MDMA, recreationally known as Ecstasy or Molly, gained high marks in a clinical trial for PTSD.
In the spring of 2017 I was serendipitously invited to what initially seemed to be the wrong scientific meeting. The invitation came thirdhand, and the details were murky but intriguing. I took a car to a train to a downtown hotel where I wound my way through a series of conference rooms before a sign on a door made it clear that something was terribly wrong. It said, “MAPS Phase 3 meeting.”
Right on the heels of this discovery, however, MDMA stepped out of the psychotherapist’s office and barreled into general circulation, becoming one of the most used substances for recreational purposes of the 1980s. In 1985 the U.S. Drug Enforcement Agency classified MDMA as a Schedule I substance, making its possession a crime punishable by up to 15 years in prison.
More recent animal data indicate that MDMA helps to extinguish memories of fearful experiences and impairs the reactivation of traumatic memories in rodents. These studies have shown that even the notoriously solitary octopus develops a penchant for hugging under the influence of the compound.
Given the regulatory obstacles, creating a research program for a Schedule I substance is a difficult and time-consuming process. Such compounds are highly restricted, and permission must be obtained from the DEA to allow them to be stored at a research facility and dispensed to subjects.
Even once all the appropriate regulatory and compliance issues have been tackled, there is still the matter of manufacturing the compound. For clinical trials, this step must be performed in a “good manufacturing practices” -certified laboratory. GMP ensures that production is consistent and conducted in a clean environment and meets FDA-prescribed quality standards.
Phase 3 study participants receiving MDMA-assisted therapy showed a greater reduction in PTSD symptoms and functional impairment than participants receiving placebo plus therapy. In addition, their symptoms of depression plummeted. By the end of the study more than 67 percent of the participants in the MDMA group no longer met criteria for PTSD.
MDMA is an experiential medicine, so its therapeutic effects are influenced by the setting in which it is administered. This is a key distinction from other medications. I would not expect a blood thinner to have certain effects if I took it in my parents’ living room versus in my neighbor’s kitchen. I would not expect it to work differently depending on my mood.
Preparatory sessions were followed by an experimental session. Participants reclined on a sofa in a comfortable, dimly lit room and received a blister pack of study drug and a glass of water to begin their journey. Later came three integration sessions in which facilitators worked with participants to further untangle the trauma laid bare during the experimental session.
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