Psychedelic medicine is on its way. But it's not 'doing shrooms with your shrink'. Here's what you need to know

Many people in Australia, including psychiatrists, were surprised when earlier this year the medicines regulator down-scheduled MDMA, known colloquially as ecstasy, and psilocybin, from magic mushrooms.

This means that under certain circumstances from July 1, authorised psychiatrists 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).

It all sounds very certain but it’s not really.

Read more: Explainer: what is post-traumatic stress disorder?

Beware the hype

The Therapeutic Goods Administration decision has left a lot of questions unanswered about how the new scheme will be implemented and operated, both effectively and safely.

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.

So the world is watching closely how “psychedelic-assisted therapy”, as it’s officially called, is rolled out in Australia.

It’s a hot topic, with much public interest. But for researchers, there are concerns the hype is getting way ahead of the research.

Read more: The TGA has approved certain psychedelic treatments: the response from experts is mixed

The first steps

The Royal Australian and New Zealand College of Psychiatrists this week released guidance to their members about how this would work in practice.

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.

The guidelines also stress the importance of patient safety and appropriate training for prescribers, and advocates for continued research.

What does this mean for patients?

This has several implications for potential patients:

• 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

• 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

• 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.

Read more: Psychedelics: how they act on the brain to relieve depression

Expectations are high, but clear evidence is lacking

Despite a growing body of evidence, psychedelic-assisted therapies are in their infancy.

In a time when demand for mental health services far outstrips supply, 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.

Australian research is just getting under way and so far most psychedelic research has been done overseas. Yes, early findings have been quite promising, but numbers are small, long-term follow-ups sparse, and potential risks and dangers still need to be explored.

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.