When Medsafe announced last month it had granted approval to an application to prescribe psilocybin – the active compound in “magic” mushrooms – the public response was notable for its lack of consternation. Psilocybin is, after all, a class A controlled drug, meaning, according to the Misuse of Drugs Act 1975, it poses “a very high risk of harm”.
Yet some of the reaction assumed the approval went further than it did. You are not about to be able to pop down to a dispensary and pick up some ’shrooms for the weekend. The approval – the first outside a research environment – was granted to one practising psychiatrist to administer psilocybin in the context of intensive psychotherapy for patients with treatment-resistant depression. These are people for whom conventional therapies have failed.
The psychiatrist, Professor Cameron Lacey, has a strong record in health research and three years ago conducted a trial of psilocybin-assisted therapy for depression under the wing of the University of Otago. Positive results in the trial, and Lacey’s diligence in working through the requirements in the act and its associated regulations for controlled drugs to be prescribed, have won him the approval.
He will not be the last. Medsafe’s announcement clearly anticipated further applications in its wake: “There is work under way to make it easier for more healthcare practitioners to take on this work. Medsafe is currently developing guidance to assist with the application process.”
The agency has typically been cautious in regulating psychedelic drug research in recent years, and it appears that the encouragement of Associate Health Minister David Seymour has been a significant factor in its new openness to psychedelics.
Since the June 19 announcement, at least five new applications have been registered and Medsafe has sought advice on establishing a clinical framework. It would not be a surprise to see a dozen or so authorised prescribers within the next year or so – or even for therapeutic use by authorised psychiatrists of the popular party drug MDMA to be approved , following Australia’s lead.
Researchers think the evidence already adequately supports the use of psilocybin for treatment-resistant depression and end-of-life anxiety and MDMA for post-traumatic stress disorder. These therapies will not be cheap to access – the drugs don’t cost much, but therapists’ time does.
In contrast to Australia, this would not require legislative change. The provisions for authorised prescribers to import and administer controlled drugs are already there in our law. But the last (and first) time they were used, when then-associate health minister Peter Dunne granted permission for cannabidiol to be given to Alex Renton 10 years ago, was effectively the start of the road to the Medicinal Cannabis Scheme. One-off approvals for psychedelics could be replaced by a regulatory system in the next five years, as it was for cannabis.
The medicinal cannabis experience contains lessons. We now essentially have two tiers of the law: an enabling one for people who buy their weed from a clinic, and a punitive one for everyone else.
In 2023, an Otago study placed psychedelics (it used the term “hallucinogens”) near the bottom of the harm scale, between kava and vaping, below cannabis, and far below alcohol. All of those are legal drugs. Yet unauthorised possession of class A magic mushrooms, which grow wild, continues to attract a maximum penalty of six months’ imprisonment – and life imprisonment for growing them or giving them to someone else. The fact we would not expect such sentences to be dished out is its own argument that we should not classify drugs as uniquely harmful unless we actually think they are. That, really, is the conversation ahead of us.
