Australia authorised-psychiatrist prescribing (MDMA, psilocybin)

Domain VII · Transpersonal, psychedelic & altered states · 2023 · Australia

What it is

This is a regulated access pathway, not a single therapy. Since 1 July 2023, MDMA (for PTSD) and psilocybine (for treatment-resistant depression, TRD) have been Schedule 8 in the Poisons Standard for those two uses only, and only when prescribed by a specialist psychiatrist who holds TGA Authorised…

Format

• The number and spacing of medicine sessions are set by each protocol and are deliberately not described here.
• Ideally the same therapists attend every session.

Who practises it, and how they are trained or regulated

• Training and competence (AP psychiatrist)
• RANZCP lists 14 competencies across knowledge, safety and ethics, and hands-on training. Hands-on training includes supervised treatment of a real patient and working as part of the treating dyad.
• A "significant experiential part" of training must be delivered in person.

Evidence status, as the guide reports it

• The whole team must be HREC-approved, and supporting therapists must be trained in evidence-informed psychedelic-assisted psychotherapy protocols.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Pushing past a "no". That is a consent breach, not therapy.
• Last-minute ambivalence. The person may withdraw without penalty.
• Anyone leaving unstable, and anyone without the planned support at home.
• Drift away from the protocol, and therapist fatigue during long sessions.
• Hyperventilation or effortful breathing. Slow the pace and keep it gentle.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.