/jrh.12328">underutilized</a>. <a href="https://doi.org/10.1001/jama.2021.1741">Buprenorphine</a> is an opioid with a “ceiling effect,” meaning it does not intoxicate like morphine or heroin but instead satiates an opioid craving. Buprenorphine assists people in transitioning away from uncontrolled use and mitigates physical cravings. People who are prescribed it are often able to work, attend therapy and regain enjoyment of day-to-day life. </p>
<p>Nonetheless, buprenorphine’s availability <a href="https://doi.org/10.1002/pds.4984">varies widely by state</a>, and people of color are <a href="https://doi.org/10.1377/hlthaff.2020.02261">persistently underprescribed</a> this lifesaving medication. Methadone has been used as a treatment for opioid use disorder since the 1950s, yet it is persistently <a href="https://doi.org/10.1007/s11606-018-4801-3">hard to access</a> long term. Researchers point to the <a href="https://doi.org/10.1080/08897077.2019.1640833">ongoing role of stigma</a> in the underuse of both of these medications. </p>
<h2>Better paths forward</h2>
<p>Public health officials, harm reduction activists and concerned citizens across the U.S. are working to secure <a href="https://doi.org/10.1097/01.NPR.0000534948.52123.fb">safer injection sites</a> where people can use drugs in the presence of medical staff. Such sites facilitate the prevention of fatal overdose by assuring an adequate and timely medical response and open a pathway for further health care and addiction-related treatment. In response to the pandemic’s strains on inpatient care facilities, <a href="https://doi.org/10.1016/j.jsat.2021.108552">take-home methadone</a> availability was expanded in new ways – a change that some treatment experts <a href="https://doi.org/10.1016/j.jsat.2020.108246">hope will be permanent</a>. </p>
<p>For people who use drugs, the <a href="https://doi.org/10.1016/j.jhealeco.2019.01.001">potency and contents of their drugs are often unknown</a>. <a href="https://doi.org/10.1016/j.drugpo.2018.10.001">Drug-checking programs</a> allow people to inspect the <a href="https://doi.org/10.1016/j.drugpo.2018.09.009">contents of their drugs for fentanyl</a> at home with a simple test strip. Such programs have recently gained traction with <a href="https://www.cdc.gov/media/releases/2021/p0407-Fentanyl-Test-Strips.html">federal support</a>. States also continue to expand <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049966/">access to naloxone</a>, an overdose reversal nasal spray that is simple to administer. People who use drugs or have loved ones who use drugs are encouraged to receive training on how to administer naloxone and to carry the nasal spray on them. </p>
<p>Those who argue for a <a href="https://doi.org/10.1503/cmaj.201618">safer supply</a> and <a href="https://doi.org/10.1016/j.socscimed.2021.113986">decriminalization of drugs</a> point to success abroad. <a href="https://www.rand.org/content/dam/rand/pubs/working_papers/WR1200/WR1263/RAND_WR1263.pdf">Heroin-assisted treatment</a> is shown to be effective in keeping people away from an unpredictable drug market, thus lowering the risk of overdose. Germany’s use of <a href="https://doi.org/10.1111/j.1360-0443.2008.02185.x">heroin-assisted treatment</a> improved patients’ physical and mental health while dramatically reducing illicit drug use. In the early 2000s, <a href="https://doi.org/10.1177/2050324516683640">Portugal decriminalized</a> all drugs in response to consistently having the highest fatal overdose rates in Western Europe. With diversion of funds away from prohibition to education and treatment, Portugal saw a drop in overall drug use and now boasts among the lowest fatal overdose rates in Western Europe.</p>
<p>Americans are the world’s <a href="https://doi.org/10.1111/add.14234">largest consumers</a> of drugs and consistently have among the highest rates of opioid and cocaine dependence globally. In <a href="https://gc-cuny.academia.edu/EmilyCampbell?from_navbar=true">my own research</a>, I’ve found that people often describe drug use as a battle between sobriety and death. But the heartbreaking surge in accidental, fatal overdose deaths tells a much more complex story. Ignoring the evidence will surely cost many more lives.</p>
<p><em>If you or someone you care about has a substance use disorder and wants help, you can call SAMHSA’s National Helpline: 1-800-662-HELP (4357). Immediate emotional support is available from the National Suicide Prevention Hotline 800-273-8255.</em> </p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/167100/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily B. Campbell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>False narratives about drug addiction and policies that are not supported by research are deepening the overdose epidemic in the US.Emily B. Campbell, Visiting Assistant Professor of Sociology, College of the Holy CrossLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1635682021-08-16T12:29:11Z2021-08-16T12:29:11ZRat poison is just one of the potentially dangerous substances likely to be mixed into illicit drugs<figure><img src="https://images.theconversation.com/files/415548/original/file-20210810-17-n2r4rx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Impurities are often added to recreational drugs to mask poor quality.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-man-holding-cocaine-royalty-free-image/1076137624">Sebastian Leesch/EyeEm via Getty Images</a></span></figcaption></figure><p>Over 150 people in Illinois started <a href="https://doi.org/10.1056/NEJMoa1807652">bleeding uncontrollably</a> after using <a href="https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice">synthetic cannabis-based products</a> – including fake marijuana, Spice and K2 – that contained the rat poison brodifacoum in March and April 2018. By the end of July 2021, these banned products were still being sold in <a href="https://www.usatoday.com/story/news/nation/2018/07/20/fda-warning-synthetic-marijuana-rat-poison/802585002/">10 states and the District of Columbia</a>, resulting in hundreds of severe bleeds and several deaths.</p>
<p>Illicit drug use was responsible for <a href="https://ourworldindata.org/illicit-drug-use#direct-deaths-drug-overdoses">an estimated 166,613 deaths worldwide in 2017 due to overdose</a>. The increased risk of disease and injury associated with illicit drug use caused an <a href="https://ourworldindata.org/illicit-drug-use#indirect-deaths-drug-use-as-a-risk-factor-for-premature-death">additional estimated 585,348 premature deaths</a>. And it’s impossible to tease out whether people were harmed by the drugs themselves or by the myriad impurities added to them.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=lWAD9d8AAAAJ&hl=en">clinical pharmacologist</a> and guest editor for a <a href="https://doi.org/10.1002/jcph.1921">special supplement</a> in the Journal of Clinical Pharmacology on commonly abused substances. I also <a href="https://doi.org/10.1002/jcph.1860">surveyed the research</a> in 2021 on what’s known about illicit drug adulteration. The research is clear: Adding impurities to, or adulterating, illicit drugs is a longstanding and widespread practice with harmful consequences. </p>
<h2>You seldom get what you pay for</h2>
<p>Drugmakers <a href="https://doi.org/10.1002/dta.220">include other ingredients for a few reasons</a>, whether to cut costs by bulking up their product with cheaper nonactive ingredients or to achieve particular effects by adding other drugs to mask poor product quality or imitate the desired effect of the drug itself.</p>
<p>Prior to the 2000s, drugs including cocaine and heroin were being “cut,” or diluted, with <a href="https://doi.org/10.1002/jcph.1860">inactive ingredients like sugars</a> to enlarge supply and increase profits. Since then, buyers of cocaine and heroin products frequently receive a cocktail of adulterants that mimic the product’s intended effects or mask side effects due to poor quality.</p>
<p>For example, the active ingredient of ecstasy, MDMA, is what produces the product’s intended effects. However, a 2004 study assessing ecstasy tablets from drug seizures at raves found that <a href="https://doi.org/10.1007/s00213-003-1712-7">20% of the products contained no MDMA</a>, and dosage varied widely in products that did. Cheaper and more dangerous <a href="https://doi.org/10.1002/jcph.266">stimulants and psychedelics</a> like <a href="https://doi.org/10.1002/jcph.742">synthetic bath salts</a> and LSD are frequently swapped for MDMA without alerting the buyer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Five ecstasy tablets on a white background." src="https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some drugs are so adulterated that they contain little to none of the active ingredient that buyers seek.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ecstasy-pills-royalty-free-image/508919350">portokalis/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Drugs added to intensify effects</h2>
<p><a href="https://doi.org/10.1111/1556-4029.13968">Over 70% of cocaine products</a> contain <a href="https://doi.org/10.1038/clpt.2010.156">levamisole</a>, a drug for worm infections that increases the intensity and duration of stimulant effects. It was <a href="https://doi.org/10.1016/j.psym.2013.02.012">banned in the U.S. in 1999</a> because it <a href="https://doi.org/10.1111/1556-4029.13968">suppresses red and white blood cell production</a> and increases the risk of life-threatening infections and anemia. These side effects are seen at doses over 150 milligrams, and <a href="https://doi.org/10.1111/1556-4029.13968">35% of seized cocaine products in the U.S.</a> exceed that level.</p>
<p>Other additives are commonly added to cocaine to intensify effects. <a href="https://doi.org/10.1016/j.ijcard.2011.06.105">Aminorex</a>, a stimulant and appetite suppressant, was <a href="https://doi.org/10.1016/j.ijcard.2011.06.105">withdrawn by the FDA in 1972</a> after it caused a number of <a href="https://go.gale.com/ps/i.do?id=GALE%7CA181301396&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=1082801X&p=AONE&sw=w&userGroupName=anon%7E1f297428">pulmonary hypertension</a> cases that resulted in heart failure and death. Similarly, <a href="https://doi.org/10.1001/jama.291.2.216">caffeine</a> is <a href="https://jppres.com/jppres/pdf/vol8/jppres19.638_8.2.146.pdf">frequently added</a> to intensify the adrenaline rush. While safe when taken alone in lower doses, higher doses of caffeine in combination with other stimulants can induce <a href="https://doi.org/10.1001/jama.291.2.216">seizures and heart rhythm problems</a>.</p>
<p>For heroin, <a href="https://doi.org/10.1111/j.1556-4029.2007.00648.x">veterinary anesthetic xylazine</a> is commonly added to intensify its relaxing effect. And <a href="https://doi.org/10.1111/j.1556-4029.2007.00648.x">fentanyl is increasingly being used as a substitute</a>. Because fentanyl is <a href="https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/">50 times more potent</a> than heroin, a smaller amount of total product can produce similar effects. But adding even just a slightly larger amount of fentanyl than expected can easily result in an overdose.</p>
<h2>Covering up adulteration and poor manufacturing quality</h2>
<p>Manufacturers also add impurities to compensate for lost effects due to adulteration. Anesthetics like <a href="https://doi.org/10.1111/1556-4029.13968">lidocaine and benzocaine</a> are added to adulterated products to reproduce the tingling sensation on the gums or tongue that drug dealers look for to assess cocaine quality. While these anesthetics are FDA approved, they can cause seizures and heart rhythm problems with the wrong dose.</p>
<p>A similar technique is used for heroin. Manufacturers commonly add <a href="https://doi.org/10.1007/s11606-012-2089-2">malaria drug quinine</a> to mimic heroin’s bitter taste and the initial drop in blood pressure when it’s administered.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three pairs of hands holding packets of drugs." src="https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adulterants may be added to mimic the expected effects of a particular drug.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/drug-grams-and-tabs-royalty-free-image/482857483">KatarzynaBialasiewicz/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>Poor heroin production also creates a lot of impurities that can cause <a href="https://doi.org/10.1002/jcph.1860">severe chills and pain at the injection site</a>. To get around these side effects, manufacturers frequently add antihistamines like Benadryl and pain relievers like Tylenol. The pain reliever metamizole, which was recalled in 1977 for health risks, is sometimes used instead of Tylenol.</p>
<h2>The double-edged sword of field testing</h2>
<p>Adulterants can lead to dangerous side effects. But because additives aren’t disclosed to the buyer and most of them have been banned by the FDA, clinicians might not recognize or even suspect that an adulterant is the cause of a patient’s symptoms. </p>
