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Comment by resolutebat | Hacker News Reader

This sounds great on paper, but there's a devil lurking in the detail:

> The regulator says there are currently no approved products that contain MDMA or psilocybin. However the reclassification means psychiatrists will be able to access and legally supply certain medicines that contain them, even if they have not been evaluated for safety or effectiveness.

How exactly is this supposed to work then? Are psychiatrists supposed to order MDMA/psilocybin directly from the companies that produce the two for research use, which presumably involves fearsome bureaucracy and markups?

It sounds like this would make the law effectively a dead letter until a regular pharma company goes through the Australian approval process and gets the drugs into pharmacies. Medical marijuana in Australia has suffered from similar issues, with an onerous approval process in many states making it very difficult to get a prescription.

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It's the first step. When cannabis was legalised for medicinal purposes the doctors prescribing it had to import it from overseas suppliers.

Yes I imagine the next step is a local supplier company goes through the valid approval process and gets their product approved.

>Medical marijuana in Australia has suffered from similar issues, with an onerous approval process in many states making it very difficult to get a prescription.

I live in NSW so maybe I am a bit naive but it is possible to see a doctor over the internet that works for a dispensary in another state and have them issue you a prescription if you fit the criteria for medicinal cannabis.

I was cynical about the idea of these dispensaries having their own in house doctors but upon further thinking it makes sense since some doctors still don't acknowledge the medicinal benefit of cannabis.

Accessing medical cannabis is weird - each state has different access requirements and you must apply in the state(s) you practice in for permission (which isn’t hard) and then to the TGA for approval to prescribe.

The industry/clinic space is really bizzare. I have been bombarded with requests to work as a telehealth prescriber. Because of the restricted product supply, ‘clinics’ are popping up to offer telehealth consults and then push their products.

There are multiple issues with this:

- the doctors doing the prescribing are often junior doctors, not GPs or pain specialists

- they have a limited supply of stock and no real understanding of ‘what is right when’

- pretty much all the stoners I know have now switched to medical marijuana (which is fine but for the next point)

- the TGA will at some point come down on doctors who are doing shitty consults and just writing the prescription with a cursory ‘whatever’ - because the TGA and medical board in this country are not as toothless as in the US

So basically anyone can get a prescription, and the clinics are pushing their own (or their own imported) product so they get fat margins, and there’s some médico-légal risk.

Over time (and even now) there are increasing numbers of GPs who can prescribe and there are websites that can point you to them which is what I’d recommend if you or a loved one actually has a medical condition, as opposed to just wanting to get stoned.

>Are psychiatrists supposed to order MDMA/psilocybin directly from the companies that produce the two for research use,

As I understand it, yes.

Legalisation hasn't meant it has gone mainstream.

It is still going to be administered in very selective cases where the current range of medication and therapy has not been effective.

It may only be tens or low hundreds of people who receive these treatments in the first year.

The efficacy of the treatment will be monitored and the hope is that these patients outcomes are positive, which will add to the body of work supporting MDMA/psilocybin as an antidepressant.

It’s still a fantastic step in the right direction, giving medical practitioners the flexibility to explore new medicines for treatment. I know my perception of these substances changed after reading How to Change your mind by Michael Pollan: https://michaelpollan.com/books/how-to-change-your-mind/

Mdma is tricky, but psilocybin is easy. Psilocybe cubensis can be grown easily at significant scale outside its natural ecosystem, due to work by the late Terence Mckenna and his brother Dennis.

Treatment centers could grow them on site pretty easily needing only basic cleanliness to avoid contamination.

It's not like either is complex to manufacture/extract. And "fearsome bureaucracy" is quite normal, not a big deal.

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