Posted: 16 December 2011

The current state of MDMA- Assisted Psychotherapy- by Stephen Bright

Before 3,4 -methylenedioxymethamphetamine (MDMA) became popular as a recreational drug known as Ecstasy, it was used effectively in psychotherapy to enhance relationships and buffer fear reactions.

After emergency scheduling by the Drug Enforcement Agency in 1985, MDMA was made illegal in the USA on November 13, 1986. Other countries quickly followed the USA’s lead. This forced MDMA onto the black market, which negatively affected the quality and purity of Ecstasy.  In addition, it meant research examining the effectiveness of MDMA as a psychotherapeutic tool was politically blocked.

It is no coincidence that the Multidisciplinary Association for Psychedelic Studies (MAPS) was established by Dr Rick Doblin the same year that MDMA was permanently officially banned in the USA. MAPS has successfully funded a range of studies on controlled substances including lysergic acid diethylamide (LSD). However, MAPS is particularly focused on research that might lead to MDMA becoming a prescription medication. This would mean psychotherapists could use MDMA once again to help their patients.

Over the past 25 years, there have been several attempts to conduct clinical trials of MDMA-assisted psychotherapy worldwide. The first such study, sponsored by MAPS and conducted by Bouso, was approved in Spain in 2000 for the treatment of PTSD. However, it was shut down for political reasons in 2002 – following favourable media reports about participants who had commenced receiving the MDMA-assisted psychotherapy and reported positive results. Then in 2010, the first completed Randomised Controlled Trial of MDMA-assisted psychotherapy for Posttraumatic Stress Disorder (PTSD) was reported by Mithoefer et al. This research was funded by MAPS.

Mithoefer et al. found that MDMA-assisted psychotherapy was effective in significantly reducing the incidence of PTSD, with no adverse side effects, when compared to an inactive placebo (i.e. some participants randomly received an inactive chemical in place of MDMA). Participants in the placebo condition were then given the option to complete the therapy again, but this time with the knowledge that they would receive MDMA. Not surprisingly, seven of the eight placebo participants took up this offer. The PTSD symptoms of the person who didn’t take up the offer had already subsided as a result of participating in the study.

What is particularly significant about Mithoefer et al.’s study is that all participants had received, but not responded to, previous treatment for their PTSD, and they had lived with PTSD for an average of more than 20 years. Hence, this study showed that MDMA-assisted psychotherapy is effective for people who do not respond to existing treatments and have previously had little hope of recovery.  Seventeen of the 20 participants agreed to a long-term follow up assessment that occurred, on average, 3.5 years afterwards. The results showed that the treatment effects were generally sustained.

A similar trial has recently been completed in Switzerland; however, instead of using an inactive placebo, a low dose (25mg) of MDMA was used. The PTSD symptoms of all 12 participants in this study reduced after receiving the MDMA-assisted psychotherapy; however, due to the small sample size, these results did not reach ‘statistical significance’. A similar trial using a low dose of MDMA as the placebo has recently commenced in Israel. And another is currently underway in the USA, which aims to help war veterans with PTSD.

In Canada a study on MDMA-assisted psychotherapy is in the final stages of approval. Once approval is gained participant recruitment will commence. A trial in the UK has been proposed by Professor David Nutt, and a non-profit organisation in Australia, Psychedelic Research In Science & Medicine (PRISM), aims to establish a clinical trial in Australia to help war veterans with PTSD.

It is important to remember that while Ecstasy is the “street name” for MDMA, many Ecstasy pills do not contain any MDMA and some contain toxic adulterants. The studies reported here have been conducted in controlled therapeutic environments under professional supervision and involved the use of pure MDMA, not Ecstasy. Taking an Ecstasy pill outside of a therapeutic context may not help somebody with PTSD and is not advised by advocates of psychedelic research.

Stephen Bright, Psychologist
Psychedelic Research In Science & Medicine (PRISM) Inc.

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