Psychedelic drug MDMA could help treat PTSD – but there’s a reason it’s not widely available

SDI Productions/Getty Images About 11% of Australians will develop post-traumatic stress disorder (PTSD) at some point in their life. PTSD is a mental health disorder people may develop after experiencing or witnessing a traumatic event. People with PTSD currently have several treatment options, including certain psychological treatments and medications. In 2023, Australia became the first country in the world to allow health-care professionals to use a psychedelic drug to treat PTSD. This drug is MDMA, a synthetic compound commonly known as ecstasy. So why aren’t these drugs more widely available, nearly three years on? And who can actually use them for PTSD treatment?

How do we currently treat PTSD? PTSD symptoms can include feeling constantly on guard, experiencing flashbacks or nightmares, and avoiding people or places which remind you of the traumatic event. These symptoms can last for many years if left untreated. Under current Australian guidelines, people diagnosed with PTSD have several treatment options, known as first-line treatments. These include trauma-focused cognitive behavioural therapy, in which a therapist helps a patient work through distressing memories of the traumatic event. This gives patients practical skills to gradually return to places or activities they may have been avoiding. Patients may also benefit from taking medications such as paroxetine, fluoxetine, sertraline and venlafaxine. These antidepressants affect the activity of neurotransmitters in the brain, such as serotonin or noradrenaline, and help calm the body’s fear response. But medication is considered a second-line treatment. This is because they are less effective in the long term compared to trauma-focused psychological therapies. These treatments are effective ways to treat PTSD. But they may not work for everyone, for various reasons. Some people may find trauma‑focused therapies difficult to engage with or tolerate. They may also have another mental health condition which may interfere with treatment. Another way to treat PTSD In Australia, MDMA has become another way to treat PTSD. MDMA, also known as 3,4-methylenedioxy-methamphetamine, is a synthetic compound which causes your body to release high levels of dopamine. It is typically the main ingredient in the illegal drug ecstasy. Interest in using MDMA to treat PTSD has grown rapidly over the past 15 years. Scientists have been investigating whether MDMA is an effective treatment by conducting various research trials. These involve giving patients MDMA with psychotherapy, a type of therapy where patients talk to specially trained psychotherapists. Taken together, this approach is known as MDMA-assisted psychotherapy. There is conflicting evidence that MDMA-assisted psychotherapy is an effective way to treat PTSD, compared to various control conditions. A recent systematic review of all existing MDMA-assisted psychotherapy to treat PTSD found if all studies were considered, MDMA-assisted psychotherapy appears to be effective. However, when researchers examined only the most rigorous scientific studies, they found MDMA-assisted psychotherapy had little effect. This raises concerns about the safety and effectiveness of MDMA-assisted psychotherapy, and suggests we need more high-quality research. MDMA-assisted psychotherapy can also be expensive. Patients must pay for the MDMA itself, as well as psychiatry and therapy appointments. Unlike trauma-focused psychotherapies, MDMA-assisted psychotherapy requires two therapists to be present at each session. And under current guidelines patients must do a minimum of nine therapy sessions, including three MDMA dosing sessions which each last eight hours. In 2023, Australia became the first country to reclassify MDMA from being a “prohibited” to a “controlled” substance. This means it is no longer completely banned for all uses in Australia, but can be prescribed under strict conditions. To prescribe MDMA, psychiatrists must become “authorised prescribers”. As an authorised prescriber, psychiatrists must seek approval from an Human Research Ethics Committee before they can prescribe MDMA for MDMA-assisted psychotherapy. Psychiatrists must also demonstrate they have the necessary training to minimise any risk to patients. In 2026, Australia published a set of guidelines to help regulate how we use MDMA to treat PTSD. In general, the guidelines advise against using MDMA-assisted psychotherapy outside clinical trials. This is because these trials meet certain ethics and governance requirements. It is hard to replicate these conditions in a clinical setting without imposing strict rules about data collection, clinical supervision and safety processes. The guidelines also strongly advise against using MDMA-assisted psychotherapy for patients who would usually be excluded from clinical trials for safety reasons. People with cardiovascular disease (a condition affecting the heart or blood vessels) is one example. But if MDMA-assisted psychotherapy is the best option, the guidelines make clear who should have access to it. This is limited to adults who: have had PTSD symptoms for at least six months after their diagnosis have experienced moderate or severe PTSD symptoms in the past month have already received an suitable amount of first-line evidence-based treatments are not likely to be exposed to other significant traumatic events during the course of treatment. Will psychedelics become a common PTSD treatment? Australia’s new guidelines take a positively cautious approach to treating PTSD with psychedelic drugs. This is because many scientists say we need more research to know whether MDMA-assisted psychotherapy is a beneficial and safe treatment for people with PTSD. Overseas, health authorities are also approaching this topic with caution. In 2024, the United States’ Food and Drug Administration decided against approving MDMA-assisted psychotherapy for PTSD. This was to allow researchers more time to test its safety and effectiveness. So while there does seem to be a place for MDMA-assisted psychotherapy to treat PTSD, we need to make sure we’re doing it safely and effectively. Controlling access to psychedelic drugs is key to that.

As part of her academic role, Tracey Varker is Director of the Evidence Synthesis Hub at Phoenix Australia, the nation's leading organisation in posttraumatic mental health research. She receives funding from the Department of Veterans' Affairs, the Department of Health Victoria and the Latrobe Health Services Foundation. She does not receive any funding for any research that would raise a conflict of interest for the views expressed in this article. As part of her academic role, Meaghan O'Donnell is the Head of Research at Phoenix Australia, the nation's leading organisation in posttraumatic mental health research. She receives funding from the National Health and Medical Research Council, US Department of Defense, Wellcome Trust and other research funding agencies, government departments such as the Department of Veterans' Affairs, and philanthropic organisations such as the Latrobe Foundation and Ramsay Health Foundation. She does not receive any funding for any research that would raise a conflict of interest for the views expressed in this article.