*** Article published in Teen Art Out Issue #64 ***
We have all heard about ecstasy, right? Molly? What about 3,4-Methylenedioxymethamphetamine? Yes, this train of a name, or its short form, MDMA, is (probably) the substance you might find yourself taking if you are handed an ecstasy pill in a rave somewhere. However, there is way more to this psychostimulant than just being a party drug. Studies have shown its potential to help treat individuals suffering with mental health issues, such as post-traumatic stress disorder (PTSD) and alcoholism. But let me give you a bit more context about this substance.
What is MDMA?
MDMA is a psychoactive drug also classed as an “empathogen”. This means that it allows the user to experience feelings and sensations of emotional communion, oneness, relatedness and emotional openness1. By binding to serotonin transporters and blocking its reuptake into the neurons, it allows for a higher availability of free serotonin to circulate in the brain. It also promotes dopamine, noradrenaline and oxytocin release, which are the neurotransmitters responsible for the sensations I have just mentioned1.
Is it safe?
There are several things to consider when consuming MDMA – how much are you taking, how many times, and how pure it is. A 2005 study showed that 61% of the tested ecstasy pills contained other drugs, with 46% containing no MDMA at all2. Between 2009 and 2013, 85% of “Molly” analysed by the DEA was mostly “bath salts” with 0% MDMA on it3. Having other substances mixed with MDMA, or completely different substances, can cause worse side effects than pure MDMA. This is why regulating MDMA could be a step forwarding in guaranteeing a safer consumption.
MAPS (Multidisciplinary Association for Psychedelic Studies) laboratory studies have shown that pure MDMA is “sufficiently safe for human consumption when taken a limited number of times in moderate doses”4. In a 2010 study comparing the side effects of several substances, and how they can be harmful to the users and to others, MDMA showed to be less harmful than cannabis, tobacco, and alcohol5.
How can MDMA be helpful for psychotherapy?
Due to its mechanism of action and pharmacology, it will produce some very pleasant effects, such as an increased sense of well-being and euphoria, sharpened sensory perception, greater sociability and also extraversion1. However, it can also cause some physical unwanted effects, such as muscular tension, jaw clenching, bruxism and increased body temperature6. There is also evidence that repeated use of MDMA might lead to serotonin neurotoxicity, which can lead to acute psychotic symptoms and cell damage1. However, the existing evidence regarding this unwanted side effects is in fact anecdotal, and it is impossible to say if the alterations in serotonin function are caused by MDMA or if they were already present. There is, however, evidence that MDMA has the ability to contribute to memory reconsolidation and fear extinction7.
Memory reconsolidation is the process of reactivating an established memory, destabilizing it, and then modifying it with more information. This destabilization is promoted by an increase in dopamine release. When a traumatic memory is recalled, it can often trigger strong feelings of fear and anxiety, but due to MDMA’s ability to release “happy” neurochemicals and hormones, instead of just feelings of fear and anxiety, there will also be emotions such as love or empathy, allowing for an update of information and a rewriting of this memory7. This is why there has been such a push for MDMA use in PTSD treatment, as well as other disorders.
During the last 10 years, MAPS has sponsored several studies to pave the way for the introduction of MDMA as an adjunct to psychotherapy treatment for PTSD sufferers. The idea is to use MDMA sporadically as an adjunct. There will be MDMA-assisted sessions as well as non-drug sessions. The ability of MDMA to release oxytocin – the same hormone mother release during child birth – has shown to facilitate emotional attachment, as well as promoting feelings of empathy and trust towards the therapists. Non-drug sessions are supposed to last up to 90 minutes, and MDMA-assisted ones can up last up to eight hours, and the participants will have their physical health assessed before the treatment. The typical dosage for the drug-assisted sessions will be of 125 mg, and after two hours a supplemental dose of half the original one might be offered to prolong the effects.
Phase 2 trials have taken place to assess how safe and beneficial this approach in psychotherapy might actually be. In a 2011 study, the results showed that the MDMA-treated participants had lower PTSD scores, as well as the results were sustained after a period of 17-74 months8. In 2013, a study conducted in Switzerland showed that MDMA-assisted therapy promoted improvements in individuals with chronic PTSD, and that MDMA was safe to use in a therapy setting, with no serious adverse events or side effects reported9. Four other phase 2 studies were completed in 2016, with 52.7% of the participants treated with MDMA no longer meeting the criteria for PTSD10. These results have provided precious evidence that MDMA can indeed be a beneficial adjunct to psychotherapy for PTSD.
“But ecstasy is a party drug!”
When someone thinks about MDMA, they usually associate it with ecstasy and its recreational use. It is seen as a party drug, as people will take it in raves whilst consuming alcohol and other substances such as cocaine. However, it is important to refer that street “ecstasy” might not even be MDMA. There is also a biased perception of the substance and political impediments and disregard for expert advice11. An example is when the UK government’s Advisory Committee on the Misuse of Drugs advised that MDMA should be a class B drug (like cannabis), and not class A, the Home Secretary disregarded it saying that changing the drug’s classification would “send the wrong message”. In fact, the chief of ACMD spoke out against this decision, ended up being sacked from his position as a drug advisor to the government11.
What the future holds
Several phase 3 trials are currently planned across the world, including the United Kingdom. It is extremely important to understand that the use of MDMA as an adjunct to psychotherapy cannot be directly compared with the morbidity and mortality statistics when it is used for recreational purposes, without supervision and in an uncontrolled manner12. When asked about their experiences with MDMA-assisted therapy, participants have said that MDMA helped them thinking about traumatic experiences in a more neutral and safe manner. Other participants said that being on MDMA was the first time they felt compassion for themselves, or that it allowed them to see trauma without fear or hesitation and finally processing things and move forward7.
There is still a lot to be done when it comes to implementing MDMA into therapy. More phase 3 trials are necessary, changing the public’s perception is imperative and government backing is also crucial. MDMA research is also extremely expensive, since 1g of pure MDMA can cost hundreds of euros to produce. Further research is also necessary to assess the possible long-term effects that MDMA therapy might have. For now, the future seems promising.
References
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8. Mithoefer MC, Wagner MT, Mithoefer AT, Jerome L, Martin SF, Yazar-Klosinski B, et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. Journal of Psychopharmacology. 2012 Nov 20;27(1):28–39.
9. Oehen P, Traber R, Widmer V, Schnyder U. A randomized, controlled pilot study of MDMA (±3,4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). Journal of Psychopharmacology. 2012 Oct 31;27(1):40–52.
10. Feduccia AA, Holland J, Mithoefer MC. Progress and promise for the MDMA drug development program. Psychopharmacology. 2017 Nov 20;235(2):561–71.
11. Sessa B. MDMA and PTSD treatment. Neuroscience Letters [Internet]. 2017 May;649:176–80. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0304394016304906
12. Sessa B, Higbed L, Nutt D. A Review of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy. Frontiers in Psychiatry [Internet]. 2019 Mar 20;10(138). Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00138/full
Author: Lúcia Correia