In Melbourne's St Vincent's Hospital, down the hall from the cancer day unit, there's an unassuming room known simply as "The Retreat".
This is where a select few volunteers are offered a unique opportunity: to confront their deepest fears under a heavy dose of a psychedelic.
Terminally ill patients spend three to four hours here under the influence of psilocybin, the psychedelic compound found in "magic mushrooms".
The participants are supported by therapy before, during and after their psychedelic experience.
"We go to a lot of trouble to make sure that it doesn't look like a hospital room, but it looks more like a really chilled, really comfortable and inviting atmosphere," clinical psychologist Marg Ross said as she walked around the room.
The experience offers patients a rare chance to process the unavoidable reality of their imminent death, and to learn how to say goodbye to everyone they know.
"When you use terms like anxiety and depression, I think it kind of simplifies it a bit," psychiatrist Justin Dwyer said.
"Actually what people are dealing with is terror, which is very difficult to put into words this sense that you will no longer be.
"The standard treatment, things like anti-depressants, anti-anxiety drugs, really have very little to offer."
It's a novel approach to palliative care, and for the time being, it won't be available in Australia outside these four walls.
Australia's drug regulator, the Therapeutic Goods Administration (TGA), yesterday rejected an application seeking to have two currently prohibited drugs rescheduled as controlled medicines in Australia.
Psilocybin the drug used in the St Vincent's trial was one of them.
The proposal sought to make it easier for doctors to prescribe the psychedelic as well as MDMA, also known as ecstasy, to people suffering from chronic anxiety, depression and PTSD.
The TGA's interim decision to reject the change follows an application made last July by the psychedelics advocacy group Mind Medicine Australia (MMA), run by soprano singer Tania De Jong and chaired by her investment banker husband, Peter Hunt.
MMA points to clinical trials completed overseas, where psilocybin was found to be effective in treating anxiety and depression in terminally ill cancer patients.
Last November, Johns Hopkins University in the US found psilocybin to be four times more effective than medicines traditionally prescribed to treat major depression.
But these trials have not yet advanced to Stage 3, which tests safety and efficacy on large populations.
Ms De Jong and Mr Hunt expressed disappointment yesterday at the TGA's desire to wait until current clinical research is complete before the rescheduling of these controversial drugs is considered.
"That could be years away," Mr Hunt said.
"How many people are going to suffer between now and then? And frankly, how many people are going to die from suicide because they can't actually get the treatments they need to get?
"It is frankly nonsense to make these people who are suffering wait any longer."
The TGA cited advice from the Royal Australian and New Zealand College of Psychiatrists, which argued that while there are indications emerging that psilocybin can offer therapeutic benefits, the evidence "just isn't quite there yet".
The trial at St Vincent's in Melbourne was established as a landmark opportunity to expand upon overseas studies by examining psilocybin's effectiveness as a therapeutic tool for not just cancer patients, but people with other terminal illnesses too.
But the project was thrown an unexpected curveball in the form of a global pandemic.
"We'd only really just commenced before COVID hit and we've been on hold for several months, but we've just started recruiting again," Dr Ross said.
She quickly pointed out how the richness of the patient experiences had already affected all involved.
"One of our qualitative researchers conducted an interview for one of our participants post-dose and emerged from the interview room and just burst into tears because of the profundity of what she'd heard in this interview."
"To see and witness such profundity in that room, a sense of peace that can be achieved for people who are really struggling with and quite anguished by their death is something that I'm hoping that we can continue to offer beyond this study.
"Hopefully we can contribute to the body of research that will support that.
"If it continues to track the way that it has been, we can provide that experience for more people going forward who are facing death."
Researchers hope that Australia could be joining a "psychedelic renaissance", a revival of clinical studies into psychedelic therapy that's underway in the United States and the United Kingdom after decades of indifference by the world's major research institutions .
As well as the St Vincent's trial, at least three other psilocybin trials are in the pipeline in Australia, while two more are investigating MDMA's potential for treating PTSD.
"To paraphrase Malcolm Turnbull, there's never been a more exciting time to be a psychedelic researcher in Australia," quipped Dr Martin Williams, one of the lead investigators of the St Vincent's project.
In the absence of regulated psychedelic treatment, there are Australians with significant mental health challenges who are turning to underground psychedelic ceremonies.
Background Briefing attended a private event at a farmhouse near the New South WalesQueensland border where a local variation of the traditional South American brew ayahuasca was imbibed.
The active ingredient in ayahuasca is DMT, a powerful psychedelic that can produce immersive hallucinations, and according to its devotees, even spiritual revelations.
The host of the farmhouse ceremony was Julian, a psychedelic enthusiast who's been brewing DMT concoctions for two decades using Australian natives.
Several species of Australian acacia trees more commonly known as wattles can be a particularly rich source of DMT; the tea made from them is sometimes called "Aussie-huasca".
Julian said that the worst that's happened during a ceremony was when one participant ended up knocking out his front teeth.
"I find people [are] generally very well behaved," he said.
"It's ultimately about the medicine, what it does. I try and remain faithful to that and really step out of the way and let the medicine do its work."
Like psilocybin, DMT is classed as a Schedule 9 drug by the TGA, meaning it's illegal to possess for recreational use in all states and territories.
Julian shrugged off the suggestion he was engaging in criminal behaviour.
"I don't know if that's the right question. The right question we should have is, is it beneficial? Is it helpful to people? Is it useful? Is it doing good for society?"
One attendee aged in his 30s, Jimmy*, said he was returning for his fourth ayahuasca ceremony because he believed it helped him process his childhood trauma resulting from domestic violence.
"I looked at my life, pretty much everything was just in ruins, and I just had to have the challenge of digging myself out of that," Jimmy said.
Without expert psychological support available, Jimmy had been using the ayahuasca experience to explore his own issues with expressing his feelings.
"One of my biggest struggles was my voice," he said.
"Every time I tried to express myself, or voice an opinion, my stepfather would just come down like the ton of bricks. So I traded my voice and self-expression for safety."
Jimmy credits ayahuasca with helping him turn his life around.
"Oh, absolutely. Because there are people in advanced ages that have lived their whole life through suffering. And this was like an intervention.
"So I've been through that trench of pain and misery and depression and anxiety and suffering. And now I'm just going up.
"I see things are getting much better. I've done ayahuasca, but it was like inner work [through] this inner foundation I've had to set."
Experts caution that unlawful users keen to experiment can face a host of risks, and not just potential legal troubles.
Psychedelic brews like ayahuasca can have potentially fatal interactions with prescription medication or cause frightening or anxiety-inducing hallucinations, and for a small percentage, a trip can spark a psychotic episode.
"We know that psychedelic substances can present a risk for people who have got a predisposition to a psychosis or a bipolar spectrum disorder," Dr Ross said.
Dr Dwyer added: "Is it something that I would recommend that people go out and just do? No, it's not.
"Aside from the fact that it's illegal, I think too that the psychological work that goes on around it is really very, very important."
*This name has been changed to provide anonymity
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The legal and illegal ways people are turning to psychedelics as the drug regulator rejects reclassification bid - ABC News
