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EV1144

Psychedelic PTSD research in Australia: Inclusion of Indigenous and culturally diverse communities

PSYCHEDELIC PTSD RESEARCH IN AUSTRALIA: INCLUDING INDIGENOUS AND CULTURALLY DIVERSE COMMUNITIES

Although MDMA-assisted psychotherapy appears promising for PTSD, ethnic diversity in existing randomized trials is low, and no studies have been specifically designed for Indigenous and culturally diverse communities in Australia.

The aim of this poster is to review the evidence base for psychedelic-assisted psychotherapy for post-traumatic stress disorder (PTSD) and propose an equity-focused research agenda that includes Indigenous and culturally and linguistically diverse (CALD) communities in Australia. The evidence base consists of a systematic review and meta-analysis of 11 randomized controlled trials involving a total of 358 participants; 8 studies contributed to the meta-analysis, and the agents examined were MDMA, ketamine, and cannabidiol. For MDMA, moderate-to-large reductions in PTSD symptoms and higher rates of clinical response and of no longer meeting diagnostic criteria for PTSD were reported; for ketamine, the pooled effect was small and nonsignificant; cannabidiol was examined in only one study, with no clear benefit demonstrated. Overall safety was considered acceptable, but reporting was not consistent across studies. Reporting of race and ethnicity was inconsistent across the 11 randomized trials; across the review, at least 58 of the 358 participants (16.2%) were documented as non-White or non-Caucasian, while in studies that explicitly reported race, this proportion was 58 of 242 participants (24.0%). The study-level distribution was 0/20 in the 2011 pilot MDMA trial, 2/28 in the 2018 phase 2 MDMA trial, 21/90 in the 2021 phase 3 MDMA trial, and 35/104 in the 2023 phase 3 MDMA trial; no study was specifically designed for Aboriginal and Torres Strait Islander peoples or CALD communities in Australia. The ability of authorized psychiatrists in Australia to prescribe MDMA for treatment-resistant PTSD makes equitable research an urgent priority. As next steps, the author recommends co-design with communities, culturally safe consent processes and language access pathways, therapist training in cultural safety and trauma-informed care, transparent reporting of race and ethnicity in all studies, and outcome measures that are meaningful to patients and communities.

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