<p>While consumer-based methods to test for drug impurities may help, they aren’t foolproof. Volunteers at music festivals in the 2010s offered <a href="https://www.hopkinsmedicine.org/news/media/releases/on_site_ecstasy_pill_testing_services_may_reduce_user_risks_at_concerts_and_raves">MDMA purity testing</a> so attendees could decide whether they wanted to use the drugs they had. If they were injured, attendees could alert emergency personnel about potential adulterants they were exposed to. Unfortunately, over 40% of the adulterated samples were missed by those field testing kits and discovered days later only with sophisticated laboratory equipment.</p>
<p>With illicit drugs, the difference between what you believe you are buying and what is actually in the product can be the difference between life and death. If you are suffering from drug addiction, <a href="https://www.samhsa.gov/find-help/national-helpline">resources are available</a> to help you manage your addiction and achieve sobriety.</p><img src="https://counter.theconversation.com/content/163568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In an effort to reduce costs, drugmakers and dealers often cut, or adulterate, recreational drugs with substances that have been banned by the FDA.C. Michael White, Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1656122021-08-12T22:46:04Z2021-08-12T22:46:04ZAfter the last ‘summer of terrible drugs’ it’s time to make NZ’s temporary drug checking law permanent<figure><img src="https://images.theconversation.com/files/415776/original/file-20210812-16-183ol7v.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C5988%2C3935&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>With the summer music festival season approaching (COVID willing), hopes are high that the current temporary recreational drug checking law will become permanent. If and when that happens, New Zealand will take another small step down the long drug reform road from criminalisation to harm prevention. </p>
<p>Submissions to parliament’s health select committee on the <a href="https://www.legislation.govt.nz/bill/government/2021/0034/latest/LMS493289.html?search=ts_act%40bill%40regulation%40deemedreg_drug+and+substance+_resel_25_a&amp;p=1">Drug and Substance Checking Bill</a> have now closed, with a report due in October. If the <a href="https://www.legislation.govt.nz/act/public/2020/0063/latest/LMS430928.html">stop-gap law</a> rushed in for the 2020-21 summer is made permanent it will allow buyers of otherwise illegal drugs to have them independently checked without either the user or testing agency risking prosecution.</p>
<p>It’s an important service, given the dangers inherent in the illicit drug market and the chances of substances being cut or compromised with other toxic stimulants, as happened with some <a href="https://www.nzherald.co.nz/nz/wellingtonians-warned-harmful-substances-in-party-drugs-well-distributed-across-nz/KCEWCNW4G3AMRZ5CZACVMV2V2I/">MDMA circulating</a> last year.</p>
<p>Making testing legal, even if what is being tested isn’t, is a tacit acknowledgement that New Zealand’s “war on drugs” – which began 122 years ago with the <a href="http://www.nzlii.org/nz/legis/hist_act/opa19011ev1901n26307/">Opium Prohibition Act</a> – needs rethinking.</p>
<p>Despite generations of effort, the supply, demand and diversity of illegal drugs have grown, not diminished. Profit, pleasure and addiction have proved exceptionally powerful forces both <a href="https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html">internationally</a> and domestically. </p>
<p>And while border seizures were <a href="https://www.nzherald.co.nz/nz/covid-19-coronavirus-drug-seizures-at-border-decline-dramatically-after-year-of-pandemic/DCILXNEZJEWHGK3J4MJOAWTW2M/">way down</a> due to COVID-19 restrictions, the black market in New Zealand for illegal drugs (not counting cannabis) is still worth an estimated <a href="https://www.police.govt.nz/about-us/publication/national-wastewater-testing-programme-quarter-1-2021">NZ$77 million per quarter</a>.</p>
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<h2>Success and failure</h2>
<p>New Zealand first tried a different approach in 1987. The then Labour government introduced a national needle exchange program — a world first that allowed intravenous drug users to receive clean needles. The program significantly <a href="https://www.scimex.org/newsfeed/needle-exchanges-helped-reduced-nz-hiv-transmissions">reduced the risk of catching HIV</a> or hepatitis C, <a href="https://www.beehive.govt.nz/release/needle-and-syringe-exchange-programme-saves-lives">saving lives</a> and tens of millions in health spending.</p>
<p>The next innovation was a world-leading attempt to legalise and regulate the rapidly evolving synthetic drug market. It ultimately <a href="https://www.rnz.co.nz/news/the-wireless/375177/a-drug-experiment-gone-wrong">fell over</a> due to practical problems implementing the Psychoactive Substances Act, public backlash and resistance to animal testing.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/we-cant-eradicate-drugs-but-we-can-stop-people-dying-from-them-54636">We can't eradicate drugs, but we can stop people dying from them</a>
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</em>
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<p>This pattern of innovation and failure has continued. While the use of <a href="https://www.legislation.govt.nz/regulation/public/2019/0321/latest/LMS285243.html#LMS285242">medical cannabis</a> became legal in 2019, the referendum on legalising recreational cannabis <a href="https://www.theguardian.com/world/2020/nov/06/new-zealand-narrowly-votes-no-to-legalising-cannabis-in-referendum">failed</a> at last year’s general election.</p>
<p>A <a href="https://www.legislation.govt.nz/act/public/2019/0042/latest/whole.html">2019 amendment</a> to the Misuse of Drugs Act did pass, however, giving police clearer discretion not to prosecute for possession of small amounts of illegal drugs. Despite room for improvement, the new system has seen <a href="https://www.nzherald.co.nz/nz/politics/drug-law-impact-revealed-number-of-people-charged-per-month-dropping-dramatically-less-bias-against-maori/WQBN5JSLNN5XTN4HYZAFUT7XSE/">fewer prosecutions for personal use</a> and has helped shift the focus towards health and away from the criminal courts.</p>
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<h2>Drug checking prevents tragedies</h2>
<p>Given Labour’s parliamentary majority and that the drug checking bill is a government initiative, it’s likely to pass. If for some reason it didn’t, individuals or organisations handling drugs to check them would risk being charged with possession or supply. </p>
<p>Anyone allowing drug testing to operate on their premises would also be at risk because their co-operation could be seen as evidence of knowledge that illegal drugs were being consumed.</p>
<p>Most critically, if drug users can’t get reliable information about what they’re taking, their uninformed choices carry unpredictable and potentially extreme risks. Naïve customers and untrustworthy dealers can be a fatal combination.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-doctors-are-backing-pill-testing-at-music-festivals-across-australia-109430">Here's why doctors are backing pill testing at music festivals across Australia</a>
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</em>
</p>
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<p>Between 2017 and 2019, more than <a href="https://www.rnz.co.nz/news/national/398453/synthetic-cannabis-more-than-70-deaths-in-two-years-blamed-on-the-drug">70 deaths</a> were attributed to synthetic cannabis in New Zealand. </p>
<p>When the volunteer drug checking and harm reduction organisation <a href="https://knowyourstuff.nz/">Know Your Stuff NZ</a> checked 2,744 samples of other drugs at 27 events between April 2020 and March 2021, “<a href="https://knowyourstuff.nz/2021/07/07/this-was-the-summer-of-terrible-drugs/">only 68%</a> of all the samples checked were the substance that people expected”. They called it “the summer of terrible drugs”.</p>
<p>Even cannabis sourced illegally for medicinal reasons is often <a href="https://www.stuff.co.nz/national/health/125563016/few-would-provide-an-effective-dose-esr-does-firstofitskind-testing-on-black-market-medicinal-cannabis-products">not what people expect</a>, or even effective. Not surprisingly, then, research has shown <a href="https://www.karger.com/Article/FullText/507049">the vast majority of people</a> would opt to have their illegal drugs tested if they could do so without risk of arrest and could trust the information.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-reducing-harm-to-society-is-the-goal-a-cost-benefit-analysis-shows-cannabis-prohibition-has-failed-145688">If reducing harm to society is the goal, a cost-benefit analysis shows cannabis prohibition has failed</a>
</strong>
</em>
</p>
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<h2>Protection from black markets</h2>
<p>It’s been argued that drug checking only encourages the use of illegal and harmful substances. But the <a href="https://openaccess.wgtn.ac.nz/articles/report/Drug_Checking_at_New_Zealand_Festivals_Final_Report_/13936346">evidence</a>
suggests <a href="https://pubmed.ncbi.nlm.nih.gov/33677840/">otherwise</a>.</p>
<p>Rather, informed decisions produce changes in behaviour. When drug customers realise they have been misled or have misunderstood the nature of a given substance, they typically take less, or none.</p>
<p>The so-called war on drugs may be turning into a war on misinformation. If the Drug and Substance Checking Act finally comes into force by December, as has been promised, it will reflect a legislative trend toward harm reduction.</p>
<p>It will not stop the illegal use of drugs. But it will be one step further towards making New Zealand citizens safer from the scourge of unregulated and dangerous black markets for drugs.</p><img src="https://counter.theconversation.com/content/165612/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Gillespie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Drug and Substance Checking Bill currently moving through parliament marks another milestone in New Zealand’s shift away from criminalisation and towards harm reduction.Alexander Gillespie, Professor of Law, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1603342021-05-05T12:10:32Z2021-05-05T12:10:32ZMDMA may help treat PTSD – but beware of claims that Ecstasy is a magic bullet<figure><img src="https://images.theconversation.com/files/398754/original/file-20210504-18-qqqs9u.jpg?ixlib=rb-1.1.0&rect=30%2C0%2C6669%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">PTSD is typically treated with therapy and sometimes medications, under the care of a psychiatrist. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/depressed-veteran-meets-with-psychologist-royalty-free-image/639017362?adppopup=true">SDI Productions/Getty Images</a></span></figcaption></figure><p>Recent clinical trials, <a href="https://www.nytimes.com/2021/05/03/health/mdma-approval.html">including one soon to be published in Nature Medicine</a>, have suggested that <a href="https://www.drugabuse.gov/drug-topics/mdma-ecstasymolly">MDMA</a> combined with psychotherapy may help treat post-traumatic stress disorder, or PTSD. The news generated considerable optimism and excitement <a href="https://www.nytimes.com/2021/05/03/health/mdma-approval.html">in the media</a>, and some in the scientific community. </p>
<p>As a <a href="https://www.starclab.org/members/arash-javanbakht">psychiatrist and an expert in neurobiology and treatment of PTSD</a>, I think these developments may be important – but not the major breakthrough that some people are suggesting. This approach is not a new magic bullet.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/4RwOQcBM6cM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A combat veteran discusses his experience with PTSD.</span></figcaption>
</figure>
<h2>PTSD, a disorder of emotional memories</h2>
<p>Post-traumatic stress disorder is a result of <a href="https://theconversation.com/veterans-refugees-and-victims-of-war-crimes-are-all-vulnerable-to-ptsd-130144">exposure to extreme traumatic experiences,</a> such as natural disasters, motor vehicle accidents, assault, robbery, rape, combat and torture. Based on the type and severity of the trauma, people may develop PTSD, a condition of heightened anxiety that includes flashbacks, nightmares and avoidance of any reminder of trauma.</p>
<p>In the neuroscience world, we see <a href="https://www.ptsd.va.gov">PTSD</a> as a disorder of emotional memories, where recall of a traumatic memory can trigger high anxiety as if the event is happening in the here and now. People with PTSD often develop fear responses to anything remotely reminding them of the trauma.
