What psychedelic assisted therapy could mean for meth use

Australian researchers have just completed the worlds first study into psychedelic assisted psychotherapies (PAT) for methamphetamine use disorder. But what is PAT? And how could it change the treatment landscape?

Researchers at St Vicent Hospital in Sydney have recently completed a promising study into psychedelic assisted psychotherapies (PAT) for methamphetamine use disorder.

The study, led by Associate Professor Dr Jonathan Brett, is a world first and could be the first step to revolutionising treatment for meth use disorder.

Indigenous and First Nations people have used psychedelics for therapeutic practices for thousands of years, but Western medicine has only recently begun investigating its potential benefits for treating mental health issues such as depression and post-traumatic stress disorder.

Its use for people experiencing meth use disorder is practically unheard of, until now.

Treating meth use disorder

Dr Jonathan Brett is a medical doctor specialising in clinical pharmacology, toxicology and addiction. He splits his time between clinical work at the Psychiatry and Non-prescription Drug and Alcohol Unit at St. Vincent’s Hospital and research at the University of New South Wales.

According to Brett, previous studies into the use of PAT to address alcohol and nicotine use have demonstrated promising results which led him to consider the possibility of PAT to treat meth use disorder.

“Australia has one of the highest rates per capita of methamphetamine use disorder in the world and I see people presenting to hospital with meth related issues on just about every clinical shift I do,” says Brett.

According to Brett, current treatments have high relapse rates or are difficult to access leaving many to struggle on their own.

“In general nothing works particularly well and there’s a big need for new treatments given the impact meth use disorder can have on people’s health and wellbeing.”

Which led him to investigate PAT as a potential treatment.

“We have just completed the worlds first study of PAT for people seeking treatment for meth use disorder at St. Vincent’s Hospital in Sydney and we are in the process of analysing results,” he says.

“This was a small study of 15 people to show it was safe and possible to do in an outpatient setting but the quality of life and drug use outcomes from this study seem promising.

“We are hoping to secure funds to do a much larger study across several sites in Australia to see if this really works as a treatment for meth use disorder.”

How does psychedelic assisted psychotherapy work?

PAT is the combination of ‘talk therapy’ ­with psychedelics. Talk therapy, as the name suggests, involves talking through issues and thought processes with a therapist. Cognitive behavioural therapy is a type of talk therapy.

On the psychedelic side of things, psilocybin – the psychedelic chemical in magic mushrooms – is the most commonly used substance, however, researchers are investigating the potential of ayahuasca and DMT too.

Some psychonauts may already be familiar with the use of psychedelics for healing purposes though the process for PAT is far more structured than a trip at a trance festival.

“We know that set and the setting in which the psychedelic experience happens is very important as it directly affects the psychedelic experience,” explains Brett.

Before PAT can be considered, the patient is assessed for suitability and safety.

“There are concerns that psychedelics are not safe in people with a personal or family history of psychosis or [for people] taking certain medications,” says Brett.

“If we think it is safe to proceed, participants have around three preparatory therapy sessions with two therapists to allow them to feel comfortable and trusting enough to really let go during the dosing day with psilocybin.

“The therapists also help the participant set goals for what they want to get out of the treatment and to tell them about what will happen on dosing day.”

This goal setting is important because the aim of PAT is to adjust ‘unhelpful’ belief systems – for example thinking ‘I’m not good enough’.

“An analogy commonly used is of skiing down a ski slope, the more you ski in the same tracks the harder it is to move out of these tracks.

“PAT is like a fresh dump of snow, allowing you to get out of the tracks of unhelpful beliefs.”

On dosing day, the patient is taken into a private hospital room with a comfortable lounge and given a macro-dose of psilocybin. According to Brett this is roughly 25mg or “equivalent to about four to five grams of dried mushrooms”.

Under the supervision of the therapists, the patient spends most of the time lying on a sofa listening to a specially designed play list. Surprisingly, not a lot of talking happens during this session.

“People are encouraged to pay attention to their internal experiences,” says Brett.

“They are with us for around eight hours and are then discharged into the care of a support person who looks out for them for the next 24 hours.”

The talking happens the following day when patients return for ‘integration’ therapy to “help them make sense of their experiences in the context of their goals”. This may happen over a number of sessions.

What does this mean for treatment options?

PAT could be an effective means to help those who use meth to self-medicate or those looking to break certain thought patterns surrounding their methamphetamine use. Unfortunately, the hefty price tag attached to PAT is likely an insurmountable obstacle for many.

In July 2023, the Therapeutic Goods Administration announced it was changing the classification of psilocybin and MDMA to enable prescribing by authorised psychiatrists for treatment resistant depression (psilocybin) and post-traumatic stress disorder (MDMA). Despite this, treatment is not yet legally available for other conditions nor subsidised by the federal government making it a very costly endeavour – potentially $20K per treatment according to Brett.

Still, studies like those by Brett and his team are a step in the right direction. Particularly since Brett’s team made a conscious effort to include input from peers in the study’s design.

“It’s been tremendous to work with NUAA who have been involved at every step,” he says.

“We did a focus group last year to help us understand people’s experiences of using meth and psychedelics, what kind of interventions they are interested in and to help us understand how best to design a larger trial of PAT for meth use disorder.”

Input from peers led to the researchers to see the importance of letting all study participants receive a psilocybin dose even if they are in the placebo group.

Brett says lack of consumer input has been detrimental to developing effective treatments in the past and hopes to continue working with peers if they receive funding for further studies.

“Right now, I’m keen to write up our study findings for PAT for meth use disorder and then secure funds for a larger trial to understand whether it really works for this condition.”