Two New Zealand Psychiatrists Approved to Prescribe MDMA for PTSD

New Zealand’s medicines regulator, Medsafe, has approved two Kiwi psychiatrists to prescribe and administer MDMA for PTSD, it announced on Friday.

Both the Ministry of Health and those involved in pushing for the move emphasised that it will be delivered in the context of a broader treatment program and in tandem with psychotherapy.

The move comes after the country approved a psychiatrist to prescribe psilocybin for treatment-resistant depression in June last year. There are currently two clinicians¹ approved to do so, and a separate two who may now prescribe MDMA. “So far, nobody has been given authorisation to prescribe both psilocybin and MDMA,” James Bunn, co-founder of psychedelic training organisation The Psychedelic Training Centre NZ told Psychedelic Alpha.

It also aligns the country with its larger neighbour, Australia, which allowed medical use of MDMA and psilocybin for PTSD and treatment-resistant depression, respectively, via a limited rescheduling in July 2023.

At least one Kiwi politician, Deputy Prime Minister David Seymour, has touted the country’s move to allow limited psilocybin and MDMA prescribing as evidence of its commitment to making “innovative treatments” more accessible. “It will lead to more Kiwis being able to access the medicines they need to live a fulfilling life”, he said in a statement.

While Seymour might be hoping to notch a political win ahead of a November election in New Zealand, the scale of access to these investigational drugs will surely be modest. Indeed, looking to Australia, the model² that New Zealand is largely copying, the number of patients treated has not exceeded one hundred per year, according to data obtained from the country’s drug regulator.

But numbers might begin ticking up slowly in Australia, with one public (the Department of Veterans’ Affairs) and one private (Medibank) payor now reimbursing psychedelic therapy in some cases.

In New Zealand, meanwhile, there is no funding for psychedelic therapies, with patients paying out of pocket for both MDMA and psilocybin treatment.

The country does have a system that allows patients to claim back medical expenses. But Bunn says that the current reality is “a long way away from allowing either psilocybin or MDMA to be claimable through New Zealand’s government-backed Accident Compensation Corporation.”

Dr Gary Wynn, one of the psychiatrists now cleared to prescribe the drug, told Psychedelic Alpha that he is hopeful that reimbursement will come in time, and emphasised that “this is a start”. “Getting this approval and getting started with these treatments is what I hope will move us towards more public support and more general access”, he told us.

Aside from securing reimbursement, other barriers to scalability include provider capacity.

Wynn said that it took thirteen months to secure approval. “Some of that was because it was the first one”, he told us, adding that he expects that subsequent applicants could see decisions in something closer to six months.

Wynn hopes to dose his first patients in the next month or two. His patient volume will be modest, with a three-dose protocol translating to an upper limit of around fifteen patients per year. Wynn expects it will be slower than this to begin with, and if he secures approval to prescribe psilocybin, those patients would cannibalise some of the MDMA session availability.

Future tweaks to the protocol could increase capacity, but Wynn emphasised that the primary goal now is to “get things settled and moving with the basic protocol”.

Bunn agrees. He said that psychedelic therapy care delivery teams need not be made up exclusively of specialist GPs or psychiatrists, and that “other healthcare professionals with the right training can be involved in patient dosing, working under the authorised prescriber’s care.”

Indeed, the regulator is currently sitting with further applications, we understand, including those from clinicians who participated in a recent cohort of Bunn’s training program.

He hopes that bringing more approved prescribers into the fold will increase capacity and, potentially, reduce costs for patients, which is expected to sit at around NZ$15,000 (~US$9,000). “With only two authorised prescribers in the country for each drug”, he told us, “they can effectively charge what they like.”

Any clinicians looking for approval must demonstrate “substantial expertise”, as well as “provide detailed information about how treatment would be delivered safely and appropriately”, in order to be approved by Medsafe, according to the agency.

But experience in administering the drug is difficult to obtain in the Kiwi context, given the low number of clinical trials of psychedelics in the island nation. For his part, Wynn cited a certificate in psychedelic-assisted therapy completed via the nonprofit Mind Medicine Australia, a training program that included an experiential element via the Canadian nonprofit TheraPsil, and his work running a ketamine clinic that has involved over one hundred sessions.

Wynn’s practice has focused on PTSD for more than twenty years, making MDMA a more obvious fit, given late-stage trials in that indication. Still, he has submitted a protocol for psilocybin, he told us, which he hopes to secure soon.

Despite looming challenges around scale and accessibility, Wynn was upbeat. “I have not seen or heard a negative response”, he told us on Monday, “other than frustration at the cost”.