Three Challenges for Psychedelics in Australia in 2024

1 Feb

2024 promises to be a big year for psychedelics everywhere, but nowhere more than in Australia. Cost, legality, and education are the three key are that are pivotal to how psychedelics will fit into our legal and social landscape in the near future. As legal psychedelic assisted therapy (PAT) ramps up, more education providers open their doors, and communities grapple with prohibition and access, I look at the challenges faced by psychedelics in Australia for 2024 and make some predictions on what we’ll see in the year ahead.

Just so we’re clear, none of this constitutes medical, legal, or financial advice, nor am I encouraging anyone to do anything illegal.

Cost

As of July 2023, psychedelic assisted therapy has been legal, albeit under limited conditions, in Australia. The only available pricing we have for PAT in Australia right now is from Monarch Mental Health Group. According to a recent mail-out, they will charge $25,000 for a 12-week course of MDMA or psilocybin assisted therapy that includes three sessions of preparation, up to three dosing experiences (supervised by two sitters) and three integration sessions per dose[i].

Yes, the cost comes down to a bit over $13,000 if all government rebates for the psychiatrist reviews are included. But it’s worth noting that this is still an enormous amount of money for many Australians to find. For example, at the end of 2020, Westpac bank reported that while the average savings per customer were $22,020, the median amount in savings was $3,559[ii]. So, 50% of their customers had less than $3,559 in savings. And this was before the breakout of inflation and interest rate rises designed to curtail it. I don’t have current figures on median savings, but household income to saving ratios have declined markedly since 2020 and are now at their lowest level since December 2007[iii].

Line graph of Australian seasonally-adjusted household income to savings ratio

While many people suffering from depression or PTSD manage their work lives well enough to earn a good living, that these conditions can disrupt ability to work and therefore impact income is well-established.

So, no, not many Aussies have the available cash for a course of psilocybin or MDMA therapy, least of all those who need it most.

How to lower these costs is a conundrum. The main costs are not the doses of psilocybin or MDMA themselves, though paying thousands for the equivalent of a handful of shrooms that cost nothing to forage or very little to grow shouldn’t be overlooked. Rather, much of the cost is associated with the cost of staff, not least psychiatrists, who generally charge upwards of $500/hour, or clinical psychologists at close to $300/hour. Throw in the cost of facilities, administration, storage of restricted medicines, and it all adds up to a lot, very quickly.

Will the cost come down? It’s common to for people to say that as more psychiatrists offer these services, the cost to patients/clients will decrease. But, despite there being around 4,000 psychiatrists and over 10,000 clinical psychologists practicing in Australia, the amount they charge is consistent. I am going out on a limb here, but most of these professionals are not going to charge less for their part in providing PAT.

Possible avenues to lower costs to patients could include the acceptance of group dosing and/or therapy sessions. But these aren’t accepted treatment modalities yet, so this would be years away. It’s not clear how exactly much this would save while overall responsibility for each patient’s program of treatment rests with a psychiatrist.

Another way costs to clients could come down is for greater government subsidization. But, as the example from Monarch shows, people eligible for maximum Medicare support would already have the government covering almost half the cost. I would anticipate that this alone will attract some regulatory scrutiny. I am genuinely unsure of how much more of $25,000 the federal government would be willing to cover in a privately-owned setting. (The one exception I can see to this might be the Department of Veterans' Affairs, but that remains to be seen.)

If the setting were government owned and the staff largely state health employees, that would be different. But that is so far away it’s not funny. PAT, in a public hospital or clinic? By the end of the decade, maybe. And even then, unless the way we fund mental health services in Australia radically changes, the waiting lists will be long, and eligibility will be limited to the most urgent cases.

Of course, I’ve failed to mention a whole other avenue for the cost of accessing psychedelics to come down, which is to not place their legal use solely at the discretion of psychiatrists jumping through TGA and HREC hoops. Make no mistake, there are people who need this intensive approach to PAT. But there are also people who would benefit who probably don’t require the supervision of a multidisciplinary team of psychiatrists and clinical psychologists. And there are people who just want to trip when they’re out camping with their friends or at a music festival, who, with a little thought and preparation, can probably do so without harming themselves or anyone else. Allowing these latter two categories to be legal wouldn’t directly lower the cost of serious PAT, but it would mean that only the people who really needed it would have to go down that route, reducing one incentive for PAT providers to raise prices in response to that unmet demand.

