Reflections on ‘Psychedelics – a national discussion’, Aotearoa, New Zealand

By Dr Fiona Hutton Associate professor, Institute of Criminology

Te Herenga Waka, Victoria University

I recently had the privilege of attending a gathering focused on psychedelics hosted by the University of Auckland. Events like these contribute to sensible and informed debate about important issues - like the development of psychedelic therapy. It was an event that provided a forum for thoughtful, inspiring and informed discussion around a range of issues related to using psychedelics to help those suffering from mental health issues, trauma, PTSD, addiction and end of life anxiety.

Research thus far, both historical and contemporary, has demonstrated the efficacy of psychedelics such as LSD (lysergic acid diethylamide) and psilocybin (a naturally occurring hallucinogenic substance in some species of mushrooms) for treating a variety of conditions. For example, Griffiths et al., (2016) found that a single high dose of psilocybin was effective in treating depressed mood and anxiety about death in patients with a life threating cancer diagnosis, while psychedelics can also help to treat addictions to substances like alcohol, tobacco, heroin and cocaine. Importantly psychedelics have a low potential for addiction and are not viewed as addictive, making them ideal to treat addictions to other substances (see Nutt, 2024). Ayahuasca is a a plant brew that originates from the Amazon rainforest and has historically been used by the indigenous peoples of the Northwest Amazon for healing and divination – in small scale studies it has been found to be beneficial in those with depression (Sanches et al., 2016), suicidality (Zeifman et al., 2019) and anxiety, panic (Santos et al., 2016). In a 2019 study by Berlowitz et al., after ayahuasca assisted therapy, substance disorder inpatients had reduced drug use and craving.

Since approximately the 1990s/early 2000s there has been a ‘psychedelic renaissance’, as it has been referred to, with renewed interest in psychedelics to treat the aforementioned conditions.  However, the debates about psychedelics as a medicine or as a form of healing or therapy are inevitably bound up in debates around recreational use with all the stigmatising tropes that this engenders. Stigma surrounding people who use drugs (PWUD) is embedded in dehumanising language in media and public discourse. Politicians enact knee-jerk reactions to moral panic type reporting about drugs and addiction which further embeds harm while offering no solutions for those caught in the web of prohibition and criminalisation. That prohibition itself causes an immense amount of harm to PWUD is usually the ‘elephant in the room’ in discussions about drugs, with the harm caused by the current New Zealand 1975 Misuse of Drugs Act (MoDA, 1975) carefully sidestepped in conservative discourse about policy and drugs. This ‘elephant in the room’ was writ large at this event, acknowledged, challenged and thoughtfully discussed – many of those in the room and their whānau (Māori term for extended family) had suffered harm through the regime of prohibition, with its basis in racism, punishment and inequity.

As one of the keynote speakers pointed out ‘Te mana o te kupu’ – ‘words have power’ and nowhere is this more apparent that in debates around drugs and people who use them. However, some people’s words have more power than others and this has led to the suppression and sidelining of centuries, if not millennia of indigenous knowledge about the use of substances such as psilocybin. The New Zealand Tohunga Suppression Act (1907) meant that the passing down of mātauranga (Māori knowledge) was curtailed. Therefore, in Aotearoa New Zealand (AoNZ) accounts of the use of indigenous psilocybe fungi in healing are scarce (Hodge et al., 2024). The voices of those with lived or living experiences of using psychedelics for healing purposes are also often silenced in debates about ‘science’ and ‘evidence’, so it was refreshing to see this challenged alongside speakers who noted the limitations of randomised controlled trials (RCTs), and the value of real world evidence (RWE) in this field (see Hutton, Noller & McSherry, 2023; Schlag et al., 2022 for a discussion of RWE).

