“Let us beware of the temptation to elevate practices still under study into a ‘therapeutic revolution'”

2023-07-30 11:00:11

Le 1is July, the Therapeutic Goods Administration, Australia’s drug regulator, legalized the medical use of two psychedelic substances, psilocybin (the active ingredient in magic mushrooms) and MDMA (contained in ecstasy), to treat resistant depression and post-traumatic stress disorder.

This unexpected decision raised lively debates in the scientific and medical community, opposing the heralds of psychedelic democratization and the protests of those who find these therapies too immature to be integrated into current care.

Indeed, there has been a movement for the rehabilitation of psychedelic medicine for fifteen years. After decades of prohibition, the therapeutic potential of these molecules is once again studied in research protocols around the world, resulting in publications in major medical journals.

Caution for use in clinical practice

This new wave of research tends to show that psychotherapy assisted by psychedelics is effective and well tolerated in the treatment of several psychiatric disorders. In addition, the action of these treatments seems to be faster than that of conventional treatments, with an effect that could be lasting from the first administration.

However, despite the rich prospects offered by psychedelics, caution remains in order for their use in clinical practice. Indeed, the majority of data in humans is limited to small cohorts of individuals, with longitudinal follow-ups of a few months. Only MDMA has been the subject of a published phase 3 study, while that on psilocybin has not yet started. The very promising results obtained are still preliminary and must be confirmed by larger studies.

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In addition, psychedelics quickly lead after their administration to an intense subjective experience for a few hours, including perceptual distortions, emotional and cognitive changes or even a mystical feeling. This state, specific to each, is the desired effect during their recreational use. It is often a memorable experience that users find enjoyable.

Importance of prior preparation and support

Nevertheless, it is also likely to destabilize some people or to be associated with an anxious experience. In addition, although hindsight on recreational use pleads in favor of good tolerance, rare but serious cases of endangerment during consumption have been reported, depending in particular on unsafe contextual elements.

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