In the more than two years since Australia legalised MDMA and psilocybin for therapeutic use, in tightly controlled clinical settings, our revolutionary healthcare promise seems to be delivering only for the wealthy elite.
On paper, authorised psychiatrists can prescribe these drugs for post-traumatic stress disorder (PTSD) and for treatment-resistant depression (TRD). In practice, access is laden with so many guardrails that it’s virtually cordoned off. Instead of providing at least part of an answer to the 'national crisis' that experts and industry bodies decry in our failing mental healthcare system, Australia has put a velvet rope across breakthrough treatments.
Australia has put a velvet rope across breakthrough treatments.
'It is by far the biggest paradigm shift in mental health treatments for 60 years', says Peter Hunt, co-founder of the nation’s most-effective lobby group in the psychedelic medicine space. According to their data, in the 28 months following the Therapeutic Goods Administration's (TGA) historic decision, just 160 people have been treated nationwide. It’s a minute fraction of the estimated 1.4 million Australians who could be eligible.
A velvet rope around 'breakthrough' care
Money and regulation are the twin barriers to access here and their bottlenecking is by design.
The prescriber maze
In order to deliver treatment, psychiatrists must become Authorised Prescribers (APs). It's an arduous process that can take six months or more and involves consultation with and approval from the TGA, a Human Research Ethics Committee, the state or territory health department, and the Office of Drug Control. They will also need to run their practice to clinical standard, meaning every patient is treated as though they are part of a research trial. This system keeps a tight leash on safety but chokes supply.
This system keeps a tight leash on safety but chokes supply.
The $24,000 price tag
It’s similarly maze-like for patients who, once they navigate their way through the approvals and referrals, will find a prohibitive price tag awaiting them. Australia’s first purpose-built psychedelic therapy clinic, Clarion Clinic (now Mind Medicine Australia Clinic), was reported as charging $24,000 for a nine-month program. Director Professor Suresh Sundram told The Guardian that the drugs themselves are relatively cheap but it's the psychotherapy that drives costs and accounts for 85% of the total bill. That’s because the AP needs to be present alongside their team at all times during drug treatment, which means paying for the time of an additional trained psychologist and sometimes even another psychiatrist.
'A one-dose protocol would be about $8–10,000', Hunt says. 'Two doses, you’re probably looking at $18–20,000. Three doses, you’re probably looking at somewhere between $24,000 and $30,000.'
For the wealthy, this might mean deferring an overseas family holiday. For those on welfare, it’s out of the question entirely. 'There’s a real equity issue here', Hunt says.
For the wealthy, this might mean deferring an overseas family holiday. For those on welfare, it’s out of the question entirely.
Waiting for the system to catch up
The only way the price issue is going to be overcome is through public funding. Such a decision must be made by the Medicare Services Advisory Committee (MSAC), the body deciding whether new services receive subsidies.
However, MSAC needs more than safety data. It wants proof the treatment is cost-effective over the long term compared to existing treatments. Right now, Australia doesn’t have that quality of evidence, although an ANU-led outcomes registry is being set up to track patient results, with the first data set expected soon. Hunt says he expects the data will be 'really positive', but until MSAC is convinced, patients will continue to foot the bill themselves.
In a way, it’s hardly surprising for a highly risk-averse nation suddenly thrust into global leadership in an incredibly complicated field. Indeed, the medical community remains split on whether or not the TGA moved too quickly. Professor Susan Russell, who leads Australia’s largest psilocybin trial, has warned that while results are promising, 'there actually isn’t good evidence' yet for routine use in depression treatment. Traumatising trips and the let-down of last-ditch failures are very real risks while robust phase-3 data is still thin on the ground.
Hunt believes the TGA is like a rabbit in headlights following their decision. 'They did it on evidence and all credit to them… but they’ve become way too cautious'. MMA has trained around 600 clinicians and treatment centres are now open in virtually every major city and some regional areas too. But, without systemic reform, supply is always going to fall woefully short of demand.
What happens when the system says no
All of this makes Australia’s pathway one of the most conservative and tightly controlled amongst the nations with some established legal mechanisms for access to these treatments. In Canada and Switzerland, for example, patients can access psychedelics through case-by-case permits without the ethics-committee burden. Those models still involve close supervision but they move a lot faster. Here, the insistence on trial-grade oversights and a psychiatrist-led model keeps things slow, expensive, and unequal.
Where the formal system fails of course, the underground continues to fill the gap. Unregulated therapists throughout the country offer similar-looking treatments for hundreds, not thousands, although the quality and safety varies wildly. Drug purity, suitability screenings, and therapeutic follow ups are a pot luck and every tragic mishap outside the system reinforces the stifling caution within.
The Australian model was built to avoid a disastrous failure to launch which, when you’re talking about powerful mind-altering interventions, is both necessary and commendable. However, it has resulted in a press release masquerading as a breakthrough.
It has resulted in a press release masquerading as a breakthrough.
What would make it fair?
For people living with these debilitating and life-altering conditions, change cannot come fast enough. Further funding of cost-effectiveness research, fast-tracking of MSAC considerations on therapy time, streamlining prescriber approvals once safety is clear, and a rollout of national training standards ought to be pursued as priority.
Until we can build equity into the system with means-tested treatments, greater subsidy programs, and culturally-safe access for Aboriginal and Torres Strait Islander communities and marginalised groups, these potentially life-saving medicines will remain the most exclusive VIP club in Australian healthcare.
*Correction, 4 December 2025: This article originally referred to Clarion Clinic. The clinic has since changed its name and is now operating as Mind Medicine Australia Clinic.
