Unregulated drug use in mental health treatment

Although psychedelics are illegal in South Africa, many self-proclaimed healers and shamans in Cape Town publicly declare that they incorporate them into their treatments.

Anyone convicted of commercial use faces a fine, up to 25 years in prison, or both.

Photographer Stuart Dodds is one of those wishing to receive treatment from a shaman.

In an elegant wooden cabin nestled in the woods on the outskirts of Cape Town, he is about to undergo his second psychedelic experiment to treat a series of mental health problems he has been suffering from. He has tried prescription medications but is convinced that psychedelics hold the key to his recovery.

“My mom died suddenly, which was hell,” the 53-year-old says. “And then my ex-husband broke up a year after my mom died, too. That’s kind of when the rug was pulled out a little bit.”

At a cost of around $2,000 (£1,500), his chosen psychedelic experience involves taking doses of psilocybin (aka magic mushrooms) and MDMA (aka the party drug, ecstasy). Organizers say the fees also include accommodation and a range of support services.

There is a growing body of research and trials on its effectiveness in treating mental health conditions, but there are warnings about its use outside of controlled clinical settings.

Megan Hardy, who refers to herself as a “medicine woman” and is in charge of the session with Mr Dodds, also takes a smaller dose of both drugs before the ritual. She claims it helps her “move to the same frequencies” as the person she’s treating.

“The shamanic term is a footnote in every world,” she says.

Ms. Hardy recognizes the illegality of the use of these types of drugs, but claims that the use is “just civil disobedience.”

When asked what qualifies her to determine the correct dose to take, she said that she has tested medications on herself over the years, “and learned what works in any situation.”

Increased awareness of mental health issues, coupled with an increase in clinical trials involving psychedelics, has increased public interest in the use of these drugs to treat conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD).

One in two people worldwide may develop a mental health disorder in their lifetime, according to studies by Harvard Medical School and the University of Queensland – and treating it has become a multi-billion-dollar business.

Before the psychedelic party begins, which Stewart has agreed to be filmed by the BBC World Service, Ms Hardy assures her client that he can stop at any time.

“If any of this makes you uncomfortable or it’s an exciting process… communicate that and say, ‘OK, stop.’

Her colleague Kate Ferguson also took small doses of MDMA and magic mushrooms. None of the mentors had formal medical training.

Mr. Dodds lies on a thin mattress on the cabin floor, covered with a gray comforter. He is wearing an eye mask. When the medications take effect, it seems to alternate between states of calm and moments of trembling and trembling.

“Let yourself feel it,” Mrs. Hardy whispers as she hugs him.

The two women move around the room, burning herbs and shaking shamanic rattles while singing and chanting in a purification ritual known as “smudging.” Ms Hardy encourages Mr Dodds’ body with a flying wing, in what she says is an attempt to get rid of “negative energy”.

Then I offered him more MDMA. He had already agreed to it before the ritual began, but when Mrs. Hardy asked him if he needed it, he shrugged and said, “I don’t know.”

The BBC then questioned Mr Dodds about how he agreed to take more drugs when he was already in an altered state.

“There was no coercion. It was just me thinking in that space, ‘Do I want to take this?’ I had every opportunity to say, ‘Yes,’ or ‘No,’ or ‘Yes, I’ll take it,'” he says.

But there are many people in the world of professional psychiatry pointing out the dangers of this unregulated industry.

“In order to give consent, you have to be in touch with reality,” said Dr Marcelle Stastny, head of the South African Psychiatric Association.

“If someone has actually taken psilocybin and ecstasy, they’re out of touch with reality. They’re drunk, they’re high. And (in) a lot of experiences around the world, real boundary violations are happening.”

The BBC asked Hardie whether being under the influence of drugs during her drug trial did not affect her ability to care for Mr Dodds.

“This is based on the assumption that a sober state of mind is more desirable,” the self-proclaimed therapist said. “We operate in ways that the Western mind does not understand and can seem frightening.”

There is a growing body of research investigating whether psychedelics could be a viable alternative treatment for conditions such as depression or anxiety and substance misuse.

In 2022, one of the largest peer-reviewed studies on therapeutic psychedelic use involved giving 233 participants a synthetic formulation of psilocybin.

It found that a 25mg dose taken alongside psychological support from trained therapists improved a measure of patient-reported depression.

However, a review study published by the European Medicines Agency in 2025, which looked at a total of 595 participants across eight completed studies, recommended “more clinical evidence” before allowing it to be sold.

It also warned that taking narcotic substances can lead to “increases in heart rate, blood pressure and anxiety levels”, highlighting the need to administer these substances in a “controlled environment”.

Narcotic substances remain illegal in most parts of the world. However, this has not limited the growth of the industry in South Africa, as evidenced by the increasing number of services being advertised online.

“I think it’s a big problem,” Dr. Stastny said. “It has certainly been exploding in Cape Town, in particular. People are lost and out of touch. Everyone is looking for a pill to fix everything, and there simply is no pill to fix everything.”

A few years ago, Sunette Hill, another drug guru from Cape Town, gave her patient ibogaine, a powerful narcotic extracted from plants endemic to the tropical forests of central and west-central Africa.

It unleashed an unexpected effect.

“He grabbed me by the throat,” Ms. Hill says. “He wanted to kill me. Something happened to him and he just wanted to kill me.”

Ibogaine can be used as a powerful detox medication for people suffering from addiction. Purchase or use is illegal in South Africa and is only permitted under strict medical and pharmaceutical regulations.

No criminal case was opened against Hill, and since then, she has stayed away from giving narcotic drugs to other people. But it hasn’t changed her view of the industry itself.

“I, honestly, believe that psychedelics can heal the world,” she says. “I have no faith in the medical world.”

In another case, 26-year-old Milo Martinovic traveled to South Africa to seek help with drug addiction. He ended up in an unregistered facility, was treated by a dentist, and given ibogaine.

Six hours later he died.

The unregistered clinic had missed that he was addicted to Xanax, a benzodiazepine that cannot be mixed with ibogaine.

In 2024, dentist Dr. Anwar Giwa was convicted of multiple charges, including murder. The death was just one of dozens of recorded ibogaine-related deaths worldwide.

“You can’t call something a drug if it isn’t,” says Dr. Stastny. “I have seen new patients who have been disconnected for long periods after using a psilocybin trip.”

The evidence about the use of psychedelics as a medicine may be recent, but the online market for self-proclaimed therapists who offer coordinated trips involving various illegal substances is thriving.

“They just know they’ve been on a trip, they feel good, and they want to help people,” Dr. Stastny says. “Those are the best of them. The worst of them have this kind of narcissistic inflation where they go: ‘I can help people, I can do better than psychiatrists.’

Back at the jungle hut in Cape Town, the effects of Stuart Dodd’s “trip” were beginning to fade. He says he doesn’t feel “healed,” but he thinks he’s on his way there.

“I wanted to gain (more) self-awareness and understand myself,” he says. “I can feel like this is kind of an eye-opener, as I’ll probably take another trip as well after that.”