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Is MDMA or ecstasy now being used for medical purposes in the US?

“I’ve heard that MDMA is now being used for medical purposes in the US. What is it used for and how does it work?”

Yes, it’s true to a point … MDMA (the substance users want when they take ecstasy) therapy has been used in a number of research trials across the US (as well as other countries) but it is a long way away from being available to the general public. Small-scale trials have found that MDMA, when used in conjunction with psychotherapy (often referred to as ‘talking therapy’) could be useful to treat post-traumatic stress disorder (PTSD). Not surprisingly, there is lots of interest in this area.

Discussion about the therapeutic benefits of 3,4-methylenedioxymethamphetamine or MDMA goes back half a century. When the American research chemist Alexander Shulgin rediscovered the drug in the 1960s, he found that it produced emotional openness and empathy, causing users to feel in tune with each other and facilitate communication. As a result, some therapists began to use the drug in psychotherapy sessions in the US. This continued until MDMA was placed on the Controlled Substances List in the US in 1985.

Interest in MDMA therapy was renewed after a small Spanish study found that it could be useful in treating victims of sexual assault and assist them in dealing with trauma. It is the US, however, that has led the way in this area, mainly due to the large number of returning troops affected by PTSD after the Iraq and Afghanistan conflicts, who were unable to find effective treatments for their condition. Recent studies have found that after two sessions of psychotherapy with MDMA, patients with chronic PTSD who had not been helped by traditional methods saw dramatic decreases in their symptoms.

How does MDMA therapy work? According to researchers in this area, MDMA’s unique effects – decreasing fear and defensiveness and increasing trust and empathy – make it ideal for use in psychotherapy, particularly when dealing with trauma. This calmness, wellbeing and trust allows patients, guided by trained therapists, to re-examine the traumatic events in their lives safely and constructively.

The studies that have been conducted have shown that the positive results are sustained long-term, with no further MDMA interventions being required and many patients reducing or stopping their regular psychiatric medications. What makes these results particularly noteworthy is that conventional PTSD treatment is limited in its effectiveness. Often symptoms such as anxiety and depression are managed rather than treated. Potentially, the MDMA and psychotherapy combination treats the underlying condition.

Large-scale trials are currently being planned and the organisation behind the research (MAPS – Multidisciplinary Association for Psychedelic Studies) aims to make MDMA an FDA-approved prescription medicine by 2021. There are many barriers to this actually happening, including the fact that this is an illegal drug. Possibly even more important, however, is that pharmaceutical companies are not interested in the development of this therapy as the patent for MDMA has expired, meaning they are unable to make money from the drug. Without financial backing it can be extremely difficult to get new drugs and therapies approved for use.

Finally, a word of caution. It is likely that some people will self-medicate with MDMA. There is certainly evidence that some people take ecstasy/MDMA to cope with mental health issues. This is not recommended and can actually lead to greater problems. MDMA is not a ‘safe’ drug. The medical trials involve providing patients with a precisely measured dose and, in addition, they are in an environment with help on hand should they have an adverse effect to the substance and trained therapists to guide them through their experience.

It is important to remember, if it is ever approved for wider use, like any drug or drug treatment, that does not mean that it is ‘safe’ – there is always a potential risk that something could go wrong.

First published: March 2019

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