The FDA’s recent approval of a study testing the effects of methylenedioxymethylamphetamine – commonly known as ecstasy – on people with post-traumatic stress disorder is giving people something to talk about.
This controversial study will allow the Multidisciplinary Association of Psychedelic Studies, a nonprofit organization, to begin research on the effects of the drug in a therapeutic setting.
With the recent negative reports on MDMA there are a lot of questions that need to be answered.
The newly approved project will use MDMA for its therapeutic potential. MDMA was introduced in Germany in 1913 as an appetite suppressant and later used for psychotherapy in the 1970s.
According to the MAPS Web site, because MDMA operates on emotions more than cognition, the thoughts and emotions experienced under the influence of MDMA can be easily remembered long after the effects have worn off. The drug is matched with patients who suffer from post-traumatic stress disorder because it enables them to confront feelings they normally may not be able to face. MDMA has more immediate effects than other drugs used with post-traumatic stress disorder sufferers.
“Antidepressants like Zoloft are approved for PTSD, but you have to take it every day for months and months,” said Dr. Rick Doblin, president of MAPS. “But with MDMA we’re saying you only have to take it a few times and it helps psychotherapy.”
Doblin said a therapy session is a controlled situation. A lot of the time will be spent in preparation work for the session with a therapist.
“The classic thing is that you lie down on a bed, your eyes are often closed. Sometimes people even use eyeshades because you are going to have an inner experience,” Doblin said. “The idea is that when you use it in therapy it that it’s not really used for a relationship, so much as it is for you to work through your own feelings.”
Patients will lie down four or five hours, and there may be times when they will feel like talking with a therapist, Doblin said. Most of the talking is done after the session to help patients decide what to do with what they have learned.
“A lot of times when you have this idea of ecstasy you think you give it to somebody and all of the sudden they just feel happy,” Doblin said. People who have the disorder and take MDMA often re-live the incident.
Most patients feel anything but euphoric when they are revisiting these feelings, Doblin said. Most people with post traumatic stress disorder spend time shaking and crying.
“(MDMA) sort of helps to release the emotions. Once you cry after something, you can move forward,” Doblin said. “You have to feel the sadness and then you can move forward. A lot of people can’t do that when the trauma is so great they just get frozen in it. This helps with that release.”
According to Doblin, studies using MDMA to help patients deal with terminal illnesses and confront death are also in the works.
Those in pharmaceutical and drug enforcement are much less open to such an immediate answer.
Tests done with serotonin tracers have shown a dampening of the serotonin system of people who have historically used ecstasy, said Nicholas Vololato, clinical pharmacy specialist in neuropsychiatry and a professor in psychiatry at Ohio State.
“The preliminary data was that the effects may be irreversible. While it may be an acute positive effect, when the detriment of the compound is long-term, I think it’s very concerning to me,” Vololato said.
Vololato is not alone in his skepticism.
“Understand that any drug that has central nervous system activity is probably subject to some form of abuse. So there are a lot of drugs on the market that are properly prescribed that are abused every day. That’s what we spend most of our time trying to combat,” said Timothy Benedict, assistant executive director of the Ohio Board of Pharmacy.
Because of its potential for abuse, MDMA should not have wide use, Benedict said.
According to the Drug Enforcement Administration Web site, MDMA acts as both a stimulant and a hallucinogenic drug, producing hypothermia, memory loss, cognitive impairment and long-term neurochemical and brain cell damage.
Studies have shown MDMA damages neurons and the brains ability to release serotonin, said Stacey Frohnapfel, chief of communications and training at the Ohio Department of Alcohol and Drug Addiction Services. Serotonin tells the body when it’s hungry or sleepy.
“It regulates those life functions that the body needs in order to survive. And if you keep using MDMA, your brain eventually loses that ability to regulate those things,” Frohnapfel said.
Frohnapfel said some extreme cases can result in death.
According to Vololato, some work done by the Johns Hopkins group has shown deterioration of serotonin tracks from the brain of people who use the compound, which is a major risk factor.
“The department’s caution would be that it be a licensed physician who is responsible for any kind of schedule for a drug administration,” Frohnapfel said.
Doblin maintains many of the ideas people have about MDMA are because of misinformation given by the government since it was made illegal in 1985.
“The question you need to ask is the risk/benefit analysis,” Vololato said. “The risk/benefit is what it’s all about. There are some risks. People who think there aren’t any risks are mistaken. And what the benefits are is not that clear.”
Vololato said the compound, a neurotoxin, isn’t worth the risk and he would focus on other compounds and psychotherapy. He also warns generalizations about MDMA could be a problem because people are taking certain scenarios involving illicit uses of MDMA and applying them to all cases.
According to Doblin, the risks found with people who use it illegally are much larger than those for people who take it as therapy.
“What happens when people take (MDMA) at raves is different than what happens when people take it in the therapy setting because the research done on animals has shown that temperature is a really important factor for any kind of serotonin changes in the brain,” Doblin said. “Everything we have learned from people who take it all night and dance and get really hot is only of marginal relevance to people who take it lying down.”
Another challenge Doblin has is overcoming the non-therapeutic facts about MDMA.
“I think we have a dishonest educational system here fueled by intentional exaggeration and misinformation in order to make a point,” Doblin said.