The diversity represented at this gathering was a welcome change, with a panel dedicated to lived/living experience, as well as a presentation by the project, Tū Wairua which began in 2021. The impacts of colonisation have led to harmful problematic methamphetamine use (PMU) in Māori communities with no culturally appropriate effective treatments available (Hodge et al., 2024,Yasbek et al., 2022), so Tū Wairua was developed with aim of supporting Māori suffering from PMU through psychedelic assisted therapy - Tū Wairua has a focus on collaboration between western biomedical research and Māori wisdom, rangatiratanga (sovereignty, self-determination, autonomy) and rongoā Māori (traditional Māori healing) (Hodge et al., 2024). Their presentation was both sobering and inspiring in equal measure, highlighting some thorny issues related to psychedelic, particularly psilocybin, assisted therapy in AoNZ – for example can we ‘scale up’ psychedelic therapies whilst respecting indigenous knowledge and practice? Is this a desirable course of action? There is often a tension between Westernised models of practice and research and traditional use of psychedelics based on long histories of ritual and deep cultural significance (Muthukumaraswamy Forsyth & Sumner, 2022).  

In relation to psychedelics the 1975 MoDA places substances like LSD and psilocybin in Class A and Schedule 1 of drug legislation, reserved for substances that have no medical use, and which are alleged to cause the most harm. This has hampered psychedelic research since the 1970s, as noted by Nutt and Carhart-Harris (2020, p.121),

‘Since then [the war on drugs] research funding, drug production and the study of psychedelics as clinical agents virtually stopped’

The current New Zealand MoDA, 1975 does not necessarily preclude research into psychedelics - it just makes it more difficult, time consuming and expensive, meaning that

‘Medical research can be prohibitively expensive, and it can also be difficult to obtain research funding and attract sponsors’ (Gittins, 2022 p. 154).

This is despite research demonstrating that psychedelics are among the least harmful substances. Nutt et al.’s (2010) scale of harm places ‘magic’ mushrooms (containing psilocybin) and LSD at the very bottom of the harm scale in comparison to alcohol which is placed at the top. More recent expert rankings of drug harms by Bonomo et al., (2019) in the Australian context and Crossin et al., (2023) in AoNZ also ranked LSD, mushrooms, and hallucinogens at the bottom of their respective harm scales.  

A new approach to psychedelics is needed, especially given the recent stark mental health statistics. 1 in 8 people in the world live with a mental disorder (WHO, 2022, p.3), and in AoNZ around 1 in 5 New Zealanders each year experience mental illness or significant mental distress, with increasing numbers of children and young people showing signs of mental distress and intentionally self-harming. AoNZ also has persistently high suicide rates, with the suicide rate for young people among the worst in the OECD (He Ara Oranga, 2018). Further over 70% of people who attend addiction services in AoNZ present with a co-existing mental health condition, and over 50% of mental health service users are estimated to have co-existing substance use problems (He Ara Oranga, 2018). Statistics like these lend urgency to research exploring new and more effective ways of helping those with depression, PTSD, addiction and trauma related conditions - as one of the speakers noted there has been little significant innovation or breakthrough in pharmaceutical medication for mental health and depression since the 1950s – surely it’s time for innovation and change?

However, calls for change appear to fall on deaf ears with politicians often clinging to outdated arguments and refusing to consider what the evidence tells us – that prohibition has not stopped people using drugs, that it drives inequity in criminal justice statistics, causes harm in itself, and is not based on evidence. The panel on ‘policy change and legal reform’ realistically, if depressingly, noted that change will not simply be ‘a matter of rational persuasion’, and that it will take more than evidence to change the minds of politicians and some sections of the voting public. Drugs like psychedelics are surrounded by stigma, myths and stereotypes, with objections to drugs based in morality, rather than evidence – moving things forward will be challenging and the uphill struggle will continue.

Across the two days there was much discussion and debate about what could be done and how change and reform could be enacted in the face of seemingly insurmountable barriers. Despite the challenges facing research and reform, what was clear from the gathering was that across many diverse groups there is huge appetite for change, with research and evidence developing against the odds. Long may collaborations like Tū Wairua continue, and may we finally begin to see some movement away from the decades long war on drugs, towards a brighter future for those who are suffering from debilitating mental health conditions, and people are suffering. Politicians and others involved in legislative change have an ethical and moral duty to act and work towards helping them – it is unconscionable if they do not.   

