Festina Lente Down Under: What Australia Is Teaching the World About Legal Psychedelic Therapy

By: Jamarie Geller, MD, MA

There was near consensus that the TGA’s approval of MDMA-assisted therapy for PTSD and psilocybin-assisted therapy for TRD was both unexpected, and perceived by some as precipitous. Concerns have been raised, though, both about the rapid regulatory U-turn and about the glacial pace of adoption. Several factors have contributed to this slow uptake, including the high cost of treatment, restrictions on direct-to-consumer marketing, and a complex approval process for APs and clinics.
 
Until recently, there was no insurance coverage for PAT, and the cost of a standard course of care, including screening, preparation, dosing, and integration, has typically ranged from 20,000 to 30,000 AUD (13,000-20,000 USD). The TGA currently requires two therapists in each dosing session for all PAT, which some cite as appropriate given the way at least MDMA-assisted therapy has been studied, but others believe this requirement unduly raises cost to patients. However, in mid-2025, Medibank, Australia’s largest private health insurer, announced coverage for PAT through a partnership with a psychedelic service provider. In November, 2025, the Australian Department of Veterans’ Affairs also signaled plans to start coverage for eligible veterans. Although these developments are expected to expand access, affordability and equity are ongoing issues.

Many clinicians expressed difficulty navigating national regulations as they sought AP status and sought to expand clinical services at their hospital or clinic to include this kind of treatment safely and lawfully. Providers are required to submit detailed protocols outlining their therapeutic model and safety procedures. If they are approved and begin to provide PAT, however, there is relatively little systematic follow-up beyond safety reporting to assess adherence, provide ongoing support, or facilitate shared learning across sites, compounding jurisdictional variation. 

I also heard concerns from clinicians and other community members about the absence of Aboriginal and Torres Strait Islander peoples in initial and some ongoing discussions, which is especially salient given the history of Australian colonization, the use of these kinds of medicines in indigenous communities, and the urgent need to address generational and ongoing trauma. These communities have largely been excluded from both participating as facilitators and accessing treatment due to cost, regulations, and trying to fit PAT into colonial diagnostic and healthcare structures (Bianca, 2024). Across Australia, I heard understandable calls to address these injustices by consulting Aboriginal and Torres Strait Islander people in regulatory decision-making, supporting diversity in training, on treatment teams, and in research, and for increasing access.

Even with regulations in place, many clinicians expressed lingering concerns about clarity–around training standards, oversight mechanisms, and how emerging challenges will be addressed as experience accumulates. Dr. Nigel Strauss, MD, one of the country’s first APs and an ardent supporter of PAT, is discouraged by the lack of leadership by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and other professional groups. He informed me that the RANZCP psychedelic steering committee, on which he once sat, has in fact officially been disbanded. He expressed concerns about the overall lack of psychedelic knowledge amongst providers, and worries that the right experts are not being consulted. 

Additionally, due to strict restrictions on direct-to-consumer marketing and broad cultural differences, many Australians are also not aware of PAT. Many still lack a basic understanding of psychedelic medicine, don’t know that it may be available to them, nor how to find it.