Prediction for 2024: Costs of treatment and associated therapies such as integration will remain high. If fundraising efforts are successful in significantly defraying them, it will only be due to how few people are undertaking PAT.

Legality

While psychiatry and psychology are now able to legally reap the considerable financial benefits of offering both PAT and associated activities such as integration services, the picture is less rosy for underground communities in Australia.

In all states and territories, both MDMA and psilocybin, in all their forms, remain highly illegal when not used in the exact manner and settings the TGA decision specifies. There has been some minimal movement on drug law, though. Queensland has expanded its diversion program, which gives a heavily conditional 3-strikes chance to avoid going to court for possession of small quantities of illicit drugs. Similarly, New South Wales has enacted a 2-strike policy, though this is at police discretion, so it’s likely that Indigenous people will see far less benefit. Neither of these things is anywhere near the real decriminalization of all drugs, which remains too politically radical for most state governments, despite the evidence for its benefit.

The one, sort-of exception we have is in the Australian Capital Territory (ACT) where personal possession of a wide range of drugs has been decriminalized. I say ‘sort-of’ because the thresholds in some cases are ridiculous. The best example of this is the definition of ‘small quantity’ set there for psilocybin: 1.5 grams[iv]. But that’s a lot of psilocybin, you say, equivalent to fifty decent doses! The problem is that in the ACT, as in many Australian states & territories, the law considers the whole weight of the whatever has been seized. So, the definition applies equally to 1.5 grams of pure GMP-grade synthetic psilocybin, 1.5 grams of dried P. cubensis, or 1.5 grams of freshly picked P. subaeruginosa.

These ‘container laws’, as they’re known, continue to make life difficult for psychedelic users, more dangerous for all drug users (as they encourage the iron law of prohibition,) but much easier for police and prosecutors. People have learned, the hard way, that an amount of fresh magic mushrooms that might only be enough for one dose can lead to be charged with offenses that carry large fines and potentially lengthy prison sentences. In NSW, 25 grams of fresh mushrooms could see you facing 20 years inside. 100 grams of magic mushrooms carries a potential life sentence and/or a fine of over $500,000 in NSW[v].

Picking these suburban Melbourne *P. subaeruginosa* mushrooms might get you in a lot more trouble than you think, so don’t.

And remember that 2-strikes for small quantities deal we have in NSW I mentioned a couple of paragraphs back? How little magic mushroom material do you have to be caught with to qualify? The answer is 0.04 grams[vi]. That’s not even one microdose. Think on this for a while and you’ll be as unimpressed with the Minns government’s efforts in this area as I am. I, like many other activists and advocates, await their fabled drug summit with considerable interest.

The different ways possession and use of psychedelics are now legal for some people but not others are a point of deep contention here. Virtually all the big personalities behind the leading psychedelic organizations, both for- and non-profit, say they believe that the current illegality of psychedelics is wrong. But some are more circumspect in public, and many organizations balk at endorsing decriminalization, let alone moving toward safe supply outside of clinical settings.

If I can jump on my soapbox for a second (and if you’ve made it this far, I assume you probably won’t mind,) I’m going to come right out and say that it’s not just people in the underground who profit from the prohibition of psychedelics. Illegality imposes scarcity, and scarcity, along with gatekeeping, apparently allows for a lazier route to profitability. Deliberately embracing a prohibition-based business model is not just unethical. The idea that it’s good business is patently ridiculous. The fact I can give a shoulder rub to my partner or pay to get a nice but non-medical massage has not, to my knowledge, destroyed physiotherapy. It just means that physiotherapists are the only ones who can make certain therapeutic claims and do certain therapeutic work, and don’t get to monopolize manually manipulating muscles through physical touch.

But I digress. The point I was going to make is that underground psychedelic communities see above-ground psychedelic organizations that generate profit or amass power, and then refuse to endorse legal changes that would alleviate the harms of prohibition. Psychedelic communities have deeper pockets than you might think and, more importantly, will volunteer their considerable time and emotional energy if you give them reason to. But support the commercialization of psychedelics while not publicly opposing prohibition? You’ll get nothing from them except contempt.

I’ve said it before and I’ll say it again: by numbers, the real mainstream of psychedelics isn’t and will likely never be in clinical settings. The most recent figures available indicate about 1.6% of Australians over the age 14 took psychedelics at least once in the past year. That might not seem like a lot, but that is still at least 300,000 individuals[vii]. That’s a lot of people to alienate. Whatever the reason is for doing so, it must be worth a lot.

