MDMA: A medical comeback kid

By Robin Grant

MDMA, a chemical often associated with the party drug ecstasy, was once used in psychotherapy until criminalized in the mid-80s. Now it’s verging on a medical comeback.

Clinical trials in the U.S. and Europe using MDMA with psychotherapy have shown positive results in individuals suffering from severe, treatment-resistance post-traumatic stress disorder, or PTSD.

On Feb. 14, Health Canada approved an import permit of 9 grams of MDMA from Switzerland to use in clinical trials in Canada. The MDMA import is the first permit granted in Canadian history for an illegal substance.

Using MDMA, Vancouver-based psychiatrist Ingrid Pacey and psychologist Andrew Feldmar will conduct a randomized, double-bind study.

Like many street drugs, MDMA (3,4-methylenedioxymethamphetamine) is part of a diverse class of chemicals called substituted amphetamines. This group also includes methamphetamine (crystal meth) and the active component of khat plants, which are chewed for their stimulant effects in many parts of Africa and the Middle East.
Credit:  Anthony Vidal

Recruiting from the general public, the study will follow 12 PTSD sufferers for whom previous treatments failed. Participants will be given either a placebo or a large dose of MDMA. The sessions will take place under the supervision of the two therapists.

“What we are trying to prove in a double-bind study, is that psychotherapy, with severely traumatized people, is more effective under the effects of MDMA than without,” Feldmar says.

PTSD sufferers often describe the symptoms as having an alarm permanently going off in their heads. According to medical studies on PTSD and the brain, people lack the ability to switch off mechanisms that warn them of danger, which is called fear conditioning. This means specific brain mechanisms, such as those in the pre-frontal cortex, which help a person sort through emotions and overcome them, don’t function properly.

Without a functioning pre-frontal cortex, a person can’t control deep emotions and calm down immediate reactions to external events. For example, a person who hears a firecracker and gets startled can settle down. But someone with PTSD can’t control the emotional reaction, because the brain’s re-evaluation of the event doesn’t occur.

According to the Canadian military, eight per cent of Canadian soldiers posted to the Afghanistan combat mission between 2001 and 2008 suffer from PTSD. New research suggests that a pure form of the street drug ecstasy (MDMA) could help ease their symptoms.

Alternatively, neuroimaging has shown MDMA counteracts the effects of PTSD. The amygdala, the part of the brain that connects experience to memory and controls the fight-or-flight response, is overactive in someone with PTSD. But MDMA is known to slow down the amygdala while increasing blood flow in the pre-frontal cortex, simulating activity.

According to Feldmar, MDMA allows a patient to trust another person faster and more easily. This helps them open up to the therapist and feel comfortable revisiting the trauma, which sets the healing process in motion.

“When someone is given MDMA it makes it easier and faster for them to trust and feel safe and secure. So it speeds up the therapy … once the patient feels safe and secure, they will automatically remember and grieve and the grieving process is the healing of the hurt,” says Feldmar.

“When someone is given MDMA it makes it easier and faster for them to trust and feel safe and secure. So it speeds up the therapy … once the patient feels safe and secure, they will automatically remember and grieve and the grieving process is the healing of the hurt.”  – Andrew Feldmar

The study is funded by the non-profit, Multidisciplinary Association for Psychedelic Studies (MAPS), a research and educational organization that develops medical, legal and cultural contexts for people to benefit from careful uses of psychedelics and marijuana.

Canada still lags behind the United States and Switzerland. Both countries have already conducted clinical trials which test the drug on patients who suffer from severe, treatment-resistant PTSD.

South Carolina-based psychiatrist Michael Mithoefer and colleagues came together to conduct another MAPS-funded trial in the U.S.

The trial was a pilot Phase II clinical trial with 20 patients with chronic PTSD who were unable to get relief from symptoms through traditional psychotherapy and psychopharmacology.

Most MDMA is synthesized from the yellow oil of the sassafras tree.

Participants treated with a combination of MDMA and psychotherapy saw clinically and statistically important improvements in their symptoms.

According to the results, over 80 per cent of the trial group no longer met the criteria for PSTD. The subjects reported they were able to return to work following the MDMA treatment and psychotherapy.

But MDMA has a seemingly difficult road ahead. Some doctors aren’t certain of MDMA’s medical benefits. In fact, some say it is poisonous, or what is called neurotoxic.

Dr. Pierre Blier is the director of mood disorders research at the Institute of Mental Health Research at the Royal Ottawa Mental Health Centre in Ottawa and sits on its board of ethics. He says he wouldn’t approve MDMA-assisted psychotherapy unless there is significant monitoring of the patients.

Looking at tests done in non-human primates, Blier contends that MDMA use, even a small amount, causes a decrease of serotonin in the brain. As serotonin is a chemical controlling mood and other important functions such as reproduction, he says the benefits of the drug outweigh the risks.

MDMA (ecstasy) tablets sold illegally for recreational use are often brightly coloured and stamped with fanciful designs. They usually contain a mixture of MDMA and other drugs, especially amphetamine (speed).

“It penetrates into the serotonin terminals by a very specific reuptake pump for serotonin and once it’s there it actually makes some terminals burst, in scientific terms. Explode if you want. It is producing damage to these neurons,” he says.

However, the psychotherapists who advocate for the drug’s approval say most legal drugs, in large amounts, could cause harm.

“Aspirin, in high enough doses, causes harm,” Feldmar says. “Health Canada and the FDA, two very conservative agencies, have approved the drug. It’s not dangerous.”

Whatever the case, people in the field of psychotherapy can’t ignore the results of MDMA – a drug criminalized in most countries – and its curative affects on patients suffering from treatment-resistant PTSD.