We also see PTSD as a disorder of context processing: A person has the <a href="https://doi.org/10.1016/j.neuron.2016.09.039">same emotional response</a> to a loud noise in the safe civilian environment as in the battlefield. </p>
<h2>Current treatments for PTSD are effective</h2>
<p>Treatments for PTSD mostly include <a href="https://www.ptsd.va.gov/understand_tx/meds_for_ptsd.asp">antidepressant medications,</a> and <a href="https://www.ptsd.va.gov/understand_tx/talk_therapy.asp">psychotherapy</a>.</p>
<p>Psychotherapy is among the most effective treatments for PTSD, as it addresses traumatic memories and related emotional and cognitive reactions. That is, a person with PTSD may conflate the experience of trauma with being a bad person. Psychotherapies address these thought processes, or cognitions, caused by trauma.</p>
<figure class="align-center ">
<img alt="A double exposure of a woman with her hands in front of her mouth." src="https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">PTSD is often treated by directly addressing the trauma that underlies triggers.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/conceptual-image-royalty-free-image/1271702591?adppopup=true">MICROGEN IMAGES/SCIENCE PHOTO LIBRARY/Getty Images</a></span>
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<p>Trauma therapists also use <a href="https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy">exposure therapy</a> to gradually help people expose themselves to situations they avoid or the memories that terrify them until they learn that these situations are safe. The goal is to also help the brain of the person with PTSD disassociate the traumatic memories from the negative emotions that they trigger. This process is called <a href="https://doi.org/10.1523/JNEUROSCI.4268-10.2010">extinction of fear memories</a>. And it is here where researchers and others hope that MDMA and other drugs will help, by enhancing the extinction of these fear memories.</p>
<h2>MDMA: It won’t work by itself to treat PTSD</h2>
<p>Exposure therapy to traumatic memories is a difficult and exhausting process for some patients. Researchers are working to identify drugs that can enhance the effects of psychotherapy and make extinction of traumatic memories happen faster, or more effectively.</p>
<p>MDMA, or <a href="https://pubchem.ncbi.nlm.nih.gov/compound/3_4-Methylenedioxymethamphetamine">3,4-methylenedioxymethamphetamine</a>, is an agent that affects a wide range of neurotransmitters, or brain chemicals facilitating signaling between neurons including <a href="https://doi.org/10.1523/JNEUROSCI.1659-20.2020">serotonin, dopamine and norepinephrine</a>. No one knows for certain just how MDMA affects the learning brain in therapy, but there are some theories. MDMA may enhance psychotherapy by <a href="https://doi.org/10.1007/s00213-020-05548-2">reducing anxiety during recall</a> of trauma memories, helping the patient feel better about himself and others, increasing bonding with the therapist and enhancing extinction learning. </p>
<p>Recent clinical trials suggest that use of MDMA paired with carefully delivered psychotherapy <a href="https://doi.org/10.1080/20008198.2020.1840123">might improve patient outcomes</a>. Furthermore, these effects seem to persist months after the treatment. Given these positive results, the studies entered a multisite phase 3 clinical trial of 90 patients with severe PTSD with 67% experiencing significantly diminished symptoms.</p>
<p>It is very important to note that MDMA is not suggested as a standalone treatment for any condition, and only “MDMA-assisted” psychotherapy is researched in these studies. </p>
<h2>Breakthroughs sometimes break hearts</h2>
<p>Although these reports sound promising, I am skeptical of breakthrough medical pronouncements. Throughout the history of psychiatry, people have become too excited about promising cures like psychoanalysis, <a href="https://www.medicalnewstoday.com/articles/302663">ketamine</a>, <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know">cannabinoids</a>, virtual reality, <a href="https://www.healthline.com/health/propranolol-oral-tablet">propranolol</a>, opioids and memory-enhancing agents for treatment of PTSD and other psychiatric disorders. </p>
<p>Although each of these treatments helped some patients, none was a magic bullet. Many, including opioids, <a href="https://www.healthline.com/health/propranolol-oral-tablet">propranolol</a> and memory-enhancing agents, did not find their way out of the research laboratories into the real clinical world. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Rainbow pill capsule on blue background." src="https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=763&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=763&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=763&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=959&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=959&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=959&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">MDMA, though a promising candidate in PTSD treatment, is not a panacea.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tie-dye-capsule-royalty-free-image/145958929?adppopup=true">James Worrell/Getty Images</a></span>
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<p>For MDMA, we still do not have a <a href="https://doi.org/10.1080/02791072.2014.873690">solid mechanistic explanation</a> for how this drug might have rapid effects in enhancing long-lasting effects of therapy. </p>
<p>There is a large difference between a highly controlled research study with a limited number of participants and the complexities of real clinical work. For instance, a lot of psychiatric or medical conditions that many patients have are excluded from the clinical trials. Also, psychotherapies are delivered in their ideal form. In the cases of drugs such as ketamine and MDMA, it is almost impossible to blind these studies – meaning, to keep both patient and doctor in the dark about who received the trial drug or a placebo. Most patients, and consequently probably therapists, will know whether the patient received the psychoactive agent or the placebo.</p>
<p>Consequences of trauma cover a spectrum of symptoms, from zero to extremely high level. For having consistent language in research, we draw an imaginary line on this spectrum – say, 70% – and designate whoever is above the line as having PTSD. That does not mean that someone at a 65% or 60% does not have symptoms or distress. None of the studied approaches thus far totally eradicated symptoms. They just showed a larger decrease in symptoms compared with a placebo.</p>
<h2>Potential risks and dangers of MDMA</h2>
<p>While drugs called <a href="https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825">selective serotonin uptake inhibitors</a>, or SSRIs, and psychotherapy are relatively safe, agents like cannabis, ketamine and MDMA have many risks. The first is addiction. Although patients in the clinical trials are given only a limited number of doses, it is likely that someone experiencing a great feeling of relief from a drug given in the clinic will seek it on the street. </p>
<p>We are still dealing with the terrible opioid and <a href="https://theconversation.com/where-is-my-xanax-rx-why-your-doctor-may-be-concerned-about-prescribing-benzodiazepines-125346">benzodiazepine</a> pandemic, the medications about which people were so excited a few decades ago. Longitudinal studies of risks of future substance use with MDMA are currently lacking. This can be further complicated among those with a history of problems with prescription or illegal drug abuse, or those with personality disorders.</p>
<p>While the hype often suggests the drug itself is the cure, it is important to remember that what worked in these studies involved drugs and psychotherapy together.</p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Also, it is vital to remind people not to expect a cure from street drugs. At best, the effects will be as good as the therapy provided. So an unskilled person providing therapy, consultation or even friendship using such agents might create much more harm than help. Negative memories could arise that the unskilled person does not have the expertise to deal with. It is also important to know drugs obtained on the street might be very different from what is used in research. Impurities can cause a lot of harm. </p>
<p>We in the psychiatric treatment world have been here before many times. And, in some cases, we are still paying dearly for the initial excitement.</p><img src="https://counter.theconversation.com/content/160334/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s buzz about MDMA – yes, the same ingredient in the street drug known as Ecstasy – being a game changer in the treatment of PTSD. A psychiatrist who treats PTSD says, “Not so fast.”Arash Javanbakht, Associate Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1576842021-04-07T01:11:38Z2021-04-07T01:11:38ZDrug checking and an early warning network in Victoria could save lives: new coroner’s report<figure><img src="https://images.theconversation.com/files/391307/original/file-20210324-15-wlst1x.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Today the Coroners Court of Victoria <a href="https://www.coronerscourt.vic.gov.au/coroner-calls-urgent-drug-testing-services-victoria">released its findings</a> into a cluster of five drug-related deaths across Melbourne between July 2016 and January 2017.</p>
<p>The five young males, aged between 17 and 32, were all found to have consumed an unusual combination of two <a href="https://www.emcdda.europa.eu/topics/nps_en">new psychoactive substances</a>. Most of the deceased thought they were taking MDMA.</p>
<p>Coroner Paresa Spanos has recommended the Victorian government implement a <a href="https://www.emcdda.europa.eu/topics/drug-checking_en">drug checking service</a> as a matter of urgency. This is a service where people could find out the content and purity of drugs alongside a meeting with a health-care worker to talk about their drug use and test results. </p>
<p>She also recommended Victoria implement a drug early warning network. Data from the drug checking service could be cross-checked with other information we have about what drugs are out there, triggering alerts to warn people if an unusually dangerous substance is circulating. </p>
<p>As an expert witness to the coronial inquest, I argued more timely communication to the public about the dangers of this drug combination may prevent tragedies like these in future.</p>
<h2>What happened?</h2>
<p>The drugs in this novel combination are known as “25C-NBOMe” and “4-FA”. <a href="https://psychonautwiki.org/wiki/25C-NBOMe">25C-NBOMe</a> is highly potent — taking less than 1mg can produce strong psychedelic effects, and it can be <a href="https://erowid.org/chemicals/2cc_nbome/2cc_nbome_death.shtml">fatal</a>.</p>
<p><a href="https://psychonautwiki.org/w/index.php?title=4-FA">4-FA</a> is an amphetamine-type stimulant which has similar effects to amphetamine and MDMA, and can cause <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30281-7/fulltext">severe harm and death</a>. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-nbome-16950">Explainer: what is NBOMe?</a>
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<hr>
<p>All of the young men in this inquest snorted the crystalline powder, which dramatically <a href="https://psychonautwiki.org/wiki/25C-NBOMe">increases the risk of harm</a>.</p>
<p>While each substance carries substantial risks consumed on its own, the interaction between amphetamines and drugs from the NBOMe series <a href="https://psychonautwiki.org/wiki/25C-NBOMe">increases the risk</a> of heart failure and seizures. </p>
<p>While this combination is unusual, as recently as last year it was <a href="https://twitter.com/WeAreTheLoopAU/status/1303540516609339392?s=20">also detected</a> in other parts of Australia, including the Gold Coast, Brisbane, Perth and Canberra. </p>
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<h2>How can further deaths be prevented?</h2>
<p>In my report to the coroner, I argued if the deceased had known their drugs contained 25C-NBOMe combined with 4-FA, it’s reasonable to presume they either wouldn’t have taken them, or may have avoided snorting them in favour of a less risky route, such as swallowing. </p>
<p>It’s important to acknowledge that if we had a legalised and regulated supply of MDMA, we wouldn’t need to analyse samples to work out what’s in them.</p>
<p>While globally there has been recent work done on <a href="https://transformdrugs.org/publications/how-to-regulate-stimulants-a-practical-guide">how best to regulate stimulants</a> like MDMA, Australia isn’t yet considering this option.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-to-seek-help-after-taking-a-pill-109876">When to seek help after taking a pill</a>
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</em>
</p>
<hr>
<p>In the current context of drug prohibition, the most promising pathway to reduce harm among people who use drugs is to help them understand the content and purity of the drugs they may consume. </p>
<p>We can also monitor our illegal drug market more closely so all agencies involved in responding to drug problems are armed with the most current information and can tailor their responses accordingly.</p>
<h2>What’s Victoria already doing?</h2>
<p>The Victorian government and its agencies already generate useful data on drug markets. For example, Victoria Police runs a forensic analysis service for all seized drug samples, which is <a href="https://www.aic.gov.au/sites/default/files/2020-07/ti598_relationship_between_drug_price_and_purity.pdf">unique in Australia for its size and coverage</a>. While this information hasn’t historically been used to inform public health, ways of translating this data <a href="https://digital-ethnography.com/rapid-translation-of-forensic-data-from-police-drug-seizures-into-clinical-alerts-to-improve-public-health/">into useful clinical alerts</a> are currently being explored.</p>
<p>In 2020, the Victorian health department released two <a href="https://www2.health.vic.gov.au/alcohol-and-drugs/drug-alerts">public drug alerts</a>. It has also recently piloted a new drug surveillance approach including analyses of drug residue found in discarded drug paraphernalia, wastewater, and blood samples from emergency department patients.</p>
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<p>However, Victoria doesn’t currently have a service where members of the public can submit drugs for testing and receive tailored health advice, nor does it provide access to rapid forensic analysis outside the law enforcement context. </p>
<p>What’s more, Victoria doesn’t currently have a formal drug early warning network.</p>
<h2>What’s happening elsewhere?</h2>
<p>There are some excellent examples globally of agencies that run drug-checking services and collate, synthesise and assess new information about drug markets and issue public alerts. </p>
<p>The Dutch “<a href="https://idpc.net/publications/2019/07/the-drugs-information-and-monitoring-system-dims">Drugs Information and Monitoring System</a>”, established in 1992, supports a network of walk-in offices where people can submit drugs for analysis. In the event of unexpected findings, the government can act quickly by alerting people to higher risk substances circulating in the community.</p>
<p>For example, in late 2014, the Dutch system detected a lethal dose of a substance known as “PMMA” in a tablet presumed to be MDMA. Combined with further intelligence about the existence of a larger batch of this tablet, the Dutch government issued a “red alert”. This involved a mass media campaign with the message “please don’t take this tablet” pushed out via television, radio, newspapers, the internet and mobile devices. No deaths were recorded in the Netherlands from this tablet. In contrast, no such alert was issued in the UK, which went on to record <a href="https://www.bmj.com/content/365/bmj.l1784">several deaths</a> from these tablets.</p>
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<p>Victoria could also learn from <a href="https://cdpe.org/project/drug-checking-services/">the system in Toronto, Canada</a>. Similar to the Dutch service, Toronto has multiple drop-off sites where people can submit samples for testing. The service is anonymous and free. The agency publishes fortnightly online reports on the state of the local drugs market, and also issues public drug alerts where warranted.</p>
<p>New Zealand also has an early warning system for drugs, which <a href="https://www.highalert.org.nz/">launched last year</a>.</p>
<h2>Next steps</h2>
<p>This isn’t the first time drug checking has been <a href="https://www.parliament.vic.gov.au/421-lrrcsc/inquiry-into-illicit-and-synthetic-drugs-and-prescription-medication">recommended in Victoria</a>. But this time, there are reasons to be hopeful government agencies will adopt some or all of these recommendations.</p>
<p>The Andrews Labor government has a record of acting on advice from the coroner. Examples include the establishment of <a href="https://vcoss.org.au/analysis/2017/10/coroners-case-for-safe-injecting/">Melbourne’s first medically supervised injecting room</a>, the introduction of a <a href="https://www.coronerscourt.vic.gov.au/sites/default/files/2020-02/2017%206443%20Response%20to%20recommendations%20from%20DHHS_KING.pdf">real-time prescription medication monitoring system called SafeScript</a>, and the <a href="https://www.abc.net.au/news/2021-02-19/victorian-parliament-decriminalises-public-drunkenness-tanya-day/13172136">decriminalisation of public drunkenness</a> after the death of Yorta Yorta woman Tanya Day. </p>
<p>Victoria Police recently released their <a href="https://www.police.vic.gov.au/drug-strategy">new drug strategy</a>, which highlights their commitment to supporting harm-reduction initiatives and working more closely with the health department and community organisations. Supporting the coroner’s recommendations would be one way to demonstrate their commitment to these aspects of the new strategy.</p>
<p>This government has presided over a period of increased innovation in drugs policy. This report offers a further opportunity to demonstrate their commitment to reducing drug-related deaths in Victoria.</p><img src="https://counter.theconversation.com/content/157684/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monica Barratt receives (or has recently received) funding from Australian (National Health and Medical Research Council, the Australian Institute of Criminology, the National Centre for Clinical Research into Emerging Drugs) and international (US National Institutes of Health, NZ Marsden Fund) sources. She has conducted commissioned research for the NSW Coroner's Office, the WA Mental Health Commission and the Victorian Department of Health.