Prediction for 2024: Psychedelics will remain largely criminalized for nonclinical use in Australia, though pressure to support broader reforms will grow. Psychedelic organizations that pretend prohibition isn’t their problem will continue to face the opprobrium of underground communities.

Education

There are two big challenges in psychedelic education in Australia right now. One is how best to educate and train the professionals associated with delivery of PAT. The other is giving members of the public, especially those new to psychedelics, the knowledge, skills, and connections that will allow them to be safer in these spaces.

Psychedelic assisted therapy

Let’s start with PAT. Expertise in assessment & screening, prescribing, sitting/guiding for people in psychedelic states, and integration seem to all be baseline necessities for provision of this therapy. (I say ‘seem to be’ as the role of therapists in PAT is still a matter of some contention.) Deep knowledge of the ethical pitfalls of working with people in psychedelic states and commitment to avoiding them is essential, regardless of the exact therapeutic model being used.

I’m not going to comment on the specifics of whether existing psychedelic training in Australia is adequate or not. But until these courses are properly scrutinized by both a dedicated professional body and the Tertiary Education Quality and Standards Agency (TEQSA), there will be no consistency, and little certainty for the students who pay many thousands of dollars to complete them. I know that no degree is a guarantee that you will get work in a given field. But real professional degree programs at least guarantee that you’ll be qualified to do so. We are not at this point for psychedelics.

What about the rest of us?

Meanwhile, back in the actual mainstream of psychedelic experience, things are getting wild. I’m still waiting for the latest National Drug Strategy Household Survey to be released, but I would not be surprised if the rates of psychedelic use continued to rise since 2019. Anecdotally, there are more new people coming into underground psychedelic settings than I’ve ever seen in my 25 years of involvement with plant medicine & psychedelic communities. Often, these people have no illicit drug experience other than a bit of cannabis, sometimes not even that.

The hype and publicity around psychedelics attract the curious, the ‘worried well’, and those desperate for relief from a range of serious mental health concerns. The first two groups likely wouldn’t qualify for legal PAT. And among people who do, as I’ve described, they are unlikely to have the available funds for treatment. Even those unwell and wealthy enough might find themselves on unbearably long waiting lists.

These psychedelic newbies can be very vulnerable to misinformation and manipulation by bad actors in the scene. They don’t know which drug combinations are dangerous, and so will accept whatever is given to them – one example I heard was people being dosed with MDMA in the tail-end of an ayahuasca session (this is not ideal.) They don’t know which facilitators are trustworthy experts, and which are predatory and/or inept, and may have minimal idea on what red flags to look for. If they experience ongoing adverse effects (it does sometimes happen) they don’t know who can help. If a facilitator or another ceremony participant harms them, they don’t know what to do, who they can talk to, or whether they’ll get in trouble from the police in the process.

Right now, specialized psychedelic-specific harm reduction education and community integration circles are largely provided by charities such as the Australian Psychedelic Society and Psychedelically Aware. We do our best, but with limited budgets and a purely volunteer workforce, there is always far more demand than we can meet. Organisations such as NUAA and HRVic do amazing work in harm reduction for all people who use drugs, regardless of substance or route of administration, and play vital roles in providing necessary education for psychedelic communities. But even they are stretched thin.

There are online fundamentals of psychedelics courses aimed at consumers & non-professionals available from multiple private providers online. Some of these are good. Others, not so much. The cost for these courses tends to be in the hundreds rather than thousands of dollars. Most people do not undertake anything like this before using psychedelics.

I want to note that education is only part of helping people negotiate psychedelic experiences and spaces in safer ways. Community plays as big, or bigger role, but that’s a discussion for another day.

Prediction for 2024: As new education providers enter the field access for professionals will grow. If universities finally start offering psychedelic-specific graduate qualifications, expect some private and non-profit providers to lose enrolments. Charities will continue their work, though considerable fund-raising will be necessary to meet community needs. Private beginners/nonprofessional course providers will struggle if economic conditions continue to reduce disposable incomes.

The year ahead

2024 promises to be a long year, in many ways. Outside of psychedelics there is considerable near-term economic and geopolitical uncertainly. Predictions such as mine should always be taken with a grain of salt. Any serious shock or black swan event could upend things entirely. Even if nothing surprising comes to pass, the professional psychedelic sector and psychedelic communities in Australia will continue to change in ways we can’t always predict. But having had some experience in both underground and more public psychedelic contexts, I think I won’t be too far off the mark.

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