Bibliography 

Berlowitz I, Walt H, Ghasarian C, Mendive F, Martin‐Soelch C. (2019). Short‐term treatment effects of a substance use disorder therapy involving traditional Amazonian medicine. J Psychoactive Drugs. 2019;51(4):323–334. 10.1080/02791072.2019.1607956 

Bonomo Y, Norman A, Biondo S, Bruno R, Daglish M, Dawe S, Egerton-Warburton D, Karro J, Kim C, Lenton S, Lubman DI, Pastor A, Rundle J, Ryan J, Gordon P, Sharry P, Nutt D, Castle D.J (2019). The Australian drug harms ranking study Psychopharmacol. 2019 Jul;33(7):759-768. doi: 10.1177/0269881119841569

Crossin et al., (2023). The New Zealand drug harms ranking study: A multi-criteria decision analysis. J Psychopharmacol. 2023 Sep;37(9):891-903. doi: 10.1177/02698811231182012

Fábregas JM, González D, Fondevila S, Cutchet M, Fernández X, Barbosa PC, Alcázar-Córcoles MÁ, Barbanoj MJ, Riba J, Bouso JC. (2010). Assessment of addiction severity among ritual users of ayahuasca. Drug Alcohol Depend. 2010 Oct 1;111(3):257-61. doi: 10.1016/j.drugalcdep.2010.03.024.

Gittins, R. (2022) Enabling access to essential medicines, in Crome, Nutt & Stevens, (2022) (Eds.) Drug Science and British Drug Policy: critical analysis of the Misuse of Drugs Act 1971. Waterside Press.

Griffiths RR, Johnson MW, Carducci MA, et al. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology. 2016;30(12):1181-1197. doi:10.1177/0269881116675513

He Ara Oranga, (2018). Report of the Government Inquiry into Mental Health and Addiction  https://mentalhealth.inquiry.govt.nz/__data/assets/pdf_file/0024/20868/he-ara-oranga.pdf

Hodge, AL., Forsyth, A., Noorani, T., Muthukumaraswamy, S., Rolleston, A., and McHugh, P. (2024). Tū Wairua: Development of an Indigenous Rongoā Māori Approach to Healing with Psilocybin Containing Mushrooms. https://osf.io/preprints/psyarxiv/93x5h_v2

Hutton, F., Noller, G. and McSherry, A. (2023), Patients experiences of therapeutic cannabis consumption in New Zealand, Drugs, Habits and Social Policy, Vol. 24 No. 2, pp. 117-132. https://doi.org/10.1108/DHS-12-2022-0049

Muthukumaraswamy S, Forsyth A, Sumner RL. (2022). The challenges ahead for psychedelic 'medicine'. Aust N Z J Psychiatry. 2022 Nov;56(11):1378-1383. doi: 10.1177/00048674221081763.

Nutt, (2024). Psychedelics: The Revolutionary Drugs That Could Change Your Life--A Guide from the Expert, Balance.  

Nutt D, Carhart-Harris R. The Current Status of Psychedelics in Psychiatry. JAMA Psychiatry. 2021;78(2):121–122. doi:10.1001/jamapsychiatry.2020.2171

Nutt DJ, King LA, Phillips LD (2010). Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010 Nov 6;376(9752):1558-65. doi: 10.1016/S0140-6736(10)61462-6.

Sanches RF, de Lima Osório F, Dos Santos RG, Macedo LR, Maia-de-Oliveira JP, Wichert-Ana L, de Araujo DB, Riba J, Crippa JA, Hallak JE. (2016). Antidepressant Effects of a Single Dose of Ayahuasca in Patients With Recurrent Depression: A SPECT Study. J Clin Psychopharmacol. 2016 Feb;36(1):77-81. doi: 10.1097/JCP.0000000000000436.

Schlag, A.K., Zafar, R.R., Lynskey, M.T., Athanasiou-Fragkouli, A., Phillips, L.D. and Nutt, D.J. (2022), The value of real-world evidence: the case of medical cannabis, Frontiers in Psychiatry, Vol. 13, p. 2489, doi: 10.3389/fpsyt.2022.1027159.

World mental health report: transforming mental health for all. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

Yasbek P, M., K., Elder, H., Crossin, R, Baker, M. (2022). Minimising the harms from methamphetamine. The Helen Clark Foundation and NZ Drug Foundation.

Zeifman RJ, Palhano-Fontes F, Hallak J, Arcoverde E, Maia-Oliveira JP, Araujo DB. (2019). The Impact of Ayahuasca on Suicidality: Results From a Randomized Controlled Trial. Front Pharmacol. 2019 Nov 19;10:1325. doi: 10.3389/fphar.2019.01325.