One single psychiatrist has been approved today to prescribe psilocybin or “magic mushrooms” for treatment-resistant depression.
That psychiatrist is professor Cameron Lacey, who welcomed the approval as an opportunity to provide treatment that can change people’s lives.
“People who have experienced psilocybin often talk about it being one of the most meaningful experiences of their lives,” he told the Herald.
It does come with a catch – it is not publicly funded and similar treatments overseas can cost tens of thousands of dollars.
The announcement came today from Deputy Prime Minister David Seymour, in his role as Associate Health Minister, after approval by MedSafe.
The decision allows New Zealand to play catch-up with Australia, which made the move two years ago.
Lacey operates out of the Elimbias Health clinic in Christchurch and is also clinical director of research for Te Whatu Ora Canterbury.
The official approval to prescribe psilocybin followed his work carrying out New Zealand’s first study into psilocybin-assisted therapy for depression.
“It is very exciting for patients to get access to this outside a research setting,” he told the Herald.
He said it was intended for those who were shown to be resistant to other forms of treatment and showed positive results in two-thirds of cases, significantly higher than other methods.
“These are typically people who have endured significant depressive symptoms over a long period of time and have struggled to return to work or form serious relationships.”
Lacey said psilocybin in a clinical setting was a strictly controlled and carefully managed process using a form of the drug produced along pharmaceutical guidelines.
Along with psilocybin, most commonly known as present in the criminalised Class A “magic” mushrooms, other compounds more commonly associated with recreational use had therapeutic qualities.
Australia approved the club empathogenic drug MDMA for use in treating PTSD in 2023. Australia’s largest insurer, Medibank, today announced it would fund treatment using the drug in a Perth-based clinic.
Similarly, the anaesthetic ketamine, also a popular clubbing drug, has been found to show promise as an antidepressant.
Lacey said the drugs had “polarised” communities in the past and, in the case of psilocybin, its reputation had been swept along in the United States’ 1970s War on Drugs.
“What we’ve seen is a renaissance of interest in previously explored compounds that hold some promise for difficult-to-treat conditions.”
He said the exploration of those compounds came at a time when more commonly-used pharmaceuticals were showing fewer breakthroughs.
“Psilocybin when used in clinical settings and research settings is a very safe compound.”
The treatment programme devised by Lacey was intensive and restricted for those who were resistant to other treatments. Those interested needed to be referred by a GP and would undergo an assessment as to their eligibility.
The prospective patient would then meet with a therapist, who would work over four to six sessions to gain an understanding of the nature of their depression.
He said those sessions would also seek to set intentions as to what might be able to be explored when under the influence of psilocybin.
The “dosing session” would then take eight hours and would be supervised throughout by Lacey and another therapist.
Insights gained during that experience – described variously as magical, mystical and spiritual – would then be worked through over another handful of therapy sessions.
Lacey said it was an “intensive treatment over a couple of months” but was far less onerous than other pathways for the treatment-resistant, which could include electro-convulsive therapy or residential private hospital care.
“It’s nice to be able to offer a real message of hope for some people. It can make a significant difference to people’s lives.”
Lacey said the “real challenge” was funding as it was currently only available privately. While a price had yet to be settled on, he said comparative treatment in the US came in around US$10,000 ($16,500) while in Australia it was about US$30,000.
“We hope to be able to offer significantly less here.”
Seymour said he supported the independent decision-making of MedSafe in making the treatment available.
“Untreated depression is a very serious condition that can really decimate people’s lives. There’s a lot of research that has gone into it,” he said.
“I don’t see why we should hold back from making treatments available that will improve people’s lives because some people have a bit of reefer madness about ‘magic’ mushrooms. We should be driven by science, not misplaced sentimentality.”
University of Auckland professor Suresh Muthukumaraswamy and the School of Pharmacy said it was a mystery as to why psilocybin had such a positive impact when used in a clinical setting.
He said the drug “tends to promote neuroplasticity” in which the brain forms new neural connections and pathways. Alternately, he said it could be the “personal insights” experienced by people “during the tripping process”.
“There are risks and that’s why the screening process is really important. When done properly, the risks can be minimised.”
Muthukumaraswamy said society’s double-take reaction over the use of drugs perceived as recreational and illegal being used in pharmaceutical ways showed “we as a society are immature about our approach to drugs”.
As a pharmacist, he said: “I just think of these things as drugs.”
He said there was an “incongruity” in a physician now being able to prescribe what was a Class A drug under the Crimes Act. “Clearly, we have some classification issues.”
Muthukumaraswamy also offered a caution for those buoyed by the news and aware that it was magic mushroom season. “People shouldn’t think they can self-medicate – that’s a really bad idea.”
Along with approving psilocybin, MedSafe has reduced hurdles for people to access melatonin.
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They allege the Crown ignored Treaty obligations by not engaging with them.