In addition to her role at RMIT, Monica is a visiting fellow at the National Drug and Alcohol Research Centre, UNSW Sydney. She is an editor for two peer-reviewed journals, the International Journal of Drug Policy and Drug and Alcohol Review. She also has leadership roles at two not-for-profit harm-reduction organisations: The Loop Australia and Bluelight.org</span></em></p>I was an expert witness to the coronial inquest into five drug-related deaths across Melbourne between July 2016 and January 2017. Here’s what we should do to prevent similar tragedies.Monica Barratt, Vice Chancellor’s Senior Research Fellow, Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1504482021-01-24T18:52:06Z2021-01-24T18:52:06ZWill Australia legalise ecstasy and magic mushrooms to treat mental illness? Here’s why it’s still too soon<figure><img src="https://images.theconversation.com/files/380101/original/file-20210122-17-1i8tm1v.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5742%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While the public focus remains on COVID vaccines, the Therapeutic Goods Administration (TGA) continues to evaluate <a href="https://www.tga.gov.au/consultation-invitation/consultation-proposed-amendments-poisons-standard-acms-accs-and-joint-acmsaccs-meetings-november-2020">a range of proposals</a> around the provision of medical treatments in Australia. </p>
<p>The regulatory body is currently considering whether psychiatrists should be allowed to prescribe MDMA and psilocybin to treat mental illness within the framework of scheduled medicines. The TGA <a href="https://www.tga.gov.au/scheduling-committees-meeting-dates-and-decisions-timeframes#y2020">will announce</a> its interim decision on February 3, and will make a final ruling on April 22.</p>
<p>Psychedelic drugs for the treatment of mental illness represent a promising area. And any new treatment which could help people suffering — particularly in the wake of the pandemic — may seem like a good thing.</p>
<p>But until Australia engages in further research into the therapeutic potential of these drugs, we believe it’s too soon to make them available as medicines. </p>
<h2>The application</h2>
<p>Increasing <a href="https://link.springer.com/article/10.1007/s00213-019-05249-5">research evidence</a> suggests MDMA, commonly known as ecstasy, could be an effective adjunct to psychotherapy for people with post-traumatic stress disorder (PTSD). </p>
<p>Meanwhile, clinical trials of psilocybin, the psychoactive component of magic mushrooms, show it could assist psychotherapy in the treatment of <a href="https://www.sciencedirect.com/science/article/pii/S0165032719309127">anxiety and depression</a>, <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/dar.12544">addiction</a>, and <a href="https://www.tandfonline.com/doi/pdf/10.1080/09540261.2018.1482261">a range of other mood disorders</a>.</p>
<p>On this basis, in July 2020, an organisation called Mind Medicine Australia made an application to the TGA requesting <a href="https://mindmedicineaustralia.org.au/tga/">MDMA and psilocybin</a> be classified as Schedule 8 controlled medicines. </p>
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<img alt="Magic mushrooms." src="https://images.theconversation.com/files/380108/original/file-20210122-17-uivv7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380108/original/file-20210122-17-uivv7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380108/original/file-20210122-17-uivv7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380108/original/file-20210122-17-uivv7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380108/original/file-20210122-17-uivv7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380108/original/file-20210122-17-uivv7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380108/original/file-20210122-17-uivv7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Psilocybin, the psychoactive component of magic mushrooms, has shown promise as a treatment for a range of mood disorders.</span>
<span class="attribution"><span class="source">Jonathon Carmichael</span>, <span class="license">Author provided</span></span>
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<p>MDMA and psilocybin are currently classified as Schedule 9 prohibited drugs. Another example of a <a href="https://www.legislation.gov.au/Details/F2020L01255">Schedule 9 drug</a> is heroin.</p>
<p>As Schedule 8 controlled medicines, MDMA and psilocybin would sit alongside <a href="https://www.legislation.gov.au/Details/F2020L01255">drugs like</a> dexamphetamine, morphine and some forms of medical cannabis. Some of these and other Schedule 8 drugs such as ketamine and cocaine are used recreationally. </p>
<p>If the TGA reclassifies MDMA and psilocybin, Australia would be the first country in the world to recognise these drugs as legitimate medicines. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/psychedelics-to-treat-mental-illness-australian-researchers-are-giving-it-a-go-112952">Psychedelics to treat mental illness? Australian researchers are giving it a go</a>
</strong>
</em>
</p>
<hr>
<h2>Is Australia ready?</h2>
<p>Early research suggesting psychedelics <a href="https://maps.org/index.php?option=com_content&view=article&id=5468#earlyresearchlsd">had therapeutic potential</a> lapsed after 1971, when the drugs were made illegal around the world. But it resumed early in the 2000s, manifesting into an international renaissance in psychedelic science. </p>
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<p>Australia was <a href="https://theconversation.com/shroom-to-grow-australias-missing-psychedelic-science-17344">a little later</a> to get involved than some countries, but in the past 18 months we’ve succeeded in <a href="https://theconversation.com/psychedelics-to-treat-mental-illness-australian-researchers-are-giving-it-a-go-112952">initiating clinical research</a> locally. </p>
<p>Edith Cowan University, Monash University, the University of Melbourne, and St Vincent’s hospitals in Melbourne and Sydney <a href="https://www.canberratimes.com.au/story/7077451/mdma-psychedelic-mushroom-studies-to-move-to-recruitment-phase/">all have research</a> on psychedelic-assisted therapies either in the pipeline or already underway. The trial at St Vincent’s hospital in Melbourne is the first to have started recruiting participants.</p>
<p>These trials aim both to contribute to the research happening globally, and to demonstrate that Australia has the regulatory processes, people and infrastructure to provide these treatments safely and effectively. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-ecstasy-the-party-drug-that-could-be-used-to-treat-ptsd-55149">Weekly Dose: ecstasy, the party drug that could be used to treat PTSD</a>
</strong>
</em>
</p>
<hr>
<h2>But we’re not there yet</h2>
<p>There are three key reasons why Australia is not yet ready for MDMA and psilocybin to be rescheduled as medicines by the TGA.</p>
<p><strong>1. No accredited training</strong> </p>
<p>Australia has very few health-care professionals trained to provide psychedelic-assisted psychotherapy. These drugs produce powerful changes in consciousness that <a href="https://www.ranzcp.org/files/resources/college_statements/clinical_memoranda/cm-therapeutic-use-of-psychedelics.aspx">could lead to psychological harm</a>, rather than healing, when given to unsuitable patients, or by health-care workers without the necessary training.</p>
<p><strong>2. Prohibitive costs</strong></p>
<p>Medical cannabis is only legally available in pharmaceutical formulations — the actual plant is not available as a medicine. This makes medical cannabis expensive. Only <a href="https://www.aihw.gov.au/getmedia/108d1761-b523-492b-81cc-a09db6740e85/aihw-phe-270-Chapter6-Medicinal-cannabis.pdf.aspx">3.9% of Australians</a> using cannabis for medical reasons access it legally. We expect pharmaceutical-grade MDMA and psilocybin will also be expensive to access. </p>
<p><strong>3. Going underground</strong></p>
<p>Like medical cannabis, we’re concerned that lack of access and prohibitive costs will mean more people will access existing <a href="https://video.vice.com/en_au/video/psychedelic-psychotherapy-using-lsd-mdma-and-psilocybin-to-treat-mental-health-1-408/5c513491be4077144c5572e1">unregulated MDMA and psilocybin treatment services</a>. This puts people at risk, since there’s no quality control of either the drugs or the therapists.</p>
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<p>Should these issues arise, our efforts over recent years to finally establish psychedelic medicine in Australia could be undone.</p>
<h2>What will the TGA decide?</h2>
<p>Given these concerns, we believe it’s highly unlikely the TGA will decide to reschedule MDMA and psilocybin as medicines at this stage. </p>
<p>And while emerging evidence is continuing to suggest these drugs can be <a href="https://link.springer.com/article/10.1007/s00213-019-05249-5">effective adjuncts to psychotherapy</a>, we believe the application was made without sufficient regard to the universally accepted process of new drug approval. </p>
<p>We need to see Phase 3 clinical trials completed before any informed decisions can be made (the trials in Australia have not yet reached Phase 3). This approval process is important so we know the drugs are effective and safe, including understanding any side effects.</p>
<p>By way of comparison, we know Pfizer wouldn’t apply for TGA approval for a new antidepressant before completing Phase 3 research. Even the COVID-19 vaccines Pfizer, AstraZeneca and Moderna are fast-tracking internationally have been required to complete stringent, widely scrutinised Phase 3 trials.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-will-covid-19-vaccines-be-approved-for-use-in-australia-153640">How will COVID-19 vaccines be approved for use in Australia?</a>
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<h2>Where to from here?</h2>
<p>Current and future Australian research in this space will offer a crucial pathway for therapists to learn how to provide psychedelic-assisted psychotherapy. This is an important step before Australia is ready for MDMA and psilocybin to be approved as medicines.</p>
<p>Moving forward, we anticipate Australian health-care professional <a href="https://www.ahpra.gov.au/">registration boards</a> will come to acknowledge psychedelic-assisted psychotherapy as a speciality area of training, and will need to develop accredited training programs to meet the demand for appropriately qualified therapists.</p>
<p>Notably, none of the current research into psychedelic-assisted treatments for mental illness in Australia is receiving government funding. Government support will be important to extend this research beyond the early-phase trials, and ultimately will be crucial for the widespread rollout of this treatment. </p>
<p>Finally, to ensure equitable access, psychedelic-assisted therapies will need to be embedded within the public health-care system and supported by the Pharmaceutical Benefits Scheme.</p>
<p>Our submission to the TGA, along with others, will be made public on February 3, when the TGA announces its interim decision on the rescheduling of psilocybin and MDMA.</p>
<p><em>Correction: this article has been corrected to remove reference to methamphetamine as a Schedule 9 drug. It is a Schedule 8 drug under the Poisons Standard.</em></p>
<p><em>The text has also been amended to clarify that it is currently possible for psychiatrists in some states and territories to prescribe MDMA and psilocybin under the Special Access Scheme-B. Applications under this scheme are evaluated on a case-by-case basis.</em></p><img src="https://counter.theconversation.com/content/150448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Bright is a Director of the DGR-1 charity, Psychedelic Research in Science & Medicine Ltd (PRISM). Stephen Bright has had no formal association with Mind Medicine Australia, except through its allocated funding of PRISM's support of clinical research at St Vincent's Hospital Melbourne.</span></em></p><p class="fine-print"><em><span>Martin Williams is Executive Director of the DGR-1 charity, Psychedelic Research in Science & Medicine Ltd (PRISM), and receives fellowship funding from the Vasudhara Foundation. Martin Williams previously consulted to Mind Medicine Australia (MMA) as Scientific Officer, from 1 April 2019 to 31 March 2020. PRISM received tax-deductible donations from MMA in March and November 2019, allocated entirely to the first year of the St Vincent's Hospital Melbourne clinical trial of psilocybin-assisted therapy for anxiety and depression associated with terminal illness. Martin Williams resigned from the role of Scientific Officer with MMA on 4 April 2020, and PRISM terminated its arrangement with MMA on 4 September 2020.</span></em></p>The TGA is currently evaluating a proposal to legalise MDMA and psilocybin for the treatment of mental illness. But there are a few reasons Australia isn’t quite ready to take this step.Stephen Bright, Senior Lecturer of Addiction, Edith Cowan UniversityMartin Williams, Postdoctoral Research Associate, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1460922020-09-21T06:04:47Z2020-09-21T06:04:47ZPTSD and psychoactive drugs: MDMA treatment shows potential, but others lack evidence<figure><img src="https://images.theconversation.com/files/358968/original/file-20200921-22-k4xxl2.jpg?ixlib=rb-1.1.0&rect=11%2C5%2C3822%2C2149&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shuterstock</span></span></figcaption></figure><p>Can psychoactive drugs be used to treat mental health problems? The idea has been around for years, and recently received some <a href="https://www.abc.net.au/triplej/programs/hack/proposal-to-treat-mental-illness-with-magic-mushrooms-and-mdma/12622680">attention</a> in the media.</p>
