Interview: Psychedelic therapy in Italy, a long road ahead

Where does Italy stand in psychedelic drug research? We discuss this with Dr Matteo Buonarroti, the first Italian doctor to complete the Mind Foundation's Augmented Psychotherapy Training.

Translated from the original Italian version.

Insight 2023: Rethink Psychedelics

The INSIGHT conference organised by the MIND Foundation is an important landmark in psychedelic drug research in the medical and social science fields. Clinicians and entrepreneurs, patients and artists, journalists and politicians, newcomers to the field, and experts meet again this year in Berlin to define the state of the art on psychedelics. The 2023 edition, which takes place from 31 August to 3 September under the motto 'Rethink Psychedelics', places a specific focus on psychedelic neuroscience and social areas - such as non-clinical forms of use, psychedelics and mindfulness in business, the philosophy of the psychedelic experience, the spirituality of patients and therapists, and the knowledge in this area that can be learned from indigenous communities.

Dr. Matteo Buonarroti, the first Italian doctor to take part in the Mind Foundation's Augmented Psychotherapy Training course, will present his work "Substance-Induced Psychosis and Classic Psychedelics: Revisiting the Italian Concept of the Psychoma as a Tool for Psychopathological Investigation of Psychotic Onset", which aims to investigate how recent hypotheses on the impact of psychedelic experiences on psychological flexibility in relation to set and setting can be integrated into the psychopathological model of the psychoma and vice versa.

What is the legal situation of the medical use of psychedelics in Italy?

Dr Buonarroti: With the exception of the drug esketamine, which is widely used in public clinical settings with a conventional therapeutic model (to which psychedelic psychotherapy approaches are alien) there is currently no clinical research or therapeutic applications of other psychedelic drugs in Italy. Italy is a country that is very resistant to innovation, which slows down the introduction of these new therapeutic approaches.

For which mental illnesses or anxiety disorders does the medical use of psychedelics show the best possible effect? Where do you see contraindications to their use?

Dr Buonarroti: Currently, much of the data from the main randomised clinical trials show apparent efficacy in the treatment of post-traumatic stress disorder and drug-resistant major depression. Studies have been initiated investigating efficacy in the treatment of obsessive-compulsive disorder, eating disorders and type 2 bipolar disorder, but it is too early to draw conclusions. As for contraindications, I could answer that these drugs are not recommended in people with a family history or predisposition to psychosis. But that would be too simple an answer, in my opinion. It is necessary to look much more closely at the effects and risks based on a dimensional assessment of the person.

In international comparison, where do you see the most important breakthroughs in psychedelic therapy research worldwide and what conclusions should doctors in Italy draw from this?

Dr Buonarroti: There is no doubt that huge progress has been made in the USA and Australia. I believe that in Italy we should learn to be more open to innovation by collaborating with centres of excellence that have gained experience in the field of psychedelic therapies. We should start doing multicentre studies in collaboration with countries that have been doing this research for years. In Italy there are many doctors who have acquired expertise in this field, and most of us are forced to work abroad to make use of their skills. The resources and expertise would be there, but we are missing the will on the part of the relevant institutions.

It is understandable that the scientific community is afraid of the pathoplastic potential of drugs. However, the scientific approach requires the ability to challenge acquired paradigms based on data, that so far, show relative safety in the therapeutic use of molecules such as psilocybin, LSD and MDMA in controlled settings, as opposed to outside the clinical setting. The progressive development of this research must be pursued with courage and prudence, and Italy has consistently demonstrated its ability to maintain this delicate balance.

How can a scientific distinction be made between the insights people claim to have gained from psychedelic research and objectively verifiable research findings?

Dr Buonarroti: This is a complex question that would require a closer look at the details of the research that has been done so far. Frankly, I see excessive enthusiasm for these therapies in the general population. I think that some of those who report incredible benefits from these therapies tend to exaggerate. Science advances in small steps and with caution. Over-enthusiasm risks discrediting these therapies by lumping them into the realm of "alternative" therapies or, even worse, pseudoscience.

About Dr. Matteo Buonarroti

Dr Matteo Buonarroti's medical training is in general medicine and primary care, and is currently specialising in psychiatry at the University of Rome La Sapienza. He is actively involved in the foundation of the Italian Society of Psychedelic Medicine, whose aim is to promote research, training, and clinical practice in the field of psychedelic therapies.