<p>Interest in the potential of drugs such as MDMA (scientific name 3,4-methylenedioxymethamphetamine), ketamine, psilocybin and LSD (lysergic acid diethylamide) has been growing among scientists and doctors, as well as the wider community. </p>
<p>However, there is still debate among experts about whether these drugs are safe and effective. In a <a href="https://www.tandfonline.com/doi/full/10.1080/02791072.2020.1817639">new study</a>, we reviewed the state of the evidence for using these drugs in the treatment of post-traumatic stress disorder (PTSD). </p>
<h2>How PTSD is treated now</h2>
<p>Up to 10% of people who are exposed to traumatic events such as a serious accident, physical assault, war, natural disaster, sexual assault or abuse will develop PTSD. Symptoms can include reliving the event through unwanted thoughts, flashbacks or nightmares; feeling wound up, having trouble sleeping, concentrating or being on the lookout for danger; and avoiding reminders of the event. These symptoms may last for years if left untreated. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-post-traumatic-stress-disorder-11135">Explainer: what is post-traumatic stress disorder?</a>
</strong>
</em>
</p>
<hr>
<p>Psychotherapies such as trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) therapy are first-line treatments for PTSD. These types of treatments involve teaching patients to confront and come to terms with the painful memories, thoughts and images they have been avoiding. They also provide patients with tools to get back into the activities or places they have been avoiding, and to relax when they start to feel wound up.</p>
<p>While there is strong evidence showing these treatments are effective, not everyone responds to them. Psychoactive drugs are often touted as the solution to this problem. But does the science match the hype?</p>
<h2>What do we already know about psychoactive drugs for PTSD?</h2>
<p>Ketamine, MDMA, LSD and psilocybin have all been considered as potential treatments for PTSD:</p>
<ul>
<li><p>ketamine was developed as a general anaesthetic but is used recreationally because of its psychedelic and hallucinogenic properties. It acts mainly on the glutamergic system, which regulates large regions of the nervous system and has been implicated in the formation of traumatic memories and reduction of the stress response</p></li>
<li><p>MDMA is a synthetic compound and is typically the main constituent of “ecstasy”. It induces changes in human emotion and it is possible that MDMA, in combination with psychotherapy, can increase a person’s ability to access and process painful or negative emotions, and increase positive emotions and social interactions</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-psychiatry-ready-for-medical-mdma-94105">Is psychiatry ready for medical MDMA?</a>
</strong>
</em>
</p>
<hr>
<ul>
<li><p>LSD is a hallucinogen that produces psychosensory changes and alters cognition, often increasing optimism and inducing a sense of well-being. By increasing prosocial behaviour, it may strengthen the alliance between therapist and patient and so increase the effectiveness of psychotherapy. It can also encourage catharsis and relaxation</p></li>
<li><p>psilocybin naturally occurs in “magic mushrooms” and, like LSD, it increases a person’s sense of optimism and well-being and reduces negative mood. It can also be associated with increased capacity for introspection, and <a href="https://journals.sagepub.com/doi/10.1177/0269881116675512">research studies</a> have found it can reduce levels of anxiety and depression in cancer patients.</p></li>
</ul>
<p>But do these drugs make a real difference in resolving PTSD symptoms? And are they any better than the treatments that we already have?</p>
<h2>What does the latest evidence say?</h2>
<p>To find out what the current evidence says, my colleagues and I at <a href="https://www.phoenixaustralia.org">Phoenix Australia</a> conducted a <a href="https://www.tandfonline.com/doi/full/10.1080/02791072.2020.1817639">systematic review</a> of the published research.</p>
<p>We found two <a href="https://pubmed.ncbi.nlm.nih.gov/29563072/">small</a> randomised <a href="http://www.actnjournal.com/article.asp?issn=2542-3932;year=2017;volume=2;issue=3;spage=80;epage=90;aulast=Pradhan">trials</a> in which ketamine was used in combination with psychotherapy to treat PTSD. Overall, we found ketamine shows some promise when compared with placebo, but future research is needed to investigate how ketamine, in combination with psychotherapy, stacks up against standard PTSD treatment.</p>
<p>The effect of using MDMA with psychotherapy was a little more encouraging, with <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30135-4/fulltext">four</a> <a href="https://journals.sagepub.com/doi/10.1177/0269881110378371">small</a> <a href="https://journals.sagepub.com/doi/full/10.1177/0269881112464827">randomised</a> <a href="https://journals.sagepub.com/doi/full/10.1177/0269881118806297">trials</a> reporting positive effects in treating PTSD. We found MDMA currently has more promise than ketamine, based on the studies included in our review. It should be noted, though, that none of these four studies compared MDMA, in combination with psychotherapy, to a typical treatment for PTSD.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/358989/original/file-20200921-16-1n6sm9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358989/original/file-20200921-16-1n6sm9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358989/original/file-20200921-16-1n6sm9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358989/original/file-20200921-16-1n6sm9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358989/original/file-20200921-16-1n6sm9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358989/original/file-20200921-16-1n6sm9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358989/original/file-20200921-16-1n6sm9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Better known as the recreational drug ecstasy, MDMA may also play a valuable role in the treatment of PTSD and other mental health problems.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The MDMA studies in the review found that improvements in clinician-rated PTSD symptoms, and in self-reported physical responses to stress, were “significantly greater” for those who received MDMA and psychotherapy compared to a placebo. A <a href="https://journals.sagepub.com/doi/10.1177/0269881112456611">small trial</a> showed that 17-74 months after MDMA and therapy was delivered, on average, improvements were still being felt.</p>
<p>Another <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30135-4/fulltext">slightly larger trial</a> involved military veterans, firefighters and police officers with chronic PTSD, and found a significant reduction in the severity of symptoms. Out of 24 participants who completed a 12-month follow-up, 16 did not have a PTSD diagnosis.</p>
<p>We also looked for research on the use of LSD and psilocybin in PTSD treatment, and were surprised to discover no randomised controlled trials have been conducted.</p>
<h2>Where to from here?</h2>
<p>Attitudes towards psychoactive drugs for the treatment of PTSD are changing. Some proponents <a href="https://www.medicinenet.com/script/main/art.asp?articlekey=200991">suggest</a> they offer a “chemical safety net” for patients.</p>
<p>However, our review highlights the fact that, scientifically, this area is still in its infancy. There is a clear need for further high quality research, to provide us with a better understanding of these treatments, and how they might fit into treatment options for PTSD.</p><img src="https://counter.theconversation.com/content/146092/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracey Varker receives funding from the Defence Health Foundation. </span></em></p>Drugs like MDMA, ketamine, LSD and psylocibin may help heal the wounds of trauma - but more research is needed.Tracey Varker, Senior research fellow, Phoenix Australia, Department of Psychiatry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1294522020-01-28T06:04:37Z2020-01-28T06:04:37ZPingers, pingas, pingaz: how drug slang affects the way we use and understand drugs<figure><img src="https://images.theconversation.com/files/312175/original/file-20200128-81411-1294yay.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7348%2C4912&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Pingers' usually contain MDMA. But assuming you know exactly what's in them can be dicey.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Slang names or street names for drugs are common. From pingers (MDMA), to fishies (GHB) to going into the K-hole (ketamine), slang use marks someone as an insider with knowledge and experience of illicit drug use. </p>
<p>The use of language around drugs is important because people using drugs referred to by slang names could misunderstand what they’re getting.</p>
<p>At the same time, tuning in to drug slang offers researchers and health workers an avenue by which to track patterns of drug use.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-friends-are-taking-mdma-at-raves-and-music-festivals-is-it-safe-122128">'My friends are taking MDMA at raves and music festivals. Is it safe?'</a>
</strong>
</em>
</p>
<hr>
<h2>A bit of history</h2>
<p>Clinicians and people who study drug use have attempted to catalogue slang terms for drug use since the <a href="https://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199567256.001.0001/acprof-9780199567256-chapter-11">1930s</a>.</p>
<p>David Maurer, an American linguistics professor who studied the use of language in the American underworld, published <a href="https://www.jstor.org/stable/451532?seq=1">the first glossary</a> of drug slang terms in 1936. The aim was to guide law enforcement as well as to inform doctors, parents and teachers about drug use. </p>
<p>The definitions reflect the social and cultural values around drug-taking practices at the time. For example, <a href="https://www.jstor.org/stable/451532?seq=1">Maurer’s glossary</a> featured the term “to vipe”, meaning to smoke marijuana. The definition included how beginners were taught special smoking techniques by hostesses, likely sex workers.</p>
<h2>Why is drug slang important?</h2>
<p>The use of slang indicates a person uses drugs because <a href="https://www.csmonitor.com/The-Culture/Family/Modern-Parenthood/2013/0905/Drug-Molly-What-parents-need-to-know-about-drug-slang">they know the secret language</a> of a subculture. With this in mind, researchers seek to identify drug subcultures through understanding language use.</p>
<p>In 1979, researchers created a <a href="https://www.ncbi.nlm.nih.gov/pubmed/528729">drug slang association test</a> to identify if the number of slang names people knew related to their use of a drug type. The authors found people in prison, who commonly used opiates, knew more slang words for heroin than college students did. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-dictionary-is-totes-taking-up-the-vernacular-66570">How the dictionary is totes taking up the vernacular</a>
</strong>
</em>
</p>
<hr>
<p>More recently, <a href="https://publichealth.jmir.org/2018/1/e2/">one study</a> analysed Twitter posts to identify new slang. <a href="https://content.sciendo.com/view/journals/topling/17/1/article-p81.xml">Another study</a> used slang terms in Instagram hashtags to document drug use patterns. </p>
<p>For clinicians and researchers, slang <a href="https://doi.org/10.1080/02791072.2010.10400700">offers insights</a> into drug users’ beliefs and behaviours, which can in turn guide interventions. The slang words can be <a href="https://content.sciendo.com/view/journals/topling/17/1/article-p81.xml">metaphors for the drug effects or appearance</a>, giving health professionals an understanding of a person’s drug use experience.</p>
<p>Researchers also believe they get better results from surveys if they use the same language as people using drugs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312176/original/file-20200128-81352-at93n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312176/original/file-20200128-81352-at93n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312176/original/file-20200128-81352-at93n2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312176/original/file-20200128-81352-at93n2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312176/original/file-20200128-81352-at93n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312176/original/file-20200128-81352-at93n2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312176/original/file-20200128-81352-at93n2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The use of slang can indicate to others a person uses drugs.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Pingers</h2>
<p>As we find ourselves at the height of music festival season, let’s look at a timely example.</p>
<p>MDMA (3,4- methylenedioxymethamphetamine), or ecstasy, is one of the drugs <a href="https://www.ncbi.nlm.nih.gov/pubmed/29304871">people take most commonly</a> at music festivals. The term “pinger” (or pinga) is thought to be an Australian creation <a href="https://insight.qld.edu.au/shop/dovetail-slang-list">used to refer to MDMA</a>.</p>
<p>Most festival goers attend few events and are only <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/DPMP%20Bulletin%2028%20-%20Profiles%20and%20policing%20of%20Australian%20music%20festival%20attendees.pdf">occasional users of illegal drugs</a>, so they may be unfamiliar with slang names and what drug they refer to. The drug they purchase could be completely different to what they expected.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-nitrous-oxide-or-nangs-and-how-dangerous-is-it-108019">Explainer: what is nitrous oxide (or nangs) and how dangerous is it?</a>
</strong>
</em>
</p>
<hr>
<p>The first reference to pingers is reported to be in the glossary of an Australian surfing <a href="https://www.dictionary.com/e/slang/pingers/">book published in 2003</a>. More recently the word pinger has appeared in several pop culture dictionaries with examples related to drug use. For <a href="https://www.urbandictionary.com/define.php?term=pingers">example</a>:</p>
<p><em>>“I had so many pingers last night I was tripping balls”.</em></p>
<p>An Australian video game called <a href="https://www.complex.com/pop-culture/2016/01/big-city-earnerz-is-the-eshest-game-youll-play-this-summer/">Big City Earnez</a> has players collecting “pingaz” – things that look like tablets – in different Melbourne suburbs and hiding from the police. </p>
<p>None of these examples refer to MDMA specifically, but there’s an assumption people know what the word pinger means, including the drug’s use and effects.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312178/original/file-20200128-81346-1ke2aam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312178/original/file-20200128-81346-1ke2aam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312178/original/file-20200128-81346-1ke2aam.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312178/original/file-20200128-81346-1ke2aam.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312178/original/file-20200128-81346-1ke2aam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312178/original/file-20200128-81346-1ke2aam.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312178/original/file-20200128-81346-1ke2aam.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drug slang is part of the music festival vernacular.</span>
<span class="attribution"><span class="source">Yvette de Wit/Unsplash</span></span>
</figcaption>
</figure>
<p>And the term’s use has spread out of Australia. By 2012, <a href="https://www.vice.com/en_uk/article/wnvwwx/artist-carving-limestone-pingers-daniel-davis-interview">Vice.com</a>, a UK website that regularly reports on popular and emerging drug use, was using the term pinger to describe MDMA.</p>
<p>Slang can also describe ways drugs are used. “Shelving a pinger” refers to <a href="https://www.vice.com/en_uk/article/xdp374/question-of-the-day-shelved-a-pinger">inserting a drug in the anus</a>.</p>
<h2>Buyer beware</h2>
<p>A problem with relying on slang to identify drugs is meanings change over time. It took a few years for pinger to be used in the UK as slang for MDMA. In 2009 police in England and Wales were issued with a list of 3,000 words to learn so they could “<a href="https://www.telegraph.co.uk/news/uknews/law-and-order/6519172/Police-given-3000-word-A-to-Z-of-drugs-slang-to-stay-ahead-of-criminals.html">stay ahead of criminals</a>”. Pinger was not on the list but ping-on was listed as meaning opium and pingus as the <a href="https://www.telegraph.co.uk/news/uknews/law-and-order/6521761/Drugs-slang-what-police-must-learn-I-to-Q.html">prescription drug Rohypnol</a> (a sedative and muscle relaxant).</p>
<p>Slang terms are also culturally specific. Not all countries use the same slang even when English is the main language. In Ireland “yoke” is a word used to refer to <a href="https://www.vice.com/en_uk/article/exqgw4/irish-pill-poppin">MDMA pills or capsules</a> while “molly” is a common word <a href="https://www.theguardian.com/music/shortcuts/2013/jul/14/why-us-pop-mad-molly-aka-ecstasy">in the United States</a>. “Shelving a pinger” is called “boofing a roll” <a href="https://www.forbes.com/sites/brucelee/2018/09/29/what-exactly-is-boofing-and-why-you-should-never-do-it/#9ab24692a94d">in the US</a>. Beyond the likelihood of embarrassment, misunderstanding slang terms can increase the risk of drug-related harms.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
</strong>
</em>
</p>
<hr>
<p>And even if you’re clear on the terminology, a label doesn’t mean a drug is necessarily what you think it is. A pinger may have MDMA in it, a combination of drugs or no drugs at all. </p>
<p>The risk of using slang is thinking you know what it means and not asking for clarification. If you’re buying pingers or another drug called by a slang name, it’s important to ask what it is.</p><img src="https://counter.theconversation.com/content/129452/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan has received funding from NHMRC, ARC and NSW Health for research projects related to drug use and treatment. Julaine works as Director of Research for Western NSW Local Health District and holds appointments at The University of Wollongong, The National Drug and Alcohol Research Centre at UNSW, University of QLD and Charles Sturt University.</span></em></p>Drug slang can help researchers understand drug trends. But if you’re taking a drug called by a street name, make sure you know what it is.Julaine Allan, Senior research fellow, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1276092019-12-19T21:26:27Z2019-12-19T21:26:27ZMDMA-assisted couples therapy: How a psychedelic is enhancing intimacy and healing PTSD<figure><img src="https://images.theconversation.com/files/306751/original/file-20191213-85417-l5ggy.jpg?ixlib=rb-1.1.0&rect=188%2C98%2C5144%2C3342&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research over the last decade has shown MDMA-assisted psychotherapy to be effective in treating PTSD from military combat, sexual assault and childhood abuse. Now researchers are trialing MDMA with couples and finding promising results. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Post-traumatic stress disorder (PTSD) is a mental health condition, triggered by experiencing or witnessing a terrifying or threatening event. Symptoms can include re-experiencing the trauma, avoidance, nightmares and severe anxiety. Living with PTSD can feel devastating, permanent and life-defining. </p>
<p>The path to relieving suffering can also feel overwhelming — diving into past pain, memories and experience to understand and move through them can be horrifying, especially when your system is screaming for you to avoid them. People’s defence systems can be so strong, their narratives about the world so stuck, that the best treatments we have available do not work for everyone. </p>
<p>That’s where the synthetic psychoactive drug MDMA (3,4 methylenedioxymethamphetamine) comes in — as a supportive catalyst to a therapeutic process.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-real-promise-of-lsd-mdma-and-mushrooms-for-medical-science-100579">The real promise of LSD, MDMA and mushrooms for medical science</a>
</strong>
</em>
</p>
<hr>
<p>MDMA has been showing excellent effect for the treatment of PTSD from many different causes — including <a href="https://doi.org/10.1016/S2215-0366(18)30135-4">military combat</a>, <a href="https://doi.org/10.1177/0269881110378371">sexual assault and childhood abuse</a> — over the <a href="https://doi.org/10.1007/s00213-019-05249-5">past decade</a>, coupled with an inner-directed, supportive model of psychotherapy. </p>
<p>This therapy combination has received “<a href="https://doi.org/10.3389/fpsyt.2019.00650">breakthrough therapy designation</a>” from the Food and Drug Administration (FDA) in the United States. It is currently being tested in a large, multi-site randomized controlled trial, sponsored by the <a href="https://mdmaptsd.org/">Multidisciplinary Association for Psychedelic Studies (MAPS)</a>. </p>
<h2>How MDMA works in the brain</h2>
<p>MDMA is a drug that alters mood and perception. In non-clinical settings, it is a common recreational drug — known as Ecstasy (E) or Molly. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">MDMA can produce blissful experiences, but also can be used to revisit traumatic memories.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>MDMA works on numerous <a href="https://doi.org/10.1016/j.biopsych.2013.12.015">neural structures</a> (especially the amygdala and pre-frontal cortex) and <a href="https://journals.lww.com/drug-monitoring/Abstract/2004/04000/Human_Pharmacology_of_MDMA__Pharmacokinetics,.9.aspx">enhances the secretion of hormones and neurotransmitters</a> — namely <a href="https://www.the-scientist.com/news-opinion/serotonin-and-dopamine-responsible-for-the-pros-and-cons-of-mdma--66837">serotonin, dopamine</a>, norepinephrine and oxytocin, among others. </p>
<p>The drug can produce joyful, blissful experiences and, in the context of PTSD treatment, can <a href="https://doi.org/10.1016/j.pnpbp.2018.03.003">allow for a revisiting of traumatic memories</a>, emotions and context with greater ease and less avoidance than would be possible without the drug. </p>
<p>MDMA-facilitated psychotherapy embeds the use of MDMA within a psychotherapy treatment for PTSD, therefore providing a deeply evocative template to be able to work from — to move the seemingly immovable presence of the trauma. </p>
<h2>Revisiting traumatic memories</h2>
<p>As a clinical psychologist and researcher, I’ve focused my work on trauma and relationships for the past decade. As the <a href="http://www.remedycentre.ca/">founder of Remedy</a>, a mental health innovation community, and an adjunct professor in psychology at Ryerson University, my goal has been to illuminate treatments for trauma that can have deep, profound and lasting effects. This is what inspired me to work with MDMA.</p>
<p>Our <a href="https://doi.org/10.1080/02791072.2019.1589028">team recently conducted a pilot trial</a> of cognitive behavioural conjoint therapy (CBCT) for PTSD in combination with MDMA, with six couples in Charleston, S.C. The therapy was successful in reducing PTSD symptoms in the majority of couples and improved their relationship satisfaction.</p>
<p>We are now preparing to run a pilot trial of cognitive processing therapy (CPT) with MDMA and a larger randomized controlled trial of CBCT with MDMA that will take place in Toronto, pending government and regulatory approvals. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">MDMA-assisted psychotherapy could offer hope to those in the military who serve in conflict zones, and veterans who struggle with PTSD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Preparation and integration</h2>
<p>Cognitive behavioural conjoint therapy, <a href="https://jamanetwork.com/journals/jama/fullarticle/1346190">a treatment for couples</a>, has demonstrated excellent effect in reducing symptoms for people with PTSD, and also for their intimate relationships and their loved ones.</p>
<p>Cognitive processing therapy, a treatment that focuses on meaning-making about a trauma in order to unravel thoughts and feelings that are stuck, is one of the approaches that has received the strongest recommendation in <a href="https://istss.org/clinical-resources/treating-trauma/new-istss-prevention-and-treatment-guidelines">international treatment guidelines</a>. It was also recently featured on <a href="https://www.thisamericanlife.org/682/ten-sessions">NPR’s <em>This American Life</em></a>. </p>
<p>We test these highly effective trauma-focused treatments alongside the catalyst of MDMA, to see if it offers an additive or potentiating effect. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ketamine-the-illicit-party-psychedelic-that-promises-to-heal-depression-115697">Ketamine: The illicit party psychedelic that promises to heal depression</a>
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</em>
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<p>Sessions with MDMA are daylong, occurring two or three times over the course of several weeks or months, depending on the study. Research participants are accompanied by two therapists. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If MDMA-assisted psychotherapy becomes legal, it may be life-saving for people living with PTSD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The therapeutic work done before the MDMA sessions prepares clients for the experience. The work afterwards integrates the experience, using the template of the MDMA session to scaffold new learnings and new ways of potentially understanding their traumatic experiences.</p>
<h2>A life-saving legal medicine?</h2>
<p>The large randomized controlled trial sponsored by MAPS is designed to collect enough evidence on the safety and efficacy of MDMA in treatment to make it a legal medicine.</p>
<p>As evidence accumulates for MDMA’s effectiveness, there is the possibility that MDMA will become legal — a medicine to be used in psychotherapy and prescribed for PTSD. </p>
<p>The ability to use it in practice will be potentially life-altering and life-saving for people living with PTSD.</p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/127609/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Wagner received funding from the Multidisciplinary Association for Psychedelic Studies. </span></em></p>MDMA is better known as the party psychedelic Ecstasy or Molly. Used clinically, together with psychotherapy, it reduces symptoms of post-traumatic stress disorder, and shows promise with couples.Anne Wagner, Adjunct Professor, Psychology, Faculty of Arts, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1279192019-11-29T03:55:15Z2019-11-29T03:55:15ZParents of teens, here’s what you really need to know about MDMA<figure><img src="https://images.theconversation.com/files/304200/original/file-20191128-176629-1msht1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just around 3% of teens have used MDMA (ecstasy) in the past year.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-cheering-crowd-sitting-upon-shoulders-63911971?src=ed7875ef-bfd7-4bb9-9c82-906ad7006c79-1-31">Franz Pfluegl/Shutterstock</a></span></figcaption></figure><p>We all want to reduce drug-related harm and ensure young people don’t take unnecessary risks. But <a href="http://www.emcdda.europa.eu/attachements.cfm/att_93977_EN_Health%20Development%20Agency%20Review%20of%20Reviews.pdf">decades of research</a> shows fear isn’t an effective way to do this. </p>
<p>This week, Newscorp Australia released <a href="https://www.dailytelegraph.com.au/search-results?q=ripple+effect">The Ripple Effect</a>, a series of articles and <a href="https://www.dailytelegraph.com.au/news/rippleeffect/drugs/the-ripple-effect-education-video-part-one-molly-and-the-toxic-relationship-that-can-turn-deadly/news-story/ead6e1f87dc712deea960f841529a653">accompanying videos</a> about party drugs, aimed at parents of young people.</p>
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<strong>
Read more:
<a href="https://theconversation.com/is-your-teen-off-to-schoolies-heres-what-to-say-instead-of-freaking-out-126203">Is your teen off to schoolies? Here's what to say instead of freaking out</a>
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<p>Rather than drawing on the science about reducing harm, the series overstates the nation’s drug problem and the likelihood of problems from taking MDMA (ecstasy). And it’s likely to scare the wits out of parents of teens.</p>
<p>So, what do parents really need to know about party drugs?</p>
<h2>Most young people don’t use drugs</h2>
<p>Illicit drug use among teens is low and has <a href="https://www.aihw.gov.au/getmedia/15db8c15-7062-4cde-bfa4-3c2079f30af3/21028a.pdf.aspx?inline=true">been in decline</a> for nearly a decade.</p>
<p>Although Australians overall have a relatively high rate of MDMA use compared to similar countries, only a small proportion of teenagers (around 3%) and young adults (7%) have <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">used MDMA</a> in the last year. Among high school students, the overwhelming majority (94%) have <a href="https://www.health.gov.au/resources/collections/australian-secondary-school-students-alcohol-and-drug-assad-survey-2017">never tried</a> MDMA.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">Three Charts on who uses illicit drugs in Australia</a>
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<p>Normalising the idea that drug use isn’t that common is a key <a href="https://www.unodc.org/documents/prevention/UNODC_2013_2015_international_standards_on_drug_use_prevention_E.pdf">prevention strategy</a> in drug education. If young people think “everyone” is using drugs, they are more likely to want to do it too.</p>
<h2>Scare tactics don’t work</h2>
<p>As the <a href="https://www.dailytelegraph.com.au/news/rippleeffect/drugs/nsw-health-ditches-mdma-fear-campaign-in-favour-of-stayok/news-story/fbfa1cfe6b42e33776e9fc5ef2cd2bd9">Ripple Effect</a> notes, NSW Health decided to drop a “shock campaign” on MDMA. The <a href="https://bmjopen.bmj.com/content/5/9/e007449">evidence</a> shows scare tactics don’t help reduce young people’s drug use.</p>
<p>Fatal overdoses are relatively rare. Most people who use party drugs have no adverse consequences. So when young people see messages suggesting all drug use is dangerous, they know it’s not true and may switch off, ignoring effective harm reduction messages. </p>
<p>Describing drugs as “deadly” or “dangerous” can actually make them more <a href="https://www.tandfonline.com/doi/abs/10.1080/09581590601045220">appealing</a>, encouraging some people to seek out more of the potent product.</p>
<p>A far more effective approach is to <a href="https://www.unodc.org/documents/prevention/UNODC_2013_2015_international_standards_on_drug_use_prevention_E.pdf">normalise not using alcohol or other drugs</a>.</p>
<p>Two examples of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22455104">effective</a> approaches were the <a href="https://abovetheinfluence.com">Above The Influence</a> and <a href="http://myowninfluence.org">Be Under Your Own Influence</a> media campaigns by the US <a href="https://www.whitehouse.gov/ondcp/">Office of National Drug Control Policy</a>. These campaigns promoted not using drugs as a way to support the goals of autonomy and achievement.</p>
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<h2>Prohibition doesn’t work either</h2>
<p>The idea we can eliminate drugs from society by telling young people to “<a href="https://en.wikipedia.org/wiki/Just_Say_No">just say no</a>” is, at best, misguided. Campaigns with a prohibition approach are <a href="https://www.scientificamerican.com/article/why-just-say-no-doesnt-work/">not effective</a>.</p>
<p>These interventions fail for <a href="https://www.indiana.edu/%7Eengs/articles/drughysteria.html">many reasons</a>. They don’t teach teens the interpersonal skills needed to refuse drugs; they don’t address internal motivation to experiment or take risks; and they don’t take into account the “forbidden fruit” effect in which restricted or banned activities become more desirable. </p>
<p>Young people who use drugs say the threat of police and drug dogs <a href="https://www.ncbi.nlm.nih.gov/pubmed/30176423">does not deter</a> them from taking drugs. The NSW Coroner recently noted that some police practices at festivals, such as strip searches and sniffer dogs, can result in young people making more <a href="https://theconversation.com/when-the-coroner-looked-at-how-to-cut-drug-deaths-at-music-festivals-the-evidence-won-but-what-happens-next-126669">dangerous decisions</a> about drug use, such as taking multiple doses at once. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-the-coroner-looked-at-how-to-cut-drug-deaths-at-music-festivals-the-evidence-won-but-what-happens-next-126669">When the coroner looked at how to cut drug deaths at music festivals, the evidence won. But what happens next?</a>
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<h2>Harm reduction is effective</h2>
<p>The reality is that a small percentage of people will experiment with drugs and some will continue to use them. Harm reduction accepts that reality and seeks to keep those who choose to use drugs as safe as possible. Most people who <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">use drugs</a> do so only occasionally and for a short time in their lives.</p>
<p>While all drug use <a href="https://theconversation.com/how-does-mdma-kill-109506">carries risks</a>, most drug-related problems, including fatal overdoses, are preventable. This is because drug-related harms are heavily dependent on a range of factors such as temperature, knowledge of what you are taking, and how you take a drug.</p>
<p>How events such as music festivals are <a href="http://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">regulated</a> impacts the kinds of harms that arise. Freely available water, medical staff who understand drug use, peer support and education can greatly reduce risks.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">Testing festival goers' pills isn't the only way to reduce overdoses. Here's what else works</a>
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<p>We recently conducted a review of drug-checking facilities internationally and found compelling evidence these services can <a href="https://www.360edge.com.au/assets/uploads/2019/11/360Edge-What-works-Testing-drugs-for-harm-reduction-November-2019.pdf">reduce risky behaviour and reduce the chance of finding adulterants in illicit drugs</a>. Many MDMA related deaths can be traced to people not knowing the contents or dosage of the pill they have taken.</p>
<p>Data from a dance festival pill testing initiative in Portugal found <a href="https://www.ncbi.nlm.nih.gov/pubmed/28635119">74% of participants</a> would not use the tested drug after receiving unanticipated results; they said they were concerned about the “unknown” nature of the adulterants or potential harms of known adulterants.</p>
<p>In countries where pill testing is well-established, tested samples <a href="https://www.ncbi.nlm.nih.gov/pubmed/28582668">more closely match what people think they are buying</a>, compared to countries not using these services.</p>
<h2>Talk early, openly and often to young people about drugs</h2>
<p>Remember, few young people use recreational drugs. And if they do, their drug use is most likely to be occasional. More than half the people who use MDMA use only <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">once or twice a year</a>.</p>
<p>Preventing drug use and reducing harms can start at an early age, even before school. Early and age-appropriate education about medicines, tobacco, alcohol and illicit drugs means a young person already has well-formed attitudes before the influence of their peers kicks in.</p>
<p>Children are strongly influenced by their <a href="https://theconversation.com/how-does-ice-use-affect-families-and-what-can-they-do-41186">parents’ attitudes</a> when it comes to alcohol and other drug use. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393944/">For example</a>, exposure to parents’ drinking or drug use can increase risk of teens drinking and using drugs; an inattentive approach to monitoring children’s activities is associated with teen alcohol and other drug use; and openness to discussing drugs is associated with lower rates of substance use. </p>
<p>Young people with parents who keep an open and honest dialogue about drugs are more likely to discuss difficult issues with them.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
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<img src="https://counter.theconversation.com/content/127919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jarryd Bartle works as a paid consultant in the alcohol and other drug sector. </span></em></p><p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector, including education and training for parents on drugs. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Paula Ross works as a paid consultant in the alcohol and other drug sector and has a private practice.</span></em></p>Few teens use MDMA and scare tactics, like those we’ve seen recently, are unlikely to reduce existing drug use further.Jarryd Bartle, Sessional Lecturer, RMIT UniversityNicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityPaula Ross, Sessional psychology lecturer, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1266692019-11-08T09:10:13Z2019-11-08T09:10:13ZWhen the coroner looked at how to cut drug deaths at music festivals, the evidence won. But what happens next?<figure><img src="https://images.theconversation.com/files/300794/original/file-20191107-10930-k7z0iz.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If NSW takes on the coroner's recommendations, it will be among the most innovative and evidence-based states in Australia on drug policy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/crowd-concert-retro-style-photo-278935319">from www.shutterstock.com</a></span></figcaption></figure><p>The much-awaited <a href="http://www.coroners.justice.nsw.gov.au/Documents/Redacted%20findings%20in%20the%20joint%20inquest%20into%20deaths%20arising%20at%20music%20festivals%20including%20annexures%20-%208%20November%202019.pdf">NSW coroner’s report into music festival deaths</a> was released today.</p>
<p>In the report, Deputy State Coroner Harriet Grahame recommends pill testing, a ban on sniffer dogs and a reduction in the number of strip searches, among other measures to prevent deaths.</p>
<p>These evidence-based strategies for harm reduction are to be applauded. But it remains to be seen if the NSW government will change its stance on drug use and harm reduction to implement the coroner’s recommendations.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-mdma-kill-109506">How does MDMA kill?</a>
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</p>
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<p>The inquest examined the deaths of six young people who died during or just after attending music festivals in NSW between December 2017 and January 2019.</p>
<p>All died as a result of taking MDMA or ecstasy. Five of the six also had other drugs in their system.</p>
<p>In the report, Grahame said:</p>
<blockquote>
<p>It can be hard for the community to grapple with some of the underlying issues when drug use is illegal and drug users are stigmatised. It is difficult to properly explain the potential risks to young people if our only permissible message is “just say no”. While we continue to hide the true extent of drug use, it remains inherently more dangerous.</p>
</blockquote>
<p>However, Grahame noted the NSW government had already put in place, since these deaths, a range of measures including more formalised emergency medical responses at festivals and clinical guidelines on how to manage drug incidents before the person reaches hospital.</p>
<p>She also noted festival organisers had implemented strategies that improved safety since these deaths.</p>
<h2>What did the coroner recommend?</h2>
<p><strong>Drug checking</strong></p>
<p>The coroner recommended the government introduce <a href="https://www.theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">drug checking</a>, which includes a range of approaches designed to test the content of illicit drugs and alert people to dangerous substances. She said the evidence for it was “compelling”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">Testing festival goers' pills isn't the only way to reduce overdoses. Here's what else works</a>
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<p>These approaches include mobile facilities at festivals to test drugs brought by festival goers with direct feedback to them, sometimes referred to as “pill testing”. </p>
<p>Grahame recommended a mobile unit at festivals and other events to test drugs acquired by police. </p>
<p>She also recommended a fixed site facility. This is a permanent site, outside the festival, where people could bring drugs to be tested and receive harm-reduction advice.</p>
<p>These recommendations are a significant step forward and would place NSW in line with international best practice.</p>
<p><strong>No more sniffer dogs and fewer strip searches</strong></p>
<p>Grahame recommended stopping the use of drug sniffer dogs at festivals because of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/30176423">harm it causes</a>.</p>
<p>This includes festival goers taking drugs before the festival (pre-loading), taking double the dose, or panicking and taking drugs quickly to avoid detection.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-time-to-change-our-drug-dog-policies-to-catch-dealers-not-low-level-users-at-public-events-111710">It's time to change our drug dog policies to catch dealers, not low-level users at public events</a>
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<p>She also recommended strip searches should be used only in extreme circumstance.</p>
<p>She said:</p>
<blockquote>
<p>Risky ingestion and secretion, trauma especially when coupled with strip search and the destruction of trust between young people and police are all serious concerns.</p>
</blockquote>
<p>She said the NSW police commissioner should issue operational guidelines to direct how police should exercise their discretion with illicit drug use and possession at festivals. She encouraged police to engage more positively and not to take punitive approaches with festival goers.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/unlawful-strip-searches-are-on-the-rise-in-nsw-and-police-arent-being-held-accountable-121986">Unlawful strip searches are on the rise in NSW and police aren’t being held accountable</a>
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<p>Other recommendations included:</p>
<ul>
<li><p>the NSW government facilitate a meeting with a range of stakeholders, including the health department, festival health services, festival promoters and other experts, to ensure mandatory minimum standards for policing, medical services and harm reduction at music festivals</p></li>
<li><p>the redefining of drug use as a health rather than law-enforcement issue</p></li>
<li><p>a drug summit to develop evidence-based drug policy. She recommended the summit include consideration of guidelines for drug-checking services, drug education, decriminalisation of personal use drugs and regulation of some currently illicit drugs.</p></li>
</ul>
<p>These recommendations are key because it’s important stakeholders work together with the best interest of young people at heart. Our best approach, as the coroner has indicated, is to keep young people as safe as possible in the short period in which they experiment with illicit drugs.</p>
<p>She also recommended improved drug education for young people and their parents.</p>
<h2>What happens next?</h2>
<p>Policy on alcohol and other drugs is largely the responsibility of the states and territories. So, it will be up to the NSW government to implement most of these recommendations.</p>
<p>However, the government has already <a href="https://www.smh.com.au/politics/nsw/berejiklian-remains-opposed-to-pill-testing-despite-coroner-s-findings-20191015-p530y9.html">shown strong opposition</a> to what we know works to reduce harms (like drug checking) and escalated what we know increases harms (like drug dogs and strip searches). We need to wait and see whether it can find a way to re-adjust its position on drug use and harm reduction and follow the coroner’s recommendations.</p>
<p>If this happens, NSW will be among the most innovative and evidence-based states in Australia on drug policy, and among leaders globally.</p><img src="https://counter.theconversation.com/content/126669/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research.
</span></em></p>Pill testing, no more sniffer dogs and fewer strip searches are some of the ways the NSW coroner says will reduce drug deaths at music festivals.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1221282019-10-23T04:59:37Z2019-10-23T04:59:37Z‘My friends are taking MDMA at raves and music festivals. Is it safe?’<figure><img src="https://images.theconversation.com/files/288664/original/file-20190820-123736-amjiz1.png?ixlib=rb-1.1.0&rect=77%2C59%2C3892%2C1916&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No drug is 100% safe. </span> <span class="attribution"><span class="source">Wes Mountain</span></span></figcaption></figure><blockquote>
<p>My friends are taking ecstasy at raves and music festivals. Is it safe? — Anonymous</p>
</blockquote>
<h2>Key points</h2>
<ul>
<li>no drug use, including ecstasy, is 100% safe</li>
<li>festivals can present unique risks </li>
<li>look out for friends, know the risks and where to get help.</li>
</ul>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<h2>What is ecstasy or MDMA?</h2>
<p>Ecstasy is a slang term for drugs <em>meant</em> to contain 3,4- methylenedioxymethamphetamine (MDMA), a stimulant that can also cause mild hallucinations at high doses. While ecstasy was traditionally sold as tablets, it’s <a href="https://ndarc.med.unsw.edu.au/sites/default/files/National%20EDRS%20Interview%20Report%202018_1.pdf">increasingly sold in crystal, capsule and powder forms</a>. </p>
<p>According to the <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/data">most recent data</a>, only 1% of Australians aged 12-17 said they had tried ecstasy. However, studies suggest young Australians who attend music festivals are <a href="https://www.ncbi.nlm.nih.gov/pubmed/29304871">much more likely</a> to have tried it.</p>
<hr>
<p><iframe id="rsqsA" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/rsqsA/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<h2>So, is it ‘safe’?</h2>
<p>There seems to be a common perception ecstasy is “safe”. But no drug use — legal or illegal — is completely safe. While drug experts <a href="https://www.ncbi.nlm.nih.gov/pubmed/31081439">rank</a> ecstasy as less harmful than other drugs, such as “ice” and alcohol, there are still significant risks involved:</p>
<ol>
<li><p>given ecstasy is illegal, the market is unregulated. As a result, drugs sold as “ecstasy” <a href="https://www.harmreductionaustralia.org.au/wp-content/uploads/2018/06/Pill-Testing-Pilot-ACT-June-2018-Final-Report.pdf">commonly do not contain MDMA</a> and may contain something far more dangerous. This means the effects can be unpredictable</p></li>
<li><p>even if your drugs contain MDMA, the dose or potency can <a href="https://www.acic.gov.au/sites/default/files/illicit_drug_data_report_2017-18.pdf?v=1564727746">vary hugely</a>. Recently, <a href="https://www.smh.com.au/national/nsw/tragic-reveller-told-friend-he-would-push-through-inquest-hears-20190716-p527lm.html">very high purity ecstasy</a> has been detected in Australia. This can significantly increase the risk of overdosing or having serious side-effects </p></li>
<li><p>even pure MDMA at normal recreational doses can be risky in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24899699">wrong conditions</a> (for instance, when it’s very warm)</p></li>
<li><p>common short-term effects also include <a href="https://www.ncbi.nlm.nih.gov/pubmed/16771886">increased heart rate and body temperature, teeth grinding and anxiety</a>. While evidence on the long-term effects of taking MDMA is still emerging, there may be lasting impacts on <a href="https://www.ncbi.nlm.nih.gov/pubmed/23881877">memory, mood, cognition and sleep</a>.</p></li>
</ol>
<h2>What are the risks when taking it at festivals?</h2>
<p>In recent years, there have been more reports of <a href="https://www.smh.com.au/national/nsw/music-festival-deaths-inquest-set-down-for-july-20190228-p510sz.html">drug-related deaths at festivals</a>. While the media typically describes deaths involving ecstasy as “overdoses”, most ecstasy-related deaths are <a href="https://www.tandfonline.com/doi/abs/10.1080/14659891.2018.1436607?journalCode=ijsu20">not</a> the result of simply taking too much. </p>
<p>Drug experiences can be influenced by <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front12-fa-toc%7Edrugtreat-pubs-front12-fa-secb%7Edrugtreat-pubs-front12-fa-secb-2%7Edrugtreat-pubs-front12-fa-secb-2-5">lots of different things</a> and music festivals can sometimes result in a “perfect storm” of risk factors. For example, an experienced male taking an ecstasy pill at a quiet gathering at home is likely to have a very different experience to an inexperienced female taking her ecstasy pills at a crowded festival on a 35°C day. </p>
<p>Females, those with lower body weight, and/or those who haven’t used ecstasy before, and therefore haven’t built up any physical tolerance, should use a smaller dose.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=559&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=559&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=559&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=702&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=702&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=702&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drug experiences can be affected by lots of different things.</span>
</figcaption>
</figure>
<p>Some key risks at music festivals include:</p>
<ul>
<li><p><strong>hyperthermia aka heatstroke:</strong> MDMA <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/">affects the body’s ability to regulate temperature</a> (it can increase body temperature and also make it harder to cool down). Environmental factors at festivals such as warm weather, crowds and dancing can significantly increase the risk of overheating (see <a href="https://dancesafe.org/heatstroke/">tips</a> for staying cool)</p></li>
<li><p><strong>hyponatremia aka water intoxication:</strong> MDMA can <a href="https://www.ncbi.nlm.nih.gov/pubmed/23476039">disrupt the body’s water/electrolyte balance</a> (can make your body <a href="https://cjasn.asnjournals.org/content/3/6/1852">retain water</a>). While you need water to avoid dehydrating, drinking too much can also be dangerous. Read up on these <a href="https://drugaware.com.au/getting-the-facts/staying-safe/#Dehydration-and-overhydration">guidelines</a> on dehydration and overhydration for more information</p></li>
<li><p><strong>dodgy on-site sellers:</strong> <a href="https://www.ncbi.nlm.nih.gov/pubmed/30541674">UK research</a> found people buying drugs on-site (inside the festival grounds) were more than twice as likely to buy drugs that did not contain what they thought. There have been cases where festival goers thought they were buying MDMA but actually bought N-ethylpentylone (a riskier stimulant linked to psychosis and <a href="https://www.dea.gov/press-releases/2018/08/31/dea-acts-against-dangerous-deadly-designer-synthetic-drug-linked-151">deaths</a>)</p></li>
<li><p><strong>policing or legal problems:</strong> festivals often have a heavy police presence with sniffer dogs and being caught with drugs can lead to possession or supply charges. However, it’s very important not to panic and swallow your drugs if you see sniffer dogs. This has been linked to at least three <a href="https://www.pedestrian.tv/news/defqon-1-drugs-death-reignites-sniffer-dogs-debate/">festival deaths</a> in Australia.</p></li>
</ul>
<h2>Worried about your friends?</h2>
<p>If you’re going to a rave or festival and suspect some of your friends might take illicit drugs, it’s important to be aware of the risks, look out for your friends and know where to get help. Here are some tips:</p>
<ol>
<li><p><strong>make emergency plans with friends:</strong> download the festival map, have a meeting point, make sure mobiles are charged, stick together and know where on-site support services are </p></li>
<li><p><strong>look out for <a href="https://drugaware.com.au/getting-the-facts/staying-safe/#Signs-someone-needs-immediate-help">red flag symptoms</a></strong> (for instance, feeling hot, unwell, confused or agitated) and never be scared to seek help from on-site medical or support services. They’re there to help you, not judge or arrest you</p></li>
<li><p><strong>be informed:</strong> <a href="https://drugaware.com.au/getting-the-facts/staying-safe/">Drugaware</a>, <a href="https://www.dancewizensw.org.au/patron/#block-yui_3_17_2_1_1524198824688_25530">Dancewize</a> and <a href="http://www.boomtick.com.au/listen-out-perth-save-a-mate-training/">Boomtick</a> all have great information about drugs and how to keep safe.</p></li>
</ol><img src="https://counter.theconversation.com/content/122128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jodie's doctoral research was funded by a scholarship from the Australian Government Department of Health. The National
Drug Research Institute at Curtin University is supported by funding from the Australian Government under the Drug and Alcohol Program.</span></em></p>A person’s drug experience can be influenced by many different things, such as heat, access to water and dosage.Jodie Grigg, Research